Background: chronic inflammatory demyelinating polyradiculopathy (CIDP) is likely under-recognized. Objective: This study aimed to investigate the role of Tumor necrosis factor-alpha (TNFα), nerve biopsy and matrix metalloproteinase 9 (MMP9) in CIDP diagnosis and relate them to clinical and neurophysiological parameters. Methods: Sixty patients; 42 male and 18 females, their age ranged from 14 to 81 years; fulfilling clinical and first three electrodiagnostic criteria of the European Federation of Neurological Societies/peripheral Nerve Society (EFNS/PNS) guidelines and twenty healthy controls were enrolled. The patients were submitted to neurological examination, Modified Rankin Scale (MRS), Neuropathy Impairment Score (NIS), nerve conduction studies and electromyography. Serum level of TNFα was measured by ELISA. Sural nerve biopsy was done for electron microscopic study and immunohistochemical assessment of MMP9. Results: The mean of TNFα was statistically significantly higher in the patients compared to the controls. There was a positive correlation between TNFα and distal latency and negative correlation with conduction velocity of ulnar nerve. Nerve biopsy revealed mild to moderate degree of demyelination, Schwann cell proliferations edema, regenerating clusters and endoneurial fibrosis in most of the patients. Positive epineurial blood vessels for MMP9 were prominent in 58/60 patients. No significant correlation was detected between MMP9 and clinical data. Conclusion: TNFα, MMP9 and presence of demyelination or edema in sural nerve biopsy is an additional parameter for the diagnosis of CIDP. Controlled trials on anti TNFα and MMP9 inhibitor to evaluate them as new models of CIDP treatment is recommended. (Egypt J Neurol Psychiat Neurosurg.  2010; 47(1): 75-82).  

Key Words: CIDP, TNF alpha, sural nerve biopsy and MMP-9

Correspondence to Hala A. Shaheen, Department of neurology, Fayoum University, Egypt.

Tel: +020107965888  E-mail Shaheen_a_hala@Yahoo.com