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Wieske L, Michael MR, In 't Veld SGJG, Visser A, van Schaik IN, Eftimov F, Teunissen CE. Proximity extension assay-based discovery of biomarkers for disease activity in chronic inflammatory demyelinating polyneuropathy. J Neurol Neurosurg Psychiatry 2024; 95:595-604. [PMID: 37879899 DOI: 10.1136/jnnp-2023-332398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Objective disease activity biomarkers are lacking in chronic inflammatory demyelinating polyneuropathy (CIDP), impacting treatment decisions in clinical care and outcomes in clinical trials. Using a proximity extension assay, we aimed to identify candidate serum protein biomarkers for disease activity in CIDP. METHOD We collected clinical data and serum of 106 patients with CIDP. Patients starting induction treatment (n=53) and patients on maintenance treatment starting treatment withdrawal (n=40) were assessed at baseline and at 6 months (or at relapse). Patients in remission (n=13) were assessed once. Clinical disease activity was defined based on improvement or deterioration by the minimal clinically important difference on the inflammatory Rasch-built Overall Disability Scale in combination with either grip strength or the Medical Research Council sum score. Using a proximity extension assay (Olink Explore platform), 1472 protein levels were analysed in serum. Candidate proteins were selected based on fold change>0.5 or <-0.5 and p<0.05 between clinically active and inactive disease. Longitudinal changes of candidate proteins between baseline and follow-up were analysed. RESULTS We identified 48 candidate proteins that differed between clinically active and inactive disease on cross-sectional comparison. Five of these proteins (SUGT1, IRAK4, DCTN1, 5'-nucleotidase cytosolic IIIA (NT5C3A), glutaredoxin (GLRX)) also showed longitudinal changes consistent with disease activity changes. IRAK4 was also identified in a sensitivity analysis, using another definition for disease activity. CONCLUSION Our results indicate that IRAK4 and possibly SUGT1, DCTN1, NT5C3A and GLRX are candidate biomarkers for monitoring clinical disease activity in CIDP.
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Affiliation(s)
- Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
- Department of Clinical Neurophysiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Milou R Michael
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - Sjors G J G In 't Veld
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Allerdien Visser
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Ivo N van Schaik
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
- Sanquin Bloedvoorziening, Amsterdam, Noord-Holland, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, Noord-Holland, The Netherlands
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Kmezic I, Gustafsson R, Fink K, Svenningsson A, Samuelsson K, Ingre C, Olsson T, Hansson M, Kockum I, Adzemovic MZ, Press R. Validation of elevated levels of interleukin-8 in the cerebrospinal fluid, and discovery of new biomarkers in patients with GBS and CIDP using a proximity extension assay. Front Immunol 2023; 14:1241199. [PMID: 38077366 PMCID: PMC10702497 DOI: 10.3389/fimmu.2023.1241199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
Background Biomarkers for diagnosis of inflammatory neuropathies, assessment of prognosis, and treatment response are lacking. Methods CSF and EDTA plasma from patients with Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), healthy controls (HC) and disease controls were analyzed with Olink multiplex proximity extension assay (PEA) from two independent cohorts. Levels of interleukin-8 (IL8) were further analyzed with ELISA in patients with GBS, CIDP, paraproteinemia-related demyelinating polyneuropathy (PDN), multifocal motor neuropathy (MMN), HC and disease controls. ROC analysis was performed. Outcome was measured with the GBS-disability score (GBS-ds) or Inflammatory Neuropathy Cause and Treatment (INCAT) score. Results In CSF, multiplex PEA analysis revealed up-regulation of IL8 in GBS compared to CIDP and HC respectively, and CIDP compared to HC. In addition, levels of IL2RA were upregulated in GBS compared to both HC and CIDP, SELE in GBS compared to HC, and ITGAM, IL6, and NRP1 in GBS compared to CIDP. In plasma, levels of MMP3, THBD and ITGAM were upregulated in CIDP compared to HC. Validation of multiplex IL8 results using ELISA, revealed increased levels of IL8 in CSF in patients with GBS and CIDP versus HC and non-inflammatory polyneuropathies (NIP) respectively, as well as in PDN versus NIP and HC. Levels of IL8 in CSF correlated with impairment in the acute phase of GBS as well as outcome at 6-months follow up. Conclusion IL8 in CSF is validated as a diagnostic biomarker in GBS and CIDP, and a prognostic biomarker in GBS. Multiplex PEA hereby identifies several potential biomarkers in GBS and CIDP.
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Affiliation(s)
- Ivan Kmezic
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rasmus Gustafsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Fink
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Svenningsson
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Kristin Samuelsson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Ingre
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Hansson
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine H5, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Milena Z. Adzemovic
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Neurology, Academic Specialist Centre, Stockholm Health Services, Stockholm, Sweden
| | - Rayomand Press
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Szepanowski F, Schoser B, Mausberg AK, Kleinschnitz C, Hartung H, Stettner M. Time for a standardized diagnostic response test in patients with chronic inflammatory demyelinating polyradiculoneuropathy? Brain Behav 2023; 13:e3256. [PMID: 37743581 PMCID: PMC10636379 DOI: 10.1002/brb3.3256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
Standardized pharmacological response tests are important and established diagnostic tools in the field of neurology. However, regarding therapeutic responses to intravenous immunoglobulins (IVIg) in CIDP, neither a definition of therapeutic response has been established, nor a response test has been suggested so far. Here we suggest a practical clinical approach which is supported by current literature in the field. An established standardized IVIg response test could avoid prolonged therapy without benefit for the patient and ensure a timely therapy switch or treatment escalation if required. This approach would also be advantageous due to the global scarcity of plasma derivatives as a human resource and could be the foundation to be adjusted and improved by subsequent studies.
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Affiliation(s)
- Fabian Szepanowski
- Department of NeurologyEssen University Hospital, University Duisburg‐EssenEssenGermany
- Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University of Duisburg‐EssenEssenGermany
| | - Benedikt Schoser
- Department of NeurologyFriedrich‐Baur‐Institute, Ludwig‐Maximilians‐University MunichMunichGermany
| | - Anne K. Mausberg
- Department of NeurologyEssen University Hospital, University Duisburg‐EssenEssenGermany
- Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University of Duisburg‐EssenEssenGermany
| | - Christoph Kleinschnitz
- Department of NeurologyEssen University Hospital, University Duisburg‐EssenEssenGermany
- Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University of Duisburg‐EssenEssenGermany
| | - Hans‐Peter Hartung
- Department of NeurologyMedical Faculty, Heinrich‐Heine‐University DüsseldorfDüsseldorfGermany
- Brain and Mind CenterUniversity of SydneySydneyNew South WalesAustralia
- Department of NeurologyPalacky University OlomoucOlomoucCzechia
| | - Mark Stettner
- Department of NeurologyEssen University Hospital, University Duisburg‐EssenEssenGermany
- Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University of Duisburg‐EssenEssenGermany
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Cintas P, Bouhour F, Cauquil C, Masingue M, Tard C, Sacconi S, Delmont E, Choumert A, Chanson JB, Michaud M, Solé G, Cassereau J, Noury JB, Nicolas G, Bellance R, Péréon Y, Camdessanché JP, Magy L, Attarian S. Current clinical management of CIDP with immunoglobulins in France: An expert opinion. Rev Neurol (Paris) 2023; 179:914-922. [PMID: 37019741 DOI: 10.1016/j.neurol.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/05/2023] [Accepted: 03/13/2023] [Indexed: 04/05/2023]
Abstract
Treatment strategies in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) must be adapted on a case-to-case basis. Validated and reproducible tools for monitoring treatment response are required at diagnosis, when initiating treatment and throughout follow-up. A task force of French neurologists, experts in neuromuscular disease reference centers, was assembled to provide expert advice on the management of typical CIDP with intravenous immunoglobulins (Ig), and to harmonize treatment practices in public and private hospitals. The task force also referred to the practical experience of treating CIDP with Ig at the diagnostic, induction and follow-up stages, including the assessment and management of Ig dependence, and following the recommendations of the French health agency.
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Affiliation(s)
- P Cintas
- Service de neurologie, CHU de Toulouse Purpan, centre de référence de pathologies neuromusculaires, Toulouse, France
| | - F Bouhour
- Service d'ENMG et de pathologies neuromusculaires, hospices civils de Lyon, hôpital neurologique, Lyon, France
| | - C Cauquil
- Service de neurologie, AP-HP Kremlin-Bicêtre, Paris, France
| | - M Masingue
- Service de neuromyologie, centre de référence des maladies neuromusculaires Nord/Est/Île-de-France, AP-HP Pitié-Salpêtrière, Paris, France
| | - C Tard
- Unité d'expertise cognitivo-motrice, U1172, service de neurologie, CHU de Lille, centre de référence des maladies neuromusculaires Nord/Est/Île-de-France, Lille, France
| | - S Sacconi
- Système nerveux périphérique et muscle, CHU de Nice, université Côte d'Azur, Nice, France
| | - E Delmont
- Service de neurologie, centre de référence des maladies neuromusculaires et SLA, hôpital de la Timone, Marseille, France
| | - A Choumert
- Service des maladies neurologiques rares, CHU de la Réunion, groupe hospitalier Sud Réunion, Saint-Pierre, France
| | - J-B Chanson
- Service de neurologie, CHRU Strasbourg, centre de référence neuromusculaire Nord/Est/Île-de-France, Strasbourg, France
| | - M Michaud
- Service de neurologie, CHU de Nancy, hôpital Central, Nancy, France
| | - G Solé
- Service de neurologie et maladies neuromusculaires, CHU de Bordeaux, centre de référence des maladies neuromusculaires AOC, hôpital Pellegrin, Bordeaux, France
| | - J Cassereau
- CHU d'Angers, centre de référence des maladies neuromusculaires AOC, Angers, France
| | - J-B Noury
- Inserm, LBAI, UMR1227, centre de référence des maladies neuromusculaires AOC, CHRU de Brest, Brest, France
| | - G Nicolas
- Service de neurologie, centre de référence neuromusculaire Nord-Est/Île-de-France , Université UVSQ Paris-Saclay, hôpital Raymond-Poincaré, Garches, France
| | - R Bellance
- CeRCa, site constitutif de centre de référence caribéen des maladies neuromusculaires rares, CHU de Martinique, hôpital P. Zobda-Quitman, Fort-de-France, France
| | - Y Péréon
- Explorations fonctionnelles, Filnemus, Euro-NMD, Nantes université, CHU de Nantes, centre de référence AOC, Nantes, France
| | - J-P Camdessanché
- Service de neurologie, CHU de Saint-Étienne, hôpital Nord, Saint-Étienne, France
| | - L Magy
- Service et laboratoire de neurologie, centre de référence neuropathies périphériques rares, NNerf, UR 20218 NeurIT, CHU de Limoges, hôpital Dupuytren, Limoges, France
| | - S Attarian
- Service de neurologie, centre de référence des maladies neuromusculaires et SLA, hôpital de la Timone, Marseille, France.
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Acarli ANÖ, Ünverengil G, Şirin NG, Çakar A, Durmuş H, Parman Y. Disease activity in chronic inflammatory demyelinating polyneuropathy: A comparative study of clinical and skin biopsy markers. Muscle Nerve 2022; 66:736-743. [PMID: 36151750 DOI: 10.1002/mus.27726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS Epidermal nerve fiber involvement in chronic inflammatory demyelinating neuropathy (CIDP) has been reported in a limited number of patients. We quantified small-fiber involvement in a mixed cohort of patients with typical CIDP and CIDP variants to evaluate relationships with clinical outcome measures at different disease stages. METHODS Intraepidermal nerve fiber densities (IENFDs) were evaluated by skin punch biopsies of 23 patients with CIDP and 13 healthy controls at the forearm, thigh, and distal leg. Skin sections were optimally interpreted in all three regions in 16 CIDP patients and 10 age- and sex-matched healthy controls. Statistical analysis was performed in these subjects. RESULTS The IENFDs in forearm, thigh, and distal leg were similar among seven typical CIDP and nine CIDP variants. IENFDs in those regions were significantly reduced in CIDP compared with healthy controls, with a moderate negative correlation with scores on the International Neuropathy Cause and Treatment (INCAT) Upper Limb Functional Disability Scale. The reduction in IENFD compared with controls was more remarkable in the distal leg. In clinically unstable CIDP patients, the IENFDs of distal leg and forearm were significantly reduced compared with stable CIDP patients and controls. Stable CIDP patients had significantly reduced IENFDs in distal leg and forearm compared with controls. DISCUSSION In this exploratory study, we confirm that small fibers are also affected in CIDP. Larger studies are needed to explore longitudinal changes of IENFD in CIDP and its relation to disease stage.
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Affiliation(s)
- Ayşe Nur Özdağ Acarli
- Neuromuscular Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gökçen Ünverengil
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nermin Görkem Şirin
- Neuromuscular Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Arman Çakar
- Neuromuscular Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hacer Durmuş
- Neuromuscular Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yeşim Parman
- Neuromuscular Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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van Veen R, Wieske L, Lucke I, Adrichem ME, Merkies ISJ, van Schaik IN, Eftimov F. Assessing deterioration using impairment and functional outcome measures in chronic inflammatory demyelinating polyneuropathy: a post-hoc analysis of the IOC trial. J Peripher Nerv Syst 2022; 27:144-158. [PMID: 35507446 PMCID: PMC9321849 DOI: 10.1111/jns.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/05/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS It is unclear whether frequently used cut-off values for outcome measures defining minimal clinically important differences (MCIDs) can accurately identify meaningful deterioration in chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS We used data from the IOC trial, in which sixty clinically stable CIDP patients were randomized to IVIg withdrawal or continuation. We calculated change scores of the Inflammatory Rasch-Built Overall Disability Scale (I-RODS), grip strength, and MRC sum score (MRC-SS) and classified visits based on a treatment anchor (i.e. decision to restart/increase treatment after reaching a predefined early endpoint of deterioration). The variability of scores in patients without deterioration was calculated using the limits of agreement. We defined optimized MCIDs for deterioration and specific combinations of MCIDs from different outcome measures, and subsequently calculated the accuracies of the (combined) MCIDs. RESULTS Substantial variability was found in scores of the I-RODS, grip strength and MRC-SS in patients without deterioration over time, and most MCIDs were within the limits of the variability observed in patients without deterioration. Some MCID cut-offs were insensitive but highly specific for detecting deterioration, e.g. the MCID-SE of -1.96 of the I-RODS and -2 point on the MRC-SS. Others were sensitive, but less specific, e.g. -4 centiles of the I-RODS. Some combined MCIDs resulted in high specificities and moderate sensitivities. INTERPRETATION Our results suggest that clinically important deterioration cannot be distinguished from variability over time with currently used MCIDs on the individual level. Combinations of MCIDs might improve the accuracy of determining deterioration, but this needs validation.
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Affiliation(s)
- Robin van Veen
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Luuk Wieske
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Ilse Lucke
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Max E Adrichem
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ingemar S J Merkies
- Maastricht Academic Medical Centre, Maastricht, the Netherlands.,Curaçao Medical Centre, Willemstad, Curacao
| | - Ivo N van Schaik
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Spaarne Gasthuis, Haarlem, the Netherlands
| | - Filip Eftimov
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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