title: Natalizumab treatment in a patient with chronic inflammatory demyelinating polyneuropathy.
abstract: OBJECTIVE
  To study clinical and paraclinical effects of natalizumab in a patient with chronic inflammatory demyelinating polyneuropathy (CIDP).
  
  
  METHODS
  Case report.
  
  
  METHODS
  Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany. Patient A patient with highly active CIDP who did not respond to standard therapies. Intervention Standard therapy then treatment with natalizumab (300 mg).
  
  
  METHODS
  Clinical disability, magnetic resonance imaging, and saturation of the alpha(4) integrin on T lymphocytes.
  
  
  RESULTS
  T cells expressing the alpha(4) integrin were found in the inflamed peripheral nerve. Natalizumab bound with high affinity to the alpha(4) integrin on T lymphocytes in our patient. However, the patient's clinical condition deteriorated and as seen on magnetic resonance imaging without any measurable effect after treatment with this antibody.
  
  
  CONCLUSIONS
  Although experimental evidence suggests that natalizumab could theoretically be effective in immune-mediated disorders of the peripheral nervous system, our patient with CIDP did not benefit from this therapeutic approach. Natalizumab cannot be recommended in CIDP at present and should only be explored in controlled clinical trials.
authors.affiliation: Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wolf
authors.forename: Til
authors.initials: T
authors.lastname: Menge
authors.forename: Max-Philipp
authors.initials: MP
authors.lastname: Stenner
authors.forename: Gerd
authors.initials: G
authors.lastname: Meyer zu Hörste
authors.forename: Andreas
authors.initials: A
authors.lastname: Saleh
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Hartung
authors.forename: Heinz
authors.initials: H
authors.lastname: Wiendl
authors.forename: Bernd C
authors.initials: BC
authors.lastname: Kieseier
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D017252:CD3 Complex / Q000378:metabolism; D005260:Female; D006801:Humans; D039441:Integrin alpha4 / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D000069442:Natalizumab; D009431:Neural Conduction / Q000187:drug effects / Q000502:physiology; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000503:physiopathology; D013126:Spinal Nerve Roots / Q000473:pathology; D013497:Sural Nerve / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D017252:CD3 Complex; D000069442:Natalizumab; D039441:Integrin alpha4