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Brain Advance Access originally published online on July 22, 2003
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Brain, Vol. 126, No. 10, 2220-2234, October 2003
© 2003 Guarantors of Brain
doi: 10.1093/brain/awg235

Immunoglobulins inhibit pathophysiological effects of anti-GQ1b-positive sera at motor nerve terminals through inhibition of antibody binding

Bart C. Jacobs*,1, Graham M. O’Hanlon*,3, Roland W. M. Bullens*,2, Jean Veitch3, Jaap J. Plomp2 and Hugh J. Willison3

1 Departments of Neurology and Immunology, Erasmus Medical Centre, Rotterdam, 2 Departments of Neurology and Neurophysiology, Leiden University Medical Centre, Leiden, The Netherlands and 3 University Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK *These authors contributed equally

Correspondence to: Dr B. C. Jacobs, Department of Neurology, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands E-mail: b.jacobs{at}erasmusmc.nl

High-dose intravenous immunoglobulin (IVIg) is an effective treatment for many antibody-mediated neuromuscular diseases, suggesting that IVIg directly interferes with the pathways through which the pathogenic antibodies exert their effects. However, the precise mechanisms of action are unclear. Serum anti-GQ1b antibodies are strongly associated with ophthalmoplegia in patients with Miller Fisher syndrome (MFS) and Guillain–Barré syndrome (GBS). They induce complement-mediated {alpha}-latrotoxin-like effects on mouse neuromuscular junctions (NMJs) ex vivo, comprising transient muscle fibre twitching, due to a dramatic increase in the frequency of miniature end-plate potentials (spontaneous quantal acetylcholine release), followed by transmission block. To clarify the mechanisms by which IVIg may act in MFS and GBS, we investigated its effects on the interaction of anti-GQ1b antibodies with GQ1b in vitro and on anti-GQ1b antibody-mediated NMJ injury ex vivo, using anti-GQ1b-positive serum samples from MFS/GBS patients. We show that IVIg inhibits the binding of anti-GQ1b antibodies to GQ1b, thereby preventing complement activation and subsequent pathophysiological effects in our ex vivo mouse NMJ model. These results provide further support for the hypothesis that anti-ganglioside antibodies are the pathogenic factors in MFS/GBS and show that this NMJ model provides a suitable system for investigating the therapeutic effects of IVIg in antibody-mediated neuromuscular diseases.


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