Neuroimmunology Unit, Department of Pathophysiology, National University of Athens Medical School, 75 Mikras Asias Street, Athens, Greece.
J Peripher Nerv Syst. 2011 Jun;16 Suppl 1:63-7. doi: 10.1111/j.1529-8027.2011.00311.x.
Although the majority of patients with CIDP variably respond to intravenous immunoglobulin (IVIg), steroids, or plasmapheresis, 30% of them are unresponsive or insufficiently responsive to these therapies. The heterogeneity in therapeutic responses necessitates the need to search for biomarkers to determine the most suitable therapy from the outset and explore the best means for monitoring disease activity. The ICE study, which led to the first FDA-approved indication for IVIg in CIDP, has shown that maintenance therapy prevents relapses and axonal loss. In this paper, the multiple actions exerted by IVIg on the immunoregulatory network of CIDP are discussed as potential predictors of response to therapies. Emerging molecular markers, promising in identifying responders to IVIg from non-responders, include modulation of FcγRIIB receptors on monocytes and genome-wide transcription studies related to inflammatory mediators, demyelination, or axonal degeneration. Skin biopsies, Peripheral Blood Lymhocytes, CSF, and sera are accessible surrogate tissues for further exploring these molecules during therapies.
虽然大多数 CIDP 患者对静脉注射免疫球蛋白 (IVIg)、类固醇或血浆置换有不同程度的反应，但仍有 30%的患者对这些治疗反应不佳或无反应。治疗反应的异质性需要寻找生物标志物，以便从一开始就确定最合适的治疗方法，并探索监测疾病活动的最佳方法。ICE 研究首次证明了 IVIg 在 CIDP 中的治疗作用，表明维持治疗可预防复发和轴索丢失。本文讨论了 IVIg 对 CIDP 免疫调节网络的多种作用，认为其可能是预测治疗反应的指标。新兴的分子标志物有望将 IVIg 的应答者与无应答者区分开来，包括调节单核细胞上的 FcγRIIB 受体以及与炎症介质、脱髓鞘或轴索变性相关的全基因组转录研究。皮肤活检、外周血淋巴细胞、CSF 和血清是可及的替代组织，可在治疗过程中进一步探索这些分子。
