Role of regulatory T cells in pathogenesis and therapeutics of chronic inflammatory demyelinating polyradiculoneuropathy

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most common treatable chronic acquired inflammatory neuropathy. Even though CIDP variants are frequent, the usual presenting symptoms are paresthesia, distal muscle weakness, and difficulty walking. The etiopathogenesis is not fully understood; however, the disease seems to be an autoimmune response involving both cell-mediated and humoral mechanisms. In particular, we investigated the role of regulatory T cells (Tregs) which appeared to be more significantly reduced in number than in functional activity. Additionally, dendritic cells, macrophages, B cells, and activated CD4+ T cells take part in Treg homeostasis. The therapy mainly relies on intravenous immunoglobulins which provide an antiinflammatory and immunomodulatory effect, also promoting the suppressive action of Treg. Plasma exchange and glucocorticoids are other first-line therapies whereas rituximab represents the most used alternative strategy.