Characteristic cerebrospinal fluid findings in immune checkpoint inhibitor-related peripheral neuropathy: A case report

Wako, Sho; Ikeguchi, Ryotaro; Toda, Kunio; Kobayashi, Masaki; Miyata, Ryujin; Kuramochi, Hidekazu; Ichihara, Atsuhiro; Shimizu, Yuko; Kitagawa, Kazuo

doi:10.1016/j.jneuroim.2022.578010

Cited by 3 publications

(2 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clinical suspicion should be raised in patients developing subacute ascending and symmetric limb weakness, sensory disturbances and areflexia [36]. Cytoalbuminologic dissociation has also been recognized in the cerebrospinal fluid (CSF), but cell counts might be higher compared to the classic AIDP form [37].…”

Section: Peripheral Neuropathiesmentioning

confidence: 99%

Immune checkpoint inhibitors induced side effects of the peripheral nervous system

Hundsberger,

Schreiner,

Roth

2023

Current Opinion in Neurology

View full text Add to dashboard Cite

Purpose of review This review highlights recent knowledge on the diagnosis and treatment of immune checkpoint inhibitor-induced neurological side effects (irNAE) focussing on the neuromuscular system. Recent findings irNAEs mainly resemble sporadic neuromuscular autoimmune diseases and paraneoplastic neurological syndromes. However, neurological symptoms may be unspecific (muscle weakness, fatigue) in the oncological setting and carry the risk of misdiagnosis and delayed therapeutic intervention. The role of disease-specific neuromuscular autoantibodies in the diagnosis is controversial as preexisting autoantibodies may otherwise be present before immune checkpoint inhibitor (ICI) treatment without clinical symptoms and may not develop in case of irNAE manifestation. A new necrotising form of myositis (irMyositis) has been described presenting with facial weakness and ptosis mimicking myasthenia gravis. It comes along with a high rate of severe myocarditis accounting for a triad overlap syndrome (myasthenia/myositis/myocarditis). The role of modern biologicals in the treatment of irNAEs has to be determined. Summary irNAEs are rare but carry the risk of permanent morbidity and mortality. Early suspicion and diagnosis are key to prevent neurological sequelae. Beyond interruption of ICI administration, treatment corresponds to sporadic autoimmune diseases. The myasthenia/myositis/myocarditis overlap syndrome deserves special attention as it carries the highest risk of mortality. The role of neurotoxic pretreatment regimens, preexisting subclinical neurological autoimmune diseases and the risk of ICI-re-challenge after irNAEs has to be further investigated.

show abstract

Section: Peripheral Neuropathiesmentioning

confidence: 99%

Immune checkpoint inhibitors induced side effects of the peripheral nervous system

Hundsberger,

Schreiner,

Roth

2023

Current Opinion in Neurology

View full text Add to dashboard Cite

show abstract

“…Regarding the relationship between the inhibitory immune-receptor PD-1, which is known as a checkpoint of immune regulation, and the pathology of MS among CD8positive T cells in the peripheral blood, the proportion of PD-1-positive cells is decreased in MS patients compared with healthy controls and is restored by interferon-β (IFNβ) treatment [82][83][84][85][86]. In addition, in the cerebrospinal fluid during inflammatory attacks, patients with a high proportion of PD-1+ CD8+ T cells respond better to acute treatment and are more likely to recover to their original level of neuropathy than those with a low proportion [75,87,88]. This PD-1+ CD8+ T cell content correlates with the course of disease recovery.…”

Section: Programmed Death Receptor-1 (Pd-1)-positive Cells In Ms Pati...mentioning

confidence: 99%

Unraveling the Immunopathogenesis of Multiple Sclerosis: The Dynamic Dance of Plasmablasts and Pathogenic T Cells

Matsuzaka,

Yashiro

2023

Biologics

View full text Add to dashboard Cite

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system, characterized by multiple lesions occurring temporally and spatially. Additionally, MS is a disease that predominates in the white population. In recent years, there has been a rapid increase in the number of patients, and it often occurs in young people, with an average age of onset of around 30 years old, but it can also occur in children and the elderly. It is more common in women than men, with a male-to-female ratio of approximately 1:3. As the immunopathogenesis of MS, a group of B cells called plasmablasts controls encephalomyelitis via IL-10 production. These IL-10-producing B cells, called regulatory B cells, suppress inflammatory responses in experimental mouse models of autoimmune diseases including MS. Since it has been clarified that these regulatory B cells are plasmablasts, it is expected that the artificial control of plasmablast differentiation will lead to the development of new treatments for MS. Among CD8-positive T cells in the peripheral blood, the proportion of PD-1-positive cells is decreased in MS patients compared with healthy controls. The dysfunction of inhibitory receptors expressed on T cells is known to be the core of MS immunopathology and may be the cause of chronic persistent inflammation. The PD-1+ CD8+ T cells may also serve as indicators that reflect the condition of each patient in other immunological neurological diseases such as MS. Th17 cells also regulate the development of various autoimmune diseases, including MS. Thus, the restoration of weakened immune regulatory functions may be a true disease-modifying treatment. So far, steroids and immunosuppressants have been the mainstream for autoimmune diseases, but the problem is that this kills not only pathogenic T cells, but also lymphocytes, which are necessary for the body. From this understanding of the immune regulation of MS, we can expect the development of therapeutic strategies that target only pathogenic immune cells.

show abstract

Multiple drugs

2023

Reactions Weekly

View full text Add to dashboard Cite

Characteristic cerebrospinal fluid findings in immune checkpoint inhibitor-related peripheral neuropathy: A case report

Cited by 3 publications

References 38 publications

Immune checkpoint inhibitors induced side effects of the peripheral nervous system

Immune checkpoint inhibitors induced side effects of the peripheral nervous system

Unraveling the Immunopathogenesis of Multiple Sclerosis: The Dynamic Dance of Plasmablasts and Pathogenic T Cells

Multiple drugs

Contact Info

Product

Resources

About