Submitted by Nandita Keole
Antibody and Macrophage-Mediated Segmental Demyelination in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): Clinical, Electrophysiological, Immunological, and Pathological Correlates
Vallat JM, Mathis S, Vegezzi E, et al. Eur J Neurol. 2020;27(4):692-701. doi: 10.1111/ene.14133
Retrospective study of immune reactivity to myelin in 94 patients with diagnoses of CIDP (diagnosed according to the European Federation of Neurological Societies and the Peripheral Nerve Society criteria including electrophysiological criteria). Nerve biopsy was done for those who did not fulfil these criteria at first assessment. Study was conducted in France. Sural nerve biopsies were examined using immunofluorescence and electron microscopy. It was found that many patients presented a strong IgG or IgM reactivity toward the myelin compartment and evidence of complement C3d deposition, confirming the autoimmune etiology. 9 patients needed nerve biopsy to confirm CIDP. These nerve segments were evaluated under electron microscopy and showed myelin sheath phagocytosis by macrophages in intermodal region. Per authors this data demonstrates that antibody and macrophage mediated segmental demyelination is involved in the pathogenesis of some patients with CIDP and is responsible for segmental demyelination, slowing and temporal dispersion.
Interesting to correlate NCS findings with immunological and histochemical changes. Mainly of academic interest.