Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated demyelinating peripheral neuropathy characterized by symmetric limb weakness, sensory disturbances, and diminished tendon reflexes. Its pathogenesis involves the interplay of T cells, B cells, and the complement system. Current first-line therapies including intravenous immunoglobulin, corticosteroids and plasma exchange exhibit limited efficacy, with approximately 30% of patients experiencing relapse or poor treatment response. In recent years, novel immunomodulatory therapies including anti-CD20 monoclonal antibodies, neonatal Fc receptor inhibitors, complement inhibitors, Bruton tyrosine kinase inhibitors, autologous hematopoietic stem cell transplantation, and chimeric antigen receptor T-cell therapy, have emerged as promising options for refractory CIDP, ushering in a new era of immunomodulatory treatment.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated demyelinating peripheral neuropathy characterized by symmetric limb weakness, sensory disturbances, and diminished tendon reflexes. Its pathogenesis involves the interplay of T cells, B cells, and the complement system. Current first-line therapies including intravenous immunoglobulin, corticosteroids and plasma exchange exhibit limited efficacy, with approximately 30% of patients experiencing relapse or poor treatment response. In recent years, novel immunomodulatory therapies including anti-CD20 monoclonal antibodies, neonatal Fc receptor inhibitors, complement inhibitors, Bruton tyrosine kinase inhibitors, autologous hematopoietic stem cell transplantation, and chimeric antigen receptor T-cell therapy, have emerged as promising options for refractory CIDP, ushering in a new era of immunomodulatory treatment.

Objective:To report a SPTLC2 gene mutation in a family with a phenotype of Charcot-Marie-Tooth disease.Methods:To screen the family of patients with pathogenic mutations of SPTLC2 gene from the database of hereditary peripheral neuropathy in the Department of Neurology, Peking University First Hospital, and to collect their clinical data, peripheral nerve conduction examination, nerve ultrasound examination, pathological examination of the peroneal nerve and whole exome sequencing results of prohand.Results:One family was screened, the proband was a 16-year-old female with 4 years of sensory loss and anhidrosis of both lower limbs and 16 months of walking difficulty who admitted to Peking University First Hospital in January 2022. Physical examination showed sensory loss, dry skin and weakness in distal limbs. Her father had numbness and dry skin in the distal lower limbs from childhood,weakness and atrophy of his lower limbs in adulthood. He died at age of 52 years old. The nerve conduction study revealed no action potentials of the sensory and motor nerves of the lower limbs in the proband. The amplitude of the compound muscle action potential of the motor conduction of the bilateral ulnar nerve and median nerve decreased, and the nerve conduction velocity of the bilateral median nerve were 32 m/s and 24 m/s. Neurosonography showed thickening of peripheral nerves. Sural biopsy revealed severe loss of myelinated and unmyelinated nerve fibers with onion bulbs formation. SPTLC2 gene showed a known heterozygous p.G435V mutation. The lower limb weakness was improved after oral L-serine.Conclusions:SPTLC2 gene mutation can lead to an intermediate Charcot-Marie-Tooth disease phenotype. L-serine can improve the limb weakness.