Triggers of GBS | Potential pathogenesis |
---|---|
Infectious events | |
Bacteria | |
C. jejuni | Molecular mimicry (GM1 epitopes on LOS from C. jejuni) and cross-reactivity between C. jejuni and peripheral nerve gangliosides |
M. pneumoniae | Molecular mimicry between GM1 ganglioside and M. pneumoniae |
H. influenzae | Molecular mimicry: presence of GM1 and GQ1b epitopes in H. influenzae |
Salmonella species | Unclear |
Viruses | |
CMV | Molecular mimicry: presence of GM2 and GD2 epitopes on CMV, homology between moesin (a cytoskeletal component, key role on myelination) and a CMV phosphoprotein |
HSV | Molecular mimicry: presence of GQ1b epitope on HSV-infected human fibroblasts |
VZV | Unclear |
EBV | Molecular mimicry? (anti-GQ1b antibodies); Vasculitis and neuritis caused by direct invasion |
Hepatitis virus | Molecular mimicry? (anti-GM1 and GM2 antibodies); Vasculitis and neuritis caused by immune complex accumulation |
Influenza virus | Molecular mimicry between glycoproteins of influenza viruses and glycolipids of peripheral nerves; Secondary infection |
JEV | Unclear |
HIV | Direct damage to nerves; Abnormal immunoregulation (formation of anti-sulfatide antibodies against myelin) |
ZIKV | Direct damage to nerves (neurotropism); Molecular mimicry: peptide sharing between ZIKV proteins and human myelin protein-associated GBS |
SARS-CoV-2 | Unclear; Molecular mimicry? cytokine storm? abnormal activation of T or B cells? direct invasion? complement participation and mediation? |
Non-infectious events | |
Vaccines | Unclear; Molecular mimicry? (formation of anti-GM1antibodies induced by influenza vaccines) |
Surgery | Immune dysfunction caused by surgery; Transient immunosuppression; Increased risk of secondary infection; Physical compression of the nerves; Activation of the endocrine stress systems |
Exogenous gangliosides treatment | Immunogenicity of exogenous ganglioside (producing IgG anti-ganglioside antibodies) |
ICIs | Imbalances in immunologic tolerance; Molecular mimicry? (shared GM2 and GD3 epitopes between melanoma and myelin sheath) |
Pregnancy | Transient immunosuppression; Increased risk of opportunistic infections |
SLE | Increased susceptibility to infections; Humoral immune response: autoantibodies against peripheral nerve myelin in GBS (a part of spectrum of autoantibodies observed in SLE); More potent response to neurogenic protein |