SFN Antibody fiber neuropathy (SFN) is a condition that affects thin myelinated ad and unmyelinated C-fibers, leading to pain and autonomic symptoms. While a number of medical conditions can cause SFN, more than 50% of cases are idiopathic, which has led to investigations into an autoimmune etiology. The majority of autoantibodies associated with SFN are directed against nervous system antigens and have been shown to be pathogenic. TS-HDS, FGFR3, and Plexin D1 are some of the most recognized, but new potential antibody targets have also been reported. Moreover, a growing number of case reports and larger cohort studies have demonstrated the efficacy of immunotherapy in idiopathic SFN, with symptomatic improvement seen even at low IVIG doses.
In order to better understand the pathogenesis of idiopathic SFN, proteomic analysis was conducted on peripheral blood sera from patients with iSFN and control subjects. This approach allows for the identification of putative attractive autoantibody targets and their distribution in iSFN patients.
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TS-HDS antibodies, which are directed against a complex sugar found on nerve cells, were found to be significantly higher in iSFN patients compared to controls. The high titers of these antibodies in iSFN patients correlated with increased visual analog scale (VAS) and Utah Early Neuropathy Score (UENS) scores, suggesting a relationship between the presence of these antibodies and SFN-associated pain and dysfunction. Similarly, FGFR3 antibodies were shown to be enriched in idiopathic SFN patients and were observed to have a direct association with the onset of painful, tingling, and burning sensations in the hands and feet.