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Test ID: GM1B    
Ganglioside Antibody Panel, Serum

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Useful For Suggests clinical disorders or settings where the test may be helpful

Supporting diagnosis of neurological diseases-primarily motor neuron disease and motor neuropathies

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Peripheral neuropathies are a group of disorders that results from lesions on peripheral nerves. Patients with a peripheral neuropathy can have symptoms of weakness, sensory loss, and/or autonomic dysfunction. The causes of acquired peripheral neuropathies are varied, and include vitamin deficiencies, metabolic abnormalities, infections, malignancies (paraneoplastic disorders), and autoimmune diseases. A subset of the autoimmune-mediated peripheral neuropathies is associated with the presence of circulating autoantibodies that bind to specific gangliosides. Gangliosides are glycosphingolipids that contain sialic acid residues. Although present in the plasma membranes of many cell types, gangliosides are particularly abundant in neural tissue.

 

Guillain-Barre syndrome is one class of autoimmune peripheral neuropathies, and comprises a spectrum of disorders including acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy, and acute motor and sensory axonal neuropathy. This class of autoimmune neuropathies is generally characterized by an acute onset. Although the diagnosis of these disorders is based significantly on clinical evaluation and electrophysiologic studies, assessment of ganglioside antibodies, particularly against GM1, asialo GM1, and GD1b, can provide useful information. It is thought that the Guillain-Barre syndrome disorders are triggered by an infection, which results in production of infection-associated lipooligosaccharide-specific antibodies. These antibodies subsequently bind to endogenous gangliosides, due to molecular mimicry, which leads to immune-mediate damage to the peripheral nerves, ultimately resulting in the clinical symptoms associated with the disorders.(1)

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

99% of Normals Fall at or Below This Titer

IgG monosialo GM1

1:500

IgM monosialo GM1

1:1,000

IgG asialo GM1

1:4,000

IgM asialo GM1

1:4,000

IgG disialo GD1b

1:1,000

IgM disialo GD1b

1:1,000

 

Borderline Ranges

IgG monosialo GM1

=1:1,000

IgM monosialo GM1

=1:2,000

IgG asialo GM1

=1:8,000

IgM asialo GM1

No borderline range (normal: < or =4,000)

IgG disialo GD1b

No borderline range (normal: < or =1,000)

IgM disialo GD1b

No borderline range (normal: < or =1,000)

 

Abnormal Results

IgG monosialo GM1

>1:1,000

IgM monosialo GM1

>1:2,000

IgG asialo GM1

>1:8,000

IgM asialo GM1

>1:4,000

IgG disialo GD1b

>1:1,000

IgM disialo GD1b

>1:1,000

Interpretation Provides information to assist in interpretation of the test results

High titers (>1:2,000) have been found only in patients with multifocal motor neuropathy and not with motor neuron disease. About 30% to 50% of patients with these clinical syndromes or the pure motor variant of chronic inflammatory demyelinating polyneuropathy have increased antibody titers. Increased antibody titers, therefore, appear to be a specific but not sensitive marker of those related disorders.

 

Borderline elevation of titers against ganglioside epitopes may be seen in patients with motor neuron disease or motor neuropathy

 

For IgG and IgM antibodies directed against monosialo GM1 and disialo GD1b, 99% of 182 age- and sex-stratified normal individuals had titers <1:1,000; 99% of 121 patients with well-defined motor neuron disease had titers <1:2,000; and all patients with titers >1:2,000 had motor neuropathy.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Titer values of 1:250 to 1:2,000 (modest elevations) are found in 5% of patients with motor neuron disease.

 

Patients with amyotrophic lateral sclerosis may have modest elevations of antiganglioside antibody titer.  

 

High titers have been found only in patients with multifocal motor neuron neuropathy.

Clinical Reference Provides recommendations for further in-depth reading of a clinical nature

1. Taylor BV, Gross L, Windebank AJ: The sensitivity and specificity of anti-GM1 antibody testing. Neurology 1996;47:951-955

2. Vernino S,Wolfe GI: Antibody testing in peripheral neuropathies. Neurol Clin 2007;25:29-46

3. Kaida K, Ariga T, Yu RK: Antiganglioside antibodies and their pathophysiological effects on Guillain-Barre syndrome and related disorders-a review. Glycobiology 2009;19:676-692