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Plasma Levels of Tumor Necrosis Factor  and Soluble Tumor Necrosis Factor Receptors in Patients With Narcolepsy
Hubertus Himmerich, MD;
Pierre A. Beitinger, MD;
Stephany Fulda, MSc;
Renate Wehrle, MSc;
Jakob Linseisen, PhD;
Günther Wolfram, MD;
Stephanie Himmerich, MSc;
Kurt Gedrich, PhD;
Thomas C. Wetter, MD;
Thomas Pollmächer, MD
Arch Intern Med. 2006;166:1739-1743.
Background Narcolepsy is a disabling sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. Recent studies suggest that the immune system might play a pathogenic role pointing to a possible involvement of inflammatory cytokines.
Methods We investigated a sample of 30 patients with narcolepsy in comparison with 120 sex- and age-matched and 101 sex-, body mass index (BMI)-, and age-matched randomly selected normal controls. In these groups, plasma concentrations of tumor necrosis factor  (TNF-) and its soluble receptors p55 and p75 (soluble TNF receptor [sTNF-R] p55 and sTNF-R p75) were measured using commercial enzyme-linked immunosorbent assays.
Results The narcoleptic patients showed a significantly higher BMI compared with controls of the same age. Soluble TNF-R p75 levels were consistently elevated in the narcoleptic patients compared with their sex- and age-matched (P = .001) as well as sex-, BMI-, and age-matched counterparts (P = .003). Female narcoleptic patients exhibited higher sTNF-R p55 levels compared with their sex- and age-matched controls (P = .01), but this difference disappeared when comparing patients with sex-, BMI-, and age-matched normal controls. Tumor necrosis factor levels did not differ significantly between groups.
Conclusion Narcoleptic patients show increased plasma levels of sTNF-R p75, suggesting a functional alteration of the TNF- cytokine system, further corroborating a possible pathogenic role of the immune system in this sleep disorder.
Author Affiliations: Max Planck Institute of Psychiatry, Munich, Germany (Drs Himmerich, Beitinger, Wetter, and Pollmächer and Mss Fulda and Wehrle); Departments of Human Nutrition and Cancer Prevention (Dr Linseisen), Food and Nutrition (Dr Wolfram), and Consumer Economics (Ms Himmerich and Dr Gedrich), Technical University of Munich, Freising-Weihenstephan, Germany; Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, Germany (Dr Linseisen); Center of Mental Health, Klinikum Ingolstadt, Ingolstadt, Germany (Dr Pollmächer); and Center for Neurosciences, Klinikum der Philipps–Universität, Klinik für Neurologie Marburg, Germany (Dr Himmerich).
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