The expression pattern of inflammatory mediators in cerebrospinal fluid differentiates Guillain-Barré syndrome from chronic inflammatory demyelinating polyneuropathy.
BACKGROUND
Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) share histopathological features but display different disease courses; we measured the concentration of 50 inflammatory mediators in the cerebrospinal fluid (CSF) of patients with either of these diseases.


METHODS
CSF samples were collected during a diagnostic lumbar puncture and stored at -30 degrees C. We analyzed the CSF of nine subjects with GBS; eight with CIDP; eight with diabetic polyneuropathy (DP) and seven with headache (controls). Fifty inflammatory mediators were simultaneously measured with a multiplex bead-based ELISA on a Suspension Array System. After Bonferroni's correction for repeated measures, non-parametric variance and post hoc test were calculated.


RESULTS
Thirty-two inflammatory mediators were expressed. The median concentration of IL-6, IL-9, IL-15, IL-18, CCL4, CXCL1, LIF, MIF, PDGFbb, IFN-gamma2, IL-2ra, IL-12(p40), IL-16, SCGF-b, TRAIL, FGF, G-CSF, GM-CSF, and M-CSF was not different among groups (variance: n.s.). The median concentration of CCL2, CCL7, CCL27, CXCL9, CXCL10, CXCL12, ICAM-1, VCAM1 and VEGF was higher in CIDP and GBS compared with controls (p<0.002). The median concentration of IL-8 and IL-1ra was higher in GBS than CIDP or DP or controls, whereas stem cell factor (SCF) and hepatocyte growth factor (HGF) were higher in CIDP than GBS or DP or controls (p<0.002).


CONCLUSIONS
Mediators of the recruitment and activation of lymphocytes and monocytes are expressed in the CSF of CIDP and GBS. IL-8 and IL-1ra are characteristic of GBS, whereas growth factors (SCF, HGF) of CIDP are possibly related to chronicity or to the survival/repair processes of neurons.
Clinical Immunology Department and Research Laboratory, Department of Clinical and Experimental Medicine, Università del Piemonte Orientale A. Avogadro, Novara, Italy. sainaghi@med.unipmn.it
Pier Paolo
PP
Sainaghi
Laura
L
Collimedaglia
Federica
F
Alciato
Maurizio A
MA
Leone
Paola
P
Naldi
Rossella
R
Molinari
Francesco
F
Monaco
Gian Carlo
GC
Avanzi
D000328:Adult; D020275:Guillain-Barre Syndrome / Q000134:cerebrospinal fluid*; D016298:Hematopoietic Cell Growth Factors / Q000134:cerebrospinal fluid; D017228:Hepatocyte Growth Factor / Q000134:cerebrospinal fluid; D006801:Humans; D018836:Inflammation Mediators / Q000134:cerebrospinal fluid*; D053590:Interleukin 1 Receptor Antagonist Protein / Q000134:cerebrospinal fluid; D016209:Interleukin-8 / Q000134:cerebrospinal fluid; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000134:cerebrospinal fluid*
D016298:Hematopoietic Cell Growth Factors; D018836:Inflammation Mediators; D053590:Interleukin 1 Receptor Antagonist Protein; D016209:Interleukin-8; D017228:Hepatocyte Growth Factor