Science News: High and Persistent Anti-GM1 Antibody Titers Are Associated With Poor Clinical Recovery in Guillain-Barré Syndrome

Published December 22, 2023

Science News

Submitted by: Nakul Katyal MD
Edited by: Joshua Wilson, MD

Thomma RCM, Fokke C, Walgaard C, et al. High and persistent Anti-GM1 antibody titers are associated with poor clinical recovery in Guillain-Barré syndrome. Neurol Neuroimmunol Neuroinflamm. 2023;10(4):e200107. Published 2023 Apr 14. doi:10.1212/NXI.0000000000200107

Summary: This study investigated the relationship between the serum antibody titers of ganglioside GM1 and outcomes in patients with Guillain-Barre syndrome (GBS). Patients who met the criteria for GBS were included if hospitalized within 2 weeks from the onset of weakness and unable to walk 10 meters independently. Serum anti-GM1 antibody titers were collected at study enrollment and during a 6-month follow-up appointment.

Anti-GM1 antibodies were detected in 78 (20.7%) out of 377 patients. Out of those that tested positive, 30 (38.5%) were positive for IgG alone, 24 (30.8%) were positive for IgM alone, and 24 (30.8%) were positive for both IgG and IgM. At entry, antibody titers were higher for the IgG isotype (median: 1,600, range: 100–51,200) than for the IgM isotype (median: 200, range: 100–25,600). Although all antibody titers declined during follow-up, there was considerable variation in titer course between individual patients. A subset of anti–GM1-positive patients had persistent anti-GM1 antibodies at 3 months (n = 27/43) and 6 months (n = 19/41).

Patient titers were considered high if greater than the median titer. For patients with a high anti-GM1 IgG and IgM titers at entry, recovery was slower and less complete than anti–GM1-negative patients. High vs low IgG titers, but not IgM titers, were independently associated with poor outcomes when corrected for known prognostic factors (age of onset, preceding diarrhea, and MRC sum score). Among patients with a high anti-GM1 IgG titer at entry, a slow titer decline was associated with poor outcomes at 4 weeks and 6 months. Persistent high IgG titers at 3 and 6 months were associated with poor outcomes at 6 months.

Comments: In this study, high anti-GM1 IgG and IgM titers at entry and a persistent high anti-GM1 IgG antibody titer during follow-up were associated with poor clinical outcomes in patients with GBS. The continued presence of these antibodies suggests an ongoing production beyond the acute phase of GBS, potentially predisposing to poor outcomes. The study had several limitations, including patients with relatively severe GBS, effects of IVIG treatment on GM1 antibody titers, and lack of analysis of IgG subtypes, which may influence its pathogenic effect.

Monitoring anti-GM1 antibodies during the disease course could identify patients needing additional treatment. However, further research is necessary to determine if these persistent antibodies are pathogenic and whether targeting their persistence could be a viable treatment approach.

The study highlights the role of GM1 antibody persistence as a potential factor with prognostic implications for patients with GBS. The study brings up a significant question for future research: whether individuals with GBS who have both persistent GM1 antibody levels and poor outcomes might gain advantages from additional therapeutic interventions. Nevertheless, this aspect still requires further investigation.

Article of similar interest:
Koga M. Multifaceted features of immunoglobulin G anti-GM1 antibodies in Guillain-Barré syndrome. Clin Exp Neuroimmunology. 2021;12(3):150-157. doi: 10.1111/cen3.12653