The Neuroimmunology of Guillain-Barré Syndrome and the Potential Role of an Aging Immune System

Hagen, Kathleen M.; Ousman, Shalina S.

doi:10.3389/fnagi.2020.613628

Cited by 24 publications

(19 citation statements)

References 177 publications

(237 reference statements)

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“…Furthermore, Yoshii and Shinohara discovered that natural killer cell function was lower in GBS than in the control group [ 4 ]; the authors suggested that natural killer cell activity deficiencies could leave people vulnerable to GBS because these cells suppress the immune system [ 4 ]. The majority of GBS studies, on the other hand, have concentrated on the diagnostic and prognostic role of cytokines [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of GBS studies, on the other hand, have concentrated on the diagnostic and prognostic role of cytokines [ 30 ]. Not surprisingly, because of the robust immune response, there are changes in cytokine and inflammatory biomarkers' levels in GBS [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Since then, a lot of effort has gone into figuring out how the immune system plays a role in inflammation. T cells have been found in the epineurium and endoneurium in sural nerve biopsies of GBS patients, and both CD8+ and CD4+ phenotypes have been Mediators of Inflammation detected in these infiltrating T cells [4]. In addition to T cells, there is an elevation in the number of macrophages in the epineurium and endoneurium of these nerves [4].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there are no biomarkers that can be used to help with disease diagnosis, categorization, or prognosis [ 4 ]. These characteristics often contribute to misdiagnosis, overtreatment, treatment failure, and unsatisfactory outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…These characteristics often contribute to misdiagnosis, overtreatment, treatment failure, and unsatisfactory outcomes. This thereby necessitates identification of disease biomarkers to improve GBS diagnostic and therapeutic outcomes [ 4 ]. The neutrophil to lymphocyte ratio (NLR) is a new, inexpensive, simple, widely available, and fast-responding biomarker of cellular immune activation.…”

Section: Introductionmentioning

confidence: 99%

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Role of the Neutrophil to Lymphocyte Ratio in Guillain Barré Syndrome: A Systematic Review and Meta-Analysis

Sarejloo

Khanzadeh

Hosseini

et al. 2022

Mediators of Inflammation

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In this study, we conducted a systematic review and meta-analysis regarding the role of the neutrophil to lymphocyte ratio (NLR) in Guillain Barré syndrome (GBS). The most recent update to the search was on July 18, 2022, through the databases of Web of Science, PubMed, Embase, and Scopus. The Newcastle-Ottawa scale was used for quality assessment of included studies. Finally, 14 studies were included in the review, and among them, ten studies were included in the meta-analysis. Our results showed that NLR levels were significantly increased in the patients with GBS compared with healthy controls ( SMD = 1.05 ; 95 % CI = 0.59 to 1.50, P < 0.001 ). After treatment, NLR levels were decreased to the extent that they became similar to healthy controls ( SMD = − 0.03 , 95 % CI = − 0.29 to 0.22, P = 0.204 ). Moreover, NLR was a stable predictor of outcome or response to treatment in such patients ( SMD = 1.01 , 95 % CI = 0.65 to 1.37, P < 0.001 ); the higher the NLR, the worse the outcome. In addition, patients who underwent mechanical ventilation had higher levels of NLR compared to those who did not ( SMD = 0.93 , 95 % CI = 0.05 to 1.82, P = 0.03 ). However, NLR levels were not different among distinct GBS subtypes, so it could not distinguish among them. In conclusion, our analysis indicates that the NLR levels are highly elevated in patients with GBS. Therefore, the NLR has the potential to be used as a biomarker to inform diagnosis, prognosis, or treatment responses in GBS, and future studies are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of the Neutrophil to Lymphocyte Ratio in Guillain Barré Syndrome: A Systematic Review and Meta-Analysis

Sarejloo

Khanzadeh

Hosseini

et al. 2022

Mediators of Inflammation

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The characteristics of Guillain–Barre syndrome in children in pre‐COVID‐19 and during the COVID‐19 pandemic: A cross‐sectional study

Javankiani,

Nasrollahizadeh,

Gharib

et al. 2023

Health Science Reports

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Background and AimsIn the pathophysiology of Guillain–Barre syndrome (GBS), inflammation and immunity are believed to play a key role. The neutrophil‐lymphocyte ratio (NLR), monocyte‐lymphocyte ratio (MLR), and platelet‐lymphocyte ratio (PLR) have been recently identified as potential markers of inflammation or immunity. This study aimed to investigate whether NLR, MLR, and PLR are associated with GBS characteristics in children. We also assessed the impact of the COVID‐19 pandemic on the characteristics of GBS in Iran.MethodsIn this retrospective cross‐sectional study, we reviewed the records of all 150 children diagnosed with GBS in the Children's Medical Center hospital affiliated with Tehran University of Medical Sciences (TUMS) from March 2017 until March 2022. The TUMS research ethics committee approved the study (Ethics code: IR.TUMS.CHMC.REC.1399.125). Patients' data including gender, age, clinical symptoms, laboratory findings, and electrodiagnostic study results were collected and analyzed.ResultsThis study involved 150 children, comprising 93 boys and 57 girls, with an average age of 7.53 ± 3.75 years. The analysis demonstrated that the number of hospitalization days increased with an increase in NLR (p = 0.025). Moreover, patients with abnormal electrodiagnostic study patterns had a higher risk of intensive care unit (ICU) admission (p: 0.027), although according to binary logistic regression, respiratory failure at admission time was the only significant factor increasing the risk of ICU admission (p = 0.035). The study also found that the pandemic has resulted in a shift from acute inflammatory demyelinating polyneuropathy to acute motor axonal neuropathy as the most common EMG‐NCV pattern in our patients (p < 0.001).ConclusionWe found that higher NLR was associated with a longer hospitalization duration and could potentially distinguish between severe and mild cases of GBS. We have also shown that the COVID‐19 pandemic has changed our patients' most frequent electromyography and nerve conduction velocity (EMG‐NCV) patterns.

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COVID‐19 as a trigger of Guillain‐Barré syndrome: A review of the molecular mechanism

Malekpour

Khanmohammadi

Meybodi

et al. 2023

Immunity Inflam & Disease

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Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) caused a pandemic with serious complications. After coronavirus disease 2019 (COVID‐19), several post‐acute COVID‐19 syndromes (PACSs) and long‐COVID sequels were reported. PACSs involve many organs, including the nervous, gustatory, and immune systems. One of the PACSs after SARS‐CoV‐2 infection and vaccination is Guillain‐Barré syndrome (GBS). The incidence rate of GBS after SARS‐CoV‐2 infection or vaccination is low. However, the high prevalence of COVID‐19 and severe complications of GBS, for example, autonomic dysfunction and respiratory failure, highlight the importance of post‐COVID‐19 GBS. It is while patients with simultaneous COVID‐19 and GBS seem to have higher admission rates to the intensive care unit, and demyelination is more aggressive in post‐COVID‐19 GBS patients. SARS‐CoV‐2 can trigger GBS via several pathways like direct neurotropism and neurovirulence, microvascular dysfunction and oxidative stress, immune system disruption, molecular mimicry, and autoantibody production. Although there are few molecular studies on the molecular and cellular mechanisms of GBS occurrence after SARS‐CoV‐2 infection and vaccination, we aimed to discuss the possible pathomechanism of post‐COVID‐19 GBS by gathering the most recent molecular evidence.

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The Neuroimmunology of Guillain-Barré Syndrome and the Potential Role of an Aging Immune System

Cited by 24 publications

References 177 publications

Role of the Neutrophil to Lymphocyte Ratio in Guillain Barré Syndrome: A Systematic Review and Meta-Analysis

Role of the Neutrophil to Lymphocyte Ratio in Guillain Barré Syndrome: A Systematic Review and Meta-Analysis

The characteristics of Guillain–Barre syndrome in children in pre‐COVID‐19 and during the COVID‐19 pandemic: A cross‐sectional study

COVID‐19 as a trigger of Guillain‐Barré syndrome: A review of the molecular mechanism

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