Antiganglioside, antiganglioside-complex, and antiglycolipid-complex antibodies in immune-mediated neuropathies

Purpose of review: There has been a recent renewed interest in the prevalence of antiglycolipid antibodies and their associations with specific clinical phenotypes in Guillain-Barre syndrome. Recent reports have sought to confirm and expand the antibody-phenotype associations of antiganglioside antibodies, antiganglioside-complex antibodies, and antiglycolipid-complex antibodies in the various acute immune-mediated neuropathies. This is a rapidly developing field with technical advances in assay methodology, which have resulted in numerous new putative antibody-phenotype associations. Recent findings: Antibodies against single ganglioside species remain the most established serological marker of Guillain-Barre syndrome and its myriad clinical variants. Antibodies against combinations of gangliosides, ganglioside-complex antibodies, detected by the ELISA method have emerged as putative markers of certain clinical features or pathological subtypes, specifically acute motor axonal neuropathy, but do not seem to greatly increase the diagnostic sensitivity of antibody testing as most also react with single ganglioside species. The novel assay method of the combinatorial glycoarray allows high-throughput detection of antibodies recognizing combinations of gangliosides and other glycolipids and early studies suggest it identifies antibody-phenotype associations in addition to significantly increasing the sensitivity of serological testing, including for the acute inflammatory demyelinating polyneuropathy variant. Summary: Antibodies against single ganglioside species remain diagnostically useful in routine clinical practice. Antibodies against ganglioside complexes, or gangliosides and other glycolipid complexes, are emerging as useful markers of various clinic features and pathological subtypes; however, the precise associations remain to be fully delineated and confirmed. The antibody-complex detection methods are rapidly evolving but in most centres are not yet available in routine clinical practice