A study of T CD4, CD8 and B lymphocytes in narcoleptic patients

Abstract

Narcolepsy is characterized by excessive daytime sleep and cataplexy. Sleep paralysis and hypnagogic hallucinations can be added to this clinical picture 1,2 . Narcolepsy involves an unknown physiopathology but with a known association with the HLA DQB1*06023 allele 3 . This would fortify the hypothe- ABSTRACT -Narcolepsy is characterized by excessive daytime sleep and cataplexy. Little is known about the possible difference in pathophysiology between patients with or without cataplexy. Obje�tive: To quantify T CD4, T CD8 and B lymphocytes in subgroups of patients with narcolepsy and the presence or absence of the HLA-DQB1*0602 allele between groups. Method: Our study was prospective and controlled (transversal) with 22 narcoleptic patients and 23 health control subjects. Patients underwent an all-night polysomnographic recording (PSG) and a multiple sleep latency Test (MSLT). The histocompatibility antigen allele (HLA-DQB1*0602), T CD4, CD8 and B lymphocytes were quantified in control subjects and in narcoleptics. Results: The HLA-DQB1*0602 allele was identified in 10 (62.5%) of our 16 cataplexic subjects and in 2 (33.3%) of the 6 patients without cataplexy (p=0.24). In control subjects, HLA-DQB1*0602 allele was identified in 5 (20%). A significant decrease in T CD4 and B lymphocytes was found in narcoleptic patients with recurrent cataplexy when compared with our patients without cataplexy. Con�lusion: Autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis were associated with a decrease in sub-group of T CD4 and B lymphocytes. A drop in B lymphocytes count in reumathoid arthritis might, it is posited, be correlated to the presence of HLA-DRB1 allele along with an overall worsened outcome of the affliction. The theory of an increase in consumption of B lymphocytes over the maturation phase has likewise been put forward. Our study reinforces the view that narcolepsy should be considered from an immunological perspective.Key wORDS: narcolepsy, lymphocytes, immunology, HLA-DQB1*0602 allele. estudo dos linfócitos t Cd4, Cd8 e B em pacientes com narcolepsiaReSUMO -A narcolepsia é caracterizada por sonolência excessiva diurna e cataplexia. Pouco se sabe sobre as diferenças fisiopatológicas entre pacientes com e sem cataplexia. Objetivo: Quantificar os linfócitos T CD4, T CD8 e B e a presença do alelo HLA-DQB1*0602 nos subgrupos de pacientes com narcolepsia. Mé� todo: O estudo foi prospectivo e controlado (transversal) com 22 pacientes portadores de narcolepsia e 23 sujeitos controle. Os pacientes realizaram polissonografia (PSG) de noite inteira e teste de múltiplas latên-cias do sono (TMLS). O alelo do antígeno de histocompatibilidade (HLA-DQB1*0602) e os linfócitos T CD4, T CD8 e B foram quantificados nos pacientes e sujeitos controle. Resultados: O alelo HLA-DQB1*0602 foi encontrado em 10 (62,5%) dos 16 pacientes com cataplexia e em 2 (33,3%) dos 6 pacientes sem cataplexia (p=0,24). Nos sujeitos controle, o alelo HLA-DQB1*0602 foi encontrado em 5 sujeitos (20%). Um aumento significativo...

Prevalence of the HLA-DQB1*0602 allele in narcolepsy and idiopathic hypersomnia patients seen at a sleep disorders outpatient unit in São Paulo

“…Some patients taking antidepressives drugs, dopamine agonists, and other drugs can simulate characteristics of narcolepsy. Clinical and electrophysiological differentiation could be difficult in these situations [13][14][15] . The gold standard exam for narcolepsy with cataplexy is Hypocretin-1 dosage, but in patients without cataplexy and in IH, diagnosis is not yet automatic.…”

Narcolepsy: an interface among neurology, immunology, sleep, and genetics

“…19 However, the HLA-DQB1 Ã 0602 allele is more present in patients with narcolepsy and cataplexy, with a decrease in the population of hypocretinergic cells directly to an immunological mechanism. 17,26 Clinical improvement after using immunoglobulin and prednisone strengthens this hypothesis. 27,28 The association between narcolepsy and the TCR α locus, as well as the decrease in the concentration of soluble CD40 ligand (CD40L) in patients with narcolepsy, are strong indications of an autoimmune mechanism.…”

Low CD40L levels and relative lymphopenia in narcoleptic patients

“…Some authors have shown higher IL-6 levels and no changes in TNF-␣ levels and lymphocytes numbers in narcoleptic patients compared with controls matched by HLA-DR2 [9]. Others have demonstrated different T CD4 and B lymphocytes counts according the severity of cataplexy [10].…”