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Hirano M, Kuwahara M, Yamagishi Y, Samukawa M, Fujii K, Yamashita S, Ando M, Oka N, Nagano M, Matsui T, Takeuchi T, Saigoh K, Kusunoki S, Takashima H, Nagai Y. CANVAS-related RFC1 mutations in patients with immune-mediated neuropathy. Sci Rep 2023; 13:17801. [PMID: 37853169 PMCID: PMC10584897 DOI: 10.1038/s41598-023-45011-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023] Open
Abstract
Cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) has recently been attributed to biallelic repeat expansions in RFC1. More recently, the disease entity has expanded to atypical phenotypes, including chronic neuropathy without cerebellar ataxia or vestibular areflexia. Very recently, RFC1 expansions were found in patients with Sjögren syndrome who had neuropathy that did not respond to immunotherapy. In this study RFC1 was examined in 240 patients with acute or chronic neuropathies, including 105 with Guillain-Barré syndrome or Miller Fisher syndrome, 76 with chronic inflammatory demyelinating polyneuropathy, and 59 with other types of chronic neuropathy. Biallelic RFC1 mutations were found in three patients with immune-mediated neuropathies, including Guillain-Barré syndrome, idiopathic sensory ataxic neuropathy, or anti-myelin-associated glycoprotein (MAG) neuropathy, who responded to immunotherapies. In addition, a patient with chronic sensory autonomic neuropathy had biallelic mutations, and subclinical changes in Schwann cells on nerve biopsy. In summary, we found CANVAS-related RFC1 mutations in patients with treatable immune-mediated neuropathy or demyelinating neuropathy.
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Affiliation(s)
- Makito Hirano
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Motoi Kuwahara
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yuko Yamagishi
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Makoto Samukawa
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kanako Fujii
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Shoko Yamashita
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masahiro Ando
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Nobuyuki Oka
- Department of Neurology, NHO Minami-Kyoto Hospital, Joyo, Japan
| | - Mamoru Nagano
- Department of Anatomy, Kindai University, Faculty of Medicine, Osakasayama, Japan
| | - Taro Matsui
- Division of Neurology, Anti-Aging, and Vascular Medicine, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Toshihide Takeuchi
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kazumasa Saigoh
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshitaka Nagai
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
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Campylobacter jejuni Infection, Anti-Ganglioside Antibodies, and Neuropathy. Microorganisms 2022; 10:microorganisms10112139. [PMID: 36363731 PMCID: PMC9695184 DOI: 10.3390/microorganisms10112139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Preceding infection with Campylobacter jejuni (Cj) occurs in approximately 30% of patients with Guillain–Barre syndrome (GBS), and the risk of GBS following Cj infection is increased by 77 to 100-fold. GBS is most often of the axonal subtype and is thought to be mediated by IgG antibodies to peripheral nerve gangliosides that are cross reactive with oligosaccharides in the Cj lipopolysaccharides (LPS). The antibodies are thought to be induced by molecular mimicry, where immune reactivity to a cross reactive epitope in the infectious organism and normal tissue can cause autoimmune disease. Clonally restricted IgM antibodies that react with the same oligosaccharides in gangliosides and Cj-LPS are associated with chronic neuropathies of otherwise similar phenotypes. The anti-ganglioside antibodies in GBS are of the IgG1 and IgG3 subclasses, indicating T-cell reactivity to the same antigens that could help disrupt the blood–nerve barrier. Cj infection can activate multiple innate and adoptive pro-inflammatory pathways that can overcome immune tolerance and induce autoimmunity. Elucidation of the specific immune mechanisms involved in the development of the autoantibodies and neuropathy would help our understanding of the relation between infection and autoimmunity and aid in the development of more effective preventive interventions and therapies.
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Abstract
Understanding of Guillain-Barré syndrome (GBS) has progressed substantially since the seminal 1916 report by Guillain et al. Although Guillain, Barré, and Strohl summarised the syndrome based on observations of two French infantrymen, 2012 saw the beginning of an ambitious collaborative study designed to collect detailed data from at least 1,000 patients worldwide (IGOS, www.gbsstudies.org/about-igos). Progress has been made in many areas even since GBS was last reviewed in this journal in 2009. GBS subsequently received prominent attention in light of concerns regarding H1N1 influenza vaccinations, and several large-scale surveillance studies resulted. Despite these developments, and promising pre-clinical studies, disease-modifying therapies for GBS have not substantially altered since intravenous immunoglobulin was introduced over 20 years ago. In other areas, management has improved. Antibiotic prophylaxis in ventilated patients reduces respiratory tract infection, thromboprophylaxis has reduced the risk of venous thromboembolism, and there is increasing awareness of the benefit of high-intensity rehabilitation. This article highlights some of the interesting and thought-provoking developments of the last 3 years, and is based on a plenary lecture given at the 2012 Peripheral Nerve Society (PNS) meeting.
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Affiliation(s)
- Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Kiriyama T, Hirano M, Kusunoki S, Morita D, Hirakawa M, Tonomura Y, Kitauchi T, Ueno S. Asymmetrical weakness associated with central nervous system involvement in a patient with guillain-barrè syndrome. Clin Med Case Rep 2009; 2:51-4. [PMID: 24179374 PMCID: PMC3785336 DOI: 10.4137/ccrep.s3180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Guillain-Barrè syndrome (GBS) is usually associated with symmetrical weakness, and therefore asymmetrical weakness may confuse diagnosis. We report on a patient with GBS subsequent to Campylobacter jejuni enteritis who had asymmetrical weakness with CNS involvement. The patient tested positive for anti-ganglioside antibodies, including anti-GM1 IgM, anti-GD1b IgG, and anti-GT1a IgG. Patients with GBS can manifest asymmetrical signs and symptoms attributable to CNS involvement. Prompt, accurate diagnosis and treatment of post-C. jejuni GBS is especially important because its prognosis is relatively poor.
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Affiliation(s)
- Takao Kiriyama
- Department of Neurology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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Lee G, Jeong Y, Wirguin I, Hays AP, Willison HJ, Latov N. Induction of human IgM and IgG anti-GM1 antibodies in transgenic mice in response to lipopolysaccharides from Campylobacter jejuni. J Neuroimmunol 2004; 146:63-75. [PMID: 14698848 DOI: 10.1016/j.jneuroim.2003.10.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Campylobacter jejuni lipopolysaccharides (LPS) are implicated in the development of autoantibodies to GM1 ganglioside in patients with neuropathy following C. jejuni infection. CjLPS bears oligosaccharides that are cross reactive with GM1 ganglioside and presumably exerts its effects via molecular mimicry. To study the mechanisms that are involved in development of the autoantibody response, a transgenic mouse line was developed that expresses an IgM anti-GM1 antibody derived from a patient with multifocal motor neuropathy (MMN). In vivo stimulation of the transgenic mice with C. jejuni lipopolysaccharides (CjLPS), but not of wild-type mice readily elicited high serum titers of anti-GM1 IgM antibodies, followed by IgG anti-GM1 antibodies after two booster injections. In in vitro experiments, CjLPS stimulated the transgenic B-cells at lower concentration than control LPS. The increased sensitivity to CjLPS and the induction of IgG anti-GM1 by CjLPS but not control LPS are consistent with a mechanism of B-cell activation that involves both the LPS and the antigen-specific surface Ig receptors, with possible participation of T-cells.
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Affiliation(s)
- Grace Lee
- Department of Neurology and Neuroscience, Weill Medical College, Cornell University, New York, NY, USA.
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