Ambiguous value of anti-ganglioside IgM autoantibodies in Guillain-Barré syndrome and its variants

Abstract

Anti-ganglioside autoantibodies of the IgG type are detected in a half of patients with Guillain-Barré syndrome (GBS), and their detection strongly supports the diagnosis of GBS. In contrast, anti-ganglioside IgM antibodies are also often detected in GBS patients, but it remains unclear whether IgM antibodies indicate a diagnosis of GBS. We identified four GBS patients (3.3%) who tested positive for IgM antibodies but negative for IgG antibodies among 122 patients with GBS and its variants. These four patients were all adolescents or young adults (age 13-22 years), experienced preceding gastrointestinal symptoms, and had serological and/or bacterial evidence of recent Campylobacter jejuni enteritis. Serum IgG reacted strongly with the lipo-oligosaccharide (LOS) of the C. jejuni isolates from these patients' stool specimens. Thin-layer chromatography with immunostaining showed that their serum IgG reacted with resorcinol-positive portion of LOS, suggesting that these patients had IgG autoantibodies against sialic acid-containing epitopes, probably unrecognized ganglioside-like structures on the bacterial LOS. We also examined anti-ganglioside autoantibodies in 22 patients with C. jejuni enteritis without subsequent neurological disorders and detected IgM antibodies in seven (32%) patients. Our data indicate that anti-ganglioside IgM antibodies can be detected in C. jejuni enteritis without complication of GBS, and that the detection of anti-ganglioside IgM antibodies does not always support a diagnosis of GBS. IgG autoantibodies against unrecognized gangliosides might play a role in the development of disease in patients with GBS in whom only anti-ganglioside IgM antibodies are detected by routine clinical testing.

Anti‐ganglioside antibodies in Guillain–Barré syndrome and chronic inflammatory demyelinating polyneuropathy in Chinese patients

“…In this study, IgM antibodies were more common than IgG antibodies in the CIDP patients, and similar frequencies of these 2 antibody types were observed in the GBS patients, in contrast to findings from another country (Table ) . IgG anti‐ganglioside antibodies were detected in half of the GBS patients in this study, and IgG detection is strong evidence for a diagnosis of GBS . Another study of Chinese patients reported that IgG anti‐GM1 antibodies against gangliosides were more common in GBS patients, whereas the frequencies of IgG antibodies against other gangliosides did not differ significantly .…”

“…Although we found that IgM antibodies were more common than IgG antibodies in our population, there were no significant differences in IgM positivity between the AIDP and AMAN patients. Similarly, a recent study showed that IgM anti‐ganglioside antibodies are considerably limited compared with IgG antibodies for determining the particular disease present . Kuwahara et al .…”

Antecedent infections in Fisher syndrome: sources of variation in clinical characteristics

“…Serum IgM and IgG antibodies against isolated gangliosides (GM2, GM1, GD1a, GalNAc-GD1a, GD1b, GT1a, GT1b, or GQ1b; 10 pmol/well) and ganglioside complexes (GM1/GD1a and GM1/GT1a) were measured by enzyme-linked immunosorbent assay (ELISA) as described elsewhere [ 9 ]. IgG subclasses of anti-GQ1b and anti-GT1a antibodies were examined as reported previously [ 10 ].…”

Physiology of gangliosides and the role of antiganglioside antibodies in human diseases

“…79 In particular, IgG AGAs are found in more than half of GBS patients and are strongly indicative of the disease, while the role of IgM is still not clear. 80 GBS a is the most common cause of a flaccid pararalysis worldwide. It is considered to be a postinfectious, inflammatory, peripheral neuropathy.…”