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Roggenbuck D, Delmont E, Reinhold D, Schierack P, Conrad K, Boucraut J. Autoimmune Peripheral Neuropathies and Contribution of Antiganglioside/Sulphatide Autoantibody Testing. Mediterr J Rheumatol 2020; 31:10-18. [PMID: 32411930 PMCID: PMC7219652 DOI: 10.31138/mjr.31.1.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/04/2020] [Indexed: 12/13/2022] Open
Abstract
Peripheral immune-mediated polyneuropathies (IMPN) are a diverse group of rare neurological illnesses characterized by nerve damage. Leading morphological features are mostly nerve fibre demyelination or combination of axonal damage and demyelination. There has been remarkable progress in the clinical and electrophysiological categorization of acute (fulminant, life-threatening) and chronic (progressive/remitting-relapsing) immune-mediated neuropathies recently. Besides electrophysiological and morphological makers, autoantibodies against glycolipids or paranodal/nodal molecules have been recommended as candidate markers for IMPN. The progress in testing for autoantibodies (autoAbs) to glycolipids such as gangliosides and sulfatide may have significant implications on the stratification of patients and their treatment response. Thus, this topic was reviewed in a presentation held during the 1st Panhellenic Congress of Autoimmune Diseases, Rheumatology and Clinical Immunology in Portaria, Pelion, Greece. For acute IMPN, often referred to as Guillain-Barré syndrome and its variants, several serological markers including autoAbs to gangliosides and sulphatide have been employed successfully in clinical routine. However, the evolution of serological diagnosis of chronic variants, such as chronic inflammatory demyelinating polyneuropathy or multifocal motor neuropathy, is less satisfactory. Serological diagnostic markers could, therefore, help in the differential diagnosis due to their assumed pathogenic role. Additionally, stratification of patients to improve their response to treatment may be possible. In general, a majority of patients respond well to causal therapy that includes intravenous immunoglobulins and plasmapheresis. As second line therapy options, biologicals (e.g., rituximab) and immunosuppressant or immunomodulatory drugs may be considered when patients do not respond adequately.
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Affiliation(s)
- Dirk Roggenbuck
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Germany.,Institute of Biotechnology, Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus Senftenberg, Senftenberg, Germany
| | - Emilien Delmont
- Referral Center for Neuromuscular Diseases and ALS, La Timone Hospital, AP-HM, Marseille France
| | - Dirk Reinhold
- Institute of Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Peter Schierack
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Germany.,Institute of Biotechnology, Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus Senftenberg, Senftenberg, Germany
| | - Karsten Conrad
- Institute of Immunology, Medical Faculty of the Technical University Dresden, Dresden, Germany
| | - Joseph Boucraut
- Aix Marseille Université, Institut de Neurosciences de la Timone, Medicine Faculty, Marseille, France.,Immunology laboratory, Conception Hospital, AP-HM, Marseille, France
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Yanagida H, Sugimoto K, Izu A, Wada N, Sakata N, Takemura T. Guillain-Barré syndrome and Crohn disease: a case report. J Child Neurol 2014; 29:NP78-80. [PMID: 24092893 DOI: 10.1177/0883073813503903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Development of both Crohn disease and Guillain-Barré syndrome likely involves autoimmunity associated with excessive inflammatory cytokines. We treated a girl who developed Guillain-Barré syndrome during the course of Crohn disease. Although high-dose γ-globulin therapy administered initially for Guillain-Barré syndrome was ineffective, plasmapheresis ameliorated her acute neuropathic symptoms. Crohn disease was managed with Salazopyrin administration and enteral feeding. Chronic inflammation of the intestinal mucosa caused by Crohn disease can allow presentation of microbial intestinal antigens normally hidden from the immune system. Such presentation could incite an extraintestinal immune response on the basis of molecular mimicry, leading to activation of systemic autoimmunity against the nervous system. Accordingly, concurrence of Guillain-Barré syndrome and Crohn disease in our patient appeared to result from shared autoimmune mechanisms and systemic and local increases in cytokine concentrations. The patient also developed erythema nodosum and gall stones, relatively common complications of Crohn disease. However, Guillain-Barré syndrome is rare.
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Affiliation(s)
- Hidehiko Yanagida
- Department of Pediatrics, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Keisuke Sugimoto
- Department of Pediatrics, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Akane Izu
- Department of Pediatrics, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Norihisa Wada
- Department of Pediatrics, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Naoki Sakata
- Department of Pediatrics, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Tsukasa Takemura
- Department of Pediatrics, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
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Galban-Horcajo F, Fitzpatrick AM, Hutton AJ, Dunn SM, Kalna G, Brennan KM, Rinaldi S, Yu RK, Goodyear CS, Willison HJ. Antibodies to heteromeric glycolipid complexes in multifocal motor neuropathy. Eur J Neurol 2012; 20:62-70. [PMID: 22727042 DOI: 10.1111/j.1468-1331.2012.03767.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 04/24/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Measurement of anti-GM1 IgM antibodies in multifocal motor neuropathy (MMN) sera is confounded by relatively low sensitivity that limits clinical usefulness. Combinatorial assay methods, in which antibodies react to heteromeric complexes of two or more glycolipids, are being increasingly applied to this area of diagnostic testing. METHODS A newly developed combinatorial glycoarray able to identify antibodies to 45 different heteromeric glycolipid complexes and their 10 individual glycolipid components was applied to a randomly selected population of 33 MMN cases and 57 normal or disease controls. Comparison with an enzyme-linked immunosorbent assay (ELISA) was conducted for selected single glycolipids and their complexes. RESULTS By ELISA, 22/33 MMN cases had detectable anti-GM1 IgM antibodies, whereas 19/33 MMN samples were positive for anti-GM1 antibodies by glycoarray. Analysis of variance (anova) revealed that of the 55 possible single glycolipids and their 1:1 complexes, antibodies to the GM1:galactocerebroside (GM1:GalC) complex were most significantly associated with MMN, returning 33/33 MMN samples as positive by glycoarray and 29/33 positive by ELISA. Regression analysis revealed a high correlation in absolute values between ELISA and glycoarray. Receiver operator characteristic analysis revealed insignificantly different diagnostic performance between the two methods. However, the glycoarray appeared to offer slightly improved sensitivity by identifying antibodies in four ELISA-negative samples. CONCLUSIONS The use of combinatorial glycoarray or ELISA increased the diagnostic sensitivity of anti-glycolipid antibody testing in this cohort of MMN cases, without significantly affecting specificity, and may be a useful assay modification for routine clinical screening.
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Affiliation(s)
- F Galban-Horcajo
- Glasgow Biomedical Research Centre, College of Medical, Veterinary and Life Science, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Stommel EW, Cohen JA, Fadul CE, Cogbill CH, Graber DJ, Kingman L, Mackenzie T, Channon Smith JY, Harris BT. Efficacy of thalidomide for the treatment of amyotrophic lateral sclerosis: a phase II open label clinical trial. ACTA ACUST UNITED AC 2010; 10:393-404. [PMID: 19922130 DOI: 10.3109/17482960802709416] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neuroinflammation through the cytokine, tumor necrosis factor-alpha (TNF-alpha) is thought to play an important role in the pathogenesis of amyotrophic lateral sclerosis (ALS). We conducted a preliminary phase II trial of thalidomide, which reduces levels of TNF-alpha pre-transcriptionally and post-transcriptionally in vivo and has been shown to prolong disease duration and extend the lifespan of transgenic animal models of ALS. Patients who met diagnostic criteria for ALS received thalidomide at escalating doses to a target dose of 400 mg/day. The primary endpoints in the trial were the ALS Functional Rating Scale (ALSFRS) and pulmonary function testing (PFT) curves after nine months of thalidomide treatment that were compared to historical controls. Secondary endpoints were: survival stratified for newly diagnosed and progressive disease, toxicity, quality of life, and serum cytokine measurements. Twenty-three patients were enrolled, but only 18 were evaluable for the primary outcome. There was no improvement in the ALSFRS or PFT compared to historical controls. Thalidomide had several side-effects in our ALS patients. There was no significant shift in cytokine profile after treatment compared to baseline. In conclusion, treatment of ALS with the TNF-alpha inhibitor, thalidomide, does not appear to effectively modulate disease progression and can cause adverse effects.
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Affiliation(s)
- Elijah W Stommel
- Department of Medicine (Section of Neurology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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van Sorge NM, van den Berg LH, Geleijns K, van Strijp JA, Jacobs BC, van Doorn PA, Wokke JHJ, van de Winkel JGJ, Leusen JHW, van der Pol WL. Anti-GM1 IgG antibodies induce leukocyte effector functions via Fcgamma receptors. Ann Neurol 2003; 53:570-9. [PMID: 12730990 DOI: 10.1002/ana.10503] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated neuropathy, in which leukocytes and humoral components of the immune system proposedly initiate localized inflammation. An important pathogenic role for anti-GM1 ganglioside antibodies has been suggested. Therefore, we evaluated anti-GM1 IgG antibody-induced leukocyte effector functions such as degranulation and phagocytosis using serum of 24 GBS patients. Serum without anti-GM1 antibodies of 9 GBS patients as well as pooled serum from healthy individuals served as controls. Ten out of 15 (67%) of anti-GM1 IgG positive sera were capable of inducing leukocyte degranulation, and 8 out of 15 (53%) of anti-GM1 IgG positive sera were capable of inducing phagocytosis of GM1-coated beads. In all of these sera anti-GM1 antibody titers were >or=1:800. No leukocyte degranulation or phagocytosis was observed in control sera. Leukocyte activation was completely abrogated in the presence of IgG receptor (FcgammaR) blocking antibodies, suggesting a crucial role for leukocyte FcgammaR in GBS pathogenesis. No correlation of antibody titers with the extent of leukocyte activation, or severity of disease was observed. These data document the capacity of anti-GM1 IgG antibodies to activate leukocyte inflammatory functions, and suggest an important role for anti-ganglioside IgG antibodies in the pathogenesis of GBS.
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Affiliation(s)
- Nina M van Sorge
- Department of Neurology and Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Angelov DN, Waibel S, Guntinas-Lichius O, Lenzen M, Neiss WF, Tomov TL, Yoles E, Kipnis J, Schori H, Reuter A, Ludolph A, Schwartz M. Therapeutic vaccine for acute and chronic motor neuron diseases: implications for amyotrophic lateral sclerosis. Proc Natl Acad Sci U S A 2003; 100:4790-5. [PMID: 12668759 PMCID: PMC153634 DOI: 10.1073/pnas.0530191100] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Therapeutic vaccination with Copaxone (glatiramer acetate, Cop-1) protects motor neurons against acute and chronic degenerative conditions. In acute degeneration after facial nerve axotomy, the number of surviving motor neurons was almost two times higher in Cop-1-vaccinated mice than in nonvaccinated mice, or in mice injected with PBS emulsified in complete Freund's adjuvant (P < 0.05). In mice that express the mutant human gene Cu/Zn superoxide dismutase G93A (SOD1), and therefore simulate the chronic human motor neuron disease amyotrophic lateral sclerosis, Cop-1 vaccination prolonged life span compared to untreated matched controls, from 211 +/- 7 days (n = 15) to 263 +/- 8 days (n = 14; P < 0.0001). Our studies show that vaccination significantly improved motor activity. In line with the experimentally based concept of protective autoimmunity, these findings suggest that Cop-1 vaccination boosts the local immune response needed to combat destructive self-compounds associated with motor neuron death. Its differential action in CNS autoimmune diseases and neurodegenerative disorders, depending on the regimen used, allows its use as a therapy for either condition. Daily administration of Cop-1 is an approved treatment for multiple sclerosis. The protocol for non-autoimmune neurodegenerative diseases such as amyotrophic lateral sclerosis, remains to be established by future studies.
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Affiliation(s)
- D N Angelov
- Department of Oto-Rhino-Laryngology, University of Cologne, D50924 Cologne, Germany
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Obal I, Siklós L, Engelhardt JI. Altered calcium in motoneurons by IgG from human motoneuron diseases. Acta Neurol Scand 2002; 106:282-91. [PMID: 12371922 DOI: 10.1034/j.1600-0404.2002.01252.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The effect of IgG from patients with multifocal motor neuropathy (MMN) on the content and distribution of calcium in spinal motoneurons was compared with the effect of IgG from patients with sporadic amyotrophic lateral sclerosis (SALS) and IgG from normal individuals. MATERIAL AND METHODS Different purified IgG samples were injected intraperitoneally in mice. Then, the animals were subjected to histochemical techniques to visualize calcium in electron microscopic sections. RESULTS Quantitative morphometric analysis verified that IgG from MMN decreased the vesicular and axoplasmic calcium content in the axon terminals at the neuromuscular junctions and had no influence on the perikaryon. In contrast to this, IgG from patients with SALS increased the intracellular calcium both in the axon terminal and in the perikaryon. IgG from normal individuals exerted no effect. Elevated intracellular calcium may contribute to motoneuron degeneration. The lack of such effect with MMN immunoglobulins helps to explain the relative sparing of motoneurons in the disease.
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Affiliation(s)
- I Obal
- Department of Neurology, University of Szeged, Szeged, Hungary.
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Mya MM, Saxena RK, Roy A. Sensitivity and specificity of isolated antigen fromPlasmodium falciparum culture supernatant. Indian J Clin Biochem 2002; 17:75-82. [PMID: 23105341 PMCID: PMC3453713 DOI: 10.1007/bf02867946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Immunological sensitivity and specificity properties of isolated Plasmodium falciparum (GPL) antigen from culture supernatant have been measured and compared with malarial antigens and non malarial filtered paper blood sera for potency and efficacy. Latex bead coded GPL, Pf and RESA antigens immunoreaction properties of human filter paper blood samples (FPB) were studied by laser light scattering immunoassay (LIA) and Enzyme linked immunoabsorbent assay (ELISA) techniques. Results of GP. antigen sensitivity study by LIA method showed a very high malaria antibody binding response (MABR) i.e. 6% compared with 78% with RESA and 88% Pf antigens. Malaria detection by ELISA method also found similar results. Specificity study of GPL antigen for different non malarial filter paper blood sera (NMFS) showed no immunoreaction however Pf and RESA antigen showed few positive immunological responses. These results suggest that sensitivity and specificity properties of isolated GPL antigen is better than other antigens.
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Affiliation(s)
- M. M. Mya
- Centre for Biomedical Engineering, Indian Institute of Technology, 110016 New Delhi
| | - R. K. Saxena
- Centre for Biomedical Engineering, Indian Institute of Technology, 110016 New Delhi
| | - Arati Roy
- Malaria Research Centre, 22, Shamnath Marg, 110054 Delhi
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