Clinical and diagnostic features of anti-neurofascin-155 antibody-positive neuropathy in Han Chinese

Objective: To investigate the clinical features of Han Chinese patients with anti-neurofascin-155 (NF155) antibody-positive neuropathy. Methods: We screened 194 patients with peripheral neuropathy for NF155 antibodies using a cell-based assay (CBA) and teased-fiber immunofluorescence assay. We summarized the clinical findings of seropositive patients. Results: The sera from 17 patients reacted to human embryonic kidney 293 cells transfected with NF155. Eleven of these patients had the immunoglobulin G (IgG) 4 isotype, a younger onset age, tremor, higher levels of cerebrospinal fluid protein, a larger diameter of the lumbosacral nerve root on magnetic resonance imaging, and the distal demyelinating symmetric phenotype. Most patients responded to steroids and rituximab. For the remaining six seropositive patients in CBA, the predominant antibody isotype was IgG3, IgG1, or undetectable, and only one patient with IgG3 showed a positive result in the teased-fiber immunofluorescence assay. These patients did not share the typical features displayed by patients with the IgG4 isotype. Interpretation: In the Han Chinese population, a significant proportion of patients who fulfilled the criteria for chronic inflammatory demyelinating polyradiculoneuropathy diagnosis had anti-NF155 IgG4 antibody-positive neuropathy and displayed specific phenotypes. Ambiguous staining patterns may appear, and the potential for false positivity should be considered. For patients who presented with specific phenotypes, identifying antibodies and subtypes involved a significant laboratory workup.