Clinical correlates of serum anti-GT1a IgG antibodies
Introduction
Guillain–Barré syndrome (GBS) is characterized by the acute onset of limb weakness. Bulbar palsy, which causes respiratory failure or aspiration and occasionally may require intubation, has been reported in two-fifths of GBS patients studied [1]. Ropper [2] described three patients, in whom oropharyngeal, neck, and shoulder weaknesses progressed acutely. He called this regional variant “pharyngeal-cervical-brachial weakness resembling botulism or diphtheria” and, elsewhere, proposed diagnostic criteria [1].
Cumulative evidence supports the speculation that anti-ganglioside antibodies function in the development of GBS and its variants [3]. A patient developed the pharyngeal-cervical-brachial variant (PCB) after an intramuscular injection of bovine ganglioside mixture [4], indicative that anti-ganglioside antibodies also have a pathogenetic role in the development of PCB. Anti-GT1a IgG antibodies with and without GQ1b reactivity have been detected in patients who have acute oropharyngeal palsy [5], [6], PCB [7], [8], [9], or GBS [10], [11], [12]. On the other hand, anti-GQ1b IgG antibody with anti-GT1a reactivity has been found in patients who have Fisher syndrome (FS), Bickerstaff's brainstem encephalitis (BBE), acute ophthalmoparesis (AO) without ataxia, or ataxic GBS [13], [14], [15]. The nosological relationship between PCB and these other conditions, however, has yet to be established. The aim of our study was to clarify the clinical features of anti-GT1a-positive patients who had various neurological disorders and the relationships between PCB and related conditions.
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Patients
A sequential retrospective study was made of 2,148 consecutive patients with various neurological disorders. Serum samples were obtained from patients who had been referred to our laboratory for serum anti-ganglioside antibody testing by Japanese university and district general hospitals between August 1999 and November 2001.
Enzyme-linked immunosorbent assay
Serum IgG antibodies to GT1a, GQ1b, GM1, GM1b, GM2, GD1a, GalNAc-GD1a, GD1b, and GT1b were measured routinely by an enzyme-linked immunosorbent assay (ELISA) as reported
Clinical features of patients with anti-GT1a IgG antibodies
Anti-GT1a IgG antibodies were positive in 140 patients (median age, 40; 77 men, 63 women), 12 of whom were reported elsewhere [11]. Table 2 shows the clinical profiles during illness. Eighty-nine percent of the patients had an antecedent illness (upper respiratory tract infectious symptoms alone, 65%; diarrhea alone, 8%; both, 16%). The most frequent initial symptom was diplopia, the second unsteady gait; both cardinal symptoms of FS.
Most patients had muscular weakness of acute and monophasic
Discussion
The 140 patients with anti-GT1a IgG antibodies had a variety of clinical features. The triad of FS, ophthalmoplegia, ataxia, and areflexia were frequent because half the population sample consisted of FS patients. We elsewhere reported the frequencies of neurological signs in patients with anti-GQ1b IgG [15]. They were similar to those in the patients with anti-GT1a IgG in the current study. The GBS population, however, was larger in the anti-GT1a IgG-positive (16%) than in the anti-GQ1b
Acknowledgments
We thank Ms. Y. Tsuchiya (Dokkyo University, Tochigi) for her technical assistance. This study was supported in part by grants-in-aid from the Uehara Memorial Foundation; for Scientific Research (B) (KAKENHI 14370210 to N.Y.) from the Ministry of Education, Culture, Sports, Science and Technology of Japan; and a Research Grant for Neuroimmunological Diseases from the Ministry of Health, Labour, and Welfare of Japan.
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Clinical characterization of anti-GQ1b antibody syndrome in Korean children
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Gangliosides and Autoimmune Peripheral Nerve Diseases
2018, Progress in Molecular Biology and Translational ScienceCitation Excerpt :However, some anti-GT1a antibodies in PCB are monospecific and do not cross-react with GQ1b, making it a relatively specific marker of this variant. Acute oropharyngeal palsy is likely an even further restricted regional variant and this has also been associated with anti-GT1a antibodies.51,52 There is some evidence for the preferential binding of anti-GT1a antibodies to the lower cranial nerves thereby suggesting that the restricted clinical manifestations arise because of variations in regional expression, accessibility, or microenvironment of gangliosides on peripheral nerves membranes.
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2016, Journal of Clinical NeuroscienceCitation Excerpt :Another question is whether OGBS is an independent entity across the GBS spectrum. Most previous studies of OGBS have categorized this syndrome mainly with immunological profiles, including positivity of anti-GT1a or anti-GQ1b antibodies [19,22,23]. However, this immunological categorization has considerable limitations.
Autoimmune peripheral neuropathies
2015, Clinica Chimica ActaPolycranial neuropathy and sensory ataxia with IgG anti-GD1a antibody as a variant of Guillain-Barré syndrome
2013, Journal of Clinical NeuroscienceCitation Excerpt :Our patient had only the anti-GD1a antibody (without any other anti-ganglioside antibodies), so the internal ophthalmoplegia and ataxia are difficult to explain. But, some patients with anti-GQ1b or anti-GT1a antibodies have similar symptoms to those with the anti-GD1a antibody, and the molecular mimicry of the sugar moiety from the ganglioside could explain this.11,12 Our patient had polycranial neuropathy associated with high titers of IgG anti-GD1a antibody.