title: Ambiguous value of anti-ganglioside IgM autoantibodies in Guillain-Barré syndrome and its variants.
abstract: Anti-ganglioside autoantibodies of the IgG type are detected in a half of patients with Guillain-Barré syndrome (GBS), and their detection strongly supports the diagnosis of GBS. In contrast, anti-ganglioside IgM antibodies are also often detected in GBS patients, but it remains unclear whether IgM antibodies indicate a diagnosis of GBS. We identified four GBS patients (3.3%) who tested positive for IgM antibodies but negative for IgG antibodies among 122 patients with GBS and its variants. These four patients were all adolescents or young adults (age 13-22 years), experienced preceding gastrointestinal symptoms, and had serological and/or bacterial evidence of recent Campylobacter jejuni enteritis. Serum IgG reacted strongly with the lipo-oligosaccharide (LOS) of the C. jejuni isolates from these patients' stool specimens. Thin-layer chromatography with immunostaining showed that their serum IgG reacted with resorcinol-positive portion of LOS, suggesting that these patients had IgG autoantibodies against sialic acid-containing epitopes, probably unrecognized ganglioside-like structures on the bacterial LOS. We also examined anti-ganglioside autoantibodies in 22 patients with C. jejuni enteritis without subsequent neurological disorders and detected IgM antibodies in seven (32%) patients. Our data indicate that anti-ganglioside IgM antibodies can be detected in C. jejuni enteritis without complication of GBS, and that the detection of anti-ganglioside IgM antibodies does not always support a diagnosis of GBS. IgG autoantibodies against unrecognized gangliosides might play a role in the development of disease in patients with GBS in whom only anti-ganglioside IgM antibodies are detected by routine clinical testing.
authors.affiliation: Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Minami-kogushi 1-1-1, Ube, Yamaguchi, 755-8505, Japan, kogamrk@yamaguchi-u.ac.jp.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Koga
authors.forename: Masaki
authors.initials: M
authors.lastname: Takahashi
authors.forename: Keiko
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanda
mesh_terms: D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002169:Campylobacter Infections / Q000276:immunology*; D016123:Campylobacter jejuni / Q000276:immunology*; D005260:Female; D005732:Gangliosides / Q000276:immunology*; D020275:Guillain-Barre Syndrome / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007075:Immunoglobulin M / Q000276:immunology*; D008297:Male; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D005732:Gangliosides; D007074:Immunoglobulin G; D007075:Immunoglobulin M