THE SPECTRUM OF IMMUNE-RESPONSES TO CAMPYLOBACTER-JEJUNI AND GLYCOCONJUGATES IN GUILLAIN-BARRE-SYNDROME AND IN OTHER NEUROIMMUNOLOGICAL DISORDERS

An acute infectious illness frequently precedes the Guillain-Barre syn drome. Recently, Campylobacter jejuni was claimed to be a predominant precipitating agent that may also trigger a humoral immune response to glycoconjugates of peripheral myelin in Guillain-Barre syndrome. Beca use of conflicting reports, we determined the frequency of a recent in fection with C. jejuni in 38 patients with Guillain-Barre syndrome usi ng a highly sensitive and specific immunoblot technique, and of the pr esence of circulating antibodies to gangliosides. We detected IgM and/ or IgG C. jejuni directed antibodies in 15 of 38 patients with Guillai n-Barre syndrome. In contrast, only 7 of 39 healthy control subjects, 3 of 20 patients with multiple sclerosis, and 2 of 72 patients with ne uroborreliosis showed IgA or IgM antibody responses to C. jejuni. In G uillain-Barre syndrome, C. jejuni-specific antibodies were predominant ly directed to outer membrane proteins of one specific serotype, Lior 11, whereas the most common serotype associated with enteritis in Germ any is Lior 4. Two of 27 patients with Guillain-Barre syndrome had gan glioside-specific IgA antibodies; 1 of 32 patients, antibodies of IgM; and 4 of 31 patients, antibodies of IgG class. There was no correlati on between severity, type (axonal versus demyelinating), and outcome o f the disease and the presence or absence of a humoral immune response to C. jejuni or to glycoconjugates. Our findings do not support previ ous suggestions that a preceding C. jejuni infection heralds a poorer outcome or that antibodies to gangliosides carry prognostic significan ce. The predilective humoral immune response to outer membrane protein s of one specific C. jejuni serotype raises new important questions co ncerning the immunopathogenic link between an acute C. jejuni infectio n and subsequent Guillain-Barre syndrome.