Dysregulated CSF T-cell responses and their evolution after intravenous immunoglobulin in Guillain-Barré syndrome.

In treatment-naïve Guillain-Barré syndrome, CSF shows compartmental enrichment of Th1-polarized CD4+ and activated/resident-memory CD8+ T cells plus macrophages, exceeding healthy controls.

• Why it matters: The cellular basis of GBS and how IVIg reshapes immune responses is unclear, limiting biomarker and therapeutic targeting.
• What they did: In a prospective observational cohort, single-cell RNA-seq with paired TCR sequencing was performed on peripheral blood and CSF before and after IVIg in 9 and 8 patients (post-treatment: 6 blood, 3 CSF), compared with published healthy control datasets.
• The result: IVIg produced minimal peripheral blood changes but more substantial CSF shifts, including reduced Th1-associated and activated effector-memory states, increased Th2 and regulatory T cells, and repertoire changes, with pathogen-associated expanded clonotypes and convergent groups detected in six patients.

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