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Activated T lymphocytes and macrophages play a putative role in the pathogenesis of Guillain-Barre syndrome.Both cell types secrete tumor necrosis factor-a,a cytokine that has well-recognized toxic effects on myelin,Schwann cells,and endothelial cells.We determined serum and cerebrospinal fluid concentrations of tumor necrosis factor-a in 26 patients with Guillain-Barre syndrome,27 patients with other polyneuropathies,30 patients with neurological diseases of the central nervous system and 14 healthy control subjects.Markedly increased serum levels were detected in 14 patients(54%)with Guillain-Barre syndrome and to a significantly lesser extent,in patients with other polyneuropathies (26%)and in neurological control subjects(23%).Tumor necrosis factor-a was not detected in the cerebrospinal fluid of patients with Guillain-Barre syndrome or other polyneuropathies.Increased serum concentrations in patients with Guillain-Barre syndrome correlated directly with disease severity and these concentrations returned to normal in parallel with clinical recovery.These findings emphasize the complexity of the immune response in patients with Guillain-Barre syndrome and suggest that tumor necrosis factor-a may be important in the pathogenesis of peripheral demyelination in this disorder. |
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