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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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Rumsey JW, Lorance C, Jackson M, Sasserath T, McAleer CW, Long CJ, Goswami A, Russo MA, Raja SM, Gable KL, Emmett D, Hobson-Webb LD, Chopra M, Howard JF, Guptill JT, Storek MJ, Alonso-Alonso M, Atassi N, Panicker S, Parry G, Hammond T, Hickman JJ. Classical Complement Pathway Inhibition in a "Human-On-A-Chip" Model of Autoimmune Demyelinating Neuropathies. ADVANCED THERAPEUTICS 2022; 5:2200030. [PMID: 36211621 PMCID: PMC9540753 DOI: 10.1002/adtp.202200030] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Indexed: 07/21/2023]
Abstract
Chronic autoimmune demyelinating neuropathies are a group of rare neuromuscular disorders with complex, poorly characterized etiology. Here we describe a phenotypic, human-on-a-chip (HoaC) electrical conduction model of two rare autoimmune demyelinating neuropathies, chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN), and explore the efficacy of TNT005, a monoclonal antibody inhibitor of the classical complement pathway. Patient sera was shown to contain anti-GM1 IgM and IgG antibodies capable of binding to human primary Schwann cells and induced pluripotent stem cell derived motoneurons. Patient autoantibody binding was sufficient to activate the classical complement pathway resulting in detection of C3b and C5b-9 deposits. A HoaC model, using a microelectrode array with directed axonal outgrowth over the electrodes treated with patient sera, exhibited reductions in motoneuron action potential frequency and conduction velocity. TNT005 rescued the serum-induced complement deposition and functional deficits while treatment with an isotype control antibody had no rescue effect. These data indicate that complement activation by CIDP and MMN patient serum is sufficient to mimic neurophysiological features of each disease and that complement inhibition with TNT005 was sufficient to rescue these pathological effects and provide efficacy data included in an investigational new drug application, demonstrating the model's translational potential.
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Affiliation(s)
- John W Rumsey
- Hesperos, Inc., 12501 Research Parkway, Suite 100, Orlando, FL 32826
| | - Case Lorance
- Hesperos, Inc., 12501 Research Parkway, Suite 100, Orlando, FL 32826
| | - Max Jackson
- Hesperos, Inc., 12501 Research Parkway, Suite 100, Orlando, FL 32826
| | - Trevor Sasserath
- Hesperos, Inc., 12501 Research Parkway, Suite 100, Orlando, FL 32826
| | | | | | - Arindom Goswami
- NanoScience Technology Center, University of Central Florida, Orlando, Florida, USA
| | - Melissa A Russo
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Shruti M Raja
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Karissa L Gable
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Doug Emmett
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Lisa D Hobson-Webb
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Manisha Chopra
- Department of Neurology, The University of North Carolina - Chapel Hill, School of Medicine, Chapel Hill, NC, USA
| | - James F Howard
- Department of Neurology, The University of North Carolina - Chapel Hill, School of Medicine, Chapel Hill, NC, USA
| | - Jeffrey T Guptill
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Michael J Storek
- Sanofi, Immunology and Inflammation, 225 2 Ave, Waltham, MA, 02451 USA
| | | | - Nazem Atassi
- Sanofi, Neurology Early Development, 50 Binney Street, Cambridge, MA, 02142 USA
| | - Sandip Panicker
- Bioverativ, a Sanofi company, 225 2 Ave, Waltham, MA, 02451 USA
| | - Graham Parry
- Bioverativ, a Sanofi company, 225 2 Ave, Waltham, MA, 02451 USA
| | - Timothy Hammond
- Sanofi, Neurological Diseases, 49 New York Ave, Framingham, MA, 01701 USA
| | - James J Hickman
- Hesperos, Inc., 12501 Research Parkway, Suite 100, Orlando, FL 32826
- NanoScience Technology Center, University of Central Florida, Orlando, Florida, USA
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Higgoda R, Perera D, Thirumavalavan K. Multifocal motor neuropathy presenting as a post-infectious complication of dengue: a CASE report. BMC Infect Dis 2018; 18:415. [PMID: 30134860 PMCID: PMC6103970 DOI: 10.1186/s12879-018-3334-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 08/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background Dengue infection is an endemic illness in the tropics and it is associated with a wide variety of post infectious complications. With the increasing prevalence of dengue infection in endemic regions, post-infectious neurological complications following dengue infection are now been reported more frequently. We report a patient who developed multifocal motor neuropathy (MMN) with conduction blocks following dengue infection during the immediate post-infectious period. MMN is a rare neurological disorder with an autoimmune etiology and to best of our knowledge this is the first reported case of MMN occurring following dengue infection as a post dengue neurological complication. Case presentation A 20 year old Sri Lankan male who was treated for serologically confirmed dengue infection presented to us with 1 month history of bilateral hand weakness which has started 5 days after the dengue infection (5 days after the discharge). On examination he had asymmetrical motor weakness of the hands and to a lesser degree in feet. There was no sensory impairment. Nerve conduction studies confirmed MMN with conduction blocks. He was started on intravenous immunoglobulin therapy for which he showed a good response. Conclusion The authors report the first case of MMN complicating dengue fever in a previously healthy male from Sri Lanka. Thus it should be borne in mind that although rare, MMN can occur as a post-infectious complication of dengue fever.
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Doppler K, Appeltshauser L, Wilhelmi K, Villmann C, Dib-Hajj SD, Waxman SG, Mäurer M, Weishaupt A, Sommer C. Destruction of paranodal architecture in inflammatory neuropathy with anti-contactin-1 autoantibodies. J Neurol Neurosurg Psychiatry 2015; 86:720-8. [PMID: 25694474 DOI: 10.1136/jnnp-2014-309916] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/31/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Autoantibodies against paranodal proteins have been described in patients with inflammatory neuropathies, but their association with pathology of nodes of Ranvier is unclear. We describe the clinical phenotype and histopathological changes of paranodal architecture of patients with autoantibodies against contactin-1, identified from a cohort with chronic inflammatory demyelinating polyradiculoneuropathy (n=53) and Guillain-Barré syndrome (n=21). METHODS We used ELISA to detect autoantibodies against contactin-1. Specificity of the autoantibodies was confirmed by immunoblot assay, binding to contactin-1-transfected human embryonic kidney cells, binding to paranodes of murine teased fibres and preabsorption experiments. Paranodal pathology was investigated by immunofluorescence labelling of dermal myelinated fibres. RESULTS High reactivity to contactin-1 by ELISA was found in four patients with chronic inflammatory demyelinating polyradiculoneuropathy and in none of the patients with Guillain-Barré syndrome, which was confirmed by cell binding assays in all four patients. The four patients presented with a typical clinical picture, namely acute onset of disease and severe motor symptoms, with three patients manifesting action tremor. Immunofluorescence-labelling of paranodal proteins of dermal myelinated fibres revealed disruption of paranodal architecture. Semithin sections showed axonal damage but no classical signs of demyelination. INTERPRETATION We conclude that anti-contactin-1-related neuropathy constitutes a presumably autoantibody-mediated form of inflammatory neuropathy with distinct clinical symptoms and disruption of paranodal architecture as a pathological correlate. Anti-contactin-1-associated neuropathy does not meet morphological criteria of demyelinating neuropathy and therefore, might rather be termed a 'paranodopathy' rather than a subtype of demyelinating inflammatory neuropathy.
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Affiliation(s)
- Kathrin Doppler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | | | - Kai Wilhelmi
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Carmen Villmann
- Institute for Clinical Neurobiology, University Hospital Würzburg, Würzburg, Germany
| | - Sulayman D Dib-Hajj
- Department of Neurology, Yale University School of Medicine, New Haven, USA Center of Neuroscience and Regeneration Research, Veterans Affairs Medical Center, West Haven, USA
| | - Stephen G Waxman
- Department of Neurology, Yale University School of Medicine, New Haven, USA Center of Neuroscience and Regeneration Research, Veterans Affairs Medical Center, West Haven, USA
| | - Mathias Mäurer
- Department of Neurology, Caritas-Krankenhaus Bad Mergentheim GmbH, Bad Mergentheim, Germany
| | - Andreas Weishaupt
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
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Vlam L, Cats EA, Harschnitz O, Jansen MD, Piepers S, Veldink JH, Franssen H, Stork ACJ, Heezius E, Rooijakkers SHM, Herpers BL, van Strijp JA, van den Berg LH, van der Pol WL. Complement activity is associated with disease severity in multifocal motor neuropathy. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e119. [PMID: 26161430 PMCID: PMC4484896 DOI: 10.1212/nxi.0000000000000119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/11/2015] [Indexed: 11/19/2022]
Abstract
Objective: To investigate whether high innate activity of the classical and lectin pathways of complement is associated with multifocal motor neuropathy (MMN) and whether levels of innate complement activity or the potential of anti-GM1 antibodies to activate the complement system correlate with disease severity. Methods: We performed a case-control study including 79 patients with MMN and 79 matched healthy controls. Muscle weakness was documented with Medical Research Council scale sum score and axonal loss with nerve conduction studies. Activity of the classical and lectin pathways of complement was assessed by ELISA. We also determined serum mannose-binding lectin (MBL) concentrations and polymorphisms in the MBL gene (MBL2) and quantified complement-activating properties of anti-GM1 IgM antibodies by ELISA. Results: Activity of the classical and lectin pathways, MBL2 genotypes, and serum MBL concentrations did not differ between patients and controls. Complement activation by anti-GM1 IgM antibodies was exclusively mediated through the classical pathway and correlated with antibody titers (p < 0.001). Logistic regression analysis showed that both high innate activity of the classical pathway of complement and high complement-activating capacity of anti-GM1 IgM antibodies were significantly associated with more severe muscle weakness and axonal loss. Conclusion: High innate activity of the classical pathway of complement and efficient complement-activating properties of anti-GM1 IgM antibodies are determinants of disease severity in patients with MMN. These findings underline the importance of anti-GM1 antibody–mediated complement activation in the pathogenesis and clinical course of MMN.
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Affiliation(s)
- Lotte Vlam
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Elisabeth A Cats
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Oliver Harschnitz
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Marc D Jansen
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Sanne Piepers
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Jan Herman Veldink
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Hessel Franssen
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Abraham C J Stork
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Erik Heezius
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Suzan H M Rooijakkers
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Bjorn L Herpers
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Jos A van Strijp
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - Leonard H van den Berg
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
| | - W Ludo van der Pol
- Brain Center Rudolf Magnus (L.V., E.A.C., O.H., M.D.J., S.P., J.H.V., H.F., A.C.J.S., L.H.v.d.B., W.L.v.d.P.), Department of Neurology and Department of Medical Microbiology (E.H., S.H.M.R., J.A.v.S.) University Medical Center Utrecht, the Netherlands; and Regional Public Health Laboratory Kennemerland (B.L.H.), Haarlem, the Netherlands
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Harschnitz O, Jongbloed BA, Franssen H, Straver DCG, van der Pol WL, van den Berg LH. MMN: from immunological cross-talk to conduction block. J Clin Immunol 2014; 34 Suppl 1:S112-9. [PMID: 24728842 PMCID: PMC4050293 DOI: 10.1007/s10875-014-0026-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/19/2014] [Indexed: 12/11/2022]
Abstract
Multifocal motor neuropathy (MMN) is a rare inflammatory neuropathy characterized by progressive, asymmetric distal limb weakness and conduction block (CB). Clinically MMN is a pure motor neuropathy, which as such can mimic motor neuron disease. GM1-specific IgM antibodies are present in the serum of approximately half of all MMN patients, and are thought to play a key role in the immune pathophysiology. Intravenous immunoglobulin (IVIg) treatment has been shown to be effective in MMN in five randomized placebo-controlled trials. Despite long-term treatment with intravenous immunoglobulin (IVIg), which is efficient in the majority of patients, slowly progressive axonal degeneration and subsequent muscle weakness cannot be fully prevented. In this review, we will discuss the current understanding of the immune pathogenesis underlying MMN and how this may cause CB, available treatment strategies and future therapeutic targets.
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Affiliation(s)
- Oliver Harschnitz
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center Rudolf Magnus, Utrecht, 3584 CG, The Netherlands
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Prevalence, specificity and functionality of anti-ganglioside antibodies in neuropathy associated with IgM monoclonal gammopathy. J Neuroimmunol 2014; 268:89-94. [PMID: 24529728 DOI: 10.1016/j.jneuroim.2014.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/23/2014] [Accepted: 01/27/2014] [Indexed: 11/21/2022]
Abstract
IgM antibodies against gangliosides and their complexes were studied in sera from 54 patients with polyneuropathy and IgM monoclonal gammopathy (IgM-PNP) without anti-MAG antibodies. Anti-ganglioside antibodies were found in 19 (35%) patients. Five (9%) patients had antibodies against ganglioside complexes. IgM antibodies against gangliosides activated complement in vitro. Light chain usage was restricted to kappa or lambda in most, but not all patients. In conclusion, anti-ganglioside antibodies in IgM-PNP are common, display pathogenic properties and do not always arise from a monoclonal B cell proliferation.
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Lawson VH, Arnold WD. Multifocal motor neuropathy: a review of pathogenesis, diagnosis, and treatment. Neuropsychiatr Dis Treat 2014; 10:567-76. [PMID: 24741315 PMCID: PMC3983019 DOI: 10.2147/ndt.s39592] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Multifocal motor neuropathy (MMN) is an uncommon, purely motor neuropathy associated with asymmetric deficits with predilection for upper limb involvement. Even in the early descriptions of MMN, the associations of anti-GM1 antibodies and robust response to immunomodulatory treatment were recognized. These features highlight the likelihood of an underlying autoimmune etiology of MMN. The clinical presentation of MMN can closely mimic several neurological conditions including those with more malignant prognoses such as motor neuron disease. Therefore early and rapid recognition of MMN is critical. Serological evidence of anti GM-1 antibodies and electrodiagnostic findings of conduction block are helpful diagnostic clues for MMN. Importantly, these diagnostic features are not universally present, and patients lacking these characteristic findings can demonstrate similar robust response to immunodulatory treatment. In the current review, recent research in the areas of diagnosis, pathogenesis, and treatment of MMN and needs for the future are discussed. The characteristic findings of MMN and treatment implications are reviewed and contrasted with other mimicking disorders.
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Affiliation(s)
- Victoria H Lawson
- Division of Neuromuscular Disorders, Department of Neurology, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - W David Arnold
- Division of Neuromuscular Disorders, Department of Neurology, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA ; Department of Physical Medicine and Rehabilitation, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
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9
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GM1 ganglioside in Parkinson's disease: Results of a five year open study. J Neurol Sci 2010; 292:45-51. [DOI: 10.1016/j.jns.2010.02.009] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 02/02/2010] [Accepted: 02/08/2010] [Indexed: 11/22/2022]
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10
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Anti-idiotypic antibody mimicking a T-antigen-specific lectin inhibits human epithelial tumor cell proliferation. Immunol Cell Biol 2010; 88:787-94. [PMID: 20404839 DOI: 10.1038/icb.2010.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cancer-associated mucins show frequent alterations of oligosaccharide chain profile. Terminal structures may be deleted, thereby exposing normally 'cryptic' structures such as Tn (GalNAcα-O-Ser/Thr) and T antigen (Galβ1-3GalNAcα-O-Ser/Thr). Overexpression of these commonly hidden glycoforms, and reduced level of naturally occurring anti-T or anti-Tn antibodies, is associated with epithelial tumor progression and aggressiveness. The lectin from the common edible mushroom Agaricus bisporus (ABL) shows high affinity binding to T antigen, and reversible noncytotoxic inhibitory effect on epithelial tumor cell proliferation. The aim of this study was to induce immune response with tumor-associated glycan specificity and biological activity similar to those of ABL. An anti-idiotypic (Id) antibody strategy was developed using ABL as first template. ABL was purified by affinity chromatography and assayed as immunogen in rabbit. Rabbit IgG was purified from anti-ABL serum using a protein G column, and specific anti-ABL IgG was obtained by affinity chromatography using immobilized ABL. Affinity-purified anti-ABL IgG contained an antibody fraction that recognizes the carbohydrate-binding site of ABL. This IgG was used as immunogen in mouse to yield anti-Id antibody recognizing tumor-associated glycans such as Tn and T antigen. Competitive assays showed that α-anomeric GalNAc is the main binding subsite of anti-Id antibody in glycan recognition. Anti-Id antibody bound human epithelial tumor cells, as shown by cell enzyme-linked immunosorbent assay and immunofluorescence. Anti-Id antibody raised by immunization with affinity-purified anti-ABL IgG had antiproliferative effect on human epithelial tumor cells through apoptosis induction similar to that of ABL. The anti-Id immune response developed here has potential application in cancer therapy.
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Notturno F, Del Boccio P, Luciani M, Caporale CM, Pieragostino D, Prencipe V, Sacchetta P, Uncini A. Monospecific high-affinity and complement activating anti-GM1 antibodies are determinants in experimental axonal neuropathy. J Neurol Sci 2010; 293:76-81. [PMID: 20382399 DOI: 10.1016/j.jns.2010.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 03/04/2010] [Accepted: 03/08/2010] [Indexed: 11/16/2022]
Abstract
It has been difficult to replicate consistently the experimental model of axonal Guillain-Barré syndrome (GBS). We immunized rabbits with two lipo-oligosaccharides (LOS1 and LOS2) derived from the same C. jejuni strain and purified in a slightly different way. LOS1 did not contain proteins whereas several proteins were present in LOS2. In spite of a robust anti-GM1 antibody response in all animals the neuropathy developed only in rabbits immunized with LOS1. To explain this discrepancy we investigated fine specificity, affinity and ability to activate the complement of anti-GM1 antibodies. Only rabbits immunized with LOS1 showed monospecific high-affinity antibodies which activated more effectively the complement. Although it is not well understood how monospecific high-affinity antibodies are induced these are crucial for the induction of experimental axonal neuropathy. Only a strict adherence to the protocols demonstrated to be successful may guarantee the reproducibility and increase the confidence in the animal model as a reliable tool for the study of the human axonal GBS.
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Affiliation(s)
- Francesca Notturno
- Department of Human Motor Sciences, Institute of Aging (CeSI), University G. D'Annunzio, Chieti-Pescara, Italy
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Notturno F, Luciani M, Caporale C, Ciarelli A, Uncini A. Antibodies to Ganglioside Complexes in Guillain-Barré Syndrome: Clinical Correlates, Fine Specificity and Complement Activation. Int J Immunopathol Pharmacol 2009; 22:437-45. [DOI: 10.1177/039463200902200220] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the Schwann cells and neuronal plasma membranes the gangliosides are organized in clusters forming complexes of gangliosides in the microdomains termed lipid rafts. We investigated frequency, clinical correlates, fine specificity and pro-inflammatory properties of antibodies to ganglioside complexes (GSCs) in a Guillain Barré syndrome (GBS) population. In 63 patients with different GBS variants we performed an ELISA for antibodies to Campylobacter Jejuni ( C. jejuni), gangliosides and GSCs. We studied the fine specificity of antibodies to GSCs by immunoabsorption study and performed a complement activation assay. Twenty-seven percent of patients had antibodies to GSCs and 71% had antibodies either to single gangliosides or to GSCs. Patients with antibodies to GSCs had more frequent involvement of cranial nerves but did not present more frequent antecedent respiratory, gastrointestinal or C. jejuni infection, did not have a preferential demyelinating or primary axonal GBS variant and did not develop greater disability at six months. The absorption study showed in 2 sera that antibodies to the complex GD1a/GD1b did not react with the gangliosides forming the complex or other single gangliosides, suggesting that antibodies to GSCs are targeted to new conformational glycoepitopes different from the ones displayed by the single gangliosides. Antibody anti-GSCs activated the complement more frequently than antibodies to single gangliosides. Complement activation indicates that antibodies to GSCs have high avidity, pro-inflammatory properties and may exert a pathogenic role in GBS.
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Affiliation(s)
| | - M. Luciani
- Experimental Zooprophylactic Institute “G. Caporale”, Teramo, Italy
| | | | - A. Ciarelli
- Experimental Zooprophylactic Institute “G. Caporale”, Teramo, Italy
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Willison HJ, Plomp JJ. Anti-ganglioside antibodies and the presynaptic motor nerve terminal. Ann N Y Acad Sci 2008; 1132:114-23. [PMID: 18567860 DOI: 10.1196/annals.1405.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The Guillain Barré syndromes (GBS) are the world's leading cause of acute autoimmune neuromuscular paralysis. Understanding the pathophysiological events of GBS, and improving immunotherapies are fundamental to improving the clinical outcome. Recent research into GBS and the Miller Fisher syndrome (MFS) variant has focused on the forms mediated by anti-ganglioside antibodies in which correlations have been established between anti-ganglioside antibodies and specific clinical phenotypes, notably between anti-GM1/GD1a antibodies and the acute motor axonal variant and anti-GQ1b/GT1a antibodies and MFS. Anti-ganglioside antibodies can arise through molecular mimicry with GBS-associated Campylobacter jejuni oligosaccharides. Our work has focused on axonal and glial components of the motor nerve terminal as a model site of injury, and through combined active and passive immunization paradigms in glycosyltransferase knockout mice we have developed murine neuropathy phenotypes mediated by anti-ganglioside antibodies. Several determinants influence disease expression including the level of immunological tolerance to microbial glycans that mimic self gangliosides, the degree of complement activation, and the ganglioside density in target tissue. Such studies provide us with clear information on an antibody-mediated pathogenesis model for GBS and should lead to rational therapeutic testing of agents that are potentially suitable for use in man.
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Affiliation(s)
- Hugh J Willison
- Division of Clinical Neurosciences, University of Glasgow , Scotland, UK.
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Current world literature. Curr Opin Neurol 2008; 21:615-24. [PMID: 18769258 DOI: 10.1097/wco.0b013e32830fb782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Immune responses directed towards gangliosides and their microbial mimics are important mediators of several subtypes of acute post-infectious autoimmune neuropathy, collectively referred to as the Guillain-Barré syndromes. In this diverse group of paralytic syndromes, the immunopathology is in a proportion of cases characterised by anti-ganglioside antibody deposits, accompanied by inflammatory destruction of both axonal and glial components within the PNS. By gaining an understanding of the immunological mechanisms underlying these pathological pathways, it should be possible to select the correct targets for therapeutic intervention. Recent years has seen particular progress in our understanding of the basis for, and immunological consequences of molecular mimicry between gangliosides and microbial glycans, the relationships between ganglioside antibody specificity and different clinical phenotypes of GBS, the pathological basis for antibody-mediated nerve injury and the testing of intervention strategies in pre-clinical models. The focus of this mini-review is to provide a brief background to this field, summarise a selection of recent highlights focused on our own research, identify areas of outstanding knowledge and present data that supports novel therapeutic approaches based on the latest experimental findings.
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Affiliation(s)
- Hugh J Willison
- Division of Clinical Neurosciences, University of Glasgow, Scotland.
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Susuki K, Rasband MN, Tohyama K, Koibuchi K, Okamoto S, Funakoshi K, Hirata K, Baba H, Yuki N. Anti-GM1 antibodies cause complement-mediated disruption of sodium channel clusters in peripheral motor nerve fibers. J Neurosci 2007; 27:3956-67. [PMID: 17428969 PMCID: PMC6672537 DOI: 10.1523/jneurosci.4401-06.2007] [Citation(s) in RCA: 290] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Voltage-gated Na+ (Na(v)) channels are highly concentrated at nodes of Ranvier in myelinated axons and facilitate rapid action potential conduction. Autoantibodies to gangliosides such as GM1 have been proposed to disrupt nodal Nav channels and lead to Guillain-Barré syndrome, an autoimmune neuropathy characterized by acute limb weakness. To test this hypothesis, we examined the molecular organization of nodes in a disease model caused by immunization with gangliosides. At the acute phase with progressing limb weakness, Na(v) channel clusters were disrupted or disappeared at abnormally lengthened nodes concomitant with deposition of IgG and complement products. Paranodal axoglial junctions, the nodal cytoskeleton, and Schwann cell microvilli, all of which stabilize Na(v) channel clusters, were also disrupted. The nodal molecules disappeared in lesions with complement deposition but no localization of macrophages. During recovery, complement deposition at nodes decreased, and Na(v) channels redistributed on both sides of affected nodes. These results suggest that Na(v) channel alterations occur as a consequence of complement-mediated disruption of interactions between axons and Schwann cells. Our findings support the idea that acute motor axonal neuropathy is a disease that specifically disrupts the nodes of Ranvier.
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Affiliation(s)
- Keiichiro Susuki
- Department of Neurology and Research Institute for Neuroimmunological Diseases, Dokkyo Medical University School of Medicine, Tochigi 321-0293, Japan
- Department of Neuroscience, University of Connecticut Health Center, Farmington, Connecticut 06030
| | - Matthew N. Rasband
- Department of Neuroscience, University of Connecticut Health Center, Farmington, Connecticut 06030
| | - Koujiro Tohyama
- The Center for Electron Microscopy and Bio-Imaging Research, Laboratory for Nano-Neuroanatomy, Iwate Medical University, Morioka 020-8505, Japan, and
| | - Katsura Koibuchi
- Department of Neurology and Research Institute for Neuroimmunological Diseases, Dokkyo Medical University School of Medicine, Tochigi 321-0293, Japan
| | - Saori Okamoto
- Department of Neurology and Research Institute for Neuroimmunological Diseases, Dokkyo Medical University School of Medicine, Tochigi 321-0293, Japan
| | - Kei Funakoshi
- Department of Neurology and Research Institute for Neuroimmunological Diseases, Dokkyo Medical University School of Medicine, Tochigi 321-0293, Japan
| | - Koichi Hirata
- Department of Neurology and Research Institute for Neuroimmunological Diseases, Dokkyo Medical University School of Medicine, Tochigi 321-0293, Japan
| | - Hiroko Baba
- Department of Molecular Neurobiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji 192-0392, Japan
| | - Nobuhiro Yuki
- Department of Neurology and Research Institute for Neuroimmunological Diseases, Dokkyo Medical University School of Medicine, Tochigi 321-0293, Japan
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