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World Sleep 2022 | Pathogenesis of narcolepsy type 1: The immune hypothesis

Mink Schinkelshoek, MD, PhD, Leiden University Medical Center, Leiden, Netherlands, discusses the immune hypothesis in narcolepsy. A peak in narcolepsy cases following the swine flu pandemic over a decade ago generated a surge of interest in investigating autoimmune responses in narcolepsy – yet has still proven difficult to do so. Dr Schinkelshoek states the probability that there is an autoimmune response targeting the hypocretin producing neurons, causing the onset of narcolepsy. There is evidence of some reactivity, but this can also be seen in healthy controls meaning that we cannot be certain if it is the cause of the disease. This highlights a major challenge – to pinpoint what is happening in the process leading to the destruction of hypocretin producing neurons. There are novel immunological techniques which could help dive deeper into the immune system, looking at very small immune cell populations to see whether they play a role or not. This interview took place at the World Sleep Congress 2022 in Rome, Italy.