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

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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.

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Acknowledgments

Dr Koga received a Grant-in-Aid for Scientific Research (C) (KAKENHI 15K08464) from the Ministry of Education, Culture, Sports, Science and Technology of Japan. Prof Kanda received a Research Grant for Neuroimmunological Diseases from the Ministry of Health, Labour and Welfare of Japan.

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None.

Ethical standard

The study protocol was approved by the Institutional Ethics Committee at Yamaguchi University Hospital.

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Authors and Affiliations

  1. Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Minami-kogushi 1-1-1, Ube, Yamaguchi, 755-8505, Japan

    Michiaki Koga & Takashi Kanda

  2. Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan

    Masaki Takahashi & Keiko Yokoyama

Authors
  1. Michiaki Koga
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  2. Masaki Takahashi
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  3. Keiko Yokoyama
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  4. Takashi Kanda
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Correspondence to Michiaki Koga.

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Koga, M., Takahashi, M., Yokoyama, K. et al. Ambiguous value of anti-ganglioside IgM autoantibodies in Guillain-Barré syndrome and its variants. J Neurol 262, 1954–1960 (2015). https://doi.org/10.1007/s00415-015-7806-4

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  • DOI: https://doi.org/10.1007/s00415-015-7806-4

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