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Research paper
Effective treatment with intravenous immunoglobulins reduces autoreactive T-cell response in patients with CIDP
  1. Juliane Klehmet1,
  2. Jos Goehler1,
  3. Lena Ulm1,
  4. Siegfried Kohler1,
  5. Christian Meisel2,3,
  6. Andreas Meisel1,
  7. Hendrik Harms4
  1. 1Department of Neurology, University Hospital Charité, Berlin, Germany
  2. 2Institute of Medical Immunology, Charité, Berlin
  3. 3Department of Immunology, Labor Berlin Charité
  4. 4Department of Neurology, St. Josefs Krankenhaus Potsdam, Potsdam, Germany
  1. Correspondence to Dr Juliane Klehmet, Department of Neurology, University Hospital Charité, Charitéplatz 1, Berlin 10117 Germany; juliane.klehmet{at}charite.de

Abstract

Objective To investigate changes in autoreactive T-cell responses against PMP-22 and P2 antigen as well as a T-cell memory repertoire in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) induced by repeated intravenous immunoglobulin (IVIg) treatment.

Methods In an observational trial, we prepared cryopreserved human peripheral blood monocytes from blood from 34 patients with CIDP (18 treatment naïve and 16 maintenance IVIg treatment) and from 14 healthy controls (non-immune neuropathy and healthy control). Treatment response was defined by clinical evaluation. The autoantigen-specific T-cell response was analysed by enzyme linked immunosorbent spot (ELISPOT) assay before IVIg start (baseline) and at follow-up. The T-cell memory subsets were analysed by using flow cytometric analysis.

Results Myelin-derived P2-specific and PMP-22-specific IFN-γ producers were increased in IVIg responders compared with non-responders before treatment, which decreased by repeated IVIg infusion cycles. Treatment responders but not non-responders showed higher frequencies of CD4 T effector memory (TEM) and T central memory frequencies at baseline compared with maintenance IVIg treatment patients and controls. In addition, IVIg treatment was associated with a significant reduction in CD8 TEM at follow-up.

Conclusions Our data demonstrate that immunomodulatory treatment with IVIgs on a long-term basis reduces the autoreactive T-cell response against PMP-22 and P2-antigens, which may be influenced by the altered maintenance of CD8 and CD4 effector/memory T-cell subsets towards a more anti-inflammatory immune status. Elevated PMP-22 and P2-specific T-cell responses may serve as predictors for treatment responsiveness to IVIgs warranting validation in larger studies.

  • Neuropathy

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