Contribution of gut microbiome and nutritional status in clinical outcome of intravenous immunoglobulin (IVIg) treated patients with Guillain-Barre syndrome in Bangladesh

Guillain-Barre syndrome (GBS) is a post-infectious, immune-mediated neurological disease that exhibits characteristics of flaccid paralysis in the post-poliomyelitis world. Presently, one of the standard treatments for GBS is high dose intravenous immunoglobulin (IVIg). However, the response of IVIg to treatment is highly variable among patients. Various factors have been identified to be related to the clinical course and outcome of patients and may potentially influence the response to IVIg therapy and enable a personalized medicine approach. Till date the mechanisms underlying non responsiveness to IVIg are poorly understood. Therefore, it is utmost importance to find a biomarker of treatment response that, preferably, can be determined within the first 2 weeks after the onset of GBS.The gut microbiome has recently received considerable attention for its potential role in the pathogenesis of GBS. The gut harbors an extremely complex and dynamic microbial community, including prokaryotes, eukaryote and viruses. The gut microbiomes function changes with a variety of diseases and the depletion of beneficial organisms or dysbiosis in the gut microbiota, has been implicated in the manifestation of several autoimmune disease including GBS. Brook et al. has demonstrated that gut microbiota can trigger GBS development in a mouse C. jejuni infection model. Thus, ribosomal 16S rRNA gut-metagenomics approach may give us a new insight in searching hidden genetic features by identifying novel genes and determining the etiology of functional dysbiosis in IVIg-responder or non-responder patients with respect to healthy controls. In addition, previous study demonstrated that a series of factors that influence the composition and diversity of gut microbial community including host nutrition and drug. In Bangladesh most of the GBS patients come from rural areas and have low socio economic status. Therefore, poverty and poor nutritional status may also have influence on gut microbiome community and subsequent treatment with IVIg in Bangladeshi patients with GBS.