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Anti-MAG neuropathy: From biology to clinical management. J Neuroimmunol 2021; 361:577725. [PMID: 34610502 DOI: 10.1016/j.jneuroim.2021.577725] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2022]
Abstract
The acquired chronic demyelinating neuropathies include a growing number of disease entities that have characteristic, often overlapping, clinical presentations, mediated by distinct immune mechanisms, and responding to different therapies. After the discovery in the early 1980s, that the myelin associated glycoprotein (MAG) is a target antigen in an autoimmune demyelinating neuropathy, assays to measure the presence of anti-MAG antibodies were used as the basis to diagnose the anti-MAG neuropathy. The route was open for describing the clinical characteristics of this new entity as a chronic distal large fiber sensorimotor neuropathy, for studying its pathogenesis and devising specific treatment strategies. The initial use of chemotherapeutic agents was replaced by the introduction in the late 1990s of rituximab, a monoclonal antibody against CD20+ B-cells. Since then, other anti-B cells agents have been introduced. Recently a novel antigen-specific immunotherapy neutralizing the anti-MAG antibodies with a carbohydrate-based ligand mimicking the natural HNK-1 glycoepitope has been described.
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Cleaver J, James R, Chohan G, Lyons P. Bickerstaff's brainstem encephalitis associated with anti-GM1 and anti-GD1a antibodies. BMJ Case Rep 2020; 13:e236545. [PMID: 32948528 PMCID: PMC7511636 DOI: 10.1136/bcr-2020-236545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 11/03/2022] Open
Abstract
Bickerstaff's brainstem encephalitis (BBE) is a Guillain-Barré syndrome (GBS) spectrum disorder associated with predominantly central nervous system predilection. Patients exhibit a variable constellation of depressed consciousness, bilateral external ophthalmoplegia, ataxia and long tract signs. Although the pathophysiology is not fully understood, it has been associated with anti-GQ1b antibodies in two-thirds of patients. We present a patient with clinical features consistent with BBE and positive anti-GM1 and anti-GD1a antibodies. A diagnostic approach to the acutely unwell patient with brainstem encephalitis is explored in this clinical context with a literature review of the aforementioned ganglioside antibody significance. Intravenous immunoglobulin therapy is highlighted in BBE using up-to-date evidence-based extrapolation from GBS.
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Affiliation(s)
- Jonathan Cleaver
- Department of Neurology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Richard James
- Department of Neuroradiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Gurjit Chohan
- Department of Neurology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Paul Lyons
- Department of Neurology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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3
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Zeiner PS, Brandhofe A, Müller-Eschner M, Steinmetz H, Pfeilschifter W. Area postrema syndrome as frequent feature of Bickerstaff brainstem encephalitis. Ann Clin Transl Neurol 2018; 5:1534-1542. [PMID: 30564620 PMCID: PMC6292382 DOI: 10.1002/acn3.666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/27/2018] [Accepted: 09/10/2018] [Indexed: 01/12/2023] Open
Abstract
Objective Area postrema (AP) syndrome (defined as: nausea and/or emesis and/or singultus at onset of brainstem dysfunction) comprises complex pathophysiologic mechanisms triggered by different entities. The first objective was to assess the frequency of AP syndrome as a clinical feature in brainstem encephalitis (BE). Finding an especially high prevalence of AP syndrome in Bickerstaff brainstem encephalitis (BBE), we also analyzed the frequency of AP syndrome in other autoimmune diseases with anti-ganglioside antibodies (Guillain-Barré syndrome (GBS) and its variants). Methods We systematically evaluated the prevalence of AP syndrome in BE in all patients treated at our university hospital during a 15-year period. In a second step, BBE patients were compared to GBS and Miller Fisher syndrome (MFS) patients as clinical subtypes of a disease continuum without brainstem dysfunction. Results We found AP syndrome in 8 of 21 BE patients, including 3 of 7 BBE and in 4 of 112 GBS/MFS patients. AP syndrome was as a frequent but under-recognized feature of BE with a significant impact on patients' well being. Interpretation Manifestation of AP syndrome in BBE but also in GBS and its subtypes point toward a role of autoimmune antibodies that should be investigated in future studies. Considerable misdiagnosis or nonrecognition complicates diagnostic and therapeutic management. Therefore, AP syndrome should be considered in any episode of otherwise unexplained nausea, emesis, or singultus.
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Affiliation(s)
- Pia S Zeiner
- Department of Neurology University Hospital/Goethe University Frankfurt Schleusenweg 2-16 Frankfurt/Main 60528 Germany.,Dr. Senckenberg Institute of Neurooncology University Hospital/Goethe University Frankfurt Heinrich-Hoffmann-Strasse 7 Frankfurt/Main 60528 Germany
| | - Annemarie Brandhofe
- Department of Neurology University Hospital/Goethe University Frankfurt Schleusenweg 2-16 Frankfurt/Main 60528 Germany
| | - Monika Müller-Eschner
- Institute of Neuroradiology University Hospital/Goethe University Frankfurt Schleusenweg 2-16 Frankfurt/Main 60528 Germany
| | - Helmuth Steinmetz
- Department of Neurology University Hospital/Goethe University Frankfurt Schleusenweg 2-16 Frankfurt/Main 60528 Germany
| | - Waltraud Pfeilschifter
- Department of Neurology University Hospital/Goethe University Frankfurt Schleusenweg 2-16 Frankfurt/Main 60528 Germany
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Roggenbuck JJ, Boucraut J, Delmont E, Conrad K, Roggenbuck D. Diagnostic insights into chronic-inflammatory demyelinating polyneuropathies. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:337. [PMID: 30306076 DOI: 10.21037/atm.2018.07.34] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare immune-mediated neuropathy with demyelination of nerve fibers as leading morphological feature. The course of disease can be chronic progressive or remitting relapsing. Whereas for acute immune-mediated neuropathies several serological markers have been identified and used successfully in clinical routine, the serological diagnosis of chronic variants such as CIDP has not yet been evolved satisfactory. The typical CIDP and its various atypical variants are characterized by a certain diversity of clinical phenotype and response to treatment. Thus, diagnostic markers could aid in the differential diagnosis of CIDP variants and stratification of patients for a better treatment response. Most patients respond well to a causal therapy including steroids, intravenous immunoglobulins and plasmapheresis. Apart from electrophysiological and morphological markers, several autoantibodies have been reported as candidate markers for CIDP, including antibodies against glycolipids or paranodal/nodal molecules. The present review provides a summary of the progress in autoantibody testing in CIDP and its possible implication on the stratification of the CIDP variants and treatment response.
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Affiliation(s)
| | - Joseph Boucraut
- Institut de Neurosciences de la Timone, Medicine Faculty, Aix Marseille University, Marseille, France.,Immunology laboratory, Conception Hospital, AP-HM, Marseille, France
| | - Emilien Delmont
- Referral Center for Neuromuscular Diseases and ALS, La Timone Hospital, AP-HM, Marseille, France
| | - Karsten Conrad
- Institute of Immunology, Technical University Dresden, Dresden, Germany
| | - Dirk Roggenbuck
- GA Generic Assays GmbH, Dahlewitz/Berlin, Germany.,Institute of Biotechnology, Faculty Environment and Natural Sciences, Brandenburg University of Technology, Senftenberg, Germany
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5
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Franciotta D, Gastaldi M, Benedetti L, Pesce G, Biagioli T, Lolli F, Costa G, Melis C, Andreetta F, Simoncini O, Giannotta C, Bazzigaluppi E, Fazio R, Bedin R, Ferraro D, Mariotto S, Ferrari S, Galloni E, De Riva V, Zardini E, Cortese A, Nobile-Orazio E. Diagnostics of dysimmune peripheral neuropathies. Neurol Sci 2018; 38:243-247. [PMID: 29030769 DOI: 10.1007/s10072-017-3025-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This document presents the guidelines for anti-ganglioside antibody testing that have been developed following a consensus process built on questionnaire-based surveys, internet contacts, and discussions at workshops of the sponsoring Italian Association of Neuroimmunology (AINI) congresses. Main clinical information on dysimmune peripheral neuropathies, indications and limits of anti-ganglioside antibody testing, instructions for result interpretation, and an agreed laboratory protocol (Appendix) are reported for the communicative community of neurologists and clinical pathologists.
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Affiliation(s)
- Diego Franciotta
- Laboratory of Neuroimmunology, C. Mondino National Neurological Institute, Via Mondino 2, I-27100, Pavia, Italy.
| | - Matteo Gastaldi
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Luana Benedetti
- Ospedale Policlinico San Martino IRCCS, University of Genova, Genoa, Italy
| | - Giampaola Pesce
- Ospedale Policlinico San Martino IRCCS, University of Genova, Genoa, Italy
| | | | - Francesco Lolli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | - Roberta Bedin
- Ospedale Civile Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Diana Ferraro
- Ospedale Civile Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | | | - Elisabetta Zardini
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Andrea Cortese
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
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6
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Singh MV, Weber EA, Singh VB, Stirpe NE, Maggirwar SB. Preventive and therapeutic challenges in combating Zika virus infection: are we getting any closer? J Neurovirol 2017; 23:347-357. [PMID: 28116673 PMCID: PMC5440476 DOI: 10.1007/s13365-017-0513-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/10/2017] [Indexed: 01/26/2023]
Abstract
The neuroteratogenic nature of Zika Virus (ZIKV) infection has converted what would have been a tropical disease into a global threat. Zika is transmitted vertically via infected placental cells especially in the first and second trimesters. In the developing central nervous system (CNS), ZIKV can infect and induce apoptosis of neural progenitor cells subsequently causing microcephaly as well as other neuronal complications in infants. Its ability to infect multiple cell types (placental, dermal, and neural) and increased environmental stability as compared to other flaviviruses (FVs) has broadened the transmission routes for ZIKV infection from vector-mediated to transmitted via body fluids. To further complicate the matters, it is genetically similar (about 40%) with the four serotypes of dengue virus (DENV), so much so that it can almost be called a fifth DENV serotype. This homology poses the risk of causing cross-reactive immune responses and subsequent antibody-dependent enhancement (ADE) of infection in case of secondary infections or for immunized individuals. All of these factors complicate the development of a single preventive vaccine candidate or a pharmacological intervention that will completely eliminate or cure ZIKV infection. We discuss all of these factors in detail in this review and conclude that a combinatorial approach including immunization and treatment might prove to be the winning strategy.
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Affiliation(s)
- Meera V Singh
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Emily A Weber
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Vir B Singh
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Nicole E Stirpe
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Sanjay B Maggirwar
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Cao-Lormeau VM, Blake A, Mons S, Lastère S, Roche C, Vanhomwegen J, Dub T, Baudouin L, Teissier A, Larre P, Vial AL, Decam C, Choumet V, Halstead SK, Willison HJ, Musset L, Manuguerra JC, Despres P, Fournier E, Mallet HP, Musso D, Fontanet A, Neil J, Ghawché F. Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet 2016; 387:1531-1539. [PMID: 26948433 PMCID: PMC5444521 DOI: 10.1016/s0140-6736(16)00562-6] [Citation(s) in RCA: 1592] [Impact Index Per Article: 199.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Between October, 2013, and April, 2014, French Polynesia experienced the largest Zika virus outbreak ever described at that time. During the same period, an increase in Guillain-Barré syndrome was reported, suggesting a possible association between Zika virus and Guillain-Barré syndrome. We aimed to assess the role of Zika virus and dengue virus infection in developing Guillain-Barré syndrome. METHODS In this case-control study, cases were patients with Guillain-Barré syndrome diagnosed at the Centre Hospitalier de Polynésie Française (Papeete, Tahiti, French Polynesia) during the outbreak period. Controls were age-matched, sex-matched, and residence-matched patients who presented at the hospital with a non-febrile illness (control group 1; n=98) and age-matched patients with acute Zika virus disease and no neurological symptoms (control group 2; n=70). Virological investigations included RT-PCR for Zika virus, and both microsphere immunofluorescent and seroneutralisation assays for Zika virus and dengue virus. Anti-glycolipid reactivity was studied in patients with Guillain-Barré syndrome using both ELISA and combinatorial microarrays. FINDINGS 42 patients were diagnosed with Guillain-Barré syndrome during the study period. 41 (98%) patients with Guillain-Barré syndrome had anti-Zika virus IgM or IgG, and all (100%) had neutralising antibodies against Zika virus compared with 54 (56%) of 98 in control group 1 (p<0.0001). 39 (93%) patients with Guillain-Barré syndrome had Zika virus IgM and 37 (88%) had experienced a transient illness in a median of 6 days (IQR 4-10) before the onset of neurological symptoms, suggesting recent Zika virus infection. Patients with Guillain-Barré syndrome had electrophysiological findings compatible with acute motor axonal neuropathy (AMAN) type, and had rapid evolution of disease (median duration of the installation and plateau phases was 6 [IQR 4-9] and 4 days [3-10], respectively). 12 (29%) patients required respiratory assistance. No patients died. Anti-glycolipid antibody activity was found in 13 (31%) patients, and notably against GA1 in eight (19%) patients, by ELISA and 19 (46%) of 41 by glycoarray at admission. The typical AMAN-associated anti-ganglioside antibodies were rarely present. Past dengue virus history did not differ significantly between patients with Guillain-Barré syndrome and those in the two control groups (95%, 89%, and 83%, respectively). INTERPRETATION This is the first study providing evidence for Zika virus infection causing Guillain-Barré syndrome. Because Zika virus is spreading rapidly across the Americas, at risk countries need to prepare for adequate intensive care beds capacity to manage patients with Guillain-Barré syndrome. FUNDING Labex Integrative Biology of Emerging Infectious Diseases, EU 7th framework program PREDEMICS. and Wellcome Trust.
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Affiliation(s)
- Van-Mai Cao-Lormeau
- Unit of Emerging Infectious Diseases, Institut Louis Malardé, Papeete, Tahiti, French Polynesia
| | - Alexandre Blake
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
| | - Sandrine Mons
- Service de Réanimation Polyvalente, Centre Hospitalier de Polynésie Française, Tahiti, French Polynesia
| | - Stéphane Lastère
- Clinical Laboratory, Centre Hospitalier de Polynésie Française, Tahiti, French Polynesia
| | - Claudine Roche
- Unit of Emerging Infectious Diseases, Institut Louis Malardé, Papeete, Tahiti, French Polynesia
| | - Jessica Vanhomwegen
- Institut Pasteur, Laboratory for Urgent Responses to Biological Threats, Paris, France; Unit Environment and Infectious Risks, Institut Pasteur, Paris, France
| | - Timothée Dub
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
| | - Laure Baudouin
- Service de Réanimation Polyvalente, Centre Hospitalier de Polynésie Française, Tahiti, French Polynesia
| | - Anita Teissier
- Unit of Emerging Infectious Diseases, Institut Louis Malardé, Papeete, Tahiti, French Polynesia
| | - Philippe Larre
- Service de neurologie, Centre Hospitalier de Polynésie Française, Papeete, Tahiti, Polynésie Française
| | - Anne-Laure Vial
- Direction de la Santé, Bureau de Veille Sanitaire, Papeete, French Polynesia
| | | | - Valérie Choumet
- Unit Environment and Infectious Risks, Institut Pasteur, Paris, France
| | - Susan K Halstead
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hugh J Willison
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Lucile Musset
- Department of Immunology, Laboratory of Immunochemistry & Autoimmunity, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Jean-Claude Manuguerra
- Institut Pasteur, Laboratory for Urgent Responses to Biological Threats, Paris, France; Unit Environment and Infectious Risks, Institut Pasteur, Paris, France
| | | | - Emmanuel Fournier
- Département de Neurophysiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Henri-Pierre Mallet
- Direction de la Santé, Bureau de Veille Sanitaire, Papeete, French Polynesia
| | - Didier Musso
- Unit of Emerging Infectious Diseases, Institut Louis Malardé, Papeete, Tahiti, French Polynesia
| | - Arnaud Fontanet
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France; Conservatoire National des Arts et Métiers, Paris, France; Institut Pasteur, Centre for Global Health Research and Education, Paris, France.
| | - Jean Neil
- Department of Immunology, Laboratory of Immunochemistry & Autoimmunity, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Frédéric Ghawché
- Service de neurologie, Centre Hospitalier de Polynésie Française, Papeete, Tahiti, Polynésie Française
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Stübgen JP. Lymphoma-associated dysimmune polyneuropathies. J Neurol Sci 2015; 355:25-36. [PMID: 26070654 DOI: 10.1016/j.jns.2015.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/05/2015] [Accepted: 06/01/2015] [Indexed: 12/24/2022]
Abstract
Lymphoma consists of a variety of malignancies of lymphocyte origin. A spectrum of clinical peripheral neuropathy syndromes with different disease mechanisms occurs in about 5% of lymphoma patients. There exists a complex inter-relationship between lymphoproliferative malignancies and autoimmunity. An imbalance in the regulation of the immune system presumably underlies various immune-mediated neuropathies in patients with lymphoma. This article reviews lymphoma and more-or-less well-defined dysimmune neuropathy subgroups that are caused by humoral and/or cell-mediated immune disease mechanisms directed against known or undetermined peripheral nerve antigens.
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Affiliation(s)
- Joerg-Patrick Stübgen
- Department of Neurology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY 10065-4885, USA.
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Nowling TK, Mather AR, Thiyagarajan T, Hernández-Corbacho MJ, Powers TW, Jones EE, Snider AJ, Oates JC, Drake RR, Siskind LJ. Renal glycosphingolipid metabolism is dysfunctional in lupus nephritis. J Am Soc Nephrol 2015; 26:1402-13. [PMID: 25270066 PMCID: PMC4446878 DOI: 10.1681/asn.2014050508] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/07/2014] [Indexed: 11/03/2022] Open
Abstract
Nearly one half of patients with lupus develop glomerulonephritis (GN), which often leads to renal failure. Although nephritis is diagnosed by the presence of proteinuria, the pathology of nephritis can fall into one of five classes defined by different forms of tissue injury, and the mechanisms involved in pathogenesis are not completely understood. Glycosphingolipids are abundant in the kidney, have roles in many cellular functions, and were shown to be involved in other renal diseases. Here, we show dysfunctional glycosphingolipid metabolism in patients with lupus nephritis and MRL/lpr lupus mice. Specifically, we found that glucosylceramide (GlcCer) and lactosylceramide (LacCer) levels are significantly higher in the kidneys of nephritic MRL/lpr lupus mice than the kidneys of non-nephritic lupus mice or healthy controls. This elevation may be, in part, caused by altered transcriptional regulation and/or activity of LacCer synthase (GalT5) and neuraminidase 1, enzymes that mediate glycosphingolipid metabolism. We show increased neuraminidase 1 activity early during the progression of nephritis (before significant elevation of GlcCer and LacCer in the kidney). Elevated levels of urinary LacCer were detected before proteinuria in lupus mice. Notably, LacCer levels were higher in the urine and kidneys of patients with lupus and nephritis than patients with lupus without nephritis or healthy controls. Together, these results show early and significant dysfunction of the glycosphingolipid metabolic pathway in the kidneys of lupus mice and patients with lupus nephritis and suggest that molecules in this pathway may serve as early markers in lupus nephritis.
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Affiliation(s)
- Tamara K Nowling
- Research Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina; Department of Medicine, Division of Rheumatology and Immunology and
| | | | | | | | - Thomas W Powers
- Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, South Carolina
| | - E Ellen Jones
- Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, South Carolina
| | - Ashley J Snider
- Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York; Research Service, Northport Veterans Affairs Medical Center, Northport, New York; and
| | - Jim C Oates
- Research Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina; Department of Medicine, Division of Rheumatology and Immunology and
| | - Richard R Drake
- Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, South Carolina
| | - Leah J Siskind
- Department of Pharmacology and Toxicology and the James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
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10
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Stathopoulos P, Alexopoulos H, Dalakas MC. Autoimmune antigenic targets at the node of Ranvier in demyelinating disorders. Nat Rev Neurol 2015; 11:143-56. [DOI: 10.1038/nrneurol.2014.260] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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11
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Kim JK, Bae JS, Kim DS, Kusunoki S, Kim JE, Kim JS, Park YE, Park KJ, Song HS, Kim SY, Lim JG, Kim NH, Suh BC, Nam TS, Park MS, Choi YC, Sohn EH, Na SJ, Huh SY, Kwon O, Lee SY, Lee SH, Oh SY, Jeong SH, Lee TK, Kim DU. Prevalence of anti-ganglioside antibodies and their clinical correlates with guillain-barré syndrome in Korea: a nationwide multicenter study. J Clin Neurol 2014; 10:94-100. [PMID: 24829594 PMCID: PMC4017025 DOI: 10.3988/jcn.2014.10.2.94] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 10/05/2013] [Accepted: 10/16/2013] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose No previous studies have investigated the relationship between various anti-ganglioside antibodies and the clinical characteristics of Guillain-Barré syndrome (GBS) in Korea. The aim of this study was to determine the prevalence and types of anti-ganglioside antibodies in Korean GBS patients, and to identify their clinical significance. Methods Serum was collected from patients during the acute phase of GBS at 20 university-based hospitals in Korea. The clinical and laboratory findings were reviewed and compared with the detected types of anti-ganglioside antibody. Results Among 119 patients, 60 were positive for immunoglobulin G (IgG) or immunoglobulin M antibodies against any type of ganglioside (50%). The most frequent type was IgG anti-GM1 antibody (47%), followed by IgG anti-GT1a (38%), IgG anti-GD1a (25%), and IgG anti-GQ1b (8%) antibodies. Anti-GM1-antibody positivity was strongly correlated with the presence of preceding gastrointestinal infection, absence of sensory symptoms or signs, and absence of cranial nerve involvement. Patients with anti-GD1a antibody were younger, predominantly male, and had more facial nerve involvement than the antibody-negative group. Anti-GT1a-antibody positivity was more frequently associated with bulbar weakness and was highly associated with ophthalmoplegia when coupled with the coexisting anti-GQ1b antibody. Despite the presence of clinical features of acute motor axonal neuropathy (AMAN), 68% of anti-GM1- or anti-GD1a-antibody-positive cases of GBS were diagnosed with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) by a single electrophysiological study. Conclusions Anti-ganglioside antibodies were frequently found in the serum of Korean GBS patients, and each antibody was correlated strongly with the various clinical manifestations. Nevertheless, without an anti-ganglioside antibody assay, in Korea AMAN is frequently misdiagnosed as AIDP by single electrophysiological studies.
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Affiliation(s)
- Jong Kuk Kim
- Department of Neurology, College of Medicine, Dong-A University, Busan, Korea
| | - Jong Seok Bae
- Department of Neurology, College of Medicine, Hallym University, Seoul, Korea
| | - Dae-Seong Kim
- Department of Neurology, School of Medicine, Pusan National University, Busan, Korea
| | - Susumu Kusunoki
- Department of Neurology, School of Medicine, Kinki University, Osaka, Japan
| | - Jong Eun Kim
- Department of Industrial and Occupational Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ji Soo Kim
- Department of Neurology, College of Medicine, Seoul National University, Seoul, Korea
| | - Young-Eun Park
- Department of Neurology, School of Medicine, Pusan National University, Busan, Korea
| | - Ki-Jong Park
- Department of Neurology, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Hyun Seok Song
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sun Young Kim
- Department of Neurology, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Jeong-Geun Lim
- Department of Neurology, School of Medicine, Keimyung University, Daegu, Korea
| | - Nam-Hee Kim
- Department of Neurology, College of Medicine, Dongguk University, Seoul, Korea
| | - Bum Chun Suh
- Department of Neurology, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Tai-Seung Nam
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Min Su Park
- Department of Neurology, School of Medicine, Yeungnam University, Daegu, Korea
| | - Young-Chul Choi
- Department of Neurology, College of Medicine, Yonsei University, Seoul, Korea
| | - Eun Hee Sohn
- Department of Neurology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Sang-Jun Na
- Department of Neurology, College of Medicine, Konyang University, Daejeon, Korea
| | - So Young Huh
- Department of Neurology, College of Medicine, Kosin University, Busan, Korea
| | - Ohyun Kwon
- Department of Neurology, School of Medicine, Eulji University, Seoul, Korea
| | - Su-Yun Lee
- Department of Neurology, College of Medicine, Dong-A University, Busan, Korea
| | - Sung-Hoon Lee
- Department of Neurology, College of Medicine, Hallym University, Seoul, Korea
| | - Sun-Young Oh
- Department of Neurology, School of Medicine, Chonbuk National University, Jeonju, Korea
| | - Seong-Hae Jeong
- Department of Neurology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Tae-Kyeong Lee
- Department of Neurology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Dong Uk Kim
- Department of Neurology, School of Medicine, Chosun University, Gwangju, Korea
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12
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Rinaldi S, Brennan KM, Kalna G, Walgaard C, van Doorn P, Jacobs BC, Yu RK, Mansson JE, Goodyear CS, Willison HJ. Antibodies to heteromeric glycolipid complexes in Guillain-Barré syndrome. PLoS One 2013; 8:e82337. [PMID: 24358172 PMCID: PMC3864991 DOI: 10.1371/journal.pone.0082337] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 10/09/2013] [Indexed: 12/29/2022] Open
Abstract
Autoantibodies are infrequently detected in the sera of patients with the demyelinating form of Guillain-Barré syndrome most commonly encountered in the Western world, despite abundant circumstantial evidence suggesting their existence. We hypothesised that antibody specificities reliant on the cis interactions of neighbouring membrane glycolipids could explain this discrepancy, and would not have been detected by traditional serological assays using highly purified preparations of single gangliosides. To assess the frequency of glycolipid complex antibodies in a Western European cohort of patients GBS we used a newly developed combinatorial glycoarray methodology to screen against large range of antigens (11 gangliosides, 8 other single glycolipids and 162 heterodimeric glycolipid complexes). Serum samples of 181 patients from a geographically defined, Western European cohort of GBS cases were analysed, along with 161 control sera. Serum IgG binding to single gangliosides was observed in 80.0% of axonal GBS cases, but in only 11.8% of cases with demyelinating electrophysiology. The inclusion of glycolipid complexes increased the positivity rate in demyelinating disease to 62.4%. There were 40 antigens with statistically significantly increased binding intensities in GBS as compared to healthy control sera. Of these, 7 complex antigens and 1 single ganglioside also produced statistically significantly increased binding intensities in GBS versus neurological disease controls. The detection of antibodies against specific complexes was associated with particular clinical features including disease severity, requirement for mechanical ventilation, and axonal electrophysiology. This study demonstrates that while antibodies against single gangliosides are often found in cases with axonal-type electrophysiology, antibodies against glycolipid complexes predominate in cases with demyelinating electrophysiology, providing a more robust serum biomarker than has ever been previously available for such cases. This work confirms the activation of the humoral immune system in the dysimmune disease process in GBS, and correlates patterns of antigen recognition with different clinical features.
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Affiliation(s)
- Simon Rinaldi
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Kathryn M. Brennan
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Gabriela Kalna
- Bioinformatics, Beatson Institute for Cancer Research, Glasgow, United Kingdom
| | - Christa Walgaard
- Department of Neurology, Erasmus Medical Centre, University Medical Center, Rotterdam, The Netherlands
| | - Pieter van Doorn
- Department of Neurology, Erasmus Medical Centre, University Medical Center, Rotterdam, The Netherlands
| | - Bart C. Jacobs
- Department of Neurology, Erasmus Medical Centre, University Medical Center, Rotterdam, The Netherlands
- Department of Immunology, Erasmus Medical Centre, University Medical Center, Rotterdam, The Netherlands
| | - Robert K. Yu
- Institute of Molecular Medicine and Genetics, Medical College of Georgia, Georgia Health Sciences University, Augusta, Georgia, United States of America
| | - Jan-Eric Mansson
- Laboratory Medicine/Clinical Chemistry, Sahlgren's University Hospital, Molndal, Sweden
| | - Carl S. Goodyear
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Hugh J. Willison
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
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13
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Therapeutics to promote CNS repair: a natural human neuron-binding IgM regulates membrane-raft dynamics and improves motility in a mouse model of multiple sclerosis. J Clin Immunol 2012; 33 Suppl 1:S50-6. [PMID: 22990667 DOI: 10.1007/s10875-012-9795-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
Abstract
We have discovered a role for natural autoantibodies in central nervous system repair, remyelination and axon protection. These natural human antibodies are of the immunoglobulin M (IgM) isotype, and they bind to the surface of neural cells. The epitope of the antibody includes sialic acid because treatment with sialidase disrupts the binding. A fully human recombinant form of one of these IgMs, rHIgM12, has the same properties as the serum-derived IgM. rHIgM12 enhanced polarized axonal outgrowth from primary neurons when presented as a substrate in vitro and improved motor functions in chronically Theiler's virus-infected SJL mice, a model of MS. rHIgM12 bound to neuronal surfaces and induced cholesterol and ganglioside (GM1) clustering, indicating that rHIgM12 functions through a mechanism of axonal membrane stabilization. Our work demonstrates that a natural human neuron-binding IgM can regulate membrane domain dynamics. This antibody has the potential to improve neurologic disease.
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14
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Motor nerve terminal destruction and regeneration following anti-ganglioside antibody and complement-mediated injury: An in and ex vivo imaging study in the mouse. Exp Neurol 2012; 233:836-48. [DOI: 10.1016/j.expneurol.2011.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 10/27/2011] [Accepted: 12/07/2011] [Indexed: 01/10/2023]
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15
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Colsch B, Jackson SN, Dutta S, Woods AS. Molecular Microscopy of Brain Gangliosides: Illustrating their Distribution in Hippocampal Cell Layers. ACS Chem Neurosci 2011; 2:213-222. [PMID: 21961052 DOI: 10.1021/cn100096h] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Gangliosides are amphiphilic molecules found in the outer layer of plasma membranes of all vertebrate cells. They play a major role in cell recognition and signaling and are involved in diseases affecting the central nervous system (CNS). We are reporting the differential distribution of ganglioside species in the rat brain's cerebrum, based on their ceramide associated core, and for the first time the presence of acetylation detected by matrix-assisted laser desorption/ionization (MALDI) mass spectrometry, which was used to map and image gangliosides with detailed structural information and histological accuracy. In the hippocampus, localization of the major species GM1, GD1, O-acetylGD1, GT1, and O-acetylGT1 depends on the sphingoïd base (d18:1 sphingosine or d20:1 eïcosasphingosine) in the molecular layer of the dentate gyrus (ML), which is made up of three distinct layers, the inner molecular layer (IML), which contains sphingosine exclusively, and the middle molecular layer (MML) and the outer molecular layer (OML) where eïcosasphingosine is the only sphingoïd base. These results demonstrate that there is a different distribution of gangliosides in neuronal axons and dendrites depending on the ceramide core of each layer. GM3, GM2, GD3, and GD2 contain sphingosine predominantly and are mainly present in body cell layers, which are made up of the pyramidal cell layer (Py) and the granular layer of the dentate gyrus (GL), in contrast with GQ1 and the O-acetylated forms of GD1, GT1, and GQ1 gangliosides, which contain both sphingoïd bases. However their distribution is based on the sialylated and acetylated oligosaccharide chains in the neuronal cell bodies.
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Affiliation(s)
- Benoit Colsch
- Structural Biology Unit, Cellular Neurobiology Section, NIDA IRP, NIH, Baltimore, Maryland 21224, United States
| | - Shelley N. Jackson
- Structural Biology Unit, Cellular Neurobiology Section, NIDA IRP, NIH, Baltimore, Maryland 21224, United States
| | - Sucharita Dutta
- Thermo Fisher Scientific, San Jose, California, United States
| | - Amina S. Woods
- Structural Biology Unit, Cellular Neurobiology Section, NIDA IRP, NIH, Baltimore, Maryland 21224, United States
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Glycosphingolipids and Kidney Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2011; 721:121-38. [PMID: 21910086 DOI: 10.1007/978-1-4614-0650-1_8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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17
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Song X, Lasanajak Y, Xia B, Heimburg-Molinaro J, Rhea JM, Ju H, Zhao C, Molinaro RJ, Cummings RD, Smith DF. Shotgun glycomics: a microarray strategy for functional glycomics. Nat Methods 2010; 8:85-90. [PMID: 21131969 PMCID: PMC3074519 DOI: 10.1038/nmeth.1540] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 11/10/2010] [Indexed: 01/11/2023]
Abstract
Major challenges of glycomics are to characterize a glycome and identify functional glycans as ligands for glycan-binding proteins (GBPs). To address these issues we have developed a general strategy termed shotgun glycomics. We focus on glycosphingolipids (GSLs), a challenging class of glycoconjugates recognized by toxins, antibodies, and GBPs. We derivatized GSLs extracted from cells with a heterobifunctional fluorescent tag suitable for covalent immobilization. Fluorescent GSLs were separated by multidimensional chromatography, quantified, and coupled to glass slides to create GSL shotgun microarrays. The microarrays were interrogated with cholera toxin, antibodies, and sera from patients with Lyme disease to identify biologically relevant GSLs that were subsequently characterized by mass spectrometry. Shotgun glycomics incorporating GSLs and potentially glycoprotein-derived glycans provides an approach to accessing the complex glycomes of animal cells and offers a strategy for focusing structural analyses on functionally significant glycans.
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Affiliation(s)
- Xuezheng Song
- Department of Biochemistry, Emory University School of Medicine, Atlanta, Georgia, USA
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18
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NGcGM3 ganglioside: a privileged target for cancer vaccines. Clin Dev Immunol 2010; 2010:814397. [PMID: 21048926 PMCID: PMC2965427 DOI: 10.1155/2010/814397] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 09/24/2010] [Indexed: 01/05/2023]
Abstract
Active specific immunotherapy is a promising field in cancer research. N-glycolyl (NGc) gangliosides, and particularly NGcGM3, have received attention as a privileged target for cancer therapy. Many clinical trials have been performed with the anti-NGc-containing gangliosides anti-idiotype monoclonal antibody racotumomab (formerly known as 1E10) and the conjugated NGcGM3/VSSP vaccine for immunotherapy of melanoma, breast, and lung cancer. The present paper examines the role of NGc-gangliosides in tumor biology as well as the available preclinical and clinical data on these vaccine products. A brief discussion on the relevance of prioritization of cancer antigens in vaccine development is also included.
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Determination of sialic acid and gangliosides in biological samples and dairy products: A review. J Pharm Biomed Anal 2010; 51:346-57. [DOI: 10.1016/j.jpba.2009.04.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 04/17/2009] [Accepted: 04/23/2009] [Indexed: 11/20/2022]
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20
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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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21
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Glycosyltransferase-catalyzed synthesis of bioactive oligosaccharides. Biotechnol Adv 2008; 26:436-56. [PMID: 18565714 DOI: 10.1016/j.biotechadv.2008.05.001] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 02/14/2008] [Accepted: 05/09/2008] [Indexed: 02/07/2023]
Abstract
Mammalian cell surfaces are all covered with bioactive oligosaccharides which play an important role in molecular recognition events such as immune recognition, cell-cell communication and initiation of microbial pathogenesis. Consequently, bioactive oligosaccharides have been recognized as a medicinally relevant class of biomolecules for which the interest is growing. For the preparation of complex and highly pure oligosaccharides, methods based on the application of glycosyltransferases are currently recognized as being the most effective. The present paper reviews the potential of glycosyltransferases as synthetic tools in oligosaccharide synthesis. Reaction mechanisms and selected characteristics of these enzymes are described in relation to the stereochemistry of the transfer reaction and the requirements of sugar nucleotide donors. For the application of glycosyltransferases, accepted substrate profiles are summarized and the whole-cell approach versus isolated enzyme methodology is compared. Sialyltransferase-catalyzed syntheses of gangliosides and other sialylated oligosaccharides are described in more detail in view of the prominent role of these compounds in biological recognition.
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