1
|
Halstead SK, Gourlay DS, Penderis J, Bianchi E, Dondi M, Wessmann A, Musteata M, Le Chevoir M, Martinez-Anton L, Bhatti SFM, Volk H, Mateo I, Tipold A, Ives E, Pakozdy A, Gutierrez-Quintana R, Brocal J, Whitehead Z, Granger N, Pazzi P, Harcourt-Brown T, José-López R, Rupp S, Schenk HC, Smith P, Gandini G, Menchetti M, Mortera-Balsa V, Rusbridge C, Tauro A, Cozzi F, Deutschland M, Tirrito F, Freeman P, Lowrie M, Jackson MR, Willison HJ, Rupp A. Serum anti-GM2 and anti-GalNAc-GD1a IgG antibodies are biomarkers for acute canine polyradiculoneuritis. J Small Anim Pract 2022; 63:104-112. [PMID: 34791652 DOI: 10.1111/jsap.13439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 08/13/2021] [Accepted: 09/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES A previous single-country pilot study indicated serum anti-GM2 and anti-GA1 anti-glycolipid antibodies as potential biomarkers for acute canine polyradiculoneuritis. This study aims to validate these findings in a large geographically heterogenous cohort. MATERIALS AND METHODS Sera from 175 dogs clinically diagnosed with acute canine polyradiculoneuritis, 112 dogs with other peripheral nerve, cranial nerve or neuromuscular disorders and 226 neurologically normal dogs were screened for anti-glycolipid antibodies against 11 common glycolipid targets to determine the immunoglobulin G anti-glycolipid antibodies with the highest combined sensitivity and specificity for acute canine polyradiculoneuritis. RESULTS Anti-GM2 anti-glycolipid antibodies reached the highest combined sensitivity and specificity (sensitivity: 65.1%, 95% confidence interval 57.6 to 72.2%; specificity: 90.2%, 95% confidence interval 83.1 to 95.0%), followed by anti-GalNAc-GD1a anti-glycolipid antibodies (sensitivity: 61.7%, 95% confidence interval 54.1 to 68.9%; specificity: 89.3%, 95% confidence interval 82.0 to 94.3%) and these anti-glycolipid antibodies were frequently present concomitantly. Anti-GA1 anti-glycolipid antibodies were detected in both acute canine polyradiculoneuritis and control animals. Both for anti-GM2 and anti-GalNAc-GD1a anti-glycolipid antibodies, sex was found a significantly associated factor with a female to male odds ratio of 2.55 (1.27 to 5.31) and 3.00 (1.22 to 7.89), respectively. Anti-GalNAc-GD1a anti-glycolipid antibodies were more commonly observed in dogs unable to walk (OR 4.56, 1.56 to 14.87). CLINICAL SIGNIFICANCE Anti-GM2 and anti-GalNAc-GD1a immunoglobulin G anti-glycolipid antibodies represent serum biomarkers for acute canine polyradiculoneuritis.
Collapse
Affiliation(s)
- S K Halstead
- Neuroimmunology Laboratory, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 8TA, UK
| | - D S Gourlay
- Neuroimmunology Laboratory, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 8TA, UK
| | - J Penderis
- Vet Extra Neurology, Broadleys Veterinary Hospital, Stirling, FK7 7LE, UK
| | - E Bianchi
- Department of Veterinary Science, University of Parma, 43126, Parma, Italy
| | - M Dondi
- Department of Veterinary Science, University of Parma, 43126, Parma, Italy
| | - A Wessmann
- Neurology and Neurosurgery Service, Pride Veterinary Centre, Pride Park, Derby, DE24 8HX, UK
| | - M Musteata
- Neurology Service, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, Iași, 700489, Romania
| | - M Le Chevoir
- Department of Neurology and Neurosurgery, University of Melbourne, Werribee, Victoria, 3030, Australia
| | - L Martinez-Anton
- Chestergates Veterinary Specialists, Telford Court, Chestergates, CH1 6LT, UK
| | - S F M Bhatti
- Small Animal Department, Small Animal Teaching Hospital, Faculty of Veterinary Medicine, Ghent University, 9820, Merelbeke, Belgium
| | - H Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, 30559, Hannover, Germany
| | - I Mateo
- Servicio de Neurología, Hospital Clínico Veterinario - Universidad Alfonso X el Sabio, Madrid, Spain
| | - A Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, 30559, Hannover, Germany
| | - E Ives
- Anderson Moores Veterinary Specialists, Hursley, Winchester, SO21 2LL, UK
| | - A Pakozdy
- University Hospital for Small Animals, University of Veterinary Medicine, Vienna, Austria
| | | | - J Brocal
- Wear Referrals Veterinary Hospital, Bradbury, Stockton-on-Tees, TS21 2ES, UK
| | - Z Whitehead
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, 0110, South Africa
| | - N Granger
- The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK.,CVS Referrals, Bristol Veterinary Specialists at Highcroft, Bristol, UK
| | - P Pazzi
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, 0110, South Africa
| | - T Harcourt-Brown
- Langford Veterinary Services, School of Veterinary Sciences, University of Bristol, Lower Langford, BS40 5DU, UK
| | - R José-López
- School of Veterinary Medicine, University of Glasgow, Glasgow, G61 1QH, UK
| | - S Rupp
- Tierklinik Hofheim, 65719, Hofheim, Germany
| | - H C Schenk
- Tierklinik Lüneburg, 21337, Lüneburg, Germany
| | - P Smith
- Hamilton Specialist Referrals, Cressex Business Park, High Wycombe, HP12 3SD, UK
| | - G Gandini
- Department of Veterinary Medical Sciences, University of Bologna, 40064, Ozzano dell'Emilia, Italy
| | - M Menchetti
- Neurology and Neurosurgery Division, San Marco Veterinary Clinic, Veggiano, Italy
| | - V Mortera-Balsa
- North Downs Specialist Referrals, 3&4 The Brewerstreet Dairy Business Park, Bletchingley, Surrey, RH1 4QP, UK
| | - C Rusbridge
- Neurology Section, Fitzpatrick Referrals, Godalming, Surrey, GU2 7AL, UK.,School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7AL, UK
| | - A Tauro
- Chestergates Veterinary Specialists, Telford Court, Chestergates, CH1 6LT, UK
| | - F Cozzi
- Clinica Neurologica Veterinaria, 20148, Milan, Italy
| | | | - F Tirrito
- Clinica Neurologica Veterinaria, 20148, Milan, Italy
| | - P Freeman
- The Queen's Veterinary School Hospital, Cambridge, CB3 0ES, UK
| | - M Lowrie
- Dovecote Veterinary Hospital, Castle Donington, Derby, DE74 2LJ, UK
| | - M R Jackson
- Institute of Cancer Sciences, University of Glasgow, Bearsden, G61 1QH, UK
| | - H J Willison
- Neuroimmunology Laboratory, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 8TA, UK
| | - A Rupp
- School of Veterinary Medicine, University of Glasgow, Glasgow, G61 1QH, UK
| |
Collapse
|
2
|
Wilder-Smith A, Preet R, Renhorn KE, Ximenes RA, Rodrigues LC, Solomon T, Neyts J, Lambrechts L, Willison HJ, Peeling R, Falconar AK, Precioso AR, Logan J, Lang T, Endtz HP, Massad E, Massad E. ZikaPLAN: Zika Preparedness Latin American Network. Glob Health Action 2017; 10:1398485. [PMID: 29235414 PMCID: PMC7011980 DOI: 10.1080/16549716.2017.1398485] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The ongoing Zika virus (ZIKV) outbreak in Latin America, the Caribbean, and the Pacific Islands has underlined the need for a coordinated research network across the whole region that can respond rapidly to address the current knowledge gaps in Zika and enhance research preparedness beyond Zika. The European Union under its Horizon 2020 Research and Innovation Programme awarded three research consortia to respond to this need. Here we present the ZikaPLAN (Zika Preparedness Latin American Network) consortium. ZikaPLAN combines the strengths of 25 partners in Latin America, North America, Africa, Asia, and various centers in Europe. We will conduct clinical studies to estimate the risk and further define the full spectrum and risk factors of congenital Zika virus syndrome (including neurodevelopmental milestones in the first 3 years of life), delineate neurological complications associated with ZIKV due to direct neuroinvasion and immune-mediated responses in older children and adults, and strengthen surveillance for birth defects and Guillain-Barré Syndrome. Laboratory-based research to unravel neurotropism and investigate the role of sexual transmission, determinants of severe disease, and viral fitness will underpin the clinical studies. Social messaging and engagement with affected communities, as well as development of wearable repellent technologies against Aedes mosquitoes will enhance the impact. Burden of disease studies, data-driven vector control, and vaccine modeling as well as risk assessments on geographic spread of ZIKV will form the foundation for evidence-informed policies. While addressing the research gaps around ZIKV, we will engage in capacity building in laboratory and clinical research, collaborate with existing and new networks to share knowledge, and work with international organizations to tackle regulatory and other bottlenecks and refine research priorities. In this way, we can leverage the ZIKV response toward building a long-term emerging infectious diseases response capacity in the region to address future challenges.
Collapse
Affiliation(s)
- A. Wilder-Smith
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå Sweden,CONTACT Annelies Wilder-Smith Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - R. Preet
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå Sweden
| | - K. E. Renhorn
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå Sweden
| | - R. A. Ximenes
- Instituto de Apoio a Fundacao, Universidade de Pernambuco, Recife, Brazil
| | - L. C. Rodrigues
- Instituto de Apoio a Fundacao, Universidade de Pernambuco, Recife, Brazil,London School of Hygiene and Tropical Medicine, London, UK
| | - T. Solomon
- Institute of Infection and Global Health, The University of Liverpool, Liverpool, UK
| | - J. Neyts
- Rega Institute for Medical Research, Department of Microbiology & Immunology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - L. Lambrechts
- Institut Pasteur, Insect-Virus Interactions Group, Department of Genomes and Genetics, CNRS Unité de Recherche Associée 3012, Paris Cedex 15, France
| | - H. J. Willison
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - R. Peeling
- London School of Hygiene and Tropical Medicine, London, UK
| | - A. K. Falconar
- London School of Hygiene and Tropical Medicine, London, UK,Departmento del Medicina, Fundacion Universidad del Norte, Barranquilla, Colombia
| | | | - J. Logan
- London School of Hygiene and Tropical Medicine, London, UK
| | - T. Lang
- The Global Health Network, Masters and Scholars of the University of Oxford, Oxford, UK
| | - H. P. Endtz
- Fondation Mérieux, Lyon, France,Department of Medical Microbiology & Infectious Diseases, Rotterdam, The Netherlands
| | - E. Massad
- Fundacao de Apoio a Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E Massad
- m Fundacao de Apoio a Universidade de Sao Paulo , Sao Paulo , Brazil
| |
Collapse
|
3
|
Galban-Horcajo F, Fitzpatrick AM, Hutton AJ, Dunn SM, Kalna G, Brennan KM, Rinaldi S, Yu RK, Goodyear CS, Willison HJ. Antibodies to heteromeric glycolipid complexes in multifocal motor neuropathy. Eur J Neurol 2012; 20:62-70. [PMID: 22727042 DOI: 10.1111/j.1468-1331.2012.03767.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 04/24/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Measurement of anti-GM1 IgM antibodies in multifocal motor neuropathy (MMN) sera is confounded by relatively low sensitivity that limits clinical usefulness. Combinatorial assay methods, in which antibodies react to heteromeric complexes of two or more glycolipids, are being increasingly applied to this area of diagnostic testing. METHODS A newly developed combinatorial glycoarray able to identify antibodies to 45 different heteromeric glycolipid complexes and their 10 individual glycolipid components was applied to a randomly selected population of 33 MMN cases and 57 normal or disease controls. Comparison with an enzyme-linked immunosorbent assay (ELISA) was conducted for selected single glycolipids and their complexes. RESULTS By ELISA, 22/33 MMN cases had detectable anti-GM1 IgM antibodies, whereas 19/33 MMN samples were positive for anti-GM1 antibodies by glycoarray. Analysis of variance (anova) revealed that of the 55 possible single glycolipids and their 1:1 complexes, antibodies to the GM1:galactocerebroside (GM1:GalC) complex were most significantly associated with MMN, returning 33/33 MMN samples as positive by glycoarray and 29/33 positive by ELISA. Regression analysis revealed a high correlation in absolute values between ELISA and glycoarray. Receiver operator characteristic analysis revealed insignificantly different diagnostic performance between the two methods. However, the glycoarray appeared to offer slightly improved sensitivity by identifying antibodies in four ELISA-negative samples. CONCLUSIONS The use of combinatorial glycoarray or ELISA increased the diagnostic sensitivity of anti-glycolipid antibody testing in this cohort of MMN cases, without significantly affecting specificity, and may be a useful assay modification for routine clinical screening.
Collapse
Affiliation(s)
- F Galban-Horcajo
- Glasgow Biomedical Research Centre, College of Medical, Veterinary and Life Science, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Rinaldi S, Brennan KM, Kalna G, Walgaard C, Jacobs BC, Yu RK, Willison HJ. 1612 Combinatorial glycoarray detects diverse new antibody specificities in Guillain-BarrÉ syndrome. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
5
|
Reid JM, Foley P, Willison HJ. Voltage-gated potassium channel-associated limbic encephalitis in the West of Scotland: case reports and literature review. Scott Med J 2010; 54:27-31. [PMID: 20034278 DOI: 10.1258/rsmsmj.54.4.27] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS The syndrome of limbic encephalitis (LE) associated with antibodies against voltage-gated potassium channels (VGKC-LE) has recently been described. The number of published cases is however small. We therefore aimed to review all cases seen at our centre and compare with published cases. METHODS Retrospective cases of VGKC-LE were identified using a questionnaire to Neurologists at the Southern General hospital, Glasgow, and by reviewing patients with a positive VGKC antibody test (2002-2007). Case-note review of identified cases and a literature review of all published cases of VGKC-LE were performed. RESULTS Seven cases were identified (four female, age range 51-81). Patients presented sub-acutely with seizures and anterograde memory loss. Five patients had medial temporal lobe change on cranial imaging. No paraneoplastic cases were identified. 5/7 patients made some improvement with immunotherapy. In 2006, 3/18 (17%) patients with a coded discharge of encephalitis were diagnosed with VGKC-LE. The literature review revealed 40 patients with VGKC-LE. Age, gender or VGKC level did not predict likelihood for a significant recovery. Patients treated < or =5 months of symptom onset with immunotherapy were more likely to make a significant recovery (83% vs. 45%, p=0.04). CONCLUSION VGKC-LE is being increasingly diagnosed and is best identified early and treated with immunotherapy to offer the greatest chance of recovery. This series and literature review expands the current published evidence in VGKC-LE.
Collapse
Affiliation(s)
- J M Reid
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK.
| | | | | |
Collapse
|
6
|
Abstract
The inflammatory neuropathies are a large diverse group of immune-mediated neuropathies that are amenable to treatment and may be reversible. Their accurate diagnosis is essential for informing the patient of the likely course and prognosis of the disease, informing the treating physician of the appropriate therapy and informing the scientific community of the results of well-targeted, designed and performed clinical trials. With the advent of biological therapies able to manipulate the immune response more specifically, an understanding of the pathogenesis of these conditions is increasingly important. This review presents a broad overview of the pathogenesis, diagnosis and therapy of inflammatory neuropathies, concentrating on the most commonly encountered conditions.
Collapse
Affiliation(s)
- M P T Lunn
- Centre for Neuromuscular Disease and Department of Molecular Neuroscience, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
| | | |
Collapse
|
7
|
Zitman FMP, Todorov B, Jacobs BC, Verschuuren JJ, Furukawa K, Furukawa K, Willison HJ, Plomp JJ. Neuromuscular synaptic function in mice lacking major subsets of gangliosides. Neuroscience 2008; 156:885-97. [PMID: 18801416 DOI: 10.1016/j.neuroscience.2008.08.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 08/04/2008] [Accepted: 08/16/2008] [Indexed: 01/27/2023]
Abstract
Gangliosides are a family of sialylated glycosphingolipids enriched in the outer leaflet of neuronal membranes, in particular at synapses. Therefore, they have been hypothesized to play a functional role in synaptic transmission. We have measured in detail the electrophysiological parameters of synaptic transmission at the neuromuscular junction (NMJ) ex vivo of a GD3-synthase knockout mouse, expressing only the O- and a-series gangliosides, as well as of a GM2/GD2-synthase*GD3-synthase double-knockout (dKO) mouse, lacking all gangliosides except GM3. No major synaptic deficits were found in either null-mutant. However, some extra degree of rundown of acetylcholine release at high intensity use was present at the dKO NMJ and a temperature-specific increase in acetylcholine release at 35 degrees C was observed in GD3-synthase knockout NMJs, compared with wild-type. These results indicate that synaptic transmission at the NMJ is not crucially dependent on the particular presence of most ganglioside family members and remains largely intact in the sole presence of GM3 ganglioside. Rather, presynaptic gangliosides appear to play a modulating role in temperature- and use-dependent fine-tuning of transmitter output.
Collapse
Affiliation(s)
- F M P Zitman
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Willison HJ, Plomp JJ. Reply to correspondence from Dr Lo. Brain 2008. [DOI: 10.1093/brain/awn160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
9
|
Nachamkin I, Arzarte Barbosa P, Barbosa PA, Ung H, Ung H, Lobato C, Gonzalez Rivera A, Rivera AG, Rodriguez P, Garcia Briseno A, Briseno AG, Cordero LM, Garcia Perea L, Perea LG, Perez JC, Ribera M, Aldama PC, Guitérrez GD, Sarnat LF, García MR, Veitch J, Fitzgerald C, Cornblath DR, Cornblath D, Rodriguez Pinto M, Pinto MR, Griffin JW, Willison HJ, Asbury AK, McKhann GM. Patterns of Guillain-Barre syndrome in children: results from a Mexican population. Neurology 2007; 69:1665-71. [PMID: 17898327 DOI: 10.1212/01.wnl.0000265396.87983.bd] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an acute, immune-mediated flaccid paralysis frequently associated with Campylobacter infection. Of two predominant GBS subtypes, a demyelinating subtype (acute inflammatory demyelinative polyneuropathy [AIDP]) predominates in the United States and Europe, and axonal subtype (acute motor axonal neuropathy [AMAN]) is the predominant form in China. Previous clinical studies suggested that AMAN also occurs in Mexican children. The purpose of this study was to describe the subtypes of GBS in children from Mexico City. METHODS We prospectively studied 121 children admitted to two pediatric hospitals in Mexico City from 1996 to 2002. Clinical histories were obtained, electrophysiologic studies were performed to determine GBS subtype, and microbiologic studies were performed. RESULTS Of the 121 children, 46 had AMAN and 32 had AIDP. The male to female ratio was 1.3 for AMAN cases (mean age = 6.3) and 3.0 for AIDP cases (mean age = 7.0). There was a strong seasonal distribution of AMAN cases in July to September. Children with AMAN, but not AIDP, had worsening of illness during hospitalization as judged by peak severity scores. Vomiting was more likely in AIDP (28.1%) vs AMAN (6.5%) (p = 0.012) and diarrhea was more common in AMAN (32.6%) than AIDP (12.5%) (p = 0.06). IgG anti-GM1 antibody titers were higher in patients with AMAN vs AIDP (p = 0.067). Anti-GD1a antibodies were equally present in both groups. Anti GQ1b titers were higher in AMAN vs AIDP (p = 0.009). Campylobacter antibody responses were positive in 44.1% of patients with AMAN and 37.0% of patients with AIDP. Twenty patients (14 = AMAN, 6 = AIDP) had positive stool cultures for C jejuni. Two serotypes, HS:19 and HS:41, accounted for 6 of 10 Campylobacter isolates available for serotyping from these cases. CONCLUSIONS This study confirms that acute motor axonal neuropathy is an important Guillain-Barré syndrome subtype in Mexican children, is associated with diarrhea, and occurs seasonally.
Collapse
Affiliation(s)
- I Nachamkin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, 4th Floor Gates Building, Philadelphia, PA 19104-4283, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
BACKGROUND Fisher syndrome is one of the regional variants of Guillain-Barré syndrome, characterised by impairment of eye movements (ophthalmoplegia), incoordination (ataxia) and loss of tendon reflexes (areflexia). It can occur in more limited forms, and may overlap with Guillain-Barré syndrome. A further variant is associated with upper motor neuron signs and disturbance of consciousness (Bickerstaff's brainstem encephalitis). All of these variants are associated with anti-GQ1b IgG antibodies. Intravenous immunoglobulin (IVIg) and plasma exchange are often used as treatments in this patient group. This review was undertaken to systematically assess any available randomised controlled data on acute immunomodulatory therapies in Fisher Syndrome or its variants. OBJECTIVES To provide the best available evidence from randomised controlled trials on the role of acute immunomodulatory therapy in the treatment of Fisher Syndrome and related disorders. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Trials register (March 2004), MEDLINE (from January 1966 to November 2004), EMBASE (from January 1980 to November 2004), CINAHL (from January 1982 to November 2004) and LILACS (from January 1982 to November 2004) for randomised controlled trials, quasi-randomised trials, historically controlled studies and trials with concurrent controls. We adapted this strategy to search MEDLINE from 1966 and EMBASE from 1980 for comparative cohort studies, case-control studies and case series. SELECTION CRITERIA All randomised and quasi-randomised controlled clinical trials (in which allocation was not random but was intended to be unbiased, e.g. alternate allocation, and non-randomised controlled studies were to have been selected. Since no such clinical trials were discovered, all retrospective case series containing five or more patients were assessed and summarised in the discussion section. DATA COLLECTION AND ANALYSIS All studies of Fisher Syndrome and its clinical variants were scrutinised for data on patients treated with any form of acute immunotherapy. Information on the outcome was then collated and summarised. MAIN RESULTS We found no randomised or non-randomised prospective controlled trials of immunotherapy in Fisher Syndrome or related disorders. We summarised the results of retrospective series containing five or more patients in the discussion section. AUTHORS' CONCLUSIONS There are no randomised controlled trials of immunomodulatory therapy in Fisher Syndrome or related disorders on which to base practice.
Collapse
Affiliation(s)
- J R Overell
- Institute of Neurological Sciences, Department of Neurology, Southern General Hospital, 1345 Govan Road, Glasgow, UK, G51 4TF.
| | | | | | | | | |
Collapse
|
11
|
Abstract
The specificity of Miller Fisher syndrome sera for ganglioside complexes may influence its pathogenesis
Collapse
|
12
|
Abstract
This presentation discusses the immunobiology of the Guillain Barré syndromes (GBS), the world's leading cause of acute autoimmune neuromuscular paralysis. By gaining an understanding of the clinical and pathophysiological pathways operating in GBS, we can hope to develop novel immunotherapies that will improve clinical outcome. Here we focus on GBS mediated by anti-ganglioside antibodies and highlight the correlations between anti-ganglioside antibody patterns and clinical phenotypes, the development of models of GBS, and the application of novel therapies based on inhibition of complement activation.
Collapse
Affiliation(s)
- H J Willison
- Division of Clinical Neurosciences, Southern General Hospital, Glasgow, Scotland, UK.
| |
Collapse
|
13
|
Jacobs BC, O'Hanlon GM, Bullens RW, Veitch J, Plomp JJ, Willison HJ. Immunoglobulins inhibit pathophysiological effects of anti-GQ1b-positive sera at motor nerve terminals through inhibition of antibody binding. Am J Ophthalmol 2004. [DOI: 10.1016/j.ajo.2003.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
14
|
Pritchard J, Gray IA, Idrissova ZR, Lecky BRF, Sutton IJ, Swan AV, Willison HJ, Winer JB, Hughes RAC. A randomized controlled trial of recombinant interferon-beta 1a in Guillain-Barré syndrome. Neurology 2003; 61:1282-4. [PMID: 14610140 DOI: 10.1212/01.wnl.0000092019.53628.88] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors recruited 19 nonambulant patients with Guillain-Barré syndrome into a pilot, double-blind, randomized, placebo-controlled safety trial of interferon beta 1a (IFN[beta]-1a) (Rebif). Participants received IFN[beta]-1a or placebo subcutaneously three times weekly, 22 microg for the first week and then 44 microg for up to 24 weeks, in addition to IV immunoglobulin (IVIg). IFN[beta] did not have any unexpected interaction with IVIg and there was no significant difference in rate of improvement.
Collapse
Affiliation(s)
- J Pritchard
- Department of Clinical Neurosciences, Guy's, King's & St. Thomas' School of Medicine, London, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Bullens RWM, O'Hanlon GM, Wagner E, Molenaar PC, Furukawa K, Furukawa K, Plomp JJ, Willison HJ. Roles of Complex Gangliosides at the Neuromuscular Junction. Ann N Y Acad Sci 2003; 998:401-3. [PMID: 14592906 DOI: 10.1196/annals.1254.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R W M Bullens
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
BACKGROUND Polymorphism of the gene encoding the cholesterol transport protein apolipoprotein E (APOE, gene; apoE, protein), known to be involved in axonal regeneration and remyelination, influences outcome after a variety of central nervous system disorders. Apolipoprotein E gene polymorphisms could affect recovery from Guillain-Barré syndrome. OBJECTIVE To correlate APOE genotypes with residual disability and degree of improvement in Guillain-Barré syndrome, assessed one year after presentation METHODS 91 patients with the syndrome were recruited from southeast England and their APOE genotypes were determined. RESULTS There were no clear differences in APOE genotype or allele frequencies when comparing the 91 patients with controls, nor when comparing 81 patients with good outcome and 10 with poor outcome. CONCLUSIONS APOE genotype did not influence susceptibility to Guillain-Barré syndrome or recovery from it. This may be because our sample size of 91 was not sufficiently large to detect small differences in recovery associated with different APOE genotypes, or because cholesterol transportation is not a crucial rate limiting step in peripheral nerve regeneration.
Collapse
Affiliation(s)
- J Pritchard
- Department of Clinical Neurosciences, Guy's, King's and St Thomas' School of Medicine, London SE1, UK.
| | | | | | | | | |
Collapse
|
17
|
Willison HJ. Anti-glycolipid antibodies in the diagnosis of autoimmune neuropathies. Rev Neurol (Paris) 2002; 158:S16-20. [PMID: 12690656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Recent years have seen major progress in our understanding of the clinical pathophysiology of autoimmune neuropathies particularly with the identification and analysis of antibodies to gangliosides and related glycolipids in the serum of patients. Anti-glycolipid antibodies react with epitopes on the carbohydrate region of glycolipid molecules and can be routinely measured by standard immunoassays. In multifocal motor neuropathy, IgM anti-GM1 antibodies that cross react with GD1b and asialo-GM1 are detectable in around 50p. 100 of cases. This condition may clinically resemble certain forms of lower motor neurone disease. IgM anti-GD1b antibodies are found in IgM paraproteinaemic neuropathy characterised by profound sensory ataxia. In the anti-myelin associated glycoprotein (anti-MAG) IgM paraproteinaemic neuropathy, antibodies also react with the acidic glycolipids, sulphated glucuronyl paragloboside and its higher lactosaminyl homologue (SGPG and SGPLG). Thus a variety of chronic syndromes can be defined by their anti-glycolipid antibody profile. In Guillain-Barré syndrome, anti GM1, GM1b, GD1a and GalNAc-GD1a antibodies are found in patients with acute motor axonal neuropathy (AMAN) and anti-GQ1b IgG antibodies are a very sensitive and specific marker for the Miller Fisher syndrome. Many other anti-glycolipid antibodies are being increasingly identified in other neuropathy subtypes. The article will summarise existing clinical and serological information in this field.
Collapse
Affiliation(s)
- H J Willison
- University Department of Neurology, Southern General Hospital, Glasgow G51 4TF, Scotland
| |
Collapse
|
18
|
Ang CW, Laman JD, Willison HJ, Wagner ER, Endtz HP, De Klerk MA, Tio-Gillen AP, Van den Braak N, Jacobs BC, Van Doorn PA. Structure Of Campylobacter Jejuni Lipopolysaccharides Determines Antiganglioside Specificity And Clinical Features Of Guillain-Barre, And Miller Fisher Patients. J Peripher Nerv Syst 2002. [DOI: 10.1046/j.1529-8027.2002.02026_4.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
19
|
Serrano‐Munuera C, Gallardo E, Rojas R, De Luna N, Gonzalez‐Masegosa A, Marti‐Masso JF, Martinez‐Matos A, Ortiz N, Rene R, Berciano J, Grau JM, Willison HJ, Graus F, Illa I. Antiganglioside antibodies in acute self‐limiting ataxic neuropathy: incidence and significance. J Peripher Nerv Syst 2002. [DOI: 10.1046/j.1529-8027.2002.02011_10.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C Serrano‐Munuera
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - E Gallardo
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - R Rojas
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - N De Luna
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - A Gonzalez‐Masegosa
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - JF Marti‐Masso
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - A Martinez‐Matos
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - N Ortiz
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - R Rene
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - J Berciano
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - JM Grau
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - HJ Willison
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - F Graus
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| | - I Illa
- Journal of Neuroimmunology 120: 78–83, 2001. Reprinted with permission from Elsevier Science BV.
| |
Collapse
|
20
|
Ang CW, Laman JD, Willison HJ, Wagner ER, Endtz HP, De Klerk MA, Tio-Gillen AP, Van den Braak N, Jacobs BC, Van Doorn PA. Structure of Campylobacter jejuni lipopolysaccharides determines antiganglioside specificity and clinical features of Guillain-Barré and Miller Fisher patients. Infect Immun 2002; 70:1202-8. [PMID: 11854201 PMCID: PMC127781 DOI: 10.1128/iai.70.3.1202-1208.2002] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Ganglioside mimicry in the lipopolysaccharide (LPS) fraction of Campylobacter jejuni isolated from Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS) patients was compared with isolates from patients with an uncomplicated enteritis. The antibody response to C. jejuni LPS and gangliosides in neuropathy patients and controls was compared as well. LPS from GBS and MFS-associated isolates more frequently contained ganglioside-like epitopes compared to control isolates. Almost all neuropathy patients showed a strong antibody response against LPS and multiple gangliosides in contrast to enteritis patients. Isolates from GBS patients more frequently had a GM1-like epitope than isolates from MFS patients. GQ1b-like epitopes were present in all MFS-associated isolates and was associated with anti-GQ1b antibody reactivity and the presence of oculomotor symptoms. These results demonstrate that the expression of ganglioside mimics is a risk factor for the development of post-Campylobacter neuropathy. This study provides additional evidence for the hypothesis that the LPS fraction determines the antiganglioside specificity and clinical features in post-Campylobacter neuropathy patients.
Collapse
Affiliation(s)
- C W Ang
- Department of Neurology, Erasmus University/Academic Hospital Dijkzigt Rotterdam, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Serrano-Munuera C, Gallardo E, Rojas R, De Luna N, González-Masegosa A, Martí-Massó JF, Martínez-Matos A, Ortíz N, Reñé R, Berciano J, Grau JM, Willison HJ, Graus F, Illa I. Antiganglioside antibodies in acute self-limiting ataxic neuropathy: incidence and significance. J Neuroimmunol 2001; 120:78-83. [PMID: 11694322 DOI: 10.1016/s0165-5728(01)00428-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Antidisialosyl antibodies have been previously associated to chronic and acute ataxic neuropathies. We studied the presence of these antibodies in nine patients with acute self-limiting ataxic neuropathy (ASLAN) using ELISA and TLC immunodetection. One patient showed serum IgG immunoreactivity against gangliosides GD3 and GQ1b. The patient's IgG was able to bind to the nodes of Ranvier on frozen human dorsal root. Our studies confirmed that antidisialosyl reactivity is associated to ataxic neuropathy and its specific binding to the dorsal root could explain the predominant sensory involvement. Nevertheless, the low incidence of this reactivity indicates that a different pathogenic mechanism should be involved in most ASLAN patients.
Collapse
Affiliation(s)
- C Serrano-Munuera
- Department of Neurology, Institut de Recerca, Hospital de la Sta. Creu i St. Pau, Universitat Autonoma, Sant Antoni Ma Claret, 167, Barcelona 08025, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Hadden RD, Gregson NA, Gold R, Willison HJ, Hughes RA. Guillain-Barré syndrome serum and anti-Campylobacter antibody do not exacerbate experimental autoimmune neuritis. J Neuroimmunol 2001; 119:306-16. [PMID: 11585634 DOI: 10.1016/s0165-5728(01)00390-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To investigate whether antibodies are pathogenic in Guillain-Barré syndrome (GBS), we injected pre-treatment serum from 11 GBS patients intraperitoneally into rats in which the blood-nerve barrier had been opened by induction of mild adoptive transfer experimental autoimmune neuritis. There was no significant clinical, neurophysiological or pathological difference between rats receiving GBS serum compared with those receiving control serum, except that GBS serum caused minor excess weight loss. Murine monoclonal antibody to Campylobacter jejuni and gangliosides also did not exacerbate disease. This experiment failed to show antibody-mediated disease exacerbation and so does not support an antibody-mediated mechanism in GBS.
Collapse
Affiliation(s)
- R D Hadden
- Department of Neuroimmunology, Guy's, King's and St. Thomas' School of Medicine, Hodgkin Building, Guy's Hospital SE1 9RT, London, UK.
| | | | | | | | | |
Collapse
|
23
|
Willison HJ, O'Leary CP, Veitch J, Blumhardt LD, Busby M, Donaghy M, Fuhr P, Ford H, Hahn A, Renaud S, Katifi HA, Ponsford S, Reuber M, Steck A, Sutton I, Schady W, Thomas PK, Thompson AJ, Vallat JM, Winer J. The clinical and laboratory features of chronic sensory ataxic neuropathy with anti-disialosyl IgM antibodies. Brain 2001; 124:1968-77. [PMID: 11571215 DOI: 10.1093/brain/124.10.1968] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The clinical and laboratory phenotype of a paraproteinaemic neuropathy syndrome termed chronic sensory ataxic neuropathy with anti-disialosyl IgM antibodies is described in a series of 18 cases. Previous single case reports have outlined some features of this syndrome. All 18 cases were defined by the presence of serum IgM antibodies which react principally with NeuAc (alpha2-8)NeuAc(alpha2-3)Gal-configured disialosyl epitopes common to many gangliosides including GDlb, GD3, GTlb and GQlb. In 17 out of 18 cases, the serum contained benign IgM paraproteins, and in four of these cases at least two IgM paraproteins were present. The IgM antibodies were also cold agglutinins in 50% of cases. The clinical picture comprised a chronic neuropathy with marked sensory ataxia and areflexia, and with relatively preserved motor function in the limbs. In addition, 16 out of 18 cases had motor weakness affecting oculomotor and bulbar muscles as fixed or as relapsing-remitting features. When present in their entirety, these clinical features have been described previously under the acronym CANOMAD: chronic ataxic neuropathy, ophthalmoplegia, IgM paraprotein, cold agglutinins and disialosyl antibodies. This distribution of clinical features is reminiscent of Miller Fisher syndrome, in which acute-phase anti-disialylated ganglioside IgG antibodies are found. Clinical electrophysiology and nerve biopsy show both demyelinating and axonal features. A partial response to intravenous immunoglobulin and other treatments is reported in some cases.
Collapse
Affiliation(s)
- H J Willison
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
O'Hanlon GM, Plomp JJ, Chakrabarti M, Morrison I, Wagner ER, Goodyear CS, Yin X, Trapp BD, Conner J, Molenaar PC, Stewart S, Rowan EG, Willison HJ. Anti-GQ1b ganglioside antibodies mediate complement-dependent destruction of the motor nerve terminal. Brain 2001; 124:893-906. [PMID: 11335692 DOI: 10.1093/brain/124.5.893] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Miller-Fisher syndrome is an autoimmune neuropathy characterized by ataxia, areflexia and ophthalmoplegia, and in the majority of cases the presence of high titres of anti-GQ1b ganglioside antibodies. In an ex vivo model, human and mouse anti-GQ1b antibodies have been shown previously to induce a complement-dependent alpha-latrotoxin-like effect on the murine motor endplate, i.e. they bring about massive quantal release of acetylcholine and eventually block neuromuscular transmission. Using immunofluorescence microscopy with image analysis, we show here that the late stages of this electrophysiological effect temporally coincide with the loss of heavy neurofilament (200 kDa) and type III beta-tubulin immunostaining and structural breakdown of the nerve terminal, as demonstrated by electron microscopy. Ultrastructurally, axon terminals were disorganized, depleted of vesicles, and subdivided by the infiltrating processes of capping Schwann cells. These findings provide clear pathological evidence to support a role for anti-ganglioside antibodies in mediating nerve terminal injury and further advance the view that this site may be of importance as a target in some human neuropathies.
Collapse
Affiliation(s)
- G M O'Hanlon
- University Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Willison HJ, Ang W, Gilhus NE, Graus F, Liblau R, Vedeler C, Vincent A. EFNS task force report: a questionnaire-based survey on the service provision and quality assurance for determination of diagnostic autoantibody tests in European neuroimmunology centres. European Federation of Neurological Societies. Eur J Neurol 2000; 7:625-8. [PMID: 11136347 DOI: 10.1046/j.1468-1331.2000.00158.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Autoantibodies to a wide variety of neural components are frequently sought in the sera of patients with neurological diseases suspected to have an antibody-associated autoimmune basis. Variations in assay methodology and availability are likely to exist throughout European diagnostic immunology centres, and interlaboratory discrepancies in performance for some assays have been reported. The availability of quality assurance is largely unknown. In this questionnaire-based EFNS task force, all 18 national representatives of the Neuroimmunology Panel within the EFNS were invited to estimate the service provision within their country; 12 panel members responded. From these responses, it emerged that a range of assays are being performed throughout European centres, involving over 20 separate antigens, using a broad array of immunodetection techniques. With the exception of the estimation of anti-AChR antibodies for the diagnosis of myasthenia gravis, no systematic quality assurance schemes are available, this being conducted on an ad hoc basis, or not at all. Since quality is a central component of assay sensitivity and specificity, we conclude that there is an urgent need to introduce pan-European quality assurance schemes, based on provision of positive and negative test sera from a central source, and in which all neuroimmunology laboratories should participate.
Collapse
Affiliation(s)
- H J Willison
- University Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, UK.
| | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
The role of antiglycolipid antibodies in peripheral neuropathy continues to be defined in terms of clinical-serological associations and innovative experimental work establishing the role of these antibodies in pathogenesis. The present review focuses on the major developments in this field over the past 12 months.
Collapse
Affiliation(s)
- C P O'Leary
- University Department of Neurology, South Glasgow University Hospitals Trust, General Hospital, UK
| | | |
Collapse
|
28
|
O'Hanlon GM, Veitch J, Gallardo E, Illa I, Chancellor AM, Willison HJ. Peripheral neuropathy associated with anti-GM2 ganglioside antibodies: clinical and immunopathological studies. Autoimmunity 2000; 32:133-44. [PMID: 11078160 DOI: 10.3109/08916930008994083] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
GM2 ganglioside is a potential peripheral nerve antigen for neuropathy-associated autoantibodies. However little data are available on their pathogenic effects, if any. In this study we have screened both neuropathy-associated and control sera for anti-GM2 antibodies and subsequently used high titre sera for immunohistological and complement mediated cytotoxicity studies. We identified abnormally elevated anti-GM2 antisera in the normal population, as well as in patients with peripheral neuropathies and other neurological diseases. GM2 antibodies were either mono-reactive, cross-reactive with GM1a, or cross-reactive with GalNAc-GM1b and/or GalNAc-GD1a. All GM2 antisera from neuropathy subjects and normal controls bound to, and were capable of complement-mediated lysis of the NSC-34 cell line which expresses high levels of membrane-associated GM2. However, in immunohistological studies on human and rodent peripheral nervous system tissues, no specific binding was seen with GM2 antisera, either cross-reactive with GalNAc-GM1b and GalNAc-GDla, or with GM1a. These data indicate that although GM2 antisera can lyse neural membranes containing GM2, this antigen(s) is not detectable by standard immunohistological techniques in human or rodent peripheral nerve. This raises doubts about their pathophysiological significance in human autoimmune neuropathy.
Collapse
Affiliation(s)
- G M O'Hanlon
- University of Glasgow Department of Neurology, Southern General Hospital, Scotland
| | | | | | | | | | | |
Collapse
|
29
|
Abstract
Miller Fisher syndrome (MFS) is clinically characterized by ataxia, areflexia, and ophthalmoplegia, and is associated with serum anti-GQ1b-ganglioside antibodies. We have previously shown that anti-GQ1b antibodies induce complement-dependent, alpha-latrotoxin-like effects at mouse neuromuscular junctions (NMJs) in vitro. This effect comprises a massive increase in spontaneous quantal acetylcholine (ACh) release, accompanied by block of evoked release and muscle paralysis. This mechanism may contribute to the motor features of MFS. Whether the block of evoked ACh release is a primary effect of anti-GQ1b antibodies or occurs secondary to massive complement-dependent spontaneous release is unknown. Using conventional micro-electrode methods, we measured in detail ACh release evoked with low- and high-rate nerve stimulation, and studied the effect on it of a purified MFS IgG and a mouse monoclonal anti-GQ1b IgM (without added complement). We found that evoked transmitter release was unaffected. Control experiments proved binding of anti-GQ1b antibody at the NMJ. We conclude that the block of nerve-evoked ACh release at the NMJ is not a primary effect of anti-GQ1b antibodies, but is dependent on antibody-mediated complement activation. It remains to be determined whether the block of nerve-evoked ACh release is the consequence of massive spontaneous ACh release or occurs as a concomitant event.
Collapse
Affiliation(s)
- R W Bullens
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
30
|
Lough JC, Rafferty D, McColl JH, Bell F, Willison HJ. The application of control limits analysis to the myometric assessment of motor performance in neuropathy patients. Eur J Neurol 2000; 7:427-34. [PMID: 10971603 DOI: 10.1046/j.1468-1331.2000.00095.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Measurement of muscle strength by myometry is used to monitor the natural course and treatment response of motor system diseases, both in individual patients and clinical trials. However, the practical usefulness of myometric data is reliant upon a statistical method for analysing serial strength measurements which distinguishes disease-related changes from random fluctuations in patient performance and operator/device dependent measurement errors. In this study we have applied control limits analysis to this problem. Using hand-held dynamometry, sets of baseline strength measurements were collected on two separate occasions during a period of clinical stability from up to four muscle groups in 22 patients with peripheral neuropathies. From these sets of data, 76 control limits were calculated and then used to describe the inter-measurement variation in muscle strength in individual muscles. The range of control limits was wide, varying from <10% of baseline (in 36% of muscles tested) to >50% (in 4% of muscles tested), with 88% of muscles falling within 30% of baseline. Follow-up data were also collected from all patients, including those undergoing treatment. Control limits analysis is a powerful and simple method for assessing the significance of motor performance changes in individual muscles in patients undergoing serial monitoring and can be easily applied to both single patients and clinical trials.
Collapse
Affiliation(s)
- J C Lough
- University Department of Neurology, Southern General Hospital, Glasgow, UK
| | | | | | | | | |
Collapse
|
31
|
Bensa S, Hadden RD, Hahn A, Hughes RA, Willison HJ. Randomized controlled trial of brain-derived neurotrophic factor in Guillain-Barré syndrome: a pilot study. Eur J Neurol 2000; 7:423-6. [PMID: 10971602 DOI: 10.1046/j.1468-1331.2000.00096.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) has the theoretical potential to protect neurones from axonal degeneration. The objective of this study was to discover whether brain-derived neurotrophic factor is safe in Guillain-Barré syndrome, and to make preliminary observations of its efficacy. This was a parallel group randomized controlled trial of subcutaneous brain-derived neurotrophic factor 25 microg/kg daily compared with placebo for up to 24 weeks or until patients could walk without aid. Six patients received brain-derived neurotrophic factor, of whom three had serious adverse events including one death. Four patients received placebo, of whom two had serious adverse events including one death. The rate and extent of recovery were similar in the two groups. This pilot study did not detect any serious adverse events attributed to brain-derived neurotrophic factor treatment.
Collapse
Affiliation(s)
- S Bensa
- Department of Neuroimmunology, Guy's, King's and St Thomas' School of Medicine, Guy's Hospital, London, UK
| | | | | | | | | |
Collapse
|
32
|
Willison HJ. King R.
An Atlas of Peripheral Nerve Pathology
Arnold, London, 1999. ISBN 0 340 586664. 217 pp h/b. Price £125.00. Neuropathol Appl Neurobiol 2000. [DOI: 10.1046/j.1365-2990.2000.026001102.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
33
|
Abstract
Over the past decade, remarkable progress has been made in our understanding of the pathogenesis of Miller Fisher syndrome (MFS), a clinical variant of Guillain Barré syndrome (GBS). MFS comprises the clinical triad of ataxia, areflexia and ophthalmoplegia. It is associated with acute-phase IgG antibodies to GQ1b and GT1a gangliosides in over 90% of cases which are highly disease specific. Like GBS, MFS is a post-infectious syndrome following diverse infections, but particular attention has been paid to its association with Campylobacter jejuni enteritis. Serostrains of C. jejuni isolated from infected patients bear ganglioside-like epitopes in their lipopolysaccharide core oligosaccharides, which elicit humoral immune responses exhibiting molecular mimicry with GQ1b/GT1a gangliosides. These antibodies are believed to be the principal cause of the syndrome and physiological studies aimed at proving this have focused on the motor-nerve terminal as a potential site of pathogenic action. This review describes these findings and formulates a pathogenesis model based on our current state of knowledge.
Collapse
Affiliation(s)
- H J Willison
- University Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK.
| | | |
Collapse
|
34
|
Goodyear CS, O'Hanlon GM, Plomp JJ, Wagner ER, Morrison I, Veitch J, Cochrane L, Bullens RW, Molenaar PC, Conner J, Willison HJ. Monoclonal antibodies raised against Guillain-Barré syndrome-associated Campylobacter jejuni lipopolysaccharides react with neuronal gangliosides and paralyze muscle-nerve preparations. J Clin Invest 1999. [PMID: 10491405 DOI: 10.1172/jci6837e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Guillain-Barré syndrome and its variant, Miller-Fisher syndrome, are acute, postinfectious, autoimmune neuropathies that frequently follow Campylobacter jejuni enteritis. The pathogenesis is believed to involve molecular mimicry between sialylated epitopes on C. jejuni LPSs and neural gangliosides. More than 90% of Miller-Fisher syndrome cases have serum anti-GQ1b and anti-GT1a ganglioside antibodies that may also react with other disialylated gangliosides including GD3 and GD1b. Structural studies on LPS from neuropathy-associated C. jejuni strains have revealed GT1a-like and GD3-like core oligosaccharides. To determine whether this structural mimicry results in pathogenic autoantibodies, we immunized mice with GT1a/GD3-like C. jejuni LPS and then cloned mAb's that reacted with both the immunizing LPS and GQ1b/GT1a/GD3 gangliosides. Immunohistology demonstrated antibody binding to ganglioside-rich sites including motor nerve terminals. In ex vivo electrophysiological studies of nerve terminal function, application of antibodies either ex vivo or in vivo via passive immunization induced massive quantal release of acetylcholine, followed by neurotransmission block. This effect was complement-dependent and associated with extensive deposits of IgM and C3c at nerve terminals. These data provide strong support for the molecular mimicry hypothesis as a mechanism for the induction of cross-reactive pathogenic anti-ganglioside/LPS antibodies in postinfectious neuropathies.
Collapse
Affiliation(s)
- C S Goodyear
- University Department of Neurology, Southern General Hospital, Glasgow G51 4TF, Scotland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Goodyear CS, O'Hanlon GM, Plomp JJ, Wagner ER, Morrison I, Veitch J, Cochrane L, Bullens RW, Molenaar PC, Conner J, Willison HJ. Monoclonal antibodies raised against Guillain-Barré syndrome-associated Campylobacter jejuni lipopolysaccharides react with neuronal gangliosides and paralyze muscle-nerve preparations. J Clin Invest 1999; 104:697-708. [PMID: 10491405 PMCID: PMC408431 DOI: 10.1172/jci6837] [Citation(s) in RCA: 168] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Guillain-Barré syndrome and its variant, Miller-Fisher syndrome, are acute, postinfectious, autoimmune neuropathies that frequently follow Campylobacter jejuni enteritis. The pathogenesis is believed to involve molecular mimicry between sialylated epitopes on C. jejuni LPSs and neural gangliosides. More than 90% of Miller-Fisher syndrome cases have serum anti-GQ1b and anti-GT1a ganglioside antibodies that may also react with other disialylated gangliosides including GD3 and GD1b. Structural studies on LPS from neuropathy-associated C. jejuni strains have revealed GT1a-like and GD3-like core oligosaccharides. To determine whether this structural mimicry results in pathogenic autoantibodies, we immunized mice with GT1a/GD3-like C. jejuni LPS and then cloned mAb's that reacted with both the immunizing LPS and GQ1b/GT1a/GD3 gangliosides. Immunohistology demonstrated antibody binding to ganglioside-rich sites including motor nerve terminals. In ex vivo electrophysiological studies of nerve terminal function, application of antibodies either ex vivo or in vivo via passive immunization induced massive quantal release of acetylcholine, followed by neurotransmission block. This effect was complement-dependent and associated with extensive deposits of IgM and C3c at nerve terminals. These data provide strong support for the molecular mimicry hypothesis as a mechanism for the induction of cross-reactive pathogenic anti-ganglioside/LPS antibodies in postinfectious neuropathies.
Collapse
Affiliation(s)
- C S Goodyear
- University Department of Neurology, Southern General Hospital, Glasgow G51 4TF, Scotland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Prendergast MM, Willison HJ, Moran AP. Human monoclonal immunoglobulin M antibodies to ganglioside GM1 show diverse cross-reactivities with lipopolysaccharides of Campylobacter jejuni strains associated with Guillain-Barré syndrome. Infect Immun 1999; 67:3698-701. [PMID: 10377164 PMCID: PMC116569 DOI: 10.1128/iai.67.7.3698-3701.1999] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We examined the reactivity of a panel of anti-GM1 immunoglobulin M monoclonal antibodies (MAbs) cloned from multifocal motor neuropathy patients with lipopolysaccharides (LPSs) of Campylobacter jejuni strains, including serotype O:41 strains associated with Guillain-Barré syndrome. The MAbs reacted with ganglioside GM1 to different degrees, and these differences in fine specificities for GM1 were reflected in the different degrees of reactivity with each of the C. jejuni LPSs tested. Antibodies could also be discriminated by the varying patterns of inhibition by cholera toxin (a GM1 ligand) in LPS binding studies. These results indicate that there is a substantial heterogeneity among C. jejuni O:41 strains in their expression of GM1-like epitopes and among the fine specificities of different neuropathy-associated anti-GM1 antibodies.
Collapse
Affiliation(s)
- M M Prendergast
- Department of Microbiology, National University of Ireland, Galway, Ireland
| | | | | |
Collapse
|
37
|
Paparounas K, O'Hanlon GM, O'Leary CP, Rowan EG, Willison HJ. Anti-ganglioside antibodies can bind peripheral nerve nodes of Ranvier and activate the complement cascade without inducing acute conduction block in vitro. Brain 1999; 122 ( Pt 5):807-16. [PMID: 10355667 DOI: 10.1093/brain/122.5.807] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The neurophysiological effects of nine neuropathy-associated human anti-ganglioside antisera, three monoclonal antibodies to ganglioside GM1 (GM1) and of the cholera toxin B subunit (a GM1 ligand) were studied on mouse sciatic nerve in vitro. GM1 antisera and monoclonal antibodies from patients with chronic motor neuropathies and Guillain-Barre syndrome, and GQ1b/ disialosyl antisera and monoclonal antibodies from patients with chronic ataxic neuropathies and Miller Fisher syndrome were studied. In vitro recording, for up to 6 h, of compound nerve action potentials, latencies, rise times and stimulus thresholds from isolated desheathed sciatic nerve was performed in the presence of antiganglioside antibodies and fresh human serum as an additional source of complement. No changes were observed over this time course, with 4-6 h values for all electrophysiological parameters being within 15% of the starting values for both normal and antibody containing sera and for the cholera toxin B subunit. Parallel experiments on identically prepared desheathed nerves performed with 0.5 nM saxitoxin led to complete conduction block within 10 min of application. Under identical conditions to those used for electrophysiological recordings, quantitative immunohistological evaluation revealed a significant increase in IgM (immunoglobulin M) deposition at nodes of Ranvier from 5.3+/-3.1% to 28.7+/-8.4% (mean+/-SEM) of desheathed nerves exposed to three normal and three antibody containing sera, respectively (P < 0.03). Complement activation was seen at 100% of normal and 79% of disease-associated IgM positive nodes of Ranvier. These data indicate that anti-ganglioside antibodies can diffuse into a desheathed nerve, bind to nodes of Ranvier and fix complement in vitro without resulting in any overt physiological deterioration of the nerve over 4-6 h. This suggests that the node of Ranvier is relatively resistant to acute antiganglioside antibody mediated injury over this time scale and that anti-ganglioside antibodies and the cholera toxin B subunit are unlikely to have major direct pharmacological effects on nodal function, at least in comparison with the effect of saxitoxin. This in vitro sciatic nerve model appears of limited use for analysing electrophysiologically the effects of anti-ganglioside antibodies on nerve function, possibly because its short-term viability and isolation from circulating systemic factors do not permit the evolution of an inflammatory lesion of sufficient magnitude to induce overt electrophysiological abnormalities. In vivo models may be more suitable for identifying the effects of these antibodies on nerve conduction.
Collapse
Affiliation(s)
- K Paparounas
- University Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK
| | | | | | | | | |
Collapse
|
38
|
Ballantyne JP, Behan PO, Bone I, Durward WF, Grosset D, Kennedy PG, Metcalfe RA, O'Leary CP, Petty RH, Thomas M, Willison HJ, Duncan R. Management of drug budgets. Neurologists do not have confidence in Glasgow's method of managing drugs budget. BMJ 1999; 318:874. [PMID: 10092279 PMCID: PMC1115293 DOI: 10.1136/bmj.318.7187.874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
39
|
Weiss MD, Dalakas MC, Lauter CJ, Willison HJ, Quarles RH. Variability in the binding of anti-MAG and anti-SGPG antibodies to target antigens in demyelinating neuropathy and IgM paraproteinemia. J Neuroimmunol 1999; 95:174-84. [PMID: 10229128 DOI: 10.1016/s0165-5728(98)00247-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Densitometry of immunostained Western blots or thin layer chromatograms and enzyme-linked immunosorbent assays (ELISAs) were used to compare the relative strengths of IgM binding to myelin-associated glycoprotein (MAG), P0 glycoprotein, peripheral myelin protein-22 (PMP-22), sulfate-3-glucuronyl paragloboside (SGPG), and other potential target antigens in a series of eleven patients with sensory or sensorimotor demyelinating neuropathy and IgM paraproteinemia. The IgM from all patients exhibited reactivity with both MAG and SGPG, and there was a statistically significant correlation between the overlay assays and ELISAs for measuring the strength of IgM binding to MAG and to SGPG. However, the data revealed variations in the relative strengths with which the antibodies bound to the potential target antigens and heterogeneity in their fine specificities. First, there was a poor correlation between the strength of binding to MAG and to SGPG, respectively. Second, reactivity with MAG or SGPG in a few of the patients was only detected by one of the two assay systems. Third, about one-third of the patients' IgM absolutely required the sulfate on SGPG for reactivity, whereas the others retained some reactivity after removal of the sulfate. Fourth, IgM from two of the patients exhibited unusually strong reactivity with the proteins of compact myelin, P0 and PMP22. These relative differences in strengths of antibody binding to the potential antigens were compared with the patients' clinical presentations and with their responses to intravenous immunoglobulin (IVIg) therapy in a clinical trial in which they participated. For the most part, these variations did not correlate with clinical presentation, which was relatively homogeneous in this series of patients. However, an inverse relationship was noted between degree of reactivity to MAG by ELISA and response to IVIg. Two of the patients who responded had only mild elevations of IgM antibodies to nerve glycoconjugates and exhibited some unusual immunochemical and clinical characteristics in comparison to the other patients. The results demonstrate differences in the relative strengths with which anti-MAG and anti-SGPG IgM antibodies from different patients bind to potential neural target antigens which may affect pathogenic mechanisms and response to therapy.
Collapse
Affiliation(s)
- M D Weiss
- Myelin and Brain Development Section, Laboratory of Molecular and Cellular Neurobiology, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | | | | | | | | |
Collapse
|
40
|
Plomp JJ, Molenaar PC, O'Hanlon GM, Jacobs BC, Veitch J, Daha MR, van Doorn PA, van der Meché FG, Vincent A, Morgan BP, Willison HJ. Miller Fisher anti-GQ1b antibodies: alpha-latrotoxin-like effects on motor end plates. Ann Neurol 1999; 45:189-99. [PMID: 9989621 DOI: 10.1002/1531-8249(199902)45:2<189::aid-ana9>3.0.co;2-t] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In the Miller Fisher syndrome (MFS) variant of the Guillain-Barré syndrome, weakness is restricted to extraocular muscles and occasionally other craniobulbar muscles. Most MFS patients have serum antibodies against ganglioside type GQ1b of which the pathophysiological relevance is unclear. We examined the in vitro effects of MFS sera, MFS IgG, and a human monoclonal anti-GQ1b IgM antibody on mouse neuromuscular junctions (NMJs). It was found that anti-GQ1b antibodies bind at NMJs where they induce massive quantal release of acetylcholine from nerve terminals and eventually block neuromuscular transmission. This effect closely resembled the effect of the paralytic neurotoxin alpha-latrotoxin at the mouse NMJs, implying possible involvement of alpha-latrotoxin receptors or associated downstream pathways. By using complement-deficient sera, the effect of anti-GQ1b antibodies on NMJs was shown to be entirely dependent on activation of complement components. However, neither classical pathway activation nor the formation of membrane attack complex was required, indicating the effects could be due to involvement of the alternative pathway and intermediate complement cascade products. Our findings strongly suggest that anti-GQ1b antibodies in conjunction with activated complement components are the principal pathophysiological mediators of motor symptoms in MFS and that the NMJ is an important site of their action.
Collapse
Affiliation(s)
- J J Plomp
- Department of Neurology, Leiden University Medical Centre, The Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Ho TW, Willison HJ, Nachamkin I, Li CY, Veitch J, Ung H, Wang GR, Liu RC, Cornblath DR, Asbury AK, Griffin JW, McKhann GM. Anti-GD1a antibody is associated with axonal but not demyelinating forms of Guillain-Barré syndrome. Ann Neurol 1999; 45:168-73. [PMID: 9989618 DOI: 10.1002/1531-8249(199902)45:2<168::aid-ana6>3.0.co;2-6] [Citation(s) in RCA: 216] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Immunopathological studies suggest that the target of immune attack is different in the subtypes of Guillain-Barré syndrome (GBS). In acute motor axonal neuropathy (AMAN), the attack appears directed against the axolemma and nodes of Ranvier. In acute inflammatory demyelinating polyneuropathy (AIDP), the attack appears directed against a component of the Schwann cell. However, the nature of the antigenic targets is still not clear. We prospectively studied 138 Chinese GBS patients and found that IgG anti-GD1a antibodies were closely associated with AMAN but not AIDP. With a cutoff titer of greater than 1:100, 60% of AMAN versus 4% of AIDP patients had IgG anti-GD1a antibodies; with a cutoff titer of greater than 1:1,000, 24% of AMAN patients and none of the AIDP patients had IgG anti-GD1a antibodies. In contrast, low levels of IgG anti-GM1 antibodies (> 1:100) were detected in both the AMAN and the AIDP forms (57% vs 35%, NS). High titers of IgG anti-GM1 (>1:1,000) were more common in the AMAN form (24% vs 8%, NS). Serological evidence of recent Campylobacter infection was detected in 81% of AMAN and 50% of AIDP patients, and anti-ganglioside antibodies were common in both Campylobacter-infected and noninfected patients. Our results suggest that IgG anti-GD1a antibodies may be involved in the pathogenesis of AMAN.
Collapse
Affiliation(s)
- T W Ho
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Antibodies to GM1 ganglioside are found in some patients with the Guillain-Barré syndrome and multifocal motor neuropathy, and may alter neuronal excitability. We measured voltage-gated sodium channel (VGSC) function by 22Na+ influx in a motor neuronal cell line (NSC19) in which we demonstrated GM1 ganglioside and tetrodotoxin-sensitive VGSC function. We were unable to detect any effect of peripheral neuropathy plasmas, with or without complement, on VGSC function in NSC19 cells.
Collapse
Affiliation(s)
- M Benatar
- Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | | | | |
Collapse
|
43
|
Willison HJ, Veitch J, Swan AV, Baumann N, Comi G, Gregson NA, Illa I, Zielasek J, Hughes RA. Inter-laboratory validation of an ELISA for the determination of serum anti-ganglioside antibodies. Eur J Neurol 1999; 6:71-7. [PMID: 10209353 DOI: 10.1046/j.1468-1331.1999.610071.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anti-ganglioside antibodies are frequently sought in the sera of patients with autoimmune peripheral neuropathy, using an enzyme-linked immunosorbent assay (ELISA) as the principal method for antibody detection. Wide variations in assay performance between laboratories have been reported. In this study, we established a standardized ELISA method between laboratories within the European Inflammatory Neuropathy Cause and Treatment (INCAT) group and determined the inter-laboratory variance in assay performance using both the standardized INCAT method and in-house local methods. As expected, the inter-laboratory variances were greater using local methods than using the standardized method, producing titre estimates which could be 24.8 or 7.6 times larger or smaller, respectively, than the true means for these laboratories. Using the standardized method, the within laboratory measurement error accounted for 41% of the inter-laboratory variation, providing a theoretical upper limit to which technical improvements within laboratories could reduce inter-laboratory variation. These data describe the intrinsic weaknesses within the widely used ganglioside antibody ELISA methods and reinforce the importance of inter-laboratory cooperation within this area. Standardized serological reagents used in this study are available from INCAT members.
Collapse
Affiliation(s)
- H J Willison
- University Department of Neurology, Southern General Hospital, Glasgow, Scotland
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Sheikh KA, Nachamkin I, Ho TW, Willison HJ, Veitch J, Ung H, Nicholson M, Li CY, Wu HS, Shen BQ, Cornblath DR, Asbury AK, McKhann GM, Griffin JW. Campylobacter jejuni lipopolysaccharides in Guillain-Barré syndrome: molecular mimicry and host susceptibility. Neurology 1998; 51:371-8. [PMID: 9710005 DOI: 10.1212/wnl.51.2.371] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study was designed to determine if the presence of specific ganglioside-like moieties in Campylobacter lipopolysaccharides (LPSs) is related to the development of Guillain-Barré syndrome (GBS), and to discover how frequently such moieties, including GM1, are present in these LPSs. METHODS We studied Campylobacter isolates and sera from seven patients with GBS (five acute motor axonal neuropathy, one acute inflammatory demyelinating polyneuropathy, and one Fisher's syndrome), and compared them with similar specimens from patients with Campylobacter enteritis alone. RESULTS All GBS patients had antiganglioside antibodies. Anti-GM1 and anti-GD1a titers were significantly elevated in post-Campylobacter GBS, both axonal and demyelinating, compared with normal control subjects or those with uncomplicated Campylobacter diarrhea. Campylobacter isolated from patients with GBS and with enteritis alone had similar ganglioside-like moieties. CONCLUSIONS These results indicate that patients who develop GBS respond differently to the ganglioside-like epitopes on Campylobacter than do non-GBS diarrhea patients. Our findings support a role for host susceptibility as a determinant for the outcome following Campylobacter infection. These findings have important implications for the development of vaccines against Campylobacter jejuni.
Collapse
Affiliation(s)
- K A Sheikh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
O'Hanlon GM, Paterson GJ, Veitch J, Wilson G, Willison HJ. Mapping immunoreactive epitopes in the human peripheral nervous system using human monoclonal anti-GM1 ganglioside antibodies. Acta Neuropathol 1998; 95:605-16. [PMID: 9650753 DOI: 10.1007/s004010050847] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A series of monoclonal IgM anti-GM1 ganglioside antibodies has been cloned from peripheral blood lymphocytes of patients with multifocal motor neuropathy and Guillain-Barré syndrome. In solid-phase immunoassay, the antibodies react with GMI, and also in differing degrees to the structurally related glycolipids asialo-GM1 (GA1) and GD1b. Here we describe the binding patterns of six human anti-GM I antibodies to epitopes within the human nervous system. Antibodies were observed to bind to motor neurons and spinal grey matter, dorsal and ventral spinal roots, dorsal root ganglion neurons, nodes of Ranvier, neuromuscular junctions and skeletal muscle. The distribution of immunoreactive epitopes, which included sensory structures, extended beyond those sites conventionally regarded as pathologically affected in anti-GM1 antibody-associated motor nerve syndromes. This undermines a model of disease pathogenesis based solely on antigen distribution. Factors other than the presence or absence of antigen, such as the local ganglioside topography, antibody penetration into, and pathophysiological vulnerability of a particular site may also influence the clinicopathological outcome of anti-GM1 antibody-mediated autoimmune attack.
Collapse
Affiliation(s)
- G M O'Hanlon
- University Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland
| | | | | | | | | |
Collapse
|
46
|
Willison HJ, Lastovica AJ, Prendergast MM, Moran AP, Walsh C, Flitcroft I, Eustace P, McMahon C, Smith J, Smith OP, Lakshmandass G, Taylor MRH, Holland CV, Cox D, Good B, Kearns GM, Gaffney P, Shark K, Frauenshuh M, Ortmann W, Messner R, King R, Rich S, Behrens T, Mahmud N, Molloy A, McPartlin J, Scott JM, Weir DG, Walsh KM, Thorburn D, Mills P, Morris AJ, Good T, Cameron S, McCruden EAB, Bennett MW, O’Connell J, Brady C, Roche D, Collins JK, Shanahan F, O’Sullivant GC, Henry M, Koston S, McMahon K, MacNee W, FitzGerald MX, O’Connor CM, McGonagle D, Gibbon W, O’Connor P, Emery P, Murphy M, Watson R, Casey E, Naidu E, Murphy M, Watson R, Barnes L, McCann S, Murphy M, Watson R, Barnes L, Sweeney E, Barrett EJ, Graham H, Cunningham RT, Johnston CF, Curry WJ, Buchanan KD, Courtney CH, McAllister AS, McCance DR, Hadden DR, Bell PM, Leslie H, Sheridan B, Atkinson AB, Kilbane MT, Smith DF, Murray MJ, Shering SG, McDermott EWM, O’Higgins NJ, Smyth PPA, McEneny J, Trimble ER, Young IS, Sharpe P, Mercer C, McMaster D, Young IS, Evans AE, Young IS, Cundick J, Hasselwander O, McMaster D, McGeough J, Savage D, Maxwell AP, Evans AE, Kee F, Larkin CJ, Watson RGP, Johnston C, Ardill JES, Buchanan KD, McNamara DA, Walsh TN, Bouchier-Hayes DJ, Madden C, Timon C, Gardiner N, Lawler M, O’Riordan J, Duggan C, McCann SR, Gowing H, Braakman E, Lawler M, Byrne C, Martens ACM, Hagenbeek A, McCann SR, Kinsella N, Cusack S, Lawler M, Baker H, White B, Smith OP, Lawler M, Gardiner N, Molloy K, Gowing H, Wogan A, McCann SR, McElwaine S, Lawler M, Hollywood D, McCann SR, Mcmahon C, Merry C, Ryan M, Smith O, Mulcahy FM, Murphy C, Briones J, Gardiner N, McCann SR, Lawler M, White B, Lawler M, Cusack S, Kinsella N, Smith OP, Lavin P, McCaffrey M, Gillen P, White B, Smith OP, Thompson L, Lalloz M, Layton M, Barnes L, Corish C, Kennedy NP, Flood P, Mulligan S, McNamara E, Kennedy NP, Flood P, Mathias PM, Ball E, Duiculescu D, Calistru P, O’Gorman N, Kennedy NP, Abuzakouk M, Feighery C, Brannigan M, Pender S, Keeling F, Varghese J, Lee M, Colreavy M, Gaffney R, Hone S, Herzig M, Walsh M, Dolan C, Wogan A, Lawler M, McCann SR, Hollywood D, Donovan D, Harmey J, Bouchier-Hayes DJ, Haverty A, Wang JH, Harmey JH, Redmond HP, Bouchier-Hayes DJ, McGreal G, Shering SG, Moriarty MJ, Shortt A, Kilbane MT, Smith DF, McDermott EWM, O’Higgins NJ, Smyth PPA, McNamara DA, Harmey J, Wang JH, Donovan D, Walsh TN, Bouchier-Hayes DJ, Kay E, Pidgeon G, Harmey J, McNamara DA, Bouchier-Hayes DJ, Dunne P, Lambkin H, Russell JM, O’Neill AJ, Dunne BM, O’Donovan M, Lawler M, Gaffney EF, Gillan JE, Cotter TG, Horan J, Jones D, Biswas SK, Mulkerrin EC, Brady H, O’Donnell J, Neary J, Healy E, Watson A, Keogh B, Ryan M, Cassidy C, Ward S, Stokes E, Keoghan F, Barrett A, O’Connell P, Ryall N, O’Connell PA, Jenkinson A, O’Brien T, O’Connell PG, Harrison R, Barrett T, Bailey DMD, Butler A, Barton DE, Byrne C, McElwaine S, McCann SR, Lawler M, Cusack S, Lawler M, White B, Smith OP, Daly G, Gill M, Heron S, Hawi Z, Fitzgerald M, Hawi Z, Mynett-Johnson L, Shiels D, Kendler K, McKeon P, Gill M, Straub R, Walsh D, Ryan F, Barton DE, McCabe D, Murphy R, Segurado R, Mulcahy T, Larson B, Comerford C, O’Connell R, O’Mahony E, Gill M, Donnelly J, Minahan F, O’Neill D, Farrell Z, O’Neill D, Jones D, Horan J, Glynn C, Biswas SK, Mulkerrin E, Brady H, Lennox SE, Murphy A, Rea IM, McNulty H, McMeel C, O’Neill D, McEvoy H, Freaney R, McKenna MJ, Crowe M, Keating D, Colreavy M, Hone S, Norman G, Widda S, Viani L, Galvin, Nolan CM, Hardiman O, Hardiman O, Brett F, Droogan O, Gallagher P, Harmey M, King M, Murphy J, Perryrnan R, Sukumaran S, Walsh J, Farrell MA, Hughes G, Cunningham C, Walsh JB, Coakley D, O’Neill D, Hurson M, Flood P, McMonagle P, Hardiman O, Ryan F, O’Sullivan S, Merry C, Dodd P, Redmond J, Mulcahy FM, Browne R, Keating S, O’Connor J, Cassidy BP, Smyth R, Sheppard NP, Cullivan R, Crown J, Walsh N, Denihan A, Bruce I, Radic A, Coakley D, Lawlor BA, Bridges PK, O’Doherty M, Farrington A, O’Doherty M, Farragher B, Fahy S, Kelly R, Carey T, Owens J, Gallagher O, Sloan D, McDonough C, Casey P, Horgan A, Elneihum A, O’Neill C, McMonagle T, Quinn J, Meagher D, Murphy P, Kinsella A, Mullaney J, Waddington JL, Rooney S, Rooney S, Bamford L, Sloan D, O’Connor JJ, Franklin R, O’Brien K, Fitzpatrick G, Laffey JG, Boylan JF, Laffey J, Coleman M, Boylan J, Laffey JG, McShane AJ, Boylan JF, Loughrey JPR, Gardiner J, McGinley J, Leonard I, Carey M, Neligan P, O’Rourke J, Cunningham A, Fennessy F, Kelly C, Bouchier-Hayes D, Fennessy F, Wang JH, Kelly C, Bouchier-Hayes D, Fennessy F, Wang JH, Kelly C, Bouchier-Hayes DJ, Kellett J, Laffey J, Murphy D, Regan J, O’Keeffe D, Mahmud A, Hemeryck L, Feely J, Mahmud A, Hemeryck L, Hall M, Feely J, Menown IBA, Mathew TP, Nesbitt GS, Syme M, Young IS, Adgey AAJ, Menown IBA, Turtle F, Allen J, Anderson J, Adgey AAJ, O’Hanlon R, Codd MB, Walkin S, McCann HA, Sugrue DD, Rasheed AM, Chen G, Kelly C, Bouchier-Hayes DJ, Leahy A, Rasheed AM, Kay E, Jina S, Bouchier-Hayes DJ, Leahy A, McDowell I, Rasheed AM, Wang JH, Wo Q, Kelly C, Bouchier-Hayes DJ, Leahy A, Shuhaibar MN, McGovern E, Turtle F, Menown IBA, Manoharan G, Kirkpatrick R, Campbell NPS, Walkin S, Codd MB, O’Hanlon R, McCarthy C, McCann HA, Sugrue DD, Wen Y, Killalea S, Hall M, Hemeryck L, Feely J, Fahy CJ, Griffith A, McGinley J, McCabe D, Fraser A, Casey E, Ryan T, Murphy R, Browne M, Fenton J, Hughes J, Timon CI, Fenton J, Curran A, Smyth D, Viani L, Walsh M, Hughes JP, Fenton J, Lee P, Kelly A, Timon CI, Hughes JP, Fenton J, Shine N, Blayney A, McShane DP, Timon CI, Hussey J, Howlett M, Langton A, McEvoy A, Slevin J, Fitzpatrick C, Turner MJ, Enright F, Goggin N, Costigan C, Duff D, Osizlok P, Wood F, Watson R, Fitzsimons RB, Flanagan N, Enright F, Barnes L, Watson R, Molloy E, Griffin E, Deasy PF, Sheridan M, White MJ, Moore R, Gray A, Hill J, Glasgow JFT, Middleton B, Slattery D, Donoghue V, McMahon A, Murphy J, Slattery D, McCarthy A, Oslislok P, Duff D, Colreavy M, Keogh I, Hone S, Walsh M, Henry M, Koston S, McMahon K, MacNee W, FitzGerald MX, O’Connor CM, Russell KJ, Henry M, Fitzgerald MX, O’Connor CM, Kavanagh PV, McNamara SM, Feely J, Barry M, O’Brien JE, McCormick P, Molony C, Doyle RM, Walsh JB, Coakley D, Codd MB, O’Connell PR, Dowey LC, McGlynn H, Thurnham DI, Elborn SJ, Flynn L, Carton J, Byrne B, O’Farrelly C, Kelehan P, O’Herlihy C, O’Hara AM, Moran AP, Orren A, Fernie BA, Merry C, Clarke S, Courtney G, de Gascun C, Mulcahy FM, Merry C, Ryan M, Barry M, Mulcahy FM, Merry C, Ryan M, Barry M, Mulcahy FM, Byrne M, Moylett E, Murphy H, Butler K, Nourse C, Thaker H, Barry C, Russell J, Sheehan G, Boyle B, Hone R, Conboy B, Butler C, Moris D, Cormican M, Flynn J, McCormack O, Corbally N, Murray A, Kirrane S, O’Keane C, Hone R, Lynch SM, Cryan B, Whyte D, Morris D, Butler C, Cormican M, Flynn J, Corbett-Feeney G, Murray A, Corbally N, Hone R, Mackle T, Colreavy M, Perkins J, Saidlear C, Young A, Eustace P, Wrigley M, Clifford J, Waddington JL, Tighe O, Croke DT, Drago J, Sibley DR, Feely J, Kelly A, Carvalho M, Hennessy M, Kelly M, Feely J, Hughes C, Hanlon M, Feely J, Sabra K, Keane T, Egan D, Ryan M, Maerry C, Ryan M, Barry M, Mulcahy FM, Maerry C, Ryan M, Barry M, Mulcahy FM, Sharma SC, Williams D, Kelly A, Carvalho M, Feely J, Williams D, Kelly A, Carvalho M, Feely J, Codd MB, Mahon NG, McCann HA, Sugrue DD, Sayers GM, Johnson Z, McNamara SM, Kavanagh PV, Feely J. National scientific medical meeting 1997 abstracts. Ir J Med Sci 1998. [DOI: 10.1007/bf02937234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
47
|
Willison HJ, O'Hanlon G, Paterson G, O'Leary CP, Veitch J, Wilson G, Roberts M, Tang T, Vincent A. Mechanisms of action of anti-GM1 and anti-GQ1b ganglioside antibodies in Guillain-Barré syndrome. J Infect Dis 1997; 176 Suppl 2:S144-9. [PMID: 9396699 DOI: 10.1086/513799] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Anti-GM1 and anti-GQ1b ganglioside antibodies are found in association with acute and chronic peripheral neuropathies, including Guillain-Barré syndrome. They are believed to arise as a result of molecular mimicry with immunogenic microbial polysaccharides. Although anti-ganglioside antibodies are suspected to play a causal role in neuropathy pathogenesis, the details of this have yet to be proven. The approach in this laboratory to solving this issue has been to generate anti-GM1 and anti-GQ1b monoclonal antibodies from peripheral blood lymphocytes of affected patients and to study their immunolocalization in peripheral nerve and their electrophysiologic effects in animal models in which peripheral nerve sites are exposed to anti-ganglioside antibodies. These data show that anti-ganglioside antibody-reactive epitopes are widely distributed in peripheral nerve and can cause electrophysiologic abnormalities in a variety of model systems; thus, these data support the view that anti-ganglioside antibody-reactive epitopes may directly contribute to neuropathy pathogenesis.
Collapse
Affiliation(s)
- H J Willison
- University Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Jacobs BC, O'Hanlon GM, Breedland EG, Veitch J, van Doorn PA, Willison HJ. Human IgM paraproteins demonstrate shared reactivity between Campylobacter jejuni lipopolysaccharides and human peripheral nerve disialylated gangliosides. J Neuroimmunol 1997; 80:23-30. [PMID: 9413256 DOI: 10.1016/s0165-5728(97)00130-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
IgM paraproteins from patients with CANOMAD (chronic ataxic neuropathy, ophthalmoplegia, M-protein, agglutination, anti-disialosyl antibodies) react with NeuAc(alpha 2-8)NeuAc epitopes on a wide range of gangliosides including GQ1b, GT1a, GD1b and GD3. The tissue distribution of reactive antigens in human peripheral nerve has not been addressed in detail. In addition, the origin of these antibodies is unknown. Here we report that purified anti-disialosyl paraproteins from two affected patients bind a wide array of human peripheral nerve structures including dorsal root ganglia, dorsal and ventral root axons, femoral and oculomotor nerves. We also show that these paraproteins bind lipopolysaccharides of Campylobacter jejuni isolates from 3/3 cases of Miller Fisher syndrome, and to a less frequent extent, from cases of Guillain-Barré syndrome and enteritis controls. In conjunction with our previous studies, these data provide a possible causal link between the origin and pathogenic effects of anti-disialosyl antibodies in human paraproteinaemic neuropathy.
Collapse
Affiliation(s)
- B C Jacobs
- Department of Neurology, Erasmus University, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
IgG antibodies to GQ1b ganglioside are found in > 90% of patients with the Miller Fisher Syndrome (MFS). MFS sera or IgG preparations have marked effects on neurotransmitter release at the neuromuscular junction, but their mode(s) of action remain unclear. To establish a cell-based system for investigating the mechanism of action of MFS serum preparations, we looked at neurotransmitter release from three cell lines. We failed to demonstrate substantial 14C-acetylcholine release from two motor-neuronal cell lines, VSC4.1 and NSC19, and therefore studied 3H-noradrenaline release from NGF-differentiated PC12 cells, a neural-crest derived catecholaminergic cell line. K(+)-induced release was inhibited by botulinum toxin and basal release was enhanced by alpha-latrotoxin, resembling that at the neuromuscular junction, although K(+)-induced release was dependent on L-type rather than P/Q-type calcium channels. The cells expressed polysialylated gangliosides on the cell surface. Incubation in heat-inactivated or untreated MFS preparations did not, however, affect basal or K(+)-induced release. Thus the PC12 cells do not appear to be sensitive to the effects of serum antibodies from MFS patients.
Collapse
Affiliation(s)
- M G Benatar
- Institute of Molecular Medicine, University of Oxford, UK
| | | | | |
Collapse
|
50
|
Abstract
Autoimmune ataxic neuropathies are a subset of the sensory ataxic neuropathies which are characterized by ataxia as the dominant presenting feature. The major known causes of autoimmune ataxic neuropathies include sensory variants of the Guillain-Barré syndrome, including Miller-Fisher syndrome, subsets of immunoglobulin M paraproteinaemic neuropathy, paraneoplastic neuropathy and the neuropathy associated with Sjögren's syndrome. Identified antigens as targets for autoantibodies include gangliosides, myelin associated glycoprotein, Hu antigen and extractable nuclear antigens. Some recent studies support the pathogenic role of anti-GD1b ganglioside antibody in autoimmune ataxic neuropathies. The major site of pathology in autoimmune ataxic neuropathies is the dorsal root ganglion, but dorsal roots and peripheral nerve myelin and axons may also be affected.
Collapse
Affiliation(s)
- C P O'Leary
- University Department of Neurology, Southern General Hospital, Glasgow, UK
| | | |
Collapse
|