Improved Serological Diagnosis Stresses the Major Role of Campylobacter jejuni in Triggering Guillain-Barré Syndrome

Abstract

Guillain-Barré syndrome (GBS) is a postinfectious autoimmune polyradiculoneuropathy. The most frequent antecedent pathogen is Campylobacter jejuni, followed by cytomegalovirus. However, more than 40% of GBS cases currently cannot be attributed to triggering events. This might be due to the shortcomings of the serological assays used for diagnosing infections, in particular for C. jejuni. In our study investigating 36 patients with acute GBS, standard serological methods identified the triggering viral or bacterial etiology in only 25% of cases. However, using a highly specific enzyme-linked immunosorbent assay based on two recombinant outer antigens encoded by C. jejuni genes Cj0017 (P39) and Cj0113 (P18), we found serological evidence of a preceding C. jejuni infection in 80.6% of the patients but in only 3.5% of the controls. We conclude that the role of C. jejuni in triggering GBS has been greatly underestimated.

Ganglioside Molecular Mimicry and Its Pathological Roles in Guillain-Barré Syndrome and Related Diseases

“…A significantly higher frequency of the 100-bp TNF-2␣ allele of the TNF-␣ microsatellite marker, which is associated with high TNF-␣ production, was found in C. jejuni-positive (Cjϩ) GBS patients compared to controls, suggesting the involvement of a genetic predisposition to high TNF-␣ secretion in the development of C. jejuni-related GBS. Schmidt-Ott (69) reported an association between 80.6% of GBS cases and Cj0017 (P39) and Cj0113 (P.18), which are encoded by C. jejuni genes. In addition, wla genes (wla cluster) that encode LOS biosynthesis (53) and the A(Ϫ670) GSNP in the promoter region of Fas and high levels of sFas (22) may be involved in the pathogenesis of GBS.…”

Automatic Evaluation of Test Strips for Anti-Ganglioside Antibodies in Patients with Guillain-Barré Syndrome Using EUROLineScan Software

“…The association of C. jejuni with GBS seems to vary in different geographic regions. In northern China, the association was seen in 66% of cases whereas in Europe only 15% was reported [32]. Serological or culture evidence of a recent C. jejuni infection ranged from 23% -45% in a series of patients with GBS in the United Kingdom, Netherlands, United States and Japan [33]- [35].…”

Is theCampylobacter jejunisecretory protein Cj0069 a suitable antigen for serodiagnostics?

“…However, since 80% of GBS cases are associated with Campylobacter seropositivity, it seems most likely that Campylobacter spp. are the main cause of this sequela [28]. Molecular mimicry between lipooligosaccharides (LOS) localized on the surface of the bacteria and CNS-gangliosides GM1 and GD1a induces cross-reacting antibodies during Campylobacter-infections.…”

“…The frequency of Campylobacter-associated post-infectious diseases was estimated at 1:1000 [28]. One of the most serious Campylobacter-associated post-infectious complications is the Guillain-Barré syndrome (GBS) [2].…”