Influence of impaired T‐ and B‐cell compartments on efficacy of IVIg in dysimmune neuropathies

Abstract

Autoimmune mechanisms are postulated to play a role in the development and progression of dysimmune neuropathies (DN). We investigated the relation between lymphocyte number and marker expression, and disease activity in 20 patients with DN under intravenous immunoglobulins (IVIg) treatment. B-and T-lymphocyte markers were studied by flow cytometry of the expression of CD5, CD25, CD23 and CD38 markers on B cells and of CD3, CD4 and CD8 markers, respectively. These parameters were compared with those obtained from matched healthy volunteers. The proportions of CD38+ B cells were higher in patients compared with those of controls. Proportions of activated CD4+ and CD8+ T cells were comparable in peripheral blood mononuclear cells of patients and controls, but a significant reduction of the absolute numbers of CD3+, CD4+ and CD8+ cells were observed in DN patients. The percentages of CD25+ memory T cells were instead significantly increased in DN patients. Lastly, T-cell reduction and the CD19/CD38 ratio over total B (CD19+) cells directly correlated with a poor response to IVIg therapy. In DN, whereas T-cell number is reduced, activated T and B cells are increased, thus suggesting an intrinsic defect of the immune response.

Disease activity in chronic inflammatory demyelinating polyneuropathy: association between circulating B-cell subsets, cytokine levels, and clinical outcomes

“…We found a significant reduction in plasma cells of CIDP patients with IVIg and steroid treatments, as well as untreated active CIDP patients, in contrast to two previous studies [ 24 , 25 ]. The study of Mata and colleagues consisted of patients with various dysimmune neuropathies including CIDP patients [ 24 ], whereas the study of Kuhnke et al reported markedly elevated plasma cell numbers in eight untreated CIDP patients and a significant decrease by IVIg treatment in six patients [ 25 ]. Similarly, our untreated CIDP patients showed relatively higher plasma cell ratios than steroid- and IVIg-treated patients.…”

“…In our study, CD3 + T cells were significantly decreased in CIDP patients with IVIg or steroid treatment compared to the untreated group, as previously reported [ 24 , 33 ]. By contrast, immune treatments failed to make a significant reversion in B-cell dysregulation in our CIDP patients.…”

“…The CD19 + B-cell percentages in untreated CIDP patients and CIDP patients with steroid treatment were significantly lower than in healthy controls, as previously reported [ 33 ]. However, the percentages of CD19 + B-cells in CIDP patients with IVIg treatment were significantly increased compared to untreated and healthy controls, as well as patients under steroid treatment, in contrast to the previous two studies including dysimmune neuropathy patients treated with IVIg [ 24 , 25 ]. In one of them, the study cohort has also included patients with other inflammatory neuropathies other than CIDP.…”

CIDP: Analysis of Immunomarkers During COVID-19 mRNA-Vaccination and IVIg-Immunomodulation: An Exploratory Study

“…Of those, reduced numbers of CD32b expressing memory B cells and monocytes, as well as increased numbers of CD16 + myeloid dendritic cells, were associated with disease activity and/or poor response to immunoglobulin therapy (Tackenberg et al 2009;Dyer et al 2016). Other studies demonstrated that CIDP is associated with a reduction of regulatory T cells, as well as with an increase of monocytes (Matà et al 2007;Sanvito et al 2009).…”