Critical illness polyneuromyopathy (CIPNM): evidence for local immune activation by cytokine-expression in the muscle tissue

M.A.C.J. Megens-de Letter, P.A. van Doorn, H.F.J. Savelkoul, J.D. Laman, P.I.M. Schmitz, A.A.W. op de Coul, L.H. Visser, M. Kross, J.L.J.M. Teepen, F.G.A. van der Meche

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In a longitudinal prospective study a muscle biopsy was taken from 30/32 (33 percent) of the 98 patients who developed critical illness polyneuropathy and myopathy (CIPNM). Neuropathic changes were found in 37 percent, myopathic in 40 percent, and a combination in 23 percent of the biopsies. The immunohistopathology showed macrophages and Th-cells in 40 percent and 60 percent of the muscle biopsies respectively. Small mainly perivascular infiltrates contained macrophages and Th-cells. ICAM-1, VCAM and MAC were found on the vascular endothelium in 58 percent, 53 percent and 79 percent respectively. In all biopsies there was an upregulation of both HLA-I and HLA-DR. Proinflammatory cytokines and TNFR75 were also produced locally (IL-1 in 71 percent, IFN- in 40 percent, IL-12 in 73 percent, TNFR75 in 90 percent). The anti-inflammatory cytokine IL-10 was simultaneously expressed in 96 percent of the biopsies. HLA-DR, TNFR75 and IL-10 differed significantly when compared with control muscle biopsies. Our data provide evidence that small numbers of activated leukocytes producing both pro- and anti-inflammatory cytokines infiltrate skeletal muscle of CIPNM patients. We propose that the local balance of leukocyte activities is of importance in the pathophysiology of muscle weakness in CIPNM.
Original languageEnglish
Pages (from-to)206-213.
JournalJournal of Neuroimmunology
Publication statusPublished - 2000


  • Critical illness polyneuropathy and myopathy
  • Cytokines
  • Immune activation
  • Immunohistochemistry
  • Muscle biopsy
  • Sepsis


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