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Neonatal Guillain-Barré syndrome

Blocking antibodies transmitted from mother to child

From the Neurologische Klinik der Bayerischen (Drs. Buchwald and Toyka), Julius-Maximilians-Universität, Würzburg, Germany; and the Department of Neurology (Drs. de Baets and Luijckx), University Hospital Maastricht, the Netherlands.

Address correspondence and reprint requests to Dr. Brigitte Buchwald, Neurologische Klinik, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.

OBJECTIVE: To investigate the role of blocking antibodies in neonatal Guillain-Barré syndrome (GBS) occurring 12 days postpartum in a child born to a mother with ongoing GBS.

METHODS: We studied plasma filtrate, purified IgG, and monovalent Fab fragments from the affected mother and serum from the neonate as well as serum samples after recovery from disease 3 months later. Experiments were performed on the hemidiaphragms of adult mice and neonatal and juvenile rats. Quantal endplate currents were recorded with the perfused macro-patch clamp electrode.

RESULTS: A dual effect was seen. Serum from mother and infant depressed quantal content by approximately 90% and reduced the amplitude of postsynaptic currents by 30 to 40%. The antibody nature of the blockade could be confirmed by showing that monovalent Fab fragments were similarly effective as purified immunoglobulin (Ig) G. No IgG antibodies to gangliosides, fetal or adult nicotinic acetylcholine receptor, or voltage-gated calcium channels could be detected, but IgM antibodies to the ganglioside GM1 were present. After recovery from GBS no blocking activity was seen in the sera of mother and infant. To elucidate why neonatal disease onset was delayed we examined the possible influence of early developmental changes in functional properties of the neuromuscular junction and applied the mother’s active serum to postnatal rats. Although blockade was present in 23-day-old rats, it was absent in 5-day-old rats.

CONCLUSION: Transplacentally transferred blocking antibodies may be specifically directed at epitopes of the mature but not the fetal neuromuscular junction.

Key words: GBS—Autoantibodies—Neuromuscular junction—Patch clamp.

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