Gangliosides and peripheral neuropathies: an overview

Glycoconjugates as target antigens in peripheral neuropathies

Identification and characterization of antigens present at the human peripheral nerve is a great challenge in the field of neuroimmunology. The latest investigations are focused on the understanding of the biology of glycoconjugates present at the peripheral nerve, and their immunological reactivity. Increased titers of antibodies that recognize carbohydrate determinants of glycoconjugates (glycolipids and glycoproteins) are associated with distinct neuropathic syndromes. There is considerable cross-reactivity among anti-ganglioside antibodies, resulting from shared oligosaccharide epitopes, possibly explaining the overlap in syndromes observed in many affected patients. Sera from patients with neuropathies (GBS, chronic inflammatory demielynating polyneuropathy - CIDP, multifocal motor neuropathy - MMN), cross-react with glycoproteins isolated from human peripheral nerve and from Campylobacter jejuni O:19. The frequency of occurrence of antibodies against these glycoproteins is different, depending of the type of neuropathy. Identification of the cross-reactive glycoproteins and possible additional auto antigens could be useful in laboratory evaluation of peripheral neuropathies and help to develop a more effective therapeutic approach.

Antibody testing in peripheral neuropathies

Many autoantibodies have been described in association with peripheral neuropathy, but the use of antibody testing in clinical practice remains a matter of some debate. Serum autoantibodies to gangliosides or glycoproteins are implicated in a variety of sensory and motor neuropathy syndromes. Paraneoplastic antibodies help identify patients who have a neuropathy related to an underlying malignancy. Detection of an autoantibody in the right clinical setting provides some evidence that the peripheral nerve disturbance is immune mediated and that immunomodulatory therapy may be of benefit.

Activity of the Motor Cortex During Scratching

In awake cats sitting with the head restrained, scratching was evoked using stimulation of the ear. Cats scratched the shoulder area, consistently failing to reach the ear. Kinematics of the hind limb movements and the activity of ankle muscles, however, were similar to those reported earlier in unrestrained cats. The activity of single neurons in the hind limb representation of the motor cortex, including pyramidal tract neurons (PTNs), was examined. During the protraction stage of the scratch response, the activity in 35% of the neurons increased and in 50% decreased compared with rest. During the rhythmic stage, the motor cortex population activity was approximately two times higher compared with rest, because the activity of 53% of neurons increased and that of 33% decreased in this stage. The activity of 61% of neurons was modulated in the scratching rhythm. The average depth of frequency modulation was 12.1 ± 5.3%, similar to that reported earlier for locomotion. The phases of activity of different neurons were approximately evenly distributed over the scratch cycle. There was no simple correlation between resting receptive field properties and the activity of neurons during the scratch response. We conclude that the motor cortex participates in both the protraction and the rhythmic stages of the scratch response.

Movement-Related Discharge of Ventromedial Medullary Neurons

Studies in anesthetized animals implicate nonserotonergic cells in the ventromedial medulla (VMM) in opioid modulation of nociceptive transmission but do not reveal the conditions that engage VMM cells in unanesthetized rats. The few studies of VMM cells in unanesthetized rats show that VMM cells change their discharge across the sleep-wake cycle and during active movements. Since active movements are more likely to occur during waking than sleep, state-related discharge may in fact represent movement-related discharge. In this study, we recorded the discharge of VMM neurons in unanesthetized, drug-free, freely moving rats and examined whether neuronal activity was related to wake/sleep state, to motor activity, or to both factors. Most cells (45/67) were more active during waking states than sleeping states, 1 cell was more active during sleep states, and the remaining 21 cells did not fire preferentially across the sleep-wake cycle. Most wake-active cells (36/45) showed discharge bursts during movement bursts, and 9/11 wake-active cells were excited by noxious heat and innocuous air puff stimulation. In contrast, few state-independent cells (9/21) showed movement-related bursts in discharge. These results suggest that VMM neurons modulate spinal processes during phasic motor activity.

Functional and structural effects of GM-1 ganglioside treatment on peripheral nerve grafting in the rat

Peripheral nerve regeneration after traumatic injury and standard repair with a nerve autograft is usually incomplete. This study tested the influence of graft vascularity and pharmacological intervention with GM-1 ganglioside on nerve regeneration in a rat sciatic nerve model. Controls included an unoperated contralateral side and sham-operated groups either with or without the GM-1. During the 5 months of recovery, locomotion was tested by the sciatic function index (SFI). At killing, anesthetized animals were prepared for nerve conduction velocity (NCV) studies, followed by the wet weight of the gastrocnemius muscle (expression of atrophy), toe-chewing (expression of lesion severity and sensory loss), and histological examination of the nerve segments. The SFI showed a slight but significant recovery for both the vascular and avascular groups (34% at 20 weeks), but when GM-1 ganglioside treatment was included, the SFI was poor throughout (20-33%). The average NCV of the graft groups without GM-1 was 46% to 57% of the normal nerve (52.7 m/s), whereas for the groups treated with GM-1, it was 63% to 64% of normal; treatment of the non-vascular graft group significantly improved recovery. A uniformly poor recovery from muscle atrophy was seen for all nerve graft groups (62-67%) compared with normal controls. The mean number of toes per foot chewed was 1.9 and 2.4 in graft groups without GM-1 treatment and 0.9 and 1.3 in graft groups treated with GM-1. This treatment significantly reduced both the extent and the number of animals exhibiting autotomy. The qualitative microscopic appearance of the distal nerve segment in all surgical groups was similar. We conclude that the systemic addition of GM-1 ganglioside enhances only some aspects of regeneration in grafted nerves, possibly with a preferential effect on sensory nerve regeneration and functional recovery.

Antibody panels in idiopathic polyneuropathy and motor neuron disease

We prospectively evaluated patients with idiopathic polyneuropathy (PN) and motor neuron disease (MND) with commercial antibody (Ab) panels. Patients with sensorimotor PN received a "sensorimotor neuropathy profile" [3-sulfated glucuronyl paragloboside (SGPG)/myelin-associated glycoprotein (MAG), GM1, asialo-GM1, GD1b, Hu, sulfatide]. Motor neuropathy or MND patients underwent a "motor neuropathy profile" (SGPG/MAG, GM1, asialo-GM1). Seven of 78 patients (9.0%) with sensorimotor PN and 3 of 44 patients (6.8%) with MND had abnormal panels. None of 60 patients with axonal sensory or sensorimotor PN had antisulfatide Ab. Seven of 13 patients (54%) with multifocal motor neuropathy had abnormal panels, with 6 seropositive to GM1. We found abnormal Ab panels in fewer than 10% of patients with idiopathic sensorimotor PN and MND. Moreover, abnormal Ab tests often did not relate to the clinical context. Our data do not support the use of commercial Ab panels in the evaluation of patients with idiopathic PN or MND.