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Research paper
Antiganglioside antibodies are associated with axonal Guillain–Barré syndrome: A Japanese–Italian collaborative study
  1. Yukari Sekiguchi1,
  2. Antonino Uncini2,3,
  3. Nobuhiro Yuki4,5,
  4. Sonoko Misawa1,
  5. Francesca Notturno2,3,
  6. Saiko Nasu1,
  7. Kazuaki Kanai1,
  8. Yu-ichi Noto1,
  9. Yumi Fujimaki1,
  10. Kazumoto Shibuya1,
  11. Shigeki Ohmori1,
  12. Yasunori Sato6,
  13. Satoshi Kuwabara1
  1. 1Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
  2. 2Department of Neuroscience and Imaging, University ‘G d’Annunzio', Chieti-Pescara, Italy
  3. 3Neurocentre of Southern Switzerland (EOC), Lugano, Switzerland
  4. 4Department of Microbiology, National University of Singapore, Singapore
  5. 5Department of Medicine, National University of Singapore, Singapore
  6. 6Clinical Research Centre, Chiba University Hospital, Chiba, Japan
  1. Correspondence to Dr S Kuwabara, Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; kuwabara-s{at}


Background Whether or not antiganglioside antibodies are related to axonal or demyelinating Guillain–Barré syndrome (GBS) is still a matter of controversy, as detailed in previous studies conducted in Western and Asian countries.

Objective To clarify whether antiganglioside antibodies are associated with axonal dysfunction in Japanese and Italian GBS patient cohorts.

Methods Clinical and electrophysiological profiles were reviewed for 156 GBS patients collected from Japan (n=103) and Italy (n=53). Serum IgG antibodies against GM1, GM1b, GD1a and GalNAc-GD1a were measured by ELISA in the same laboratory. Electrodiagnostic criteria and results of serial electrophysiological studies were used for classification of GBS subtypes: acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN).

Results In both Japanese and Italian cohorts, any of the antibodies were positive in 36% of the patients, and antibody positivity had a significant association with the AMAN electrodiagnosis. Approximately 30% of Japanese and Italian antiganglioside positive patients showed the AIDP pattern at the first examination whereas sequential studies showed that most finally showed the AMAN pattern. Clinically, seropositive patients more frequently had preceding diarrhoea and pure motor neuropathy in both Japanese and Italian cohorts; vibratory sensation was normal in 97% of Japanese and in 94% of Italian seropositive patients.

Conclusions In GBS, clinical and electrophysiological features appear to be determined by antiganglioside antibodies, and the antibodies are associated with motor axonal GBS in both Japan and Italy. Classification of the GBS subtypes as a disease entity should be made, combining the results of antiganglioside assays and serial electrodiagnostic studies.

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  • Funding This work was supported in part by the Health and Labour Sciences Research Grant on Intractable Diseases (Neuroimmunological Diseases) from the Ministry of Health, Labour and Welfare of Japan (SK).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Chiba University, Chiba, Japan, and University ‘G d’Annunzio' Chieti-Pescara, Italy

  • Provenance and peer review Not commissioned; externally peer reviewed.