Abstract

Background Clinical severity of Guillain–Barré syndrome (GBS) is highly variable, but the immunopathological reason is unknown.

Objective The study was designed to show which antibody parameters are associated with disease severity in GBS patients with serum anti-GM1 IgG antibodies.

Methods Thirty-four GBS patients with anti-GM₁ IgG antibodies were grouped into two categories according to disease severity at nadir: mild (grades 1–3 by Hughes functional scale, n=13) and severe (grades 4 and 5, n=21). Titre, affinity, fine specificity and cell binding of anti-GM₁ antibodies were obtained and compared between the two groups.

Results No differences in antibody titre (GM₁-ELISA) or affinity were found between the two patient groups. In contrast, the severe group showed a significantly higher frequency (95%, vs 46% in the mild group, p=0.002) of specific (not cross-reacting with GD_1b) anti-GM₁ antibodies. In addition, the severe group also exhibited a higher antibody binding titre to cellular GM₁.

Conclusions Differences in fine specificity of antibodies are strong indications that different regions of the GM₁-oligosaccharide are involved in antibody binding. High titres of specific anti-GM₁ antibody binding to cellular GM₁ can be explained by antigen exposure, that is, GM₁ exposes or forms mainly epitopes recognised by specific antibodies, and ‘hides’ those involved in binding of cross-reacting antibodies. Thus, the fine specificity of anti-GM₁ antibodies may influence disease severity by affecting antibody binding to cellular targets. Additionally, since antibody specificity studies are relatively easy to implement, fine specificity could be considered a useful predictor of disease severity.