g(m1)-ganglioside and Neuromuscular-Diseases

Multifocal motor neuropathy is a rare immune-mediated neuropathy characterized by progressive asymmetric weakness and atrophy without sensory abnormalities. Although disease onset is usually in adulthood, a few childhood-onset cases have been reported. Here, we report the case of an 8-year-old boy with multifocal motor neuropathy who presented with a slowly progressive left and distal upper limb weakness without sensory loss. The initial high-dose intravenous immunoglobulin treatment significantly improved left upper limb muscle weakness. Continued monthly intravenous immunoglobulin treatment gradually improved muscle strength for several months initially. While the muscle strength decreased slightly after 8 months of therapy, it was better than that before intravenous immunoglobulin treatment. One year and eight months after the initiation of treatment, serum testing for IgM antibodies to gangliosides, GM1 and GM2, was negative. This is the first pediatric report of the serum IgM autoantibodies positive to GM1 and GM2. The clinical course is similar to that of partial intravenous immunoglobulin responders among patients with adulthood-onset multifocal motor neuropathy. Since the symptoms plateaued after the initial intravenous immunoglobulin therapy, prognosis appears to be determined by the patient's initial response to intravenous immunoglobulin treatment.

Topics: Child; Diagnosis, Differential; G(M1) Ganglioside; G(M2) Ganglioside; Humans; Immunoglobulin M; Immunoglobulins, Intravenous; Immunologic Factors; Male; Neurodegenerative Diseases; Neuromuscular Diseases

Topics: Campylobacter jejuni; Distal Myopathies; Drug Therapy, Combination; G(M1) Ganglioside; Guillain-Barre Syndrome; Haplotypes; HLA-DR3 Antigen; Humans; Immunoglobulins, Intravenous; Lipopolysaccharides; Methylprednisolone; Mutation; Myositis, Inclusion Body; Neuromuscular Diseases; Randomized Controlled Trials as Topic

Pure motor neuropathy syndromes resemble amyotrophic lateral sclerosis variants with no upper motor neuron signs. Their identification is important, as, in contrast to amyotrophic lateral sclerosis, they are often immune mediated and treatable. Typically the immune-mediated motor neuropathy syndromes are distal and asymmetrical and progress slowly. The clinical features may help alert the clinician to the diagnosis, but other ancillary evidence such as abnormalities on electrophysiological testing and the presence of serum autoantibodies to neural antigens are helpful in making the diagnosis more secure. Electrophysiological abnormalities include not only motor conduction block but also other evidence of a demyelinative process such as prolonged distal latencies or F-wave abnormalities. High-titer anti-GM1 antibodies occur frequently but more specific patterns of reactivity may be especially helpful. Treatment of these motor neuropathy syndromes includes cyclophosphamide, which we use in combination with plasma exchange, and in some patients, human immune globulin. Clinical responses to therapy may occur within the first 2 to 4 months in patients with motor neuropathy syndromes with demyelinative features, but only become obvious 6 months or later after starting treatment in patients with predominantly axonal disorders.

Topics: Adult; Aged; Amyotrophic Lateral Sclerosis; Antibody Specificity; Antigens; Autoantibodies; Autoimmune Diseases; Chronic Disease; Cyclophosphamide; Diagnosis, Differential; Female; G(M1) Ganglioside; Humans; Immunosuppressive Agents; Male; Middle Aged; Neural Conduction; Neuromuscular Diseases

Electrodiagnosis rests upon sound anatomical and physiological bases of the peripheral nervous system, which are utilized for the dynamic process of differential diagnosis. If clinical and electrophysiological findings do not conform to any of the previously known diseases, there may be a chance of identifying a new entity. As an example, we report nine Japanese patients with unilateral atrophy of the distal upper limb and the cervical cord. Symptoms typically began insideously in young adulthood, progressed for a few years and then stabilized. Distribution of the muscle weakness usually corresponded to the territories of a few peripheral nerves, although not accompanied by sensory deficits. Serum anti-GM1 IgG antibodies were elevated in 6 out of 9 patients. Electrophysiological testings disclosed absent or delayed F-waves in the nerve involved. No long tract signs of the cord were demonstrated, although the spinal cord atrophy was extensive in some patients. Three showed partial clinical improvement after cyclophosphamide therapy or intravenous immunoglobulin. These findings may suggest that this entity is immune-mediated as in multifocal motor neuropathy, with its blunt of immune attack directed not only to peripheral motor nerves but also to spinal motor neurons.

Topics: Adolescent; Adult; Diagnosis, Differential; Electrodiagnosis; Electromyography; G(M1) Ganglioside; Humans; Immunoglobulin G; Male; Median Nerve; Motor Neuron Disease; Neural Conduction; Neuromuscular Diseases

Topics: Autoantibodies; G(M1) Ganglioside; Humans; Motor Neuron Disease; Neuromuscular Diseases

High titers of IgM anti-GM1 antibodies are commonly found in the serum of patients with some lower motor neuron disorders and peripheral neuropathies. Enzyme-linked immunosorbent assays (ELISA) are useful for the detection and quantitation of anti-GM1 antibodies. Testing for serum anti-GM1 activity is indicated in the diagnostic evaluation of lower motor neuron syndromes. The presence of high titers of anti-GM1 antibodies mandates careful electrophysiologic testing for the motor conduction block that is found in multifocal motor neuropathy, a treatable disorder. Quantitation of anti-GM1 antibodies may also be a useful guide in the treatment of multifocal motor neuropathy. Further study of antiglycolipid antibodies in motor neuron disorders and peripheral neuropathies may provide clues to the events that stimulate these antibodies and to the pathogenesis of such syndromes.

Topics: Amyotrophic Lateral Sclerosis; Antibody Specificity; Autoantibodies; Enzyme-Linked Immunosorbent Assay; G(M1) Ganglioside; Humans; Motor Neuron Disease; Neuromuscular Diseases; Peripheral Nervous System Diseases

Topics: Amyotrophic Lateral Sclerosis; Antibodies; Autoantibodies; Epitopes; G(M1) Ganglioside; Humans; Immunoglobulin A; Incidence; Intermediate Filaments; Motor Neurons; Nerve Tissue Proteins; Neuromuscular Diseases; Paraproteinemias

Topics: Antibodies; Diagnosis, Differential; G(M1) Ganglioside; Humans; Motor Neurons; Movement Disorders; Nervous System Diseases; Neural Conduction; Neuromuscular Diseases

Increased serum titers of antibodies against the ganglioside GM1 or its carbohydrate epitope Gal(B1-3)GalNAc have been associated with motor neuron disease, motor neuropathies with or without conduction block and sensorimotor neuropathies, whereas low level titers are part of the normal immune repertoire and are present in control groups and in neonatal blood. The target antigens of the antibodies are widely distributed and highly concentrated in the peripheral and central nervous system. The antibodies could damage neural tissue at several anatomic sites. Possible binding sites are the anterior horn cells in the spinal cord and the nodes of Ranvier. Reduction of serum titers with chemotherapy or plasmapheresis can lead to clinical improvement.

Topics: Antibody Specificity; Antigens, Tumor-Associated, Carbohydrate; Autoantibodies; Autoimmune Diseases; Disaccharides; G(M1) Ganglioside; Humans; Immunosuppressive Agents; Neuromuscular Diseases

Patient 1 was a 39-year-old man; patient 2, a 42-year-old woman; patient 3, a 78-year-old man. Leading symptoms were chronic asymmetrical weakness in all three cases, which started in a distal portion of the upper extremities. Muscle atrophy was often less prominent than would be expected from the power of the muscle. Fasciculations were observed in two patients and the initial symptom of patient 2 was painful cramp of the right thumb. Patient 1 initially had mild transient dysesthesia of the right fingers. The other two patients had no sensory symptoms or signs. General laboratory tests revealed no particular abnormalities except that patient 3 had mild diabetes mellitus, although the type of neuropathy in patient 3 was quite different from diabetic neuropathy. Total protein concentrations in the cerebrospinal fluid were 34, 32 and 43 mg/dl in three patients, respectively (normally, less than 40 mg/dl). Motor nerve conduction studies revealed conduction block in more than one nerve in every case. Conduction velocities were generally normal in those segments of nerve where conduction block was not detected. Serum anti-ganglioside antibodies were investigated by Enzyme-linked immunosorbent assay (ELISA). Glycolipids used as the antigen include GM1, GM2, GM3, GD1b, GD3, GT1b, GQ1b, GA1 and galactocerebroside. Strong IgM antibody activity against GM1, GD1b and GA1 was noted in patient 1. Weaker but significant IgM antibody activities against GM1 and GA1 were detected in patient 2 and 3. Thin-layer chromatography immunostaining also confirmed these results. Muscle biopsy in patient 1 revealed a lot of target fibers and profuse polyglucosan bodies in the axons of intramuscular nerves.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Autoantibodies; Demyelinating Diseases; Electrophysiology; Female; G(M1) Ganglioside; Humans; Male; Motor Neurons; Neural Conduction; Neuromuscular Diseases

Serum IgM binding to GM1 ganglioside (GM1) is often associated with chronic acquired motor neuropathies. This study compared the frequency and clinical associations of serum IgM binding to a different antigen, a disulphated heparin disaccharide (NS6S), with results of IgM binding to GM1.. Serums and clinical features were retrospectively compared from 75 patients with motor neuropathies and 134 controls with amyotrophic lateral sclerosis (ALS), chronic immune demyelinating polyneuropathy (CIDP) and sensory neuropathies. Clinical correlations of positive IgM anti-GM1 testing found in 27 of 2113 unselected serums were also reviewed. Serum testing for IgM binding to NS6S and GM1 used covalent antigen linkage to ELISA plates.. High titre IgM binding to NS6S and GM1 each occurred in 43%, and to one of the two in 64%, of motor neuropathy patients. Motor neuropathy syndromes were present in 25 of 27 patients with high titre serum IgM binding to GM1 in the unselected serums. IgM anti-GM1 or NS6S antibody related motor neuropathy syndromes usually have asymmetric, predominantly distal, upper extremity weakness.. IgM binding to NS6S disaccharide is associated with motor neuropathy syndromes and occurs with similar frequency to IgM binding to GM1. Testing for IgM binding to NS6S in addition to GM1 increases the frequency of finding IgM autoantibodies in motor neuropathies from 43% to 64%. High titres of serum IgM binding to GM1, tested with covalent ELISA methodology, have 93% specificity for motor neuropathy syndromes. High titres of serum IgM binding to NS6S have specificity for immune motor neuropathies compared with ALS and CIDP.

Topics: Adult; Age of Onset; Aged; Disaccharides; Electrodiagnosis; Enzyme-Linked Immunosorbent Assay; Female; G(M1) Ganglioside; Heparin; Humans; Immunoglobulin M; Male; Middle Aged; Motor Neuron Disease; Muscle Weakness; Neural Conduction; Neuromuscular Diseases; Predictive Value of Tests; Young Adult

Lower motor neuron syndromes (LMNS) are heterogenous conditions, which include patients with progressive lower motor neuron disease (LMND) and cases with the clinical phenotype of motor neuropathy (MN). The aim of this study was to estimate the IgM anti-GM1 ganglioside antibodies titer and the ratio of the light chains in order to define the presence of autoimmunity process in particular cases with LMNS. Twenty-eight patients were diagnosed with LMND and 15 patients were diagnosed with MN (10 patients with multifocal motor neuropathy with conduction block, five patients with MN without conduction block). Total of 103 patients with classical amyotrophic lateral sclerosis (ALS) and 50 healthy, age-matched persons were also tested. The IgM anti-GM1 ganglioside titer and the ratio of lambda/kappa light chains in serum were determined using the ELISA technique. High titer of IgM anti-GM1 antibodies were detected in serum of 46% LMND patients, 80% of MN patients, and 18% of the classical ALS cases. An elevated ratio of lambda/kappa light chains appeared in 18% of LMND patients, and in 67% of the MN cases. The lambda/kappa light chains ratio was normal in all ALS patients. The presence of elevated titer of IgM anti-GM1 ganglioside antibodies and the changed ratio of the light chains supports the presence of autoimmune process in LMNS and may provide clues for their management.

Topics: Adult; Amyotrophic Lateral Sclerosis; Autoantibodies; Autoimmunity; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Female; G(M1) Ganglioside; Humans; Immunoglobulin kappa-Chains; Immunoglobulin lambda-Chains; Immunoglobulin M; Male; Middle Aged; Motor Neuron Disease; Neuromuscular Diseases

A patient with chorea-acanthocytosis presenting with axonal neuropathy showed an elevation in IgM polyclonal antibodies to the GM1 ganglioside, which were estimated by enzyme-linked immunosorbent assay and complement-mediated liposome immune lysis assay (LILA). This is the first demonstration of such antibodies in chorea-acanthocytosis. Anti-GM1 antibodies might have directly caused the axonal neuropathy by binding to GM1 or cross-reactive antigens in the nerves.

Topics: Acanthocytes; Adult; Antibodies; Axons; Chorea; Enzyme-Linked Immunosorbent Assay; G(M1) Ganglioside; Humans; Male; Neuromuscular Diseases

In order to confirm the reported pathogenicity of human antibodies to monosialoganglioside GM1, immunoglobulin fractions with high anti-GM1 IgG or IgM titers were prepared from patients with Guillain-Barré syndrome and multifocal motor neuropathy respectively. These fractions were injected intraneurally into rat tibial nerves with fresh human complement. Neither the anti-GM1 IgG nor the anti-GM1 IgM fraction induced significant focal conduction block or slowing compared to a pooled fraction prepared from 5 normal individuals. In contrast, rabbit experimental allergic neuritis serum included as a positive control was highly active. Transverse sections of injected nerve failed to show evidence of demyelination. Staining for human immunoglobulin in cryostat sections showed the presence of injected anti-GM1 antibody bound to nodes of Ranvier up to 6 days following intraneural transfer. These data fail to confirm previous reports of conduction block from intraneural transfer of anti-GM1 serum and suggest that such electrophysiological effects may be the result of factors other than or in addition to anti-GM1 antibodies.

Topics: Animals; Antibodies; Female; G(M1) Ganglioside; Humans; Immunoglobulin G; Immunoglobulin M; Neural Conduction; Neuromuscular Diseases; Rats

Topics: Antibodies; Electrophysiology; G(M1) Ganglioside; Humans; Neuromuscular Diseases; Retrospective Studies

Topics: Adult; Autoantibodies; Chronic Disease; Female; G(M1) Ganglioside; Gangliosides; Humans; Neuromuscular Diseases

Topics: Antibodies, Anti-Idiotypic; Antibody Formation; Antigens, CD; B-Lymphocyte Subsets; CD5 Antigens; Cells, Cultured; Enzyme-Linked Immunosorbent Assay; G(M1) Ganglioside; Humans; Motor Neurons; Neuromuscular Diseases

Autoantibodies that bind to GM1 ganglioside and asialo GM1 (GA1) have been implicated in the pathogenesis of motor neuropathies. To investigate the structure and specificity of these autoantibodies, peripheral blood B cells from patients with motor neuron diseases and from normal individuals were immortalized by EBV, and B cells secreting anti-GM1 or GA1 antibodies were cloned. We report an analysis of the structure and specificities of eight autoantibodies from patients with motor neuropathy, and two from normal individuals. Four antibodies were IgM, six were IgG, and all bound predominantly to GA1. The sequences of V domains of H and L chains were determined by a reverse transcription-polymerase chain reaction procedure. A variety of V genes were used to encode these antibodies: four VH1, two VH3, three VH4, one VH5, two V kappa I, two V kappa II, three V kappa III, and two V lambda II. Most V genes (13/19) exhibited less than 95% similarity to known germ-line genes, which suggests that somatic mutation was required to generate these autoantibodies, or that the relevant germ-line genes have not been identified. The average length of the H chain CDR3 was 16 amino acids, and in three antibodies this segment contained more than 20 amino acids. It was not possible to identify amino acid sequences that were encoded by germ-line D segments by conventional alignment of sequences. Partial analogies could be identified by introducing gaps, allowing mismatches and searching for D-D fusions and inversions. These results indicate that anti-GA1 antibodies can be encoded by a variety of VH-VL pairs, that the antibodies exhibit extensive somatic mutation, and that the CDR3 segments are generated by a number of nonconventional mechanisms.

Topics: Adult; Amino Acid Sequence; Antibody Specificity; Autoantibodies; Base Sequence; Female; G(M1) Ganglioside; Humans; Immunoglobulin Heavy Chains; Immunoglobulin Light Chains; Immunoglobulin Variable Region; Male; Middle Aged; Molecular Sequence Data; Motor Neurons; Neuromuscular Diseases

Increased titers of antibodies to GM1 ganglioside in humans are associated with lower motor neuron disease and predominantly motor neuropathy with or without conduction block. To investigate the possible mechanism of these antibodies, we injected the serum of a patient with anti-GM1 antibodies who had motor neuron disease and multifocal motor conduction block, into rat sciatic nerve. When injected with fresh human complement, the serum-induced conduction block with temporal dispersion and deposits of immunoglobulin were detected at the nodes of Ranvier. Electron microscopic studies revealed demyelination in 6.5% of the fibers. After preabsorption with GM1, the serum had no effect, suggesting that the anti-GM1 antibodies were responsible for the conduction abnormalities.

Topics: Animals; Antibodies; Blood Physiological Phenomena; Electrophysiology; Fluorescent Antibody Technique; G(M1) Ganglioside; Humans; Male; Microscopy, Electron; Motor Neurons; Neural Conduction; Neuromuscular Diseases; Rats; Rats, Inbred Strains; Sciatic Nerve

The incidence of anti-GM1 antibodies in the serum of 104 patients with neurological diseases, 35 patients with non-neurological diseases (NND) and 41 normal controls was determined by enzyme-linked immunosorbent assay (ELISA). Anti-GM1 antibodies were found in 90% of patients presenting with a motor neuropathy (all except one had multifocal conduction blocks). A large proportion (60%) of these patients displayed high antibody titer ranging from 101 to 788. A low incidence of anti-GM1 antibodies was found in the other groups of patients, i.e. 21% of amyotrophic lateral sclerosis (ALS), 26% of other neurological diseases (OND) and 23% of NND. High antibody titers ranging from 106 to 260 were found in two (5%) ALS patients, one (2%) OND patient (myasthenia gravis), and one (3%) NND patient (Waldenström's disease). This study shows that high titers of anti-GM1 antibodies are found in a large proportion of patients with motor neuropathy with multifocal conduction blocks. This argues for a possible autoimmune origin of this neuropathy. We suggest that anti-GM1 antibody determination should be included systematically in the evaluation of all patients with motor neuron diseases and predominantly motor neuropathies.

Topics: Adult; Aged; Aged, 80 and over; Amyotrophic Lateral Sclerosis; Antibodies; G(M1) Ganglioside; Humans; Immunoglobulin G; Immunoglobulin M; Middle Aged; Neuromuscular Diseases

Recent studies reported the presence of anti-ganglioside antibodies in occasional patients with motor neuron disease. We found polyclonal serum IgM anti-GM1 antibodies by an anti-GM1 enzyme-linked immunosorbent assay (ELISA) in 9 (19%) of 48 patients with motor neuron disease. A comparable frequency of IgM anti-GM1 antibodies was found in 4 (10%) of 40 sera from patients with other neurological disease. Three (17%) of 18 sera from the patients with motor neuron disease and 2 (17%) of 12 sera from patients with other neurological diseases had anti-GM1 immunostaining as shown by thin layer chromatography immunoblot. One patient with a lower motor neuron variant of motor neuron disease or motor axonopathy without multifocal conduction block had a markedly elevated polyclonal IgM anti-GM1 ELISA titer (greater than 1:64,000) with prominent immunostaining of GM1, moderate immunostaining of GM2, and weak and inconsistent immunostaining of GD1b by thin layer chromatography immunoblot. Treatment with prednisone resulted in clinical improvement despite increasing anti-GM1 antibody titers. These data indicate that patients with motor neuron disease have measurable levels of anti-ganglioside antibodies as frequently as patients with other neurological diseases. This contrasts with a small subgroup of patients with a lower motor neuron variant of motor neuron disease or motor axonopathy who have markedly elevated levels of serum anti-ganglioside antibodies and a clinical syndrome that is treatable with immunosuppression.

Topics: Amyotrophic Lateral Sclerosis; Autoantibodies; Female; G(M1) Ganglioside; Humans; Immunoglobulin mu-Chains; Middle Aged; Motor Neurons; Neuromuscular Diseases

We studied a patient with amyotrophic lateral sclerosis, multifocal motor conduction block, and IgM anti-GM1 antibodies. A sural nerve biopsy demonstrated deposits of IgM at nodes of Ranvier by direct immunofluorescence. The deposits were granular and located in the nodal gap between adjacent myelin internodes, and in some instances, they extended along the surface of the paranodal myelin sheath. When injected into rat sciatic nerve, the serum IgM bound to the nodes of Ranvier, and the binding activity was removed by preincubation with GM1. These observations suggest that anti-GM1 antibodies may have caused motor dysfunction by binding to the nodal and paranodal regions of peripheral nerve.

Topics: Adult; Amyotrophic Lateral Sclerosis; Antibodies; Blood Physiological Phenomena; Electrodiagnosis; Female; Fluorescent Antibody Technique; G(M1) Ganglioside; Humans; Immunoglobulin M; Motor Neurons; Nerve Fibers; Neural Conduction; Neuromuscular Diseases; Ranvier's Nodes; Sciatic Nerve

We compared anti-GM1 IgM antibody titers in patients with various neurologic diseases and in normal subjects. We found increased titers in patients with lower motor neuron disease, sensorimotor neuropathy, or motor neuropathy with or without multifocal conduction block. In patients with other diseases, titers are similar to those in normal individuals, suggesting that anti-GM1 antibody levels are not increased nonspecifically after neural injury or inflammatory diseases. Anti-GM1 antibodies in many of the patients occur as monoclonal gammopathies, predominantly of lambda light-chain type, but the antibodies are sometimes polyclonal with normal or increased serum IgM concentrations. Most of the anti-GM1 antibodies appear to react with the Gal(beta 1-3)GalNAc epitope which is shared with asialo-GM1 and GD1b, but in some patients the antibodies are more specific for GM1 and associated with motor neuropathy. Patients with motor or sensorimotor peripheral neuropathy or lower motor neuron disease should be tested for anti-GM1 antibodies or anti-Gal(beta 1-3)GalNAc antibodies, as therapeutic reduction in antibody concentrations was reported to result in clinical improvement in some patients.

Topics: Adult; Aged; Autoantibodies; Central Nervous System Diseases; Female; G(M1) Ganglioside; Humans; Immunoglobulin M; Male; Middle Aged; Motor Neurons; Nervous System Diseases; Neuromuscular Diseases; Peripheral Nervous System Diseases; Sensation; Syndrome

We studied 74 patients with progressive, asymmetrical lower motor neuron syndromes. Clinical features of these patients, including age, sex, disease duration, patterns of weakness, and reflex changes, were evaluated by review of records. In each patient the clinical features were compared to the type of nerve conduction abnormalities and to the specificities of high-titer serum antiglycolipid antibodies. Antibody specificities were determined by an enzyme-linked immunosorbent assay using purified glycolipids and carbohydrates as substrates. Our results show that high titers of antibodies to glycolipids are common in sera of patients with lower motor neuron syndromes. Selective patterns of reactivity indicate that specific carbohydrate epitopes on the glycolipids are the targets of the high-titer antibodies in individual patients with lower motor neuron syndromes. Several distinct lower motor neuron syndromes can be identified based on clinical, physiological, and antiglycolipid antibody characteristics. These syndromes include multifocal motor neuropathy with evidence of multifocal conduction block on motor, but not sensory, axons and frequent (84%) high titers of anti-GM1 ganglioside antibodies; a lower motor neuron syndrome with predominantly distal weakness early in the disease course, no conduction block, and a high incidence (64%) of anti-GM1 antibodies; and a lower motor neuron syndrome with predominant early weakness in proximal muscles and serum antibodies to asialo-GM1 that do not cross-react with GM1 ganglioside.

Topics: Adult; Aged; Autoantibodies; Female; G(M1) Ganglioside; Glycolipids; Humans; Male; Middle Aged; Motor Neurons; Neural Conduction; Neuromuscular Diseases; Syndrome

We followed a patient with a lower motor neuron form of motor neuron disease whose neurologic disorder improved following immunotherapy. The patient did not have an M protein but did have IgM antibodies to ganglioside GM1 detectable at serum titers of 1:2,000 by ELISA. These antibodies were found only in the IgM fraction with lambda light chains and immunoreacted with GD1b and Gal (beta 1-3) GalNAc.

Topics: Adult; Antigens, Tumor-Associated, Carbohydrate; Autoantibodies; Chromatography, High Pressure Liquid; Disaccharides; Enzyme-Linked Immunosorbent Assay; G(M1) Ganglioside; Gangliosides; Humans; Immunoglobulin M; Immunotherapy; Male; Motor Neurons; Neuromuscular Diseases

Small amounts of oligoclonal immunoglobulins were detected by Western blotting in the serum from a patient with motor neuron syndrome. The prominent one, a monoclonal IgM lambda, reacted strongly with the gangliosides GM1 and GD1b and more weakly with asialo GM1, as shown by immunoenzymatic staining of thin-layer chromatograms of gangliosides, ELISA on purified glycolipid coats and immunoadsorption with purified GM1. Affinity-chromatography with purified GM1 resulted in the purification of monoclonal IgM lambda. This purified IgM and its Fab fragments showed the same pattern of reactivity with gangliosides as that observed with whole serum. Such monoclonal IgM could be responsible for motor neuron diseases in some patients with overt or barely detectable monoclonal gammopathies.

Topics: Aged; Antibodies, Monoclonal; Autoantibodies; Blotting, Western; Chromatography, Thin Layer; Enzyme-Linked Immunosorbent Assay; G(M1) Ganglioside; Gangliosides; Humans; Immunoglobulin M; Male; Motor Neurons; Neuromuscular Diseases

Fifty-nine percent of 49 patients with motor neuron disease and 25% of 91 control subjects had IgM antibodies to ganglioside GM1 but usually not to GD1b at titers less than 1:80. This suggests that antibodies to GM1 may be part of the normal human antibody repertoire. However, given the higher incidence of antibodies to GM1 in patients with motor neuron disease, there may be specific epitopes important in antiganglioside antibodies associated with motor neuron disease.

Topics: Autoantibodies; Female; G(M1) Ganglioside; Gangliosides; Humans; Immunoglobulin mu-Chains; Male; Middle Aged; Motor Neurons; Neuromuscular Diseases

Antibodies to gangliosides were detected in sera from three of 19 patients with chronic inflammatory polyneuropathy (CIP) by a thin-layer chromatogram overlay technique. All three of the patients fell into a clinical subset of the group that had multifocal motor neuropathy, and in all three patients the antibodies reacted with GM1 ganglioside. However, the fine specificities of the antibodies differed as demonstrated by cross-reactivity with different gangliosides in each of the three patients. The antibodies in patient 1 reacted with GM1, GD1b, and asialo-GM1 suggesting that the terminal Gal(beta 1-3)GalNAc moiety that is common to these three glycolipids is an important part of the epitope(s). This was confirmed by showing reactivity of the antibodies with Gal(beta 1-3)GalNAc conjugated to bovine serum albumin. Patient 2 had antibodies that did not react with GD1b, but cross-reacted with GM2 ganglioside suggesting that the epitope(s) involved the inner portion of the oligosaccharide moiety that is shared between GM1 and GM2. Patient 3 had antibodies that reacted with GM1 and asialo-GM1, but they did not cross-react with either GD1b or GM2. These results provide further evidence for a relationship between motor nerve syndromes and anti-GM1 antibodies and also suggest that GM1 could be a principal target antigen since other reactive gangliosides differed among the patients. However, the possible pathogenic effects of anti-GM1 antibodies on motor nerves remain to be established.

Topics: Antibodies; Antibody Specificity; Chromatography, Thin Layer; Cross Reactions; Enzyme-Linked Immunosorbent Assay; G(M1) Ganglioside; Gangliosides; Glycosphingolipids; Humans; Nervous System Diseases; Neuromuscular Diseases; Polyneuropathies

Twelve laboratories from the United States, Canada, France, Italy and Switzerland participated in a workshop to compare assays used to measure anti-GM1 antibodies, and to discuss the clinical significance of these antibodies. A panel of test samples containing varying amounts of anti-GM1 antibody was prepared by mixing varied proportions of normal serum with a serum containing a monoclonal IgM antibody that bound GM1 ganglioside. Enzyme-linked immunosorbent assay (ELISA) data were supplied by eight laboratories and ten laboratories classified the sera as negative, weakly or strongly positive. Most laboratories correctly identified the two samples that contained the highest quantities of antibody, but there was considerable disagreement on the classification of the three samples with moderate or small amounts of antibody. The sensitivity of the assays varied considerably. The more sensitive assays did not use detergent in the washing buffers, and incubated the human serum with the antigen at 4 degrees C overnight. Several investigators have identified a subset of patients with lower motor neuron disease or multifocal neuropathy who have high titers of anti-GM1 antibodies. Many patients with neurological and non-neurological diseases have low to moderate levels of anti-GM1 antibodies, and the significance of these antibodies is unclear. There was general agreement that standardization of the ELISA assays is urgently required, and that distribution of a reference high-titered antiserum would facilitate this process.

Topics: Antibodies; Carbohydrates; Enzyme-Linked Immunosorbent Assay; G(M1) Ganglioside; Humans; Motor Neurons; Neuromuscular Diseases

We compared the effects of treatment of patients with prednisone or cyclophosphamide on a series of different types of autoantibodies. Levels of antiacetylcholine receptor (anti-AChR) antibodies and of antibodies to GM1 and GD1a gangliosides were measured in patients with a variety of neuromuscular disorders before and after treatment. Most patients had several autoantibodies present. We showed that prednisone treatment resulted in a reduction in titers of anti-AChR but not antiganglioside antibodies. Cyclophosphamide treatment produced a reduction of antiganglioside antibody titers. An intravenous and oral regimen was more effective than a single intravenous course of cyclophosphamide. We conclude that an immunosuppressive medication such as prednisone may reduce levels of some autoantibodies while producing no change in others, even in an individual patient. In addition, cyclophosphamide can suppress autoantibodies that prednisone does not. These differences in immunopharmacologic responses suggest that there are several distinct mechanisms of autoantibody production in humans. The utility of immunosuppressive medications in specific disease processes may be related in part to the mechanism of production of pathogenic antibodies.

Topics: Autoantibodies; Cyclophosphamide; G(M1) Ganglioside; Gangliosides; Humans; Immunoglobulin G; Immunoglobulin M; Neuromuscular Diseases; Prednisone; Receptors, Cholinergic

IgM lambda monoclonal antibodies in two patients with motor neuron disease showed the same unique antigenic specificity. They bound to gangliosides GM1 and GD1b and to lacto-N-tetraose-BSA. By immunofluorescence microscopy they bound to central and peripheral nerve tissue and to motor end-plates at the neuromuscular junction. Sera from control subjects did not contain antibodies of similar specificity. Monoclonal IgMs with the same unique specificity could be responsible for motor neuron disease in some patients with monoclonal gammopathies.

Topics: Antibodies, Monoclonal; Autoantibodies; Epitopes; Female; Fluorescent Antibody Technique; G(M1) Ganglioside; Gangliosides; Humans; Immunoglobulin M; Male; Middle Aged; Motor Neurons; Nerve Tissue; Neuromuscular Diseases; Oligosaccharides

We demonstrated the binding of an IgM monoclonal protein, obtained from a patient with motor neuron disease, with known antibody activity against gangliosides GM1, GD1b, and asialo GM1, to neuromuscular junctions in guinea pig gastrocnemius muscle, using an indirect immunofluorescence technique. Staining disappeared after delipidation of muscle sections. Denervated muscle sections showed no labeling at the neuromuscular junction after incubation with the patient's serum. This indicates presynaptic binding of the IgM M protein and supports the concept that IgM monoclonal antibody to nerve terminal determinants may underlie a motor neuron disorder.

Topics: Animals; Antibodies, Monoclonal; Fluorescent Antibody Technique; G(M1) Ganglioside; Gangliosides; Guinea Pigs; Humans; Immunoglobulin M; Motor Neurons; Neuromuscular Diseases; Neuromuscular Junction; Staining and Labeling

Topics: Animals; Antibody Specificity; Autoantibodies; Epitopes; G(M1) Ganglioside; Gangliosides; Humans; Immunoglobulin M; Mice; Mice, Inbred Strains; Motor Neurons; Neuromuscular Diseases; Paraproteinemias

We report 2 patients with a treatable, immune-mediated motor polyneuropathy associated with antibodies to defined neural antigens. In these patients asymmetrical weakness developed in one arm and progressed over 2 to 3 years to involve the other arm, legs, and trunk. Both patients were initially diagnosed as having lower motor neuron forms of amyotrophic lateral sclerosis. However, repeated electrophysiological testing eventually showed multifocal conduction blocks in motor but not sensory fibers compatible with patchy selective demyelination. Serum testing by thin-layer chromatography and enzyme-linked immunosorbent assay revealed that both patients had high titers of antibody directed against GM1 and other gangliosides. Initial therapeutic trials of prednisone (100 mg daily for 4 to 6 months) and plasmapheresis were unsuccessful. Treatment with cyclophosphamide, however, was followed by marked improvement in strength in both patients.

Topics: Adult; Autoantibodies; Autoimmune Diseases; Cyclophosphamide; Female; G(M1) Ganglioside; Humans; Infusions, Intravenous; Male; Middle Aged; Motor Neurons; Neuromuscular Diseases; Synaptic Transmission

IgM monoclonal gammopathy has been reported in some patients with motor neuron disease. The monoclonal IgMs in several of the patients bind to the carbohydrate epitope Gal (beta 1-3) GalNAc, which is shared by gangliosides GM1 and GD1b and glycoproteins in the nervous system and crossreacted with Gal (beta 1-3) GlcNAc. They also immunostain spinal cord and gray matter and presynaptic terminals of motor neurons at the neuromuscular junction. The role and mechanisms of action of these antibodies in motor neuron disease is under investigation.

Topics: Antibodies, Monoclonal; Antibody Specificity; Female; G(M1) Ganglioside; Gangliosides; Glycoconjugates; Humans; Immunoglobulin M; Male; Middle Aged; Motor Neurons; Neuromuscular Diseases

We demonstrated that an IgM M-protein from a patient with motor neuron syndrome had antibody activity against gangliosides GM1, GD1b, and asialo GM1. Studies with a sugar-binding lectin suggested that the epitope in the patient's M-IgM involved the Gal(beta 1-3) GalNAc moiety. Immunohistological techniques demonstrated staining of axons in the lumbar roots, granular cells, and white matter in the cerebellum by the patient's M-IgM. We propose that, in this case, an autoimmune mechanism of motor neuron syndrome associated with a monoclonal protein is most likely.

Topics: Antibodies, Monoclonal; Autoantibodies; Brain; Female; G(M1) Ganglioside; Gangliosides; Humans; Middle Aged; Motor Neurons; Neuromuscular Diseases; Spinal Cord; Syndrome