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Autoantibodies to nodal isoforms of neurofascin in chronic inflammatory demyelinating polyneuropathy

Authors: Delmont, Emilien; Manso, Constance; Querol, Luis; Cortese, Andrea; Berardinelli, Angela; Lozza, Alessandro; Belghazi, Maya; +7 Authors

Autoantibodies to nodal isoforms of neurofascin in chronic inflammatory demyelinating polyneuropathy

Abstract

Chronic inflammatory demyelination polyneuropathy is a heterogeneous and treatable immune-mediated disorder that lacks biomarkers to support diagnosis. Recent evidence indicates that paranodal proteins (contactin 1, contactin-associated protein 1, and neurofascin-155) are the targets of autoantibodies in subsets of patients showing distinct clinical presentations. Here, we identified neurofascin-186 and neurofascin-140 as the main targets of autoantibodies in five patients presenting IgG reactivity against the nodes of Ranvier. Four patients displayed predominantly IgG4 antibodies, and one patient presented IgG3 antibodies that activated the complement pathway in vitro. These patients present distinct clinical features compared to those with anti-neurofascin-155 IgG4. Most patients had a severe phenotype associated with conduction block or decreased distal motor amplitude. Four patients had a subacute-onset and sensory ataxia. Two patients presented with nephrotic syndromes and one patient with an IgG4-related retroperitoneal fibrosis. Intravenous immunoglobulin and corticosteroids were effective in three patients, and one patient remitted following rituximab treatment. Clinical remission was associated with autoantibody depletion and with recovery of conduction block and distal motor amplitude suggesting a nodo-paranodopathy. Our data demonstrate that the pathogenic mechanisms responsible for chronic inflammatory demyelination polyneuropathy are broad and may include dysfunctions at the nodes of Ranvier in a subgroup of patients.

Countries
France, Italy
Keywords

IVIg, Adult, Male, Adolescent, Intravenou, Polyradiculoneuropathy, Neural Conduction, Immunoglobulins, 610, CIDP, Guillain-Barre syndrome, Adrenal Cortex Hormone, Young Adult, Adrenal Cortex Hormones, Nerve Growth Factor, 616, Ranvier's Nodes, 80 and over, Humans, Protein Isoforms, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Nerve Growth Factors, Preschool, Chronic Inflammatory Demyelinating, Child, Aged, Autoantibodies, Aged, 80 and over, Protein Isoform, Immunoglobulins, Intravenous, Middle Aged, Autoantibodie, paranode, [SDV] Life Sciences [q-bio], myelin, Polyradiculoneuropathy, Chronic Inflammatory Demyelinating, Cell Adhesion Molecule, Case-Control Studies, Child, Preschool, Guillain-Barré syndrome, Female, Case-Control Studie, Rituximab, Cell Adhesion Molecules, Human, Ranvier's Node

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    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 1%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 1%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 1%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
217
Top 1%
Top 1%
Top 1%
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bronze