Chronic Inflammatory Demyelinating Polyneuropathy: How Pathophysiology Can Guide Treatment
Corresponding Author
Karissa L. Gable
Duke University Medical Center, Durham, North Carolina, USA
Correspondence:
Karissa L. Gable ([email protected])
Contribution: Conceptualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorYingkai Li
Duke University Medical Center, Durham, North Carolina, USA
Contribution: Writing - review & editing
Search for more papers by this authorCorresponding Author
Karissa L. Gable
Duke University Medical Center, Durham, North Carolina, USA
Correspondence:
Karissa L. Gable ([email protected])
Contribution: Conceptualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorYingkai Li
Duke University Medical Center, Durham, North Carolina, USA
Contribution: Writing - review & editing
Search for more papers by this authorFunding: The authors received no specific funding for this work.
The objectives of this activity are to: 1) Understand the roles of cell-mediated and humoral-mediated immunity in the pathogenesis of CIDP, in order to facilitate rational decision-making regarding therapies; 2) Understand the underlying pathogenetic mechanisms by which first line therapies (immunoglobulins, corticosteroids, and plasma exchange) may be effective in treating CIDP; 3) Understand how targeted therapies can be used to expand the treatment options for CIDP, and the mechanisms by which they do so.
The AANEM is accredited by the American Council for Continuing Medical Education (ACCME) to providing continuing education for physicians. AANEM designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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ABSTRACT
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune demyelinating neuropathy that is most commonly characterized clinically by progressive proximal and distal weakness affecting the upper and lower extremities, sensory loss, and reduced or absent reflexes. These symptoms evolve over the time course of 8 weeks or more. While the majority of CIDP demonstrates this clinical phenotype, there are CIDP variants as well. The milieu of the underlying pathophysiology and immunologic factors involved is complex and involves components of both the innate and adaptive immune systems. As more is understood about the underlying pathophysiology, novel targets and patterns have emerged guiding further classification and management. This is most notable in the discovery of antibodies targeting paranodal and nodal regions related to anti-neurofascin-155 and anti-contactin-1 antibody-mediated disease resulting in a reclassification as demyelinating nodo-paranodopathies. Triggering antigens and correlative antibodies for CIDP are otherwise undiscovered. While first-line therapies for CIDP currently are broad and non-targeted, a shift in approach has been to develop specific targeted treatments guided by what is understood about the underlying pathophysiology. Some of these targets include specific types of B-cell depletion, complement inhibition, immunoglobulin G (IgG) reduction via inhibition of the neonatal Fc receptor (FcRn) recycling of IgGs, treatments related to T-cell dysfunction, and macrophage inhibition.
Conflicts of Interest
Karissa L. Gable has served as a paid consultant for Immunovant, Sanofi, Takeda, CSL Behring, Grifols, Argenx, Annexon and Dianthus, and InCircle. The other author declares no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
- 1R. S. Laughlin, P. J. Dyck, L. J. Melton, 3rd, C. Leibson, J. Ransom, and P. J. Dyck, “Incidence and Prevalence of CIDP and the Association of Diabetes Mellitus,” Neurology 73, no. 1 (2009): 39–45.
- 2P. J. B. Dyck and J. A. Tracy, “History, Diagnosis, and Management of Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Mayo Clinic Proceedings 93, no. 6 (2018): 777–793.
- 3E. K. Mathey, S. B. Park, R. A. Hughes, et al., “Chronic Inflammatory Demyelinating Polyradiculoneuropathy: From Pathology to Phenotype,” Journal of Neurology, Neurosurgery, and Psychiatry 86, no. 9 (2015): 973–985.
- 4P. E. Doneddu, D. Cocito, F. Manganelli, et al., “Atypical CIDP: Diagnostic Criteria, Progression and Treatment Response. Data From the Italian CIDP Database,” Journal of Neurology, Neurosurgery, and Psychiatry 90, no. 2 (2019): 125–132.
- 5P. Y. K. Van den Bergh, P. A. van Doorn, R. D. M. Hadden, et al., “European Academy of Neurology/Peripheral Nerve Society Guideline on Diagnosis and Treatment of Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Report of a Joint Task Force-Second Revision,” Journal of the Peripheral Nervous System 26, no. 3 (2021): 242–268.
- 6L. Sanvito, A. Makowska, N. Gregson, R. Nemni, and R. A. Hughes, “Circulating Subsets and CD4(+)CD25(+) Regulatory T Cell Function in Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Autoimmunity 42, no. 8 (2009): 667–677, https://doi.org/10.3109/08916930903140907.
- 7J. A. Allen, J. Lin, I. Basta, et al., “Safety, Tolerability, and Efficacy of Subcutaneous Efgartigimod in Patients With Chronic Inflammatory Demyelinating Polyradiculoneuropathy (ADHERE): A Multicentre, Randomised-Withdrawal, Double-Blind, Placebo-Controlled, Phase 2 Trial,” Lancet Neurology 23, no. 10 (2024): 1013–1024, https://doi.org/10.1016/S1474-4422(24)00309-0.
- 8P. J. Dyck, J. Daube, P. O'Brien, et al., “Plasma Exchange in Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” New England Journal of Medicine 314, no. 8 (1986): 461–465.
- 9M. M. Mehndiratta, R. A. Hughes, and J. Pritchard, “Plasma Exchange for Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Cochrane Database of Systematic Reviews 2015, no. 8 (2015): Cd003906.
- 10H. Koike, R. Nishi, S. Ikeda, et al., “Ultrastructural Mechanisms of Macrophage-Induced Demyelination in CIDP,” Neurology 91, no. 23 (2018): 1051–1060.
- 11J. W. Griffin, G. Stoll, C. Y. Li, W. Tyor, and D. R. Cornblath, “Macrophage Responses in Inflammatory Demyelinating Neuropathies,” Annals of Neurology 27 (1990): S64–S68.
- 12C. Vital, A. Vital, A. Lagueny, et al., “Chronic Inflammatory Demyelinating Polyneuropathy: Immunopathological and Ultrastructural Study of Peripheral Nerve Biopsy in 42 Cases,” Ultrastructural Pathology 24, no. 6 (2000): 363–369.
- 13G. Said and M. Hontebeyrie-Joskowicz, “Nerve Lesions Induced by Macrophage Activation,” Research in Immunology 143, no. 6 (1992): 589–599.
- 14P. W. Lampert, “Mechanism of Demyelination in Experimental Allergic Neuritis. Electron Microscopic Studies,” Laboratory Investigation 20, no. 2 (1969): 127–138.
- 15S. Izumo, C. Linington, H. Wekerle, and R. Meyermann, “Morphologic Study on Experimental Allergic Neuritis Mediated by T Cell Line Specific for Bovine P2 Protein in Lewis Rats,” Laboratory Investigation 53, no. 2 (1985): 209–218.
- 16M. Garces-Sanchez, R. S. Laughlin, P. J. Dyck, J. K. Engelstad, J. E. Norell, and P. J. Dyck, “Painless Diabetic Motor Neuropathy: A Variant of Diabetic Lumbosacral Radiculoplexus Neuropathy?,” Annals of Neurology 69, no. 6 (2011): 1043–1054, https://doi.org/10.1002/ana.22334.
- 17M. Xu, M. Pinto, C. Sun, et al., “Expanded Teased Nerve Fibre Pathological Conditions in Disease Association,” Journal of Neurology, Neurosurgery, and Psychiatry 90, no. 2 (2019): 138–140.
- 18C. Sommer, S. Koch, M. Lammens, A. Gabreels-Festen, G. Stoll, and K. V. Toyka, “Macrophage Clustering as a Diagnostic Marker in Sural Nerve Biopsies of Patients With CIDP,” Neurology 65, no. 12 (2005): 1924–1929.
- 19J. M. Vallat, F. Tabaraud, L. Magy, et al., “Diagnostic Value of Nerve Biopsy for Atypical Chronic Inflammatory Demyelinating Polyneuropathy: Evaluation of Eight Cases,” Muscle & Nerve 27, no. 4 (2003): 478–485.
- 20C. Bouchard, C. Lacroix, V. Planté, et al., “Clinicopathologic Findings and Prognosis of Chronic Inflammatory Demyelinating Polyneuropathy,” Neurology 52, no. 3 (1999): 498–503.
- 21M. C. Dalakas, “Pathogenesis of Immune-Mediated Neuropathies,” Biochimica et Biophysica Acta 1852, no. 4 (2015): 658–666.
- 22L. A. Querol, H. P. Hartung, R. A. Lewis, et al., “The Role of the Complement System in Chronic Inflammatory Demyelinating Polyneuropathy: Implications for Complement-Targeted Therapies,” Neurotherapeutics 19, no. 3 (2022): 864–873.
- 23M. C. Dalakas, H. Alexopoulos, and P. J. Spaeth, “Complement in Neurological Disorders and Emerging Complement-Targeted Therapeutics,” Nature Reviews. Neurology 16, no. 11 (2020): 601–617.
- 24J. V. Sarma and P. A. Ward, “The Complement System,” Cell and Tissue Research 343, no. 1 (2011): 227–235.
- 25M. C. Dalakas and W. K. Engel, “Immunoglobulin and Complement Deposits in Nerves of Patients With Chronic Relapsing Polyneuropathy,” Archives of Neurology 37, no. 10 (1980): 637–640.
- 26H. Koike and M. Katsuno, “Pathophysiology of Chronic Inflammatory Demyelinating Polyneuropathy: Insights Into Classification and Therapeutic Strategy,” Neurology and Therapy 9, no. 2 (2020): 213–227.
- 27I. Quast, C. W. Keller, F. Hiepe, B. Tackenberg, and J. D. Lünemann, “Terminal Complement Activation Is Increased and Associated With Disease Severity in CIDP,” Annals of Clinical Translational Neurology 3, no. 9 (2016): 730–735.
- 28C. L. Koski, “Characterization of Complement-Fixing Antibodies to Peripheral Nerve Myelin in Guillain-Barré Syndrome,” Annals of Neurology 27 (1990): S44–S47.
- 29G. Stoll, B. Schmidt, S. Jander, K. V. Toyka, and H. P. Hartung, “Presence of the Terminal Complement Complex (C5b-9) Precedes Myelin Degradation in Immune-Mediated Demyelination of the Rat Peripheral Nervous System,” Annals of Neurology 30, no. 2 (1991): 147–155.
- 30T. E. Feasby, J. J. Gilbert, A. F. Hahn, and M. Neilson, “Complement Depletion Suppresses Lewis Rat Experimental Allergic Neuritis,” Brain Research 419, no. 1–2 (1987): 97–103.
- 31J. W. Rumsey, C. Lorance, M. Jackson, et al., “Classical Complement Pathway Inhibition in a “Human-on-a-Chip” Model of Autoimmune Demyelinating Neuropathies,” Advanced Therapeutics 5, no. 6 (2022): 2200030.
- 32R. A. Hughes, D. Allen, A. Makowska, and N. A. Gregson, “Pathogenesis of Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Journal of Peripheral and Central Nervous Systems 11, no. 1 (2006): 30–46.
- 33Y. Li, J. S. Yi, J. T. Guptill, et al., “Immune Dysregulation in Chronic Inflammatory Demyelinating Polyneuropathy,” Journal of Neuroimmunology 391 (2024): 578360.
- 34M. C. Dalakas, “Advances in the Diagnosis, Pathogenesis and Treatment of CIDP,” Nature Reviews. Neurology 7, no. 9 (2011): 507–517.
- 35B. Schmidt, K. V. Toyka, R. Kiefer, J. Full, H. P. Hartung, and J. Pollard, “Inflammatory Infiltrates in Sural Nerve Biopsies in Guillain-Barre Syndrome and Chronic Inflammatory Demyelinating Neuropathy,” Muscle & Nerve 19, no. 4 (1996): 474–487.
10.1002/(SICI)1097-4598(199604)19:4<474::AID-MUS8>3.0.CO;2-9 CAS PubMed Web of Science® Google Scholar
- 36J. D. Pollard, P. A. McCombe, J. Baverstock, P. A. Gatenby, and J. G. McLeod, “Class II Antigen Expression and T Lymphocyte Subsets in Chronic Inflammatory Demyelinating Polyneuropathy,” Journal of Neuroimmunology 13, no. 2 (1986): 123–134.
- 37D. J. Mahad, S. J. Howell, and M. N. Woodroofe, “Expression of Chemokines in Cerebrospinal Fluid and Serum of Patients With Chronic Inflammatory Demyelinating Polyneuropathy,” Journal of Neurology, Neurosurgery, and Psychiatry 73, no. 3 (2002): 320–323.
- 38D. Maimone, P. Annunziata, I. L. Simone, P. Livrea, and G. C. Guazzi, “Interleukin-6 Levels in the Cerebrospinal Fluid and Serum of Patients With Guillain-Barré Syndrome and Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Journal of Neuroimmunology 47, no. 1 (1993): 55–61.
- 39L. J. Chi, W. H. Xu, Z. W. Zhang, H. T. Huang, L. M. Zhang, and J. Zhou, “Distribution of Th17 Cells and Th1 Cells in Peripheral Blood and Cerebrospinal Fluid in Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Journal of the Peripheral Nervous System 15, no. 4 (2010): 345–356.
- 40T. Schneider-Hohendorf, N. Schwab, N. Uçeyler, K. Göbel, C. Sommer, and H. Wiendl, “CD8+ T-Cell Immunity in Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Neurology 78, no. 6 (2012): 402–408.
- 41J. Klehmet, J. Goehler, L. Ulm, et al., “Effective Treatment With Intravenous Immunoglobulins Reduces Autoreactive T-Cell Response in Patients With CIDP,” Journal of Neurology, Neurosurgery, and Psychiatry 86, no. 6 (2015): 686–691.
- 42M. Staudt, J. M. Diederich, C. Meisel, A. Meisel, and J. Klehmet, “Differences in Peripheral Myelin Antigen-Specific T Cell Responses and T Memory Subsets in Atypical Versus Typical CIDP,” BMC Neurology 17, no. 1 (2017): 81.
- 43P. E. Doneddu and E. Nobile-Orazio, “Management of Chronic Inflammatory Demyelinating Polyradiculopathy,” Current Opinion in Neurology 31, no. 5 (2018): 511–516.
- 44D. Menon, H. D. Katzberg, and V. Bril, “Treatment Approaches for Atypical CIDP,” Frontiers in Neurology 12 (2021): 653734.
- 45W. X. Yan, J. Taylor, S. Andrias-Kauba, and J. D. Pollard, “Passive Transfer of Demyelination by Serum or IgG From Chronic Inflammatory Demyelinating Polyneuropathy Patients,” Annals of Neurology 47, no. 6 (2000): 765–775.
- 46K. Heininger, U. G. Liebert, K. V. Toyka, et al., “Chronic Inflammatory Polyneuropathy. Reduction of Nerve Conduction Velocities in Monkeys by Systemic Passive Transfer of Immunoglobulin G,” Journal of Neurology, Neurosurgery & Psychiatry 66, no. 1 (1984): 1–14, https://doi.org/10.1016/0022-510x(84)90136-9.
- 47L. Sanvito, A. Makowska, M. Mahdi-Rogers, et al., “Humoral and Cellular Immune Responses to Myelin Protein Peptides in Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Journal of Neurology, Neurosurgery, and Psychiatry 80, no. 3 (2009): 333–338.
- 48W. X. Yan, J. J. Archelos, H. P. Hartung, and J. D. Pollard, “P0 Protein Is a Target Antigen in Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Annals of Neurology 50, no. 3 (2001): 286–292.
- 49P. E. Doneddu, D. Cocito, R. Fazio, et al., “Prospective Open-Label Trial With Rituximab in Patients With Chronic Inflammatory Demyelinating Polyradiculoneuropathy Not Responding to Conventional Immune Therapies,” Journal of Neurology, Neurosurgery, and Psychiatry 95, no. 9 (2024): 838–844.
- 50E. Nobile-Orazio, D. Cocito, F. Manganelli, et al., “Rituximab Versus Placebo for Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Randomized Trial,” Brain 148, no. 4 (2025): 1112–1121.
- 51L. Querol, A. M. Siles, R. Alba-Rovira, et al., “Antibodies Against Peripheral Nerve Antigens in Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Scientific Reports 7, no. 1 (2017): 14411.
- 52C. P. Moritz, Y. Tholance, O. Stoevesandt, K. Ferraud, J. P. Camdessanché, and J. C. Antoine, “CIDP Antibodies Target Junction Proteins and Identify Patient Subgroups: An Autoantigenomic Approach,” Neurology Neuroimmunology & Neuroinflammation 8, no. 2 (2021): e944.
- 53P. A. van Doorn, R. D. M. Hadden, and P. Y. K. Van den Bergh, “Elucidating Autoimmune Nodopathies and the CIDP Spectrum,” Brain 144, no. 4 (2021): 1043–1045.
- 54C. Bunschoten, B. C. Jacobs, P. Y. K. Van den Bergh, D. R. Cornblath, and P. A. van Doorn, “Progress in Diagnosis and Treatment of Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Lancet Neurology 18, no. 8 (2019): 784–794.
- 55S. Ikeda, H. Koike, R. Nishi, et al., “Clinicopathological Characteristics of Subtypes of Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Journal of Neurology, Neurosurgery, and Psychiatry 90, no. 9 (2019): 988–996.
- 56E. Dziadkowiak, M. Waliszewska-Prosół, M. Nowakowska-Kotas, S. Budrewicz, Z. Koszewicz, and M. Koszewicz, “Pathophysiology of the Different Clinical Phenotypes of Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP),” International Journal of Molecular Sciences 23, no. 1 (2021): 179, https://doi.org/10.3390/ijms23010179.
- 57C. Manso, L. Querol, C. Lleixà, et al., “Anti-Neurofascin-155 IgG4 Antibodies Prevent Paranodal Complex Formation in Vivo,” Journal of Clinical Investigation 129, no. 6 (2019): 2222–2236.
- 58A. Jentzer, A. Attal, C. Roué, et al., “IgG4 Valency Modulates the Pathogenicity of Anti-Neurofascin-155 IgG4 in Autoimmune Nodopathy,” Neurology Neuroimmunology & Neuroinflammation 9, no. 5 (2022): e200014, https://doi.org/10.1212/NXI.0000000000200014.
- 59H. E. Lynch, G. L. Goldberg, A. Chidgey, M. R. Van den Brink, R. Boyd, and G. D. Sempowski, “Thymic Involution and Immune Reconstitution,” Trends in Immunology 30, no. 7 (2009): 366–373, https://doi.org/10.1016/j.it.2009.04.003.
- 60K. Naylor, G. Li, A. N. Vallejo, et al., “The Influence of Age on T Cell Generation and TCR Diversity,” Journal of Immunology 174, no. 11 (2005): 7446–7452.
- 61S. Ferrando-Martínez, E. Ruiz-Mateos, A. Hernández, et al., “Age-Related Deregulation of Naive T Cell Homeostasis in Elderly Humans,” Age 33, no. 2 (2011): 197–207.
- 62V. Calvanese, E. Lara, A. Kahn, and M. F. Fraga, “The Role of Epigenetics in Aging and Age-Related Diseases,” Ageing Research Reviews 8, no. 4 (2009): 268–276.
- 63S. Gonzalo, “Epigenetic Alterations in Aging,” Journal of Applied Physiology 109, no. 2 (2010): 586–597, https://doi.org/10.1152/japplphysiol.00238.2010.
- 64C. Franceschi, M. Capri, D. Monti, et al., “Inflammaging and Anti-Inflammaging: A Systemic Perspective on Aging and Longevity Emerged From Studies in Humans,” Mechanisms of Ageing and Development 128, no. 1 (2007): 92–105.
- 65U. Fagiolo, A. Cossarizza, E. Scala, et al., “Increased Cytokine Production in Mononuclear Cells of Healthy Elderly People,” European Journal of Immunology 23, no. 9 (1993): 2375–2378.
- 66J. Raynor, C. S. Lages, H. Shehata, D. A. Hildeman, and C. A. Chougnet, “Homeostasis and Function of Regulatory T Cells in Aging,” Current Opinion in Immunology 24, no. 4 (2012): 482–487.
- 67R. Gregg, C. M. Smith, F. J. Clark, et al., “The Number of Human Peripheral Blood CD4+ CD25high Regulatory T Cells Increases With Age,” Clinical and Experimental Immunology 140, no. 3 (2005): 540–546.
- 68D. Rosenkranz, S. Weyer, E. Tolosa, et al., “Higher Frequency of Regulatory T Cells in the Elderly and Increased Suppressive Activity in Neurodegeneration,” Journal of Neuroimmunology 188, no. 1–2 (2007): 117–127.
- 69N. Hattori, K. Misu, H. Koike, et al., “Age of Onset Influences Clinical Features of Chronic Inflammatory Demyelinating Polyneuropathy,” Journal of the Neurological Sciences 184, no. 1 (2001): 57–63.
- 70K. M. Hagen and S. S. Ousman, “The Immune Response and Aging in Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Journal of Neuroinflammation 18, no. 1 (2021): 78.
- 71K. Kuitwaard, P. A. van Doorn, T. Bengrine, et al., “Genetic Biomarkers for Intravenous Immunoglobulin Response in Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” European Journal of Neurology 28, no. 5 (2021): 1677–1683, https://doi.org/10.1111/ene.14742.
- 72M. C. Dalakas, “Update on Intravenous Immunoglobulin in Neurology: Modulating Neuro-Autoimmunity, Evolving Factors on Efficacy and Dosing and Challenges on Stopping Chronic IVIg Therapy,” Neurotherapeutics 18, no. 4 (2021): 2397–2418.
- 73J. D. Lünemann, I. Quast, and M. C. Dalakas, “Efficacy of Intravenous Immunoglobulin in Neurological Diseases,” Neurotherapeutics 13, no. 1 (2016): 34–46.
- 74N. Latov, C. Deng, M. C. Dalakas, et al., “Timing and Course of Clinical Response to Intravenous Immunoglobulin in Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Archives of Neurology 67, no. 7 (2010): 802–807, https://doi.org/10.1001/archneurol.2010.105.
- 75I. Bozovic, V. Perovic, I. Basta, et al., “Cytokine Gene Polymorphisms in Patients With Chronic Inflammatory Demyelinating Polyneuropathy,” Cells 12, no. 16 (2023): 2033.
- 76Z. Du, S. Lessard, T. Iyyanki, et al., “Genetic Analyses of Inflammatory Polyneuropathy and Chronic Inflammatory Demyelinating Polyradiculoneuropathy Identified Candidate Genes,” HGG Advances 5, no. 3 (2024): 100317.
- 77K. Kuitwaard, A. F. Hahn, M. Vermeulen, S. L. Venance, and P. A. van Doorn, “Intravenous Immunoglobulin Response in Treatment-naïve Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Journal of Neurology, Neurosurgery, and Psychiatry 86, no. 12 (2015): 1331–1336, https://doi.org/10.1136/jnnp-2014-309042.
- 78M. C. Dalakas, N. Latov, and K. Kuitwaard, “Intravenous Immunoglobulin in Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP): Mechanisms of Action and Clinical and Genetic Considerations,” Expert Review of Neurotherapeutics 22, no. 11–12 (2022): 953–962.
- 79G. Zhang, P. H. Lopez, C. Y. Li, et al., “Anti-Ganglioside Antibody-Mediated Neuronal Cytotoxicity and Its Protection by Intravenous Immunoglobulin: Implications for Immune Neuropathies,” Brain 127, no. Pt 5 (2004): 1085–1100.
- 80B. Buchwald, R. Ahangari, A. Weishaupt, and K. V. Toyka, “Intravenous Immunoglobulins Neutralize Blocking Antibodies in Guillain-Barré Syndrome,” Annals of Neurology 51, no. 6 (2002): 673–680.
- 81M. C. Dalakas, “Blockade of Blocking Antibodies in Guillain-Barré Syndromes: “Unblocking” the Mystery of Action of Intravenous Immunoglobulin,” Annals of Neurology 51, no. 6 (2002): 667–669.
- 82M. C. Dalakas and P. J. Spaeth, “The Importance of FcRn in Neuro-Immunotherapies: From IgG Catabolism, FCGRT Gene Polymorphisms, IVIg Dosing and Efficiency to Specific FcRn Inhibitors,” Therapeutic Advances in Neurological Disorders 14 (2021): 1756286421997381.
- 83K. L. Gable and J. T. Guptill, “Antagonism of the Neonatal Fc Receptor as an Emerging Treatment for Myasthenia Gravis,” Frontiers in Immunology 10 (2019): 3052.
- 84P. Boross, V. L. Arandhara, J. Martin-Ramirez, et al., “The Inhibiting Fc Receptor for IgG, FcγRIIB, Is a Modifier of Autoimmune Susceptibility,” Journal of Immunology 187, no. 3 (2011): 1304–1313, https://doi.org/10.4049/jimmunol.1101194.
- 85K. S. Nandakumar, M. Andrén, P. Martinsson, et al., “Induction of Arthritis by Single Monoclonal IgG Anti-Collagen Type II Antibodies and Enhancement of Arthritis in Mice Lacking Inhibitory FcgammaRIIB,” European Journal of Immunology 33, no. 8 (2003): 2269–2277, https://doi.org/10.1002/eji.200323810.
- 86A. Samuelsson, T. L. Towers, and J. V. Ravetch, “Anti-Inflammatory Activity of IVIG Mediated Through the Inhibitory Fc Receptor,” Science 291, no. 5503 (2001): 484–486.
- 87A. Créange, N. A. Gregson, and R. A. Hughes, “Intravenous Immunoglobulin Modulates Lymphocyte CD54 and Monocyte FcgammaRII Expression in Patients With Chronic Inflammatory Neuropathies,” Journal of Neuroimmunology 135, no. 1–2 (2003): 91–95.
- 88W. Hu, A. Janke, S. Ortler, et al., “Expression of CD28-Related Costimulatory Molecule and Its Ligand in Inflammatory Neuropathies,” Neurology 68, no. 4 (2007): 277–282.
- 89B. C. Kieseier, M. Tani, D. Mahad, et al., “Chemokines and Chemokine Receptors in Inflammatory Demyelinating Neuropathies: A Central Role for IP-10,” Brain 125, no. 4 (2002): 823–834, https://doi.org/10.1093/brain/awf070.
- 90M. C. Dalakas, “The Use of Intravenous Immunoglobulin in the Treatment of Autoimmune Neuromuscular Diseases: Evidence-Based Indications and Safety Profile,” Pharmacology & Therapeutics 102, no. 3 (2004): 177–193.
- 91C. Strehl and F. Buttgereit, “Optimized Glucocorticoid Therapy: Teaching Old Drugs New Tricks,” Molecular and Cellular Endocrinology 380, no. 1–2 (2013): 32–40.
- 92M. S. Yoon, A. Chan, and R. Gold, “Standard and Escalating Treatment of Chronic Inflammatory Demyelinating Polyradiculoneuropathy,” Therapeutic Advances in Neurological Disorders 4, no. 3 (2011): 193–200.
- 93L. Querol, J. De Sèze, T. Dysgaard, et al., “Efficacy, Safety and Tolerability of Rozanolixizumab in Patients With Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A Randomised, Subject-Blind, Investigator-Blind, Placebo-Controlled, Phase 2a Trial and Open-Label Extension Study,” Journal of Neurology, Neurosurgery, and Psychiatry 95, no. 9 (2024): 845–854.
- 94J. F. Howard, Jr., K. Utsugisawa, M. Benatar, et al., “Safety and Efficacy of Eculizumab in Anti-Acetylcholine Receptor Antibody-Positive Refractory Generalised Myasthenia Gravis (REGAIN): A Phase 3, Randomised, Double-Blind, Placebo-Controlled, Multicentre Study,” Lancet Neurology 16, no. 12 (2017): 976–986, https://doi.org/10.1016/S1474-4422(17)30369-1.
- 95A. Meisel, D. Annane, T. Vu, et al., “Long-Term Efficacy and Safety of Ravulizumab in Adults With Anti-Acetylcholine Receptor Antibody-Positive Generalized Myasthenia Gravis: Results From the Phase 3 CHAMPION MG Open-Label Extension,” Journal of Neurology 270, no. 8 (2023): 3862–3875, https://doi.org/10.1007/s00415-023-11699-x.
- 96J. F. Howard, Jr., S. Bresch, A. Genge, et al., “Safety and Efficacy of Zilucoplan in Patients With Generalised Myasthenia Gravis (RAISE): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Study,” Lancet Neurology 22, no. 5 (2023): 395–406, https://doi.org/10.1016/S1474-4422(23)00080-7.
- 97L. Querol, R. Lewis, H.-P. Hartung, et al., “Preliminary Efficacy and Safety Data From the Phase 2 Trial of Riliprubart (SAR445088), a Humanized Monoclonal Antibody Targeting Complement C1s, in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP),” Neurology 102, no. 7_supplement_1 (2024), https://doi.org/10.1212/WNL.0000000000204596.
10.1212/WNL.0000000000204596 Google Scholar
- 98J. Ruff, “Dianthus Therapeutics Highlights Recent Business Achievements and Reports Q3 Financial Results,” Media Release, 2024.
- 99 Argenx, Argenx Highlights 2025 Stategic Priorities (Argenx, 2025).
- 100R. de Peffault Latour, A. Röth, A. G. Kulasekararaj, et al., “Oral Iptacopan Monotherapy in Paroxysmal Nocturnal Hemoglobinuria,” New England Journal of Medicine 390, no. 11 (2024): 994–1008.
- 101V. Granit, M. Benatar, M. Kurtoglu, et al., “Safety and Clinical Activity of Autologous RNA Chimeric Antigen Receptor T-Cell Therapy in Myasthenia Gravis (MG-001): A Prospective, Multicentre, Open-Label, Non-Randomised Phase 1b/2a Study,” Lancet Neurology 22, no. 7 (2023): 578–590, https://doi.org/10.1016/S1474-4422(23)00194-1.
- 102W. Zhang, D. Liu, T. Zhang, et al., “BCMA-CD19 Bispecific CAR-T Therapy in Refractory Chronic Inflammatory Demyelinating Polyneuropathy,” hLife 2, no. 8 (2024): 434–438.
10.1016/j.hlife.2024.05.005 Google Scholar
- 103A. Haghikia, T. Hegelmaier, D. Wolleschak, et al., “Anti-CD19 CAR T Cells for Refractory Myasthenia Gravis,” Lancet Neurology 22, no. 12 (2023): 1104–1105.
- 104A. A. Habib, C. Zhao, I. Aban, et al., “Safety and Efficacy of Satralizumab in Patients With Generalised Myasthenia Gravis (LUMINESCE): A Randomised, Double-Blind, Multicentre, Placebo-Controlled Phase 3 Trial,” Lancet Neurology 24, no. 2 (2025): 117–127.
- 105K. Álvarez and M. Rojas, “Nanoparticles Targeting Monocytes and Macrophages as Diagnostic and Therapeutic Tools for Autoimmune Diseases,” Heliyon 9, no. 9 (2023): e19861.
- 106Z. Duan and Y. Luo, “Targeting Macrophages in Cancer Immunotherapy,” Signal Transduction and Targeted Therapy 6, no. 1 (2021): 127.