A recombinant IgG1 Fc-domain protein ameliorates inflammatory demyelinating peripheral neuropathy

Introduction Guillain–Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) are immune-mediated inflammatory neuropathies characterized by T cell– and/or autoantibody-driven injury to peripheral nerves. Although intravenous immunoglobulin (IVIg) is effective in both conditions, its use is limited by high dosing requirements, supply constraints, and manufacturing complexity. NVG-2089 is a recombinant IgG1 Fc-domain protein engineered to selectively agonize type II Fc receptors, promoting anti-inflammatory signaling through expansion of regulatory T cells (Tregs) and upregulation of the inhibitory Fcγ receptor FcγRIIB. Its efficacy in immune complex–mediated disease and T cell–driven neuroinflammation prompted evaluation of its therapeutic potential in an animal model of inflammatory demyelinating neuropathy. Methods We conducted a randomized, blinded preclinical study in the spontaneous autoimmune peripheral polyneuropathy model, a well-established murine model of inflammatory demyelinating neuropathy. Animals were treated with NVG-2089, high-dose IVIg, or vehicle. Outcomes included behavioral performance, nerve electrophysiology, peripheral nerve morphometrics, immunohistochemistry, and flow cytometric immunophenotyping. Results Both NVG-2089 and IVIg stabilized motor and sensory performance, preserved compound muscle action potential (CMAP) amplitudes, and attenuated demyelination-associated prolongation of distal latency and CMAP duration. Morphometric analyses demonstrated preservation of myelinated fiber density and normalization of g-ratio distributions in both treatment groups. Immunophenotyping indicated an expansion of functionally activated CD25 + CD39 + Tregs in the spleen, along with increased FcγRIIB expression on B cells, monocytes, and dendritic cells across systemic and nerve-associated compartments, consistent with engagement of shared anti-inflammatory pathways. Conclusions NVG-2089 demonstrated robust neuroprotective efficacy comparable to IVIg while requiring a substantially lower protein dose. These findings support NVG-2089 as a promising, dose-efficient alternative to IVIg for the treatment of inflammatory demyelinating neuropathies, including GBS and CIDP.