Meta-analysis of antiganglioside antibodies in peripheral neuropathies: a potenital diagnostic indicator in CIDP, GBS, and MMN

Suwanee, GA

Introduction: Autoimmune diseases that attack the peripheral nervous system are rare and difficult to precisely diagnose. Current diagnostic techniques rely heavily on patient symptomatology which prove problematic considering the varying presentations and the interchangeability of symptomatology among many peripheral neuropathies. Little is understood about the precise mechanism of pathogenesis which makes obtaining a biomarker challenging, but the presence of autoantibodies which target myelin proteins suggest a humoral component. In previous studies antiganglioside IgG and IgM antibodies that attack myelin have been reported in up to 60% of cases of Guillain-Barre syndrome (GBS) and 50% of cases of multifocal motor neuropathy (MMN). However, there are fewer cases of antiganglioside antibodies reported in chronic inflammatory demyelinating polyneuropathy (CIDP) with some studies citing antibodies in only 3-9% of cases. This study aims to examine the current diagnostic criteria and provide insight on antiganglioside antibodies as possible diagnostic indicators by examining previously completed studies for CIDP, GBS, and MMN.

Methods: Primary article selection began with keyword searches in PubMed and Google Scholar searching for antiganglioside antibodies in CIDP, GBS, and MMN. 16 articles were selected, and after further evaluation 9 studies met the defined inclusion criteria. The statistical software RevMan version 5.4 was used to complete both random effects meta-analyses and to produce all statistical figures.

Results: Of the 9 included studies, 5 were used in the meta-analysis comparing CIDP and GBS, and 5 were used in the meta-analysis comparing CIDP and MMN. It is noted that 1 of the 9 studies provided a comparison for each analysis and was used in both analyses. The analysis of antiganglioside IgG or IgM antibodies in CIDP compared to GBS revealed considerable heterogeneity and failed to show a significant difference (P = 0.14). However, the analysis of CIDP and MMN indicated a greater presence of antiganglioside antibodies in MMN patient sera (P < 0.00001).

Conclusion: These findings provide some support for the potential use of antiganglioside antibodies as diagnostic indicators in combination with previously established criteria. However, it should be recognized that these diseases are rare with few studies investigating this and further research is needed in disease pathogenesis.