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Shastri A, Al Aiyan A, Kishore U, Farrugia ME. Immune-Mediated Neuropathies: Pathophysiology and Management. Int J Mol Sci 2023; 24:7288. [PMID: 37108447 PMCID: PMC10139406 DOI: 10.3390/ijms24087288] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Dysfunction of the immune system can result in damage of the peripheral nervous system. The immunological mechanisms, which include macrophage infiltration, inflammation and proliferation of Schwann cells, result in variable degrees of demyelination and axonal degeneration. Aetiology is diverse and, in some cases, may be precipitated by infection. Various animal models have contributed and helped to elucidate the pathophysiological mechanisms in acute and chronic inflammatory polyradiculoneuropathies (Guillain-Barre Syndrome and chronic inflammatory demyelinating polyradiculoneuropathy, respectively). The presence of specific anti-glycoconjugate antibodies indicates an underlying process of molecular mimicry and sometimes assists in the classification of these disorders, which often merely supports the clinical diagnosis. Now, the electrophysiological presence of conduction blocks is another important factor in characterizing another subgroup of treatable motor neuropathies (multifocal motor neuropathy with conduction block), which is distinct from Lewis-Sumner syndrome (multifocal acquired demyelinating sensory and motor neuropathy) in its response to treatment modalities as well as electrophysiological features. Furthermore, paraneoplastic neuropathies are also immune-mediated and are the result of an immune reaction to tumour cells that express onconeural antigens and mimic molecules expressed on the surface of neurons. The detection of specific paraneoplastic antibodies often assists the clinician in the investigation of an underlying, sometimes specific, malignancy. This review aims to discuss the immunological and pathophysiological mechanisms that are thought to be crucial in the aetiology of dysimmune neuropathies as well as their individual electrophysiological characteristics, their laboratory features and existing treatment options. Here, we aim to present a balance of discussion from these diverse angles that may be helpful in categorizing disease and establishing prognosis.
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Affiliation(s)
- Abhishek Shastri
- Central and North West London NHS Foundation Trust, London NW1 3AX, UK
| | - Ahmad Al Aiyan
- Department of Veterinary Medicine, UAE University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Uday Kishore
- Department of Veterinary Medicine, UAE University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Maria Elena Farrugia
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, UK
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Sun S, Wen Y, Li S, Huang Z, Zhu J, Li Y. Neutrophil-to-lymphocyte ratio is a risk indicator of Guillain-Barré syndrome and is associated with severity and short-term prognosis. Heliyon 2023; 9:e14321. [PMID: 36967912 PMCID: PMC10036506 DOI: 10.1016/j.heliyon.2023.e14321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/27/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
Introduction Guillain-Barré syndrome (GBS) is an autoimmune disorder targeting the peripheral nervous system. The neutrophil-to-lymphocyte ratio (NLR), a simple indicator of immune function, is potentially related to its incidence and severity; however, this should be confirmed. We aimed to evaluate the role of NLR in the diagnosis, severity, and prognosis of GBS. Methods Data of GBS patients and controls visiting our hospital from January 2010 to December 2020 were retrospectively analyzed (Clinical trial registration: ChiCTR2100053540). Risk factors were determined through logistic regression. Smoothing curves, receiver-operating characteristic curves, and forest plots were drawn. Results We included 136 GBS patients and 211 controls. NLR, as a continuous variable, was associated with GBS risk (OR, 2.32; 95% CI, 1.68-3.21; p < 0.001), severe functional disability (OR, 1.23; 95% CI, 1.06-1.43; p = 0.006), severe weakness (OR, 1.19; 95% CI, 1.06-1.35, p = 0.004), and short-term prognosis (OR, 1.21; 95% CI, 1.08-1.36; p = 0.001). NLR was more strongly associated with GBS risk in older (≥60 years) (OR, 7.17; 95% CI, 2.38-21.61) or male (OR, 2.88; 95% CI, 1.78-4.64) patients than in younger (<60 years) (OR, 1.88; 95% CI, 1.37-2.57) or female (OR, 1.85; 95% CI, 1.24-2.77) patients. NLR was significantly associated with severe functional disability in faster disease progression (OR, 1.53; 95% CI, 1.03-12.29) and male patients (OR, 1.41; 95% CI, 1.03-1.92) versus in slower disease progression (OR, 1.12; 95% CI, 0.77-1.64) and female patients (OR, 1.12; 95% CI, 0.77-1.64). Conclusions NLR may be an independent GBS risk factor and predictor of severe functional disability, severe weakness, and short-term prognosis.
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Pabian-Jewuła S, Rylski M. Does the functional polymorphism-1562C/T of MMP-9 gene influence brain disorders? Front Cell Neurosci 2023; 17:1110967. [PMID: 37206663 PMCID: PMC10188926 DOI: 10.3389/fncel.2023.1110967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 05/21/2023] Open
Abstract
Metalloproteinase-9 (MMP-9) is one of the most strongly expressed matrix metalloproteinases (MMPs) in the brain. The MMP-9 activity in the brain is strictly regulated, and any disruptions in this regulation contribute to a development of many disorders of the nervous system including multiple sclerosis, brain strokes, neurodegenerative disorders, brain tumors, schizophrenia, or Guillain-Barré syndrome. This article discusses a relationship between development of the nervous system diseases and the functional single nucleotide polymorphism (SNP) at position -1562C/T within the MMP-9 gene. A pathogenic influence of MMP-9-1562C/T SNP was observed both in neurological and psychiatric disorders. The presence of the allele T often increases the activity of the MMP-9 gene promoter and consequently the expression of MMP-9 when compared to the allele C. This leads to a change in the likelihood of an occurrence of diseases and modifies the course of certain brain diseases in humans, as discussed below. The presented data indicates that the MMP-9-1562C/T functional polymorphism influences the course of many neuropsychiatric disorders in humans suggesting a significant pathological role of the MMP-9 metalloproteinase in pathologies of the human central nervous system.
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Affiliation(s)
- Sylwia Pabian-Jewuła
- Department of Translational Immunology and Experimental Intensive Care, Centre of Postgraduate Medical Education, Warsaw, Poland
- *Correspondence: Sylwia Pabian-Jewuła,
| | - Marcin Rylski
- Department of Radiology, Institute of Psychiatry and Neurology, Warsaw, Poland
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Dash S, Kamath U, Pai A, Rao P. Serum Inflammatory Markers in Patients with Guillain Barre Syndrome. Neurol India 2022; 70:2082-2085. [DOI: 10.4103/0028-3886.359238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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I Espiritu A, Separa KJNJ, Milla FJC, Adiao KJB, Leochico CFD, Jamora RDG. Clinical features and real-world outcomes of Guillain-Barré syndrome in the Philippines. Neurol Res 2021; 43:995-1004. [PMID: 34229572 DOI: 10.1080/01616412.2021.1948750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Our study aimed to determine the profile of Guillain-Barré syndrome (GBS) in the Philippines, compare the outcomes who received intravenous immunoglobulin (IVIg) and therapeutic plasma exchange (TPE), and determine the factors related to hospital stay and late motor recovery. METHODS We conducted a retrospective cohort study of adult GBS patients admitted to the Philippine General Hospital from 2009 to 2019. RESULTS We included 105 patients with confirmed GBS diagnoses. The median age was 43 years (interquartile range 32 to 56); the female-to-male ratio was 1.62:1; the predominant variant was acute inflammatory demyelinating polyneuropathy (n = 40, 38.1%). The difference in outcomes of patients in the IVIg (n = 44) and TPE (n = 24) groups (walking with aid/GBS-disability scores/ventilator dependency at 1 month, duration dependent on the ventilator, intensive care unit stay, and hospital stay) were not statistically significant, except for mild disability at 1 month (p = 0.009). Pneumonia, urinary tract infection, and dysautonomia were significantly related to a prolonged hospital stay. No predetermined variables were associated with late motor recovery. After adjusting for age and sex, the cumulative hazard risk for late motor recovery was 0.69 (95% CI 0.27-1.74). CONCLUSION Our study presented the first comprehensive information regarding the features and outcomes of GBS patients in the Philippines. ABBREVIATIONS AIDP - Acute inflammatory demyelinating polyneuropathy; AMAN - Acute motor axonal neuropathy; AMSAN - Acute motor and sensory axonal neuropathy; GBS - Guillain-Barré syndrome; GBS-DS - Guillain-Barré syndrome disability scale; ICU - Intensive care unit; IVIg - Intravenous immunoglobulin; MFS - Miller-Fisher syndrome; PGH - Philippine General Hospital; TPE - Therapeutic plasma exchange.
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Affiliation(s)
- Adrian I Espiritu
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Karl Josef Niño J Separa
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Francis Jordan C Milla
- College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Karen Joy B Adiao
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Carl Froilan D Leochico
- Department of Rehabilitation Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City and Global City, Philippines
| | - Roland Dominic G Jamora
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Institute for Neurosciences, St. Luke's Medical Center, Quezon City and Global City, Philippines
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Musikant D, Higa R, Rodríguez CE, Edreira MM, Campetella O, Jawerbaum A, Leguizamón MS. Sialic acid removal by trans-sialidase modulates MMP-2 activity during Trypanosoma cruzi infection. Biochimie 2021; 186:82-93. [PMID: 33891967 PMCID: PMC8187320 DOI: 10.1016/j.biochi.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 01/05/2023]
Abstract
Matrix metalloproteinases (MMPs) not only play a relevant role in homeostatic processes but are also involved in several pathological mechanisms associated with infectious diseases. As their clinical relevance in Chagas disease has recently been highlighted, we studied the modulation of circulating MMPs by Trypanosoma cruzi infection. We found that virulent parasites from Discrete Typing Units (DTU) VI induced higher proMMP-2 and MMP-2 activity in blood, whereas both low (DTU I) and high virulence parasites induced a significant decrease in proMMP-9 plasma activity. Moreover, trans-sialidase, a relevant T. cruzi virulence factor, is involved in MMP-2 activity modulation both in vivo and in vitro. It removes α2,3-linked sialyl residues from cell surface glycoconjugates, which then triggers the PKC/MEK/ERK signaling pathway. Additionally, bacterial sialidases specific for this sialyl residue linkage displayed similar MMP modulation profiles and triggered the same signaling pathways. This novel pathogenic mechanism, dependent on sialic acid removal by the neuraminidase activity of trans-sialidase, can be exploited by different pathogens expressing sialidases with similar specificity. Thus, here we present a new pathogen strategy through the regulation of the MMP network.
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Affiliation(s)
- Daniel Musikant
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Intendente Güiraldes 2160, C1428EGA, Ciudad de Buenos Aires, Argentina
| | - Romina Higa
- Consejo Nacional de Investigaciones Científicas y Técnicas, (CONICET) Godoy Cruz 2290, C1425FQB, Ciudad de Buenos Aires, Argentina; Laboratorio de Reproducción y Metabolismo, CEFYBO-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155 C1121ABG, Ciudad de Buenos Aires, Argentina
| | - Cristina E Rodríguez
- Departamento de Microbiología, IMPAM-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155 C1121ABG, Ciudad de Buenos Aires, Argentina
| | - Martin M Edreira
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Intendente Güiraldes 2160, C1428EGA, Ciudad de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, (CONICET) Godoy Cruz 2290, C1425FQB, Ciudad de Buenos Aires, Argentina; Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN-CONICET, Universidad de Buenos Aires, Intendente Güiraldes 2160 C1428EGA, Ciudad de Buenos Aires, Argentina
| | - Oscar Campetella
- Consejo Nacional de Investigaciones Científicas y Técnicas, (CONICET) Godoy Cruz 2290, C1425FQB, Ciudad de Buenos Aires, Argentina; Instituto de Investigaciones Biotecnológicas IIBio, Universidad Nacional de San Martín, 25 de Mayo y Francia B1650HMP, San Martín, San Martin, Argentina
| | - Alicia Jawerbaum
- Consejo Nacional de Investigaciones Científicas y Técnicas, (CONICET) Godoy Cruz 2290, C1425FQB, Ciudad de Buenos Aires, Argentina; Laboratorio de Reproducción y Metabolismo, CEFYBO-CONICET, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155 C1121ABG, Ciudad de Buenos Aires, Argentina
| | - María S Leguizamón
- Consejo Nacional de Investigaciones Científicas y Técnicas, (CONICET) Godoy Cruz 2290, C1425FQB, Ciudad de Buenos Aires, Argentina; Instituto de Investigaciones Biotecnológicas IIBio, Universidad Nacional de San Martín, 25 de Mayo y Francia B1650HMP, San Martín, San Martin, Argentina.
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A review of the role of genetic factors in Guillain–Barré syndrome. J Mol Neurosci 2020; 71:902-920. [DOI: 10.1007/s12031-020-01720-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
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Hayat S, Ahmad O, Mahmud I, Howlader MZH, Islam Z. Association of matrix metalloproteinase-9 polymorphism with severity of Guillain-Barré syndrome. J Neurol Sci 2020; 415:116908. [DOI: 10.1016/j.jns.2020.116908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 12/22/2022]
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Sun T, Chen X, Shi S, Liu Q, Cheng Y. Peripheral Blood and Cerebrospinal Fluid Cytokine Levels in Guillain Barré Syndrome: A Systematic Review and Meta-Analysis. Front Neurosci 2019; 13:717. [PMID: 31379477 PMCID: PMC6646663 DOI: 10.3389/fnins.2019.00717] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Guillain Barré Syndrome (GBS) is an autoimmune disorder caused by the immune-mediated damage of the peripheral nervous system. Increasing evidence suggests that inflammatory cytokines are important mediators for the onset and progression of GBS. A number of clinical studies have demonstrated elevated levels of T helper-1 (Th1-), Th2-, and Th17-related cytokines in patients with GBS; however, the results were inconsistent across studies. Methods: We performed a systematic review and a meta-analysis of studies comparing the levels of inflammatory cytokines in the cerebrospinal fluid and peripheral blood between patients with GBS and healthy individuals, using Comprehensive Meta-Analysis Version 2 software. A database search identified 30 studies comprising 1,302 patients with GBS and 1,073 healthy controls. Results: The random-effects meta-analysis demonstrated that peripheral blood tumor necrosis factor-α (Hedges g, 1.544; 95% confidence interval (CI), 0.923–2.165; p < 0.001), interleukin-1β (IL-1β; Hedges g, 0.678; 95% CI, 0.183–1.172; p = 0.007), IL-6 (Hedges g, 0.630; 95% CI, 0.100–1.160; p = 0.02), IL-4 (Hedges g, 0.822; 95% CI, 0.220–1.423; p = 0.007), IL-17 (Hedges g, 1.452; 95% CI, 0.331–2.573; p = 0.011), interferon-γ (Hedges g, 1.104; 95% CI, 0.490–1.719; p < 0.001), and C-reactive protein (Hedges g, 0.909; 95% CI, 0.453–1.365; p < 0.001) levels were significantly increased in patients with GBS when compared with healthy controls. Contrastingly, the blood IL-10 and transforming growth factor-β levels were not significantly associated with GBS. Furthermore, the meta-analysis found that cerebrospinal fluid IL-17 levels were significantly associated with GBS (Hedges g, 1.882; 95% CI, 0.104–3.661; p = 0.038). Conclusion: Altogether, our results clarified the circulating inflammatory cytokine profile in patients with GBS, and revealed that Th1-, Th2-, and Th17-related cytokines were highly elevated in the GBS patients, suggesting the potential use of these cytokines as biomarkers for GBS.
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Affiliation(s)
- Ting Sun
- Key Laboratory of Ethnomedicine for Ministry of Education, Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Xi Chen
- Key Laboratory of Ethnomedicine for Ministry of Education, Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Sha Shi
- Key Laboratory of Ethnomedicine for Ministry of Education, Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Qingshan Liu
- Key Laboratory of Ethnomedicine for Ministry of Education, Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Yong Cheng
- Key Laboratory of Ethnomedicine for Ministry of Education, Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
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Li X, Li W, Luo Y, Qin L, Su Q, Mo W. Can we assess severity of Guillain-Barré syndrome using absolute monocyte count? Int J Lab Hematol 2018; 40:488-492. [PMID: 29718547 DOI: 10.1111/ijlh.12845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/29/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an inflammatory demyelinating autoimmune disease, associated with blood-nerve barrier breakdown, inflammatory cells infiltration, and cytokine leakage in the peripheral nervous system. Currently, it has been revealed that monocytes play key roles in the inflammatory response. Therefore, we aimed to assess the correlation between monocyte count and GBS in this study. METHODS Retrospective study was conducted in 114 patients with GBS and 120 age- and gender-matched individuals. RESULTS Absolute monocyte count in patients with GBS was higher than that in healthy controls (0.61 ± 0.24 vs 0.41 ± 0.10; P < .001). Interestingly, monocyte count had significant positive correlations with CRP, ESR, and disease severity of GBS (r = .244, P = .009; r = .269, P = .004; r = .322, P < .001). A cutoff value of 0.515 for monocyte count was observed in patients with GBS (areas under the curve = 0.808, 95% confidence interval = 0.749-0.868, P < .001). Meanwhile, absolute monocyte count was independently associated with GBS in logistic regression analysis (odds ratio = 2.291, 95% confidence interval = 3.557-27.493, P < .001). CONCLUSION Our findings demonstrated that elevated monocyte count is independently associated with GBS patients, and suggested monocyte count is positively associated with disease severity of GBS.
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Affiliation(s)
- X Li
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - W Li
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Y Luo
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - L Qin
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Q Su
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - W Mo
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Shen D, Chu F, Lang Y, Geng Y, Zheng X, Zhu J, Liu K. Beneficial or Harmful Role of Macrophages in Guillain-Barré Syndrome and Experimental Autoimmune Neuritis. Mediators Inflamm 2018; 2018:4286364. [PMID: 29853789 PMCID: PMC5944239 DOI: 10.1155/2018/4286364+10.1155/2018/4286364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/01/2018] [Indexed: 01/21/2024] Open
Abstract
Guillain-Barré syndrome (GBS), an immune-mediated demyelinating peripheral neuropathy, is characterized by acute weakness of the extremities and areflexia or hyporeflexia. Experimental autoimmune neuritis (EAN) is a common animal model for GBS, which represents a CD4+ T cell-mediated inflammatory autoimmune demyelination of the peripheral nervous system (PNS), and is used to investigate the pathogenic mechanism of GBS. It has been found that macrophages play a critical role in the pathogenesis of both GBS and EAN. Macrophages have been primarily classified into two major phenotypes: proinflammatory macrophages (M1) and anti-inflammatory macrophages (M2). The two different macrophage subsets M1 and M2 may play a decisive role in initiation and development of GBS and EAN. However, recently, it has been indicated that the roles of macrophages in immune regulation and autoimmune diseases are more complex than those suggested by a simple M1-M2 dichotomy. Macrophages might exert either inflammatory or anti-inflammatory effect by secreting pro- or anti-inflammatory cytokines, and either inducing the activation of T cells to mediate immune response, resulting in inflammation and demyelination in the PNS, or promoting disease recovery. In this review, we summarize the dual roles of macrophages in GBS and EAN and explore the mechanism of macrophage polarization to provide a potential therapeutic approach for GBS in the future.
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Affiliation(s)
- Donghui Shen
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun 130021, China
| | - Fengna Chu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun 130021, China
| | - Yue Lang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun 130021, China
| | - Yunlong Geng
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun 130021, China
| | - Xiangyu Zheng
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun 130021, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun 130021, China
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska University Hospital, SE-14157 Huddinge, Stockholm, Sweden
| | - Kangding Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun 130021, China
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Beneficial or Harmful Role of Macrophages in Guillain-Barré Syndrome and Experimental Autoimmune Neuritis. Mediators Inflamm 2018; 2018:4286364. [PMID: 29853789 PMCID: PMC5944239 DOI: 10.1155/2018/4286364 10.1155/2018/4286364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Guillain-Barré syndrome (GBS), an immune-mediated demyelinating peripheral neuropathy, is characterized by acute weakness of the extremities and areflexia or hyporeflexia. Experimental autoimmune neuritis (EAN) is a common animal model for GBS, which represents a CD4+ T cell-mediated inflammatory autoimmune demyelination of the peripheral nervous system (PNS), and is used to investigate the pathogenic mechanism of GBS. It has been found that macrophages play a critical role in the pathogenesis of both GBS and EAN. Macrophages have been primarily classified into two major phenotypes: proinflammatory macrophages (M1) and anti-inflammatory macrophages (M2). The two different macrophage subsets M1 and M2 may play a decisive role in initiation and development of GBS and EAN. However, recently, it has been indicated that the roles of macrophages in immune regulation and autoimmune diseases are more complex than those suggested by a simple M1-M2 dichotomy. Macrophages might exert either inflammatory or anti-inflammatory effect by secreting pro- or anti-inflammatory cytokines, and either inducing the activation of T cells to mediate immune response, resulting in inflammation and demyelination in the PNS, or promoting disease recovery. In this review, we summarize the dual roles of macrophages in GBS and EAN and explore the mechanism of macrophage polarization to provide a potential therapeutic approach for GBS in the future.
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Beneficial or Harmful Role of Macrophages in Guillain-Barré Syndrome and Experimental Autoimmune Neuritis. Mediators Inflamm 2018; 2018:4286364. [PMID: 29853789 PMCID: PMC5944239 DOI: 10.1155/2018/4286364] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/01/2018] [Indexed: 12/11/2022] Open
Abstract
Guillain-Barré syndrome (GBS), an immune-mediated demyelinating peripheral neuropathy, is characterized by acute weakness of the extremities and areflexia or hyporeflexia. Experimental autoimmune neuritis (EAN) is a common animal model for GBS, which represents a CD4+ T cell-mediated inflammatory autoimmune demyelination of the peripheral nervous system (PNS), and is used to investigate the pathogenic mechanism of GBS. It has been found that macrophages play a critical role in the pathogenesis of both GBS and EAN. Macrophages have been primarily classified into two major phenotypes: proinflammatory macrophages (M1) and anti-inflammatory macrophages (M2). The two different macrophage subsets M1 and M2 may play a decisive role in initiation and development of GBS and EAN. However, recently, it has been indicated that the roles of macrophages in immune regulation and autoimmune diseases are more complex than those suggested by a simple M1-M2 dichotomy. Macrophages might exert either inflammatory or anti-inflammatory effect by secreting pro- or anti-inflammatory cytokines, and either inducing the activation of T cells to mediate immune response, resulting in inflammation and demyelination in the PNS, or promoting disease recovery. In this review, we summarize the dual roles of macrophages in GBS and EAN and explore the mechanism of macrophage polarization to provide a potential therapeutic approach for GBS in the future.
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Li X, Li W, Shi X, Mo L, Luo Y, Qin L, Yang Z, Mo W. Is serum bilirubin associated with the severity of Guillain-Barré syndrome? Int J Neurosci 2017; 128:595-599. [PMID: 29130362 DOI: 10.1080/00207454.2017.1404465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Our aim was to assess the correlation between serum bilirubin levels and Guillain-Barré syndrome (GBS). PATIENTS AND METHODS One hundred and one newly diagnosed patients with Guillain-Barré syndrome and 111 healthy age- and sex-matched individuals in the First Affiliated Hospital of Guangxi Medical University (Guangxi, China) from June 2012 to May 2017 were included in this study. Clinical characteristics and laboratory parameters of Guillain-Barré syndrome patients and healthy controls were retrospectively analysed. RESULTS Serum bilirubin levels in Guillain-Barré syndrome patients were significantly lower as compared with those in healthy controls (p < 0.001); besides, log C-reactive protein and erythrocyte sedimentation rate were significantly higher. We found that there was a negative correlation between GBS disability scale scores and total bilirubin, direct bilirubin, indirect bilirubin (r = -0.541, P < 0.001; r = -0.403, P < 0.001; r = -0.526, P < 0.001), respectively. Among patients with GBS, serum total bilirubin, direct bilirubin, and indirect bilirubin levels were independently associated with Guillain-Barré syndrome disability scale scores in multiple linear regression analysis, respectively. CONCLUSIONS We observed that serum bilirubin levels were lower in patients with Guillain-Barré syndrome, and suggested total bilirubin, direct bilirubin, and indirect bilirubin were independently and inversely associated with Guillain-Barré syndrome severity.
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Affiliation(s)
- Xiaohong Li
- a Department of Clinical Laboratory , First Affiliated Hospital of Guangxi Medical University , Nanning , China
| | - Wenchao Li
- a Department of Clinical Laboratory , First Affiliated Hospital of Guangxi Medical University , Nanning , China
| | - Xiang Shi
- a Department of Clinical Laboratory , First Affiliated Hospital of Guangxi Medical University , Nanning , China
| | - Lijun Mo
- a Department of Clinical Laboratory , First Affiliated Hospital of Guangxi Medical University , Nanning , China
| | - Yuzhen Luo
- a Department of Clinical Laboratory , First Affiliated Hospital of Guangxi Medical University , Nanning , China
| | - Liuqun Qin
- a Department of Clinical Laboratory , First Affiliated Hospital of Guangxi Medical University , Nanning , China
| | - Zheng Yang
- a Department of Clinical Laboratory , First Affiliated Hospital of Guangxi Medical University , Nanning , China
| | - Wuning Mo
- a Department of Clinical Laboratory , First Affiliated Hospital of Guangxi Medical University , Nanning , China
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Nyati KK, Prasad KN, Agrawal V, Husain N. Matrix metalloproteinases-2 and -9 in Campylobacter jejuni-induced paralytic neuropathy resembling Guillain-Barré syndrome in chickens. Microb Pathog 2017; 111:395-401. [PMID: 28916318 DOI: 10.1016/j.micpath.2017.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 11/19/2022]
Abstract
Inflammation in Guillain-Barré syndrome (GBS) is manifested by changes in matrix metalloproteinase (MMP) and pro-inflammatory cytokine expression. We investigated the expression of MMP-2, -9 and TNF-α and correlated it with pathological changes in sciatic nerve tissue from Campylobacter jejuni-induced chicken model for GBS. Campylobacter jejuni and placebo were fed to chickens and assessed for disease symptoms. Sciatic nerves were examined by histopathology and immunohistochemistry. Expressions of MMPs and TNF-α, were determined by real-time PCR, and activities of MMPs by zymography. Diarrhea developed in 73.3% chickens after infection and 60.0% of them developed GBS like neuropathy. Pathology in sciatic nerves showed perinodal and/or patchy demyelination, perivascular focal lymphocytic infiltration and myelin swelling on 10th- 20th post infection day (PID). MMP-2, -9 and TNF-α were up-regulated in progressive phase of the disease. Enhanced MMP-2, -9 and TNF-α production in progressive phase correlated with sciatic nerve pathology in C. jejuni-induced GBS chicken model.
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Affiliation(s)
- Kishan Kumar Nyati
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226 014, India.
| | - Kashi Nath Prasad
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226 014, India.
| | - Vinita Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226 014, India
| | - Nuzhat Husain
- Department of Pathology, Dr. RML Institute of Medical Sciences, Lucknow 226 010, India
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Garro A, Chodobski A, Szmydynger-Chodobska J, Shan R, Bialo SR, Bennett J, Quayle K, Rewers A, Schunk JE, Casper TC, Kuppermann N, Glaser N. Circulating matrix metalloproteinases in children with diabetic ketoacidosis. Pediatr Diabetes 2017; 18:95-102. [PMID: 26843101 PMCID: PMC4974171 DOI: 10.1111/pedi.12359] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Matrix metalloproteinases (MMPs) mediate blood-brain barrier dysfunction in inflammatory disease states. Our objective was to compare circulating MMPs in children with diabetic ketoacidosis (DKA) to children with type 1 diabetes mellitus without DKA. RESEARCH DESIGN AND METHODS This was a prospective study performed at five tertiary-care pediatric hospitals. We measured plasma MMP-2, MMP-3, and MMP-9 early during DKA (time 1; within 2 h of beginning intravenous fluids) and during therapy (time 2; median 8 h; range: 4-16 h). The primary outcome was MMP levels in 34 children with DKA vs. 23 children with type 1 diabetes without DKA. Secondary outcomes included correlations between MMPs and measures of DKA severity. RESULTS In children with DKA compared with diabetes controls, circulating MMP-2 levels were lower (mean 77 vs. 244 ng/mL, p < 0.001), MMP-3 levels were similar (mean 5 vs. 4 ng/mL, p = 0.57), and MMP-9 levels were higher (mean 67 vs. 25 ng/mL, p = 0.002) early in DKA treatment. MMP-2 levels were correlated with pH at time 1 (r = 0.45, p = 0.018) and time 2 (r = 0.47, p = 0.015) and with initial serum bicarbonate at time 2 (r = 0.5, p = 0.008). MMP-9 levels correlated with hemoglobin A1c in DKA and diabetes controls, but remained significantly elevated in DKA after controlling for hemoglobin A1c (β = -31.3, p = 0.04). CONCLUSIONS Circulating MMP-2 levels are lower and MMP-9 levels are higher in children during DKA compared with levels in children with diabetes without DKA. Alterations in MMP expression could mediate BBB dysfunction occurring during DKA.
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Affiliation(s)
- Aris Garro
- Departments of Pediatrics and Emergency Medicine, Rhode Island Hospital, Providence, RI, USA,Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Adam Chodobski
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Rongzi Shan
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Shara R Bialo
- Departments of Pediatrics and Emergency Medicine, Rhode Island Hospital, Providence, RI, USA,Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jonathan Bennett
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, USA
| | - Kimberly Quayle
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Arleta Rewers
- Department of Pediatrics, University of Colorado, School of Medicine, Denver, CO, USA
| | - Jeffrey E Schunk
- Department of Pediatrics, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - T Charles Casper
- Department of Pediatrics, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California Davis, Davis, CA, USA
| | - Nicole Glaser
- Department of Pediatrics, University of California Davis, Davis, CA, USA
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Wang Y, Zhang J, Luo P, Zhu J, Feng J, Zhang HL. Tumor necrosis factor-α in Guillain-Barré syndrome, friend or foe? Expert Opin Ther Targets 2016; 21:103-112. [PMID: 27817222 DOI: 10.1080/14728222.2017.1258402] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ying Wang
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Changchun, China
| | - Jingdian Zhang
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Changchun, China
| | - Peijuan Luo
- Norman Bethune Health Science Center, Jilin University, Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Changchun, China
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Jiachun Feng
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Changchun, China
| | - Hong-Liang Zhang
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Changchun, China
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Modulation of Matrix Metalloproteinases Activity in the Ventral Horn of the Spinal Cord Re-stores Neuroglial Synaptic Homeostasis and Neurotrophic Support following Peripheral Nerve Injury. PLoS One 2016; 11:e0152750. [PMID: 27028103 PMCID: PMC4814041 DOI: 10.1371/journal.pone.0152750] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/18/2016] [Indexed: 12/20/2022] Open
Abstract
Modulation of extracellular matrix (ECM) remodeling after peripheral nerve injury (PNI) could represent a valid therapeutic strategy to prevent maladaptive synaptic plasticity in central nervous system (CNS). Inhibition of matrix metalloproteinases (MMPs) and maintaining a neurotrophic support could represent two approaches to prevent or reduce the maladaptive plastic changes in the ventral horn of spinal cord following PNI. The purpose of our study was to analyze changes in the ventral horn produced by gliopathy determined by the suffering of motor neurons following spared nerve injury (SNI) of the sciatic nerve and how the intrathecal (i.t.) administration of GM6001 (a MMPs inhibitor) or the NGF mimetic peptide BB14 modulate these events. Immunohistochemical analysis of spinal cord sections revealed that motor neuron disease following SNI was associated with increased microglial (Iba1) and astrocytic (GFAP) response in the ventral horn of the spinal cord, indicative of reactive gliosis. These changes were paralleled by decreased glial aminoacid transporters (glutamate GLT1 and glycine GlyT1), increased levels of the neuronal glutamate transporter EAAC1, and a net increase of the Glutamate/GABA ratio, as measured by HPLC analysis. These molecular changes correlated to a significant reduction of mature NGF levels in the ventral horn. Continuous i.t. infusion of both GM6001 and BB14 reduced reactive astrogliosis, recovered the expression of neuronal and glial transporters, lowering the Glutamate/GABA ratio. Inhibition of MMPs by GM6001 significantly increased mature NGF levels, but it was absolutely ineffective in modifying the reactivity of microglia cells. Therefore, MMPs inhibition, although supplies neurotrophic support to ECM components and restores neuro-glial transporters expression, differently modulates astrocytic and microglial response after PNI.
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Inflammatory neuropathies: pathology, molecular markers and targets for specific therapeutic intervention. Acta Neuropathol 2015; 130:445-68. [PMID: 26264608 DOI: 10.1007/s00401-015-1466-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 08/01/2015] [Accepted: 08/02/2015] [Indexed: 12/21/2022]
Abstract
Inflammatory neuropathies encompass groups of heterogeneous disorders characterized by pathogenic immune-mediated hematogenous leukocyte infiltration of peripheral nerves, nerve roots or both, with resultant demyelination or axonal degeneration or both. Inflammatory neuropathies may be divided into three major disease categories: Guillain-Barré syndrome (particularly the acute inflammatory demyelinating polyradiculoneuropathy variant), chronic inflammatory demyelinating polyradiculoneuropathy and nonsystemic vasculitic neuropathy (or peripheral nerve vasculitis). Despite major advances in molecular biology, pathology and genetics, the pathogenesis of these disorders remains elusive. There is insufficient knowledge on the mechanisms of hematogenous leukocyte trafficking into the peripheral nervous system to guide the development of specific molecular therapies for immune-mediated inflammatory neuropathies compared to disorders such as psoriasis, inflammatory bowel disease, rheumatoid arthritis or multiple sclerosis. The recent isolation and characterization of human endoneurial endothelial cells that form the blood-nerve barrier provides an opportunity to elucidate leukocyte-endothelial cell interactions critical to the pathogenesis of inflammatory neuropathies at the interface between the systemic circulation and peripheral nerve endoneurium. This review discusses our current knowledge of the classic pathological features of inflammatory neuropathies, attempts at molecular classification and genetic determinants, the utilization of in vitro and in vivo animal models to determine pathogenic mechanisms at the interface between the systemic circulation and the peripheral nervous system relevant to these disorders and prospects for future potential molecular pathology biomarkers and targets for specific therapeutic intervention.
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20
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Sun Y, Chen H, Ma S, Liang L, Zheng Y, Guo X, Wang M, Wang W, Li G, Zhong D. Administration of SB203580, a p38 MAPK Inhibitor, Reduced the Expression of MMP9, and Relieved Neurologic Severity in the Experimental Autoimmune Neuritis (EAN) in Rats. Neurochem Res 2015; 40:1410-20. [DOI: 10.1007/s11064-015-1608-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/20/2015] [Accepted: 05/07/2015] [Indexed: 01/18/2023]
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21
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Blum S, McCombe PA. Genetics of Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): current knowledge and future directions. J Peripher Nerv Syst 2014; 19:88-103. [DOI: 10.1111/jns5.12074] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/04/2014] [Accepted: 04/09/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Stefan Blum
- The University of Queensland Centre for Clinical Research; UQ CCR; Queensland Australia
| | - Pamela A. McCombe
- The University of Queensland Centre for Clinical Research; UQ CCR; Queensland Australia
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Abstract
Understanding of Guillain-Barré syndrome (GBS) has progressed substantially since the seminal 1916 report by Guillain et al. Although Guillain, Barré, and Strohl summarised the syndrome based on observations of two French infantrymen, 2012 saw the beginning of an ambitious collaborative study designed to collect detailed data from at least 1,000 patients worldwide (IGOS, www.gbsstudies.org/about-igos). Progress has been made in many areas even since GBS was last reviewed in this journal in 2009. GBS subsequently received prominent attention in light of concerns regarding H1N1 influenza vaccinations, and several large-scale surveillance studies resulted. Despite these developments, and promising pre-clinical studies, disease-modifying therapies for GBS have not substantially altered since intravenous immunoglobulin was introduced over 20 years ago. In other areas, management has improved. Antibiotic prophylaxis in ventilated patients reduces respiratory tract infection, thromboprophylaxis has reduced the risk of venous thromboembolism, and there is increasing awareness of the benefit of high-intensity rehabilitation. This article highlights some of the interesting and thought-provoking developments of the last 3 years, and is based on a plenary lecture given at the 2012 Peripheral Nerve Society (PNS) meeting.
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Affiliation(s)
- Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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23
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Abstract
Guillain-Barré syndrome (GBS) was first described in 1916 (Guillain G, 1916) and is approaching its 100th anniversary. Our knowledge of the syndrome has hugely expanded since that time. Once originally considered to be only demyelinating in pathology we now recognise both axonal and demyelinating subtypes. Numerous triggering or antecedent events including infections are recognised and GBS is considered an immunological response to these. GBS is now considered to be a clinical syndrome of an acute inflammatory neuropathy encompassing a number of subtypes with evidence of different immunological mechanisms. Some of these are clearly understood while others remain to be fully elucidated. Complement fixing antibodies against peripheral nerve gangliosides alone and in combination are increasingly recognised as an important mechanism of nerve damage. New antibodies against other nerve antigens such as neurofascin have been recently described. Research databases have been set up to look at factors associated with prognosis and the influence of intravenous immunoglobulin (IvIg) pharmacokinetics in therapy. Exciting new studies are in progress to examine a possible role for complement inhibition in the treatment of the syndrome.
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Role of Campylobacter jejuni infection in the pathogenesis of Guillain-Barré syndrome: an update. BIOMED RESEARCH INTERNATIONAL 2013; 2013:852195. [PMID: 24000328 PMCID: PMC3755430 DOI: 10.1155/2013/852195] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/03/2013] [Indexed: 01/25/2023]
Abstract
Our current knowledge on Campylobacter jejuni infections in humans has progressively increased over the past few decades. Infection with C. jejuni is the most common cause of bacterial gastroenteritis, sometimes surpassing other infections due to Salmonella, Shigella, and Escherichia coli. Most infections are acquired due to consumption of raw or undercooked poultry, unpasteurized milk, and contaminated water. After developing the diagnostic methods to detect C. jejuni, the possibility to identify the association of its infection with new diseases has been increased. After the successful isolation of C. jejuni, reports have been published citing the occurrence of GBS following C. jejuni infection. Thus, C. jejuni is now considered as a major triggering agent of GBS. Molecular mimicry between sialylated lipooligosaccharide structures on the cell envelope of these bacteria and ganglioside epitopes on the human nerves that generates cross-reactive immune response results in autoimmune-driven nerve damage. Though C. jejuni is associated with several pathologic forms of GBS, axonal subtypes following C. jejuni infection may be more severe. Ample amount of existing data covers a large spectrum of GBS; however, the studies on C. jejuni-associated GBS are still inconclusive. Therefore, this review provides an update on the C. jejuni infections engaged in the pathogenesis of GBS.
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Saito K, Shimizu F, Koga M, Sano Y, Tasaki A, Abe M, Haruki H, Maeda T, Suzuki S, Kusunoki S, Mizusawa H, Kanda T. Blood-brain barrier destruction determines Fisher/Bickerstaff clinical phenotypes: an in vitro study. J Neurol Neurosurg Psychiatry 2013; 84:756-65. [PMID: 23584494 DOI: 10.1136/jnnp-2012-304306] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To ascertain the hypothesis that the phenotypic differences between Bickerstaff's brainstem encephalitis (BBE) and Miller Fisher syndrome (MFS) are derived from the differences in the effects of sera on blood-brain barrier (BBB) and blood-nerve barrier. BACKGROUND Antibodies against GQ1b are frequently detected in BBE and MFS, and these two disorders may share the same pathogenesis, but the clinical phenotypes of BBE and MFS are substantially different. METHODS The effects of sera obtained from BBE patients, MFS patients and control subjects were evaluated with regard to the expression of tight junction proteins and transendothelial electrical resistance in human brain microvascular endothelial cells (BMECs) and human peripheral nerve microvascular endothelial cells. RESULTS The sera obtained from BBE patients decreased the transendothelial electrical resistance values and claudin-5 protein expression in BMECs, although the sera obtained from MFS patients had no effect on BMECs or peripheral nerve microvascular endothelial cells. This effect was reversed after the application of matrix metalloproteinase (MMP) inhibitor, GM6001. The presence or absence of anti-GQ1b antibodies did not significantly influence the results. MMP-9 secreted by BMECs was significantly increased after exposure to the sera obtained from BBE patients, whereas it was not changed after exposure to the sera obtained from MFS patients. CONCLUSIONS Only the sera obtained from BBE patients destroyed BBB and it might explain the phenotypical differences between BBE and MFS. BBE sera disrupted BBB, possibly via the autocrine secretion of MMP-9 from BBB-composing endothelial cells.
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Affiliation(s)
- Kazuyuki Saito
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, Yamaguchi 7558505, Japan
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Alvarez-Lario B, Prieto-Tejedo R, Colazo-Burlato M, Macarrón-Vicente J. Severe Guillain–Barré syndrome in a patient receiving anti-TNF therapy. Consequence or coincidence. A case-based review. Clin Rheumatol 2013; 32:1407-12. [DOI: 10.1007/s10067-013-2272-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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Yosef N, Ubogu EE. α(M)β(2)-integrin-intercellular adhesion molecule-1 interactions drive the flow-dependent trafficking of Guillain-Barré syndrome patient derived mononuclear leukocytes at the blood-nerve barrier in vitro. J Cell Physiol 2012; 227:3857-75. [PMID: 22552879 DOI: 10.1002/jcp.24100] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The mechanisms of hematogenous leukocyte trafficking at the human blood-nerve barrier (BNB) are largely unknown. Intercellular adhesion molecule-1 (ICAM-1) has been implicated in the pathogenesis of Guillain-Barré syndrome (GBS). We developed a cytokine-activated human in vitro BNB model using primary endoneurial endothelial cells. Endothelial treatment with 10 U/ml tissue necrosis factor-α and 20 U/ml interferon-γ resulted in de novo expression of pro-inflammatory chemokines CCL2, CXCL9, CXCL11, and CCL20, with increased expression of CXCL2-3, CXCL8, and CXCL10 relative to basal levels. Cytokine treatment induced/enhanced ICAM-1, E- and P-selectin, vascular cell adhesion molecule-1 and the alternatively spliced pro-adhesive fibronectin variant, fibronectin connecting segment-1 expression in a time-dependent manner, without alterations in junctional adhesion molecule-A expression. Lymphocytes and monocytes from untreated GBS patients express ICAM-1 counterligands, α(M)- and α(L)-integrin, with differential regulation of α(M) -integrin expression compared to healthy controls. Under flow conditions that mimic capillary hemodynamics in vivo, there was a >3-fold increase in total GBS patient and healthy control mononuclear leukocyte adhesion/migration at the BNB following cytokine treatment relative to the untreated state. Function neutralizing monoclonal antibodies against human α(M)-integrin (CD11b) and ICAM-1 reduced untreated GBS patient mononuclear leukocyte trafficking at the BNB by 59% and 64.2%, respectively. Monoclonal antibodies against α(L)-integrin (CD11a) and human intravenous immunoglobulin reduced total leukocyte adhesion/migration by 22.8% and 17.6%, respectively. This study demonstrates differential regulation of α(M)-integrin on circulating mononuclear cells in GBS, as well as an important role for α(M)-integrin-ICAM-1 interactions in pathogenic GBS patient leukocyte trafficking at the human BNB in vitro.
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Affiliation(s)
- Nejla Yosef
- Neuromuscular Immunopathology Research Laboratory, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030-3411, USA
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28
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Chang KH, Chuang TJ, Lyu RK, Ro LS, Wu YR, Chang HS, Huang CC, Kuo HC, Hsu WC, Chu CC, Chen CM. Identification of gene networks and pathways associated with Guillain-Barré syndrome. PLoS One 2012; 7:e29506. [PMID: 22253732 PMCID: PMC3254618 DOI: 10.1371/journal.pone.0029506] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 11/29/2011] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The underlying change of gene network expression of Guillain-Barré syndrome (GBS) remains elusive. We sought to identify GBS-associated gene networks and signaling pathways by analyzing the transcriptional profile of leukocytes in the patients with GBS. METHODS AND FINDINGS Quantitative global gene expression microarray analysis of peripheral blood leukocytes was performed on 7 patients with GBS and 7 healthy controls. Gene expression profiles were compared between patients and controls after standardization. The set of genes that significantly correlated with GBS was further analyzed by Ingenuity Pathways Analyses. 256 genes and 18 gene networks were significantly associated with GBS (fold change ≥2, P<0.05). FOS, PTGS2, HMGB2 and MMP9 are the top four of 246 significantly up-regulated genes. The most significant disease and altered biological function genes associated with GBS were those involved in inflammatory response, infectious disease, and respiratory disease. Cell death, cellular development and cellular movement were the top significant molecular and cellular functions involved in GBS. Hematological system development and function, immune cell trafficking and organismal survival were the most significant GBS-associated function in physiological development and system category. Several hub genes, such as MMP9, PTGS2 and CREB1 were identified in the associated gene networks. Canonical pathway analysis showed that GnRH, corticotrophin-releasing hormone and ERK/MAPK signaling were the most significant pathways in the up-regulated gene set in GBS. CONCLUSIONS This study reveals the gene networks and canonical pathways associated with GBS. These data provide not only networks between the genes for understanding the pathogenic properties of GBS but also map significant pathways for the future development of novel therapeutic strategies.
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Affiliation(s)
- Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taiwan, Republic of China
| | - Tzi-Jung Chuang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taiwan, Republic of China
| | - Rong-Kuo Lyu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taiwan, Republic of China
| | - Long-Sun Ro
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taiwan, Republic of China
| | - Yih-Ru Wu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taiwan, Republic of China
| | - Hong-Shiu Chang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taiwan, Republic of China
| | - Chin-Chang Huang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taiwan, Republic of China
| | - Hung-Chou Kuo
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taiwan, Republic of China
| | - Wen-Chuin Hsu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taiwan, Republic of China
| | - Chun-Che Chu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taiwan, Republic of China
| | - Chiung-Mei Chen
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang Gung University, Taiwan, Republic of China
- * E-mail:
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