Abstract
Background Campylobacter jejuni is the predominant antecedent infection in Guillain-Barré syndrome (GBS). Molecular mimicry and cross-reactive immune responses to C. jejuni lipo-oligosaccharides (LOS) precipitate the development of GBS, although this mechanism has not been established in patients from developing countries. We determined the carbohydrate mimicry between C. jejuni LOS and gangliosides, and the cross-reactive antibody response in patients with GBS in Bangladesh.MethodologySera from 97 GBS patients, and 120 neurological and family controls were tested for antibody reactivity against LOS from C. jejuni isolates from GBS patients in Bangladesh (BD-07, BD-39, BD-10, BD-67 and BD-94) by enzyme-linked immunosorbent assay (ELISA). Cross-reactivity to LOS was determined by ELISA. The LOS outer core structures of C. jejuni strains associated with GBS/MFS were determined by mass spectrometry.Principle FindingsIgG antibodies to LOS from C. jejuni BD-07, BD-39, BD-10, and BD-67 IgG antibodies were found in serum from 56%, 58%, 14% and 15% of GBS patients respectively, as compared to very low frequency (<3%) in controls (p<0.001). Monoclonal antibodies specific for GM1 and GD1a reacted strongly with LOS from the C. jejuni strains (BD-07 and BD-39). Mass spectrometry analysis confirmed the presence of GM1 and GD1a carbohydrate mimics in the LOS from C. jejuni BD-07 and BD-39. Both BD-10 and BD-67 express the same LOS outer core, which appears to be a novel structure displaying GA2 and GD3 mimicry. Up to 90–100% of serum reactivity to gangliosides in two patients (DK-07 and DK-39) was inhibited by 50 µg/ml of LOS from the autologous C. jejuni isolates. However, patient DK-07 developed an anti-GD1a immune response while patient DK-39 developed an anti-GM1 immune response.ConclusionCarbohydrate mimicry between C. jejuni LOS and gangliosides, and cross-reactive serum antibody precipitate the majority of GBS cases in Bangladesh.
Highlights
Guillain-Barresyndrome (GBS) is an acute post-infectious immune-mediated peripheral neuropathy with a marked variation in pathology, clinical presentation and prognosis [1]
Carbohydrate mimicry between C. jejuni LOS and gangliosides, and cross-reactive serum antibody precipitate the majority of GBS cases in Bangladesh
Serum IgA antibodies to LOS from BD-07 and BD-39 were found in 50% and 48% of GBS patients, respectively, compared 0% in other neurological disease controls (OND) and 4% in family controls (FC) in controls (p,0.001)
Summary
Guillain-Barresyndrome (GBS) is an acute post-infectious immune-mediated peripheral neuropathy with a marked variation in pathology, clinical presentation and prognosis [1]. Poliomyelitis has been eradicated in Bangladesh, non-polio acute flaccid paralysis (AFP) cases are still frequently diagnosed. The majority of the non-polio AFP cases are diagnosed as GBS [2]. The crude incidence rates of GBS among children ,15 years of age varied from 1.5 to 1.7 per 100,000 per year in Bangladesh [2]. Campylobacter jejuni is the predominant antecedent infection in Guillain-Barresyndrome (GBS). Molecular mimicry and cross-reactive immune responses to C. jejuni lipo-oligosaccharides (LOS) precipitate the development of GBS, this mechanism has not been established in patients from developing countries. We determined the carbohydrate mimicry between C. jejuni LOS and gangliosides, and the cross-reactive antibody response in patients with GBS in Bangladesh
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