Abstract
Introduction. Immune-mediated neuropathies are caused by immune responses against self-antigens of the peripheral nervous system. The pathophysiology involves autoantibodies, cells, and soluble mediators, such as inflammatory cytokines. Objectives. i) To determine the association between the presence of anti-ganglioside antibodies, and levels of Interleukin 6 and acute phase reactants in patients with peripheral neuropathies from hospitals in Córdoba city, Argentina, between 2022 and 2024. ii) To assess the frequency of immune-mediated peripheral neuropathies in the population studied. Materials and Methods. Ambispective, analytical, correlational, cross-sectional study, including patients with suspected peripheral neuropathy, over 18 years of age. Additionally, a control group, consisting of healthcare workers without previous pathologies, was established for interleukin 6. Results. A total of 37 patients were analyzed. No significant differences were found in the Interleukin 6 levels between control patients, patients with positive anti-ganglioside antibodies, and patients with negative antibodies (p-value: 0.1466). The same was observed for the levels of acute phase reactants (p-value: 0.6346). The frequency of immune-mediated peripheral neuropathies calculated was lower than the global rate and similar to that reported for Argentina. Conclusions. We found no statistically significant correlation between the presence of anti-ganglioside antibodies and the levels of Interleukin 6 and acute phase reactants in patients with peripheral neuropathies. The incidence of immune-mediated peripheral neuropathies obtained in this study was lower than the global incidence indicated in various reports.
References
1. Leonhard SE, Mandarakas MR, De Assis Aquino Gondim F, Bateman K, Brito Ferreira ML, Cornblath DR, et al. Guía basada en la evidencia. Diagnóstico y manejo del síndrome de Guillain-Barré en diez pasos. Medicina (B Aires). 2021;81(5):817-36, https://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802021000500817
2. Kieseier BC, Mathey EK, Sommer C, Hartung HP. Immune-mediatedneuropathies. Nat Rev Dis Primers. 2018;4(1):31, https://doi.org/10.1038/s41572-018-0027-2
3. Goodfellow JA, Willison HJ. Gangliosides and autoimmune peripheralnerve diseases. Prog Mol Biol Transl Sci. 2018;156:355-82, https://doi.org/10.1016/bs.pmbts.2017.12.010
4. Wanleenuwat P, Iwanowski P, Kozubski W. Antiganglioside antibodies in neurological diseases. J Neurol Sci. 2020;408:116576, https://doi.org/10.1016/j.jns.2019.116576
5. Codebó A, Bonanno D, Almeida V, Dorigo A, Gazia V, Poyard E, et al. Síndrome de Guillain-Barré en Argentina: su importancia para la salud pública ante la emergencia del virus del Zika. Rev Argent Salud Pública. 2016;7(28):38-40, https://rasp.msal.gov.ar/index.php/rasp/article/view/170
6. Sun T, Chen X, Shi S, Liu Q, Cheng Y. Peripheral blood and cerebrospinal fluid cytokine levels in Guillain Barre syndrome: a systematic review and meta-analysis. Front Neurosci. 2019;13:717, https://doi.org/10.3389/fnins.2019.00717
7. Nyati KK, Prasad KN, Rizwan A, Verma A, Paliwal VK. TH1 and TH2 response to Campylobacter jejuni antigen in Guillain-Barré syndrome. Arch Neurol. 2011;68(4):445-52, https://doi.org/10.1001/archneurol.2011.51
8. Li S, Jin T, Zhang HL, Yu H, Meng F, Concha Quezada H, et al. Circulating Th17, Th22, and Th1 cells are elevated in Guillain-Barré síndrome and downregulated by IVIg treatments. Mediators Inflamm. 2014;2014:740947, https://doi.org/10.1155/2014/740947
9. Wu CL, Chao CH, Lin SW, Chien YY, Huang WY, Weng WC, et al. Case report: Plasma biomarkers reflect immune mechanisms of Guillain-Barré syndrome. Front Neurol. 2021;12:720794, https://doi.org/10.3389/fneur.2021.720794
10. Debnath M, Nagappa M, Talukdar PM, Subbanna M, Sundaravadivel P, Shivakumar V, et al. Comprehensive cytokine profiling provides evidence for a multi-lineage Th responses in Guillain Barré Syndrome. Cytokine. 2018;110:58-62, https://doi.org/10.1016/j.cyto.2018.04.026
11. Altaweel YA, Abdelaziz S, Fathy HA, AbdelBadea S. Correlative study between C-reactive protein, clinical severity, and nerve conduction studies in Guillain-Barré syndrome. Egypt J Neurol Psychiatr Neurosurg. 2018;54(1):4, https://doi.org/10.1186/s41983-018-0006-2
12. Cutillo G, Saariaho AH, Meri S. Physiology of gangliosides and the role of antiganglioside antibodies in human diseases. Cell Mol Immunol. 2020;17(4):313-22, https://doi.org/10.1038/s41423-020-0388-9
13. Bhagavati S. Autoimmune disorders of the nervous system: pathophysiology, clinical features, and therapy. Front Neurol. 2021;12:664664, https://doi.org/10.3389/fneur.2021.664664
14. Shastri A, Al Aiyan A, Kishore U, Farrugia ME. Immune-mediated neuropathies: pathophysiology and management. Int J Mol Sci. 2023;24(8):7288, https://doi.org/10.3390/ijms24087288
15. Wanleenuwat P, Iwanowski P, Kozubski W. Antiganglioside antibodies
in neurological diseases. J Neurol Sci. 2020;408:116576, https://doi.org/10.1016/j.jns.2019.116576
16. Reisin RC, Salutto VL, Aguirre F, Alvarez V, Barroso F, Bendersky M, Berardo A, et al. Utilidad de la identificación de anticuerpos en neuropatías periféricas, neuronopatías y ganglionopatías: revisión. Neurol Argent. 2020;12(2):98-112, https://doi.org/10.1016/j.neuarg.2020.01.004
17. Garcia-Forcada A. Neuropatías, radiculopatías y plexopatías. Medicine
(Baltimore). 2019;12(75):4423-36, https://www.medicineonline.
es/es-neuropatias-radiculopatias-y-plexopatias-articulo-S0304541219300745#:~:text=Las%20radioculopat%C3%ADas%20son%20tambi%C3%A9n%20frecuentes,lesiones%20posradioterapia%20o%20infiltraci%C3%B3n%20metast%C3%A1sica).
18. Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet. 2021;397(10280):1214-28, https://doi.org/10.1016/S0140-6736(21)00517-1
19. Castelli G, Desai KM, Cantone RE. Peripheral neuropathy: evaluation and differential diagnosis. Am Fam Physician. 2020;102(12):732-9. PMID: 33320513.
20. Alessandro L, Appiani F, Bendersky M, Borrego Guerrero B, Bruera G,Cairola P, et al. Registro argentino de manifestaciones neurológicas por coronavirus-19 (COVID-19). Neurol Argent. 2021;13(2):84-94, https://doi.org/10.1016/j.neuarg.2021.04.001
21. Yevgi R. Relationship between acute phase reactants and disability in Guillain-Barré syndrome during the COVID-19 pandemic. Arch Med Res. 2022;53(2):179-85, https://doi.org/10.1016/j.arcmed.2021.10.002
22. Mushtaq HA, Khedr A, Koritala T, Bartlett BN, Jain NK, Khan SA. A review of adverse effects of COVID-19 vaccines. Infez Med. 2020;30(1):1-10, https://doi.org/10.53854/liim-3001-1
23. Trougakos IP, Terpos E, Alexopoulos H, Politou M, Paraskevis D, Scorilas A, Gastritis E, Andreakos E, Dimopoulos M. Adverse effects of COVID-19 mRNA vaccines: the spike hypothesis. Trends Mol Med. 2022;28(7), https://doi.org/10.1016/j.molmed.2022.04.007
24. Yu M, Nie S, Qiao Y, Ma Y. Guillain-Barré syndrome following COVID-19 vaccines: A review of literature. Front Immunol. 2023;14:1078197, https://doi.org/10.3389/fimmu.2023.1078197
25. Galiero R, Caturano A, Vetrano E, Beccia D, Brin C, Alfano M, et al. Peripheral neuropathy in diabetes mellitus: pathogenetic mechanisms and diagnostic options. Int J Mol Sci. 2023;24(4):3554, https://doi.org/10.3390/ijms24043554
26. Beh SC, Greenberg BM, Frohman T, Frohman EM. Transverse myelitis. Neurol Clin. 2013;31(1):79-138, https://doi.org/10.1016/j.ncl.2012.09.008
27. Soltani Z E, Rahmani F, Rezaei N. Autoimmunity and cytokines in Guillain-Barré syndrome revisited: review of pathomechanisms with an eye on therapeutic options. Eur Cytokine Netw. 2019;30(1):1-14, https://doi.org/10.1684/ecn.2019.0424
