New immunological clues in small fiber neuropathy

Watch this on-demand webinar to better understand the etiology and pathology of small fiber neuropathy

Dr Amanda Chan, Senior Consultant at National University Hospital and Assistant Professor at National University of Singapore

Small fiber neuropathy (SFN) is underdiagnosed and underrecognized, due to a lack of diagnostic tools. However, we now know that SFN is much more common than previously thought and is much more common than other inflammatory neurological disorders. It is therefore imperative to continue research on this new entity.

More than 50% of patients suffer from idiopathic SFN, ie the cause is still unknown. Despite multiple suggestions of association between autoimmunity and SFN, few autoantibodies or immune compounds have been described. The main research objective of Dr. Amanda Chan, Senior Consultant at National University Hospital (NUH) and Assistant Professor at National University of Singapore, is to identify the etiology and pathophysiology of SFN, with a focus on immunological mechanisms.

In this SelectScience® webinar, now available on demand, Dr. Chan reviews the current literature on autoimmunity in SFN and his journey in discovering novel autoantibodies in idiopathic SFN with the innovative Sengenics KREX™ platform, including results have just been published in the highly impactful Annals of Neurology. By better understanding the pathophysiology, Dr. Chan hopes to develop precision treatments for his patients with debilitating symptoms of FNS.

Read on for highlights from the live Q&A session from registration to watch the webinar at a time that suits you.

THAT : This is a very important plan that we have moving forward because proteomics studies are looking for these autoantibodies, but we don’t know which subgroup these antibodies belong to. It is planned to perform ELISA or other cellular tests in the future to determine which antibody subgroup these autoantibodies belong to. I think this is a very important question to help us find out what the pathophysiology of idiopathic SFN is.

What would be the role of MX1 autoantibodies in iSFN patients? If its presence suggests dysfunctional immunity, anti-MX1 may be a potential biomarker to guide treatments such as immune system modulator therapies.

THAT : MX1 autoantibodies have been described in some articles, showing that they interact with TRPC6 receptors, the canonical transmembrane receptor protein, which is a transmembrane protein. And it turned out to be overexcited in patients with chronic back pain, as well as in some mouse models. I guess we still have to prove it.

What I predict is that patients with idiopathic small fiber neuropathy might have antibodies attacking MX1, which further impairs TRPC6 activity, possibly causing hyperexcitability and therefore pain. We are also working on this to delineate the mechanism behind this with in vitro models as well as electrophysiological tests.

Can you tell us what you hope for the future of your work?

THAT : Hopefully we can develop a panel that will help us in the diagnosis of SFN, help us in the treatment of SFN to develop, or even just choose, more specific treatments for our patients. My patients rely on me to provide them with an answer because many of their symptoms are quite debilitating. I have to say that I do all this mainly for my patients and I hope to be able to offer them a solution to their problems.

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Irene B. Bowles