Immune mechanisms, the role of complement, and related therapies in autoimmune neuropathies

Abstract

Introduction: Autoimmune neuropathies have diverse presentations and underlying immune mechanisms. Demonstration of efficacy of therapeutic agents that inhibit the complement cascade would confirm the role of complement activation.

Areas covered: A review of the pathophysiology of the autoimmune neuropathies, to identify those that are likely to be complement mediated.

Expert opinion: Complement mediated mechanisms are implicated in the acute and chronic neuropathies associated with IgG or IgM antibodies that target the Myelin Associated Glycoprotein (MAG) or gangliosides in the peripheral nerves. Antibody and complement mechanisms are also suspected in the Guillain-Barré syndrome and chronic inflammatory demyelinating neuropathy, given the therapeutic response to plasmapheresis or intravenous immunoglobulins, even in the absence of an identifiable target antigen. Complement is unlikely to play a role in paraneoplastic sensory neuropathy associated with antibodies to HU/ANNA-1 given its intracellular localization. In chronic demyelinating neuropathy with anti-nodal/paranodal CNTN1, NFS-155, and CASPR1 antibodies, myotonia with anti-VGKC LGI1 or CASPR2 antibodies, or autoimmune autonomic neuropathy with anti-gAChR antibodies, the response to complement inhibitory agents would depend on the extent to which the antibodies exert their effects through complement dependent or independent mechanisms. Complement is also likely to play a role in Sjogren's, vasculitic, and cryoglobulinemic neuropathies.

Keywords: Anti-ganglioside antibodies; Guillain-Barre syndrome; autoimmune neuropathy; autonomic neuropathy; chronic inflammatory demyelinating polyneuropathy; complement activation; multifocal motor neuropathy; myelin associated glycoprotein; paraneoplastic neuropathy; vasculitic neuropathy.