Chronic inflammatory demyelinating polyneuropathy: from pathogenesis to diagnosis

M.M. Sialitski

Abstract


Background. Chronic inflammatory demyelinating polyneuropathy (CIDP) — one of the most common autoimmune polyneuropathies. The use of international criteria for the diagnosis of CIDP does not lead always to the correct diagnosis. So, the search for new diagnostic biomarkers of the disease is an integral part of improving the quality of care at CIDP. The aim of our study is to investigate the relationship between B-cell activation factor (BAFF) levels in the blood serum and cerebrospinial fluid (CSF) of patients with the clinical data of the disease and electrophysiological parameters. Materials and methods.Main group in our study consisted of 59 patients diagnosed with CIDP (mean age 58.2 ± 17.2 years) based on neurological examination and electromyography that meets international criteria for the diagnosis of CIDP (INCAT, 2001). The control group included 30 individuals without any autoimmune disease. The vo­lume of the investigation included assessment of the neurological status, electroneuromyography, determining BAFF levels in the blood serum and CSF in both groups. Results. Analysis of clinical data revealed symmetrical, predominantly distal, peripheral paresis of limbs in patients. There was a frequent involvement in the pathological process of cranial nerves. Isolated loss of deep sensitivity was not characteristic of CIDP. Analysis of electrophysiological characteristics revealed the presence of mixed (axonal and demyelinating) type of peripheral nerve lesion in all patients with CIDP. There were statistically significant differences in the content of BAFF in the blood serum of patients with CIDP as compared to the control group (p = 0.001) and BAFF levels in the CSF of patients from the main group in comparison to the control group (p = 0.007). There were correlations between BAFF levels in the biological media (blood serum and CSF) and clinical features of the disease, electrophysiological parameters. Conclusions.Determining the level of BAFF in the blood serum and CSF may be useful for the diagnosis of CIDP and may show the degree of disease activity.

Keywords


chronic inflammatory demyelinating polyneuropathy; B-cell activation factor

References


Levin O.S. Polyneuropathy. Medicinskoe informacionnoe agentstvo // Clinical guidelines. 2005; Р. 94-131. (in Russian).

Ponomarev V.V., Sialitski M.M., Karneyavets S.V. Epidemiological and clinical features of chronic inflammatory demyelinating polyneuropathy // ARS MEDICA, nevrologija i nejrohirurgija. 2011; 6(42): 100-106. (in Belarus).

Vallat J.M., Sommer C., Magy L. Chronic inflammatory demyelinating polyradiculoneuropathy: diagnostic and therapeutic challenges for a treatable condition // Lancet Neurol. 2010; 9: 402-412. doi: 10.1016/S1474-4422(10)70041-7.

Gorson K.C., Katz J. Chronic Inflammatory Demyelinating Polyneuropathy // Neurol. Clin. 2013; 3: 511-532. doi: 10.1016/j.ncl.2013.01.006.

Kurenkov A.L., Kuzenkova L.M., Nikitin S.S., Bursagova B.I. Chronic inflammatory demyelinating polyneuropathy in children: diagnosis and treatment // Voprosy sovremennoj pediatrii. 2014; 13(5): 47-53. (in Russian).

Dyck P.J., Lais A.C., Ohta M. et al. Chronic inflammatory polyradiculoneuropathy // Mayo Clin. Proc. 1975; 50: 621-637. PMID: 1186294.

Kanbayashi T., Sonoo M. Acute-Onset Chronic Inflammatory Demyelinating Polyradiculoneuropathy // Brain Nerve. 2015; 67(11): 1388-96. doi: 10.11477/mf.1416200311.

Ishii J., Yuki N., Kawamoto M., Yoshimura H., Kusunoki S., Kohara N. Recurrent Guillain-Barré syndrome, Miller Fisher syndrome and Bickerstaff brainstem encephalitis // J. Neurol. Sci. 2016; 15(364): 59-64. doi: 10.1016/j.jns.2016.03.008.

Research criteria for diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP): report from an ad hoc subcommittee of the American Academy of Neurology AIDS Task Force // Neurology. 1991; 41: 617-8. PMID: 2027473.

Saperstein D.S., Katz J.S., Amato A.A., Barohn R.J. Clinical spectrum of chronic acquired demyelinating polyneuropathies // Muscle Nerve. 2001; 24: 311-24. PMID: 11353415.

Hubertus K., Bernd C. Kieseier, Sebastian J. Chronic Inflammatory Demyelinating Polyneuropathy // N. Engl. J. Med. 2005; 352: 1343-56.

Nikolaev S.G. Atlas of Electromyography. — Ivanovo: PresSto, 2010. — 468 p. (in Russian).

Van den Bergha K., Haddenb M., Bouche P. et al. European Federation of Neurological Societies / Peripheral Nerve Society Guideline on management of chronic inflammatory demyelinating polyradi­culoneuropathy: Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society // European Journal of Neurology. 2010; 17: 356–363. doi: 10.1111/j.1468-1331.2009.02930.x.

Haibullin T.I., Habirov F.A., Averianova L.A., Ahme­dova G.M. Chronic inflammatory demyelinating polyradiculoneuropathy and pathogenetically similar syndroms: diagnosis and treatment // Prakticheskaja medicina. 2014; 78(2): 21-30. (in Russian).

Dalakas MC. B cells as therapeutic targets in autoimmune neurological disorders // Nature clinical practice (Neurology). 2008; 4: 557-567. doi: 10.1038/ncpneuro0901.

Dalakas M.C. Advances in the diagnosis, pathogenesis and treatment of CIDP // Nat. Rev. Neurol. 2011; 7: 507-517. doi: 10.1038/nrneurol.2011.121.

Zavalishin I.A., Piradov M.A., Boiko A.N., Nikitin S.S., Spirin N.N., Peresedova A.V. Autoimmune diseases in neurology. Clinical guidelines // Zdorov’e cheloveka. 2014; 2: 49-63. (in Russian).

Dalakas M.C., Engel W.K. Immunoglobulin and complement deposits in nerves of patients with chronic relapsing polyneuropathy // Arch. Neurol. 1980; 37: 637-640. PMID: 6252877.

Moore P.A., Belvedere O., Orr A. BLyS: member of the tumor necrosis factor family and B lymphocyte stimulator // Science. 1999; 285(5425): 260-263. PMID: 10398604.

Schneider P., Mackay F., Steiner V. BAFF, a novel ligand of the tumor necrosis factor family, stimulates B cell growth // Journal of Experimental Medicine. 1999; 189(11): 17471756. PMID: 10359578.

Cancro P.M. BLyS Ligands and Receptors. — New York: Humana Press, a part of Springer Science + Business Media, 2010. — 289 p.

Craxton A., Magaletti D., Ryan E.J., Clark E.A. Macrophage- and dendritic cell-dependent regulation of human B-cell proliferation requires the TNF family ligand BAFF // Blood. 2003; 101(11): 4464-4471. DOI: 10.1182/blood-2002-10-3123.

Gorelik L., Gilbride K., Dobles M., Kalled S.L., Zandman D., Scott M.L. Normal B cell homeostasis requires B cell activation factor production by radiation-resistant cells // Journal of Experimental Medicine. 2003; 198( 6): 937-945. DOI: 10.1084/jem.20030789.

Oren D.A., Li Y., Volovik Y. Structural basis of BLyS receptor recognition // Nature Structural Biology. 2002; 9(4): 288-292. DOI: 10.1038/nsb769.

Ng L.G., Mackay C.R., Mackay F. The BAFF/APRIL system: life beyond B lymphocytes // Mol. Immunol. 2005; 42(7): 763-72. DOI: 10.1016/j.molimm.2004.06.041.

Ohata J., Zvaifler N.J., Nishio M. Fibroblast-like synoviocytes of mesenchymal origin express functional B cell-activating factor of the TNF family in response to proinflammatory cytokines // J. Immunol. 2005; 174(2): 864-70. PMID: 15634908.

Sasaki Y., Casola S., Kutok J.L., Rajewsky K., Schmidt-Supprian M. TNF family member B cell-activating factor (BAFF) receptor-dependent and -independent roles for BAFF in B cell physiology // J. Immunol. 2004; 173(4): 2245-52. PMID: 15294936.

Shulga-Morskaya S., Dobles M., Walsh M.E. et al. B cell-activating factor belonging to the TNF family acts through separate receptors to support B cell survival and T cell-independent antibody formation // J. Immunol. 2004; 173(4): 2331-41. PMID: 15294946.

Schiemann B., Gommerman J.L., Vora K. et al. An essential role for BAFF in the normal development of B cells through a BCMA-independent pathway // Science. 2001; 293(5537): 2111-2114. DOI: 10.1126/science.1061964.

O‘Connor B.P., Raman V.S., Erickson L.D. et al. BCMA is essential for the survival of long-lived bone marrow plasma cells // J. Exp. Med. 2004; 199(1): 91-8. DOI: 10.1084/jem.20031330.

Seshasayee D., Valdez P., Yan M., Dixit V.M., Tumas D., Grewal I.S. Loss of TACI causes fatal lymphoproliferation and autoimmunity, establishing TACI as an inhibitory BLyS receptor // Immunity. 2003; 18(2): 279-88. PMID: 12594954.

Lin W.Y., Gong Q., Seshasayee D. et al. Anti-BR3 antibodies: a new class of B-cell immunotherapy combining cellular depletion and survival blockade // Blood. 2007; 110(12): 3959-67. DOI: 10.1182/blood-2007-04-088088.

Zhou L., Zhong R., Hao W. et al. Interleukin-10 and interferon-γ up-regulate the expression of B-cell activating factor in cultured human promyelocytic leukemia cells // Experimental and Molecular Pathology. 2009; 87(1): 54-58. DOI: 10.1016/j.yexmp.2009.04.002.

Gross J.A., Johnston J., Mudri S. et al. TACI and BCMA are receptors for a TNF homologue implicated in B-cell autoimmune dise­ase // Nature. 2000; 404(6781): 995-9. DOI: 10.1038/35010115.

Khare S.D., Sarosi I., Xia X.Z. et al. Severe B cell hyperplasia and autoimmune disease in TALL-1 transgenic mice // Proc. Natl. Acad. Sci USA. 2000; 97(7): 3370-3375. DOI: 10.1073/pnas.050580697.

Mackay F., Woodcock A.S., Lawton P. et al. Mice transgenic for BAFF develop lymphocytic disorders along with autoimmune manifestations // Journal of Experimental Medicine. 1999; 190(11): 1697-1710. PMID: 10587360.

Lesley R., Xu Y., Kalled S.L. et al. Reduced competitiveness of autoantigen-engaged B cells due to increased dependence on BAFF // Immunity. 2004; 20(4): 441-453. PMID: 15084273.

Thien M., Phan T.G., Gardam S. et al. Excess BAFF rescues self-reactive B cells from peripheral deletion and allows them to enter forbidden follicular and marginal zone niches // Immunity. 2004; 20(6): 785-798. DOI: 10.1016/j.immuni.2004.05.010.

Ota M., Duong B.H., Torkamani A. et al. Regulation of the B cell receptor repertoire and self-reactivity by BAFF // Journal of Immunology. 2010; 185(7): 4128-4136. DOI: 10.4049/jimmunol.1002176.

Vincent F.B., Morand E.F., Mackay F. et al. BAFF and innate immunity: new therapeutic targets for systemic lupus erythematosus // Immunol. Cell Biol. 2012; 90: 293-303. DOI: 10.1038/icb.2011.111.

Leandro M.J., Cambridge G. Expression of B cell activating factor (BAFF) and BAFF binding receptors in rheumatoid arthritis // J. Rheumatol. 2013; 40: 1247-1250. DOI: 10.3899/jrheum.130677.

Kim J.Y., Yang Y., Moon J.S. et al. Serum BAFF expression in patients with myasthenia gravis // J. Neuroimmunol. 2008; 199: 151-154. DOI: 10.1016/j.jneuroim.2008.05.010.

Kannel K., Alnek K., Vahter L., Gross-Paju K., Uibo R., Kisand K. Changes in Blood B Cell-Activating Factor (BAFF) Le­vels in Multiple Sclerosis: A Sign of Treatment Outcome // Plos. One. 2015; 10(11): e0143393. DOI: 10.1371/journal.pone.0143393.

Baek A., Park H.J., Na S.J. et al. The expression of BAFF in themuscles of patientswith dermatomyositis // J. Neuroimmunol. 2012; 249: 96-100. DOI: 10.1016/j.jneuroim.2012.04.006.

Bick S., Tschernatsch M., Karg A. et al. Intravenous immunoglobulin inhibits BAFF production in chronic inflammatory demyelinating polyneuropathy — a new mechanism of action? // J. Neuroimmunol. 2013; 256: 84-90. DOI: 10.1016/j.jneuroim.2013.01.001.

Ritter C., Förster D., Albrecht P., Hartung H., Kieseier Bernd C.,

Lehmann Helmar C. IVIG regulates BAFF expression in patients with chronic inflammatory demyelinating polyneuropathy // Journal of Neuroimmunology. 2014; 274: 225-229. DOI: 10.1016/j.jneuroim.2014.06.007.

Bromberg B.M. Review of the evolution of electrodiagnostic criteria for chronic inflammatory demyelinating polyradicoloneupathy //

Muscle & Nerve. 2011; 780-794. DOI: 10.1002/mus.22038.

Sonja van Nes. Improving and standardising assessment of patients with immune-mediated neuropathies // Scholma Druk, Bedum; 2011. 264 p.




DOI: https://doi.org/10.22141/2224-0713.4.90.2017.107266

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