title: Characterization of IgG4 anti-neurofascin 155 antibody-positive polyneuropathy.
abstract: OBJECTIVE
  To investigate anti-neurofascin 155 (NF155) antibody-positive chronic inflammatory demyelinating polyneuropathy (CIDP).
  
  
  METHODS
  Sera from 50 consecutive CIDP patients diagnosed in our clinic, 32 patients with multiple sclerosis, 40 patients with other neuropathies including 26 with Guillain-Barré syndrome (GBS)/Fisher syndrome, and 30 healthy controls were measured for anti-NF antibodies by flow cytometry using HEK293 cell lines stably expressing human NF155 or NF186. Four additional CIDP patients with anti-NF155 antibodies referred from other clinics were enrolled for clinical characterization.
  
  
  RESULTS
  The positivity rate for anti-NF155 antibodies in CIDP patients was 18% (9/50), who all showed a predominance of IgG4 subclass. No other subjects were positive, except one GBS patient harboring IgG1 anti-NF155 antibodies. No anti-NF155 antibody carriers had anti-NF186 antibodies. Anti-NF155 antibody-positive CIDP patients had a significantly younger onset age, higher frequency of drop foot, gait disturbance, tremor and distal acquired demyelinating symmetric phenotype, greater cervical root diameter on magnetic resonance imaging neurography, higher cerebrospinal fluid protein levels, and longer distal and F-wave latencies than anti-NF155 antibody-negative patients. Marked symmetric hypertrophy of cervical and lumbosacral roots/plexuses was present in all anti-NF155 antibody-positive CIDP patients examined by neurography. Biopsied sural nerves from two patients with anti-NF155 antibodies demonstrated subperineurial edema and occasional paranodal demyelination, but no vasculitis, inflammatory cell infiltrates, or onion bulbs. Among anti-NF155 antibody-positive patients, treatment responders more frequently had daily oral corticosteroids and/or immunosuppressants in addition to intravenous immunoglobulins than nonresponders did.
  
  
  CONCLUSIONS
  Anti-NF155 antibodies occur in a subset of CIDP patients with distal-dominant involvement and symmetric nerve hypertrophy.
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ogata
authors.affiliation: Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamasaki
authors.affiliation: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Hiwatashi
authors.affiliation: Department of Neurology and Rehabilitation, National Hospital Organization Minami-Kyoto Hospital Joyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Oka
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan ; Department of Neurology, Kawamura Hospital Gifu, Japan.
authors.forename: Nobutoshi
authors.initials: N
authors.lastname: Kawamura
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Matsuse
authors.affiliation: Department of Neurology, Kinki University Faculty of Medicine Osaka, Japan.
authors.forename: Motoi
authors.initials: M
authors.lastname: Kuwahara
authors.affiliation: Department of Neurology, Kinki University Faculty of Medicine Osaka, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Neurology, Kinki University Faculty of Medicine Osaka, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Kusunoki
authors.affiliation: Department of Neurology, Matsuyama Red Cross Hospital Matsuyama, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Fujimoto
authors.affiliation: Department of Neurology, Matsuyama Red Cross Hospital Matsuyama, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ikezoe
authors.affiliation: Department of Neurology, Yokohama City University Medical Center Yokohama, Japan.
authors.forename: Hitaru
authors.initials: H
authors.lastname: Kishida
authors.affiliation: Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine Yokohama, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Tanaka
authors.affiliation: Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Matsushita
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Murai
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan.
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Kira