Blood Biomarkers for Prognostic Stratification in Guillain-Barré Syndrome

Integration of a Blood Biomarker Panel for Prognostic Stratification in Guillain-Barré Syndrome: A Mexico-Spain Collaborative Study (BioGBS)

Guillain-Barré syndrome (GBS) is an acute immune-mediated peripheral neuropathy characterized by substantial variability in clinical severity, functional recovery, and pain outcomes. The lack of validated and accessible prognostic biomarkers limits early risk stratification and individualized rehabilitation strategies.

This observational, longitudinal, retrospective and prospective study aims to evaluate a panel of five blood biomarkers (EGR1, EGR2, GBP1, miR-29c, and Piccolo) and determine their association with functional recovery, pain trajectories, and neurophysiological characteristics in patients with GBS.

The study will include at least 70 patients with GBS and 70 healthy controls. Patients will undergo longitudinal clinical and molecular assessments across different disease stages, whereas healthy controls will provide a single blood sample for reference measurements. Gene and microRNA expression will be quantified using quantitative reverse transcription polymerase chain reaction (qRT-PCR), and serum Piccolo concentrations will be assessed using ELISA or validated immunoassays.

Clinical assessments will include the GBS Disability Scale, Medical Research Council (MRC) Sum Score, Functional Independence Measure (FIM), and validated pain questionnaires. Molecular and clinical data will be integrated using multivariable statistical analyses to identify prognostic molecular signatures and develop predictive models.

The project also aims to support external validation in Mexican populations through international collaboration with Spanish research institutions.

Study Overview

• Status: Recruiting
• Conditions: Guillain Barré Syndrome
• Intervention / Treatment: Diagnostic test: Blood Biomarker Panel Assessment (EGR1, EGR2, GBP1, miR-29c, and Piccolo)

Detailed Description

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy affecting the peripheral nervous system. It is characterized by heterogeneous clinical presentations, including progressive weakness, sensory disturbances, pain, autonomic dysfunction, and, in severe cases, respiratory failure. Although immunomodulatory treatments and multidisciplinary rehabilitation have improved clinical outcomes, predicting individual recovery trajectories remains challenging.

Current prognostic assessment relies primarily on clinical and electrophysiological parameters, which may not adequately capture the molecular mechanisms underlying immune activation, peripheral nerve injury, remyelination, and functional recovery.

Previous investigations conducted by the research group identified differential expression of EGR1, EGR2, GBP1, and miR-29c in peripheral blood mononuclear cells (PBMCs) obtained from patients with GBS. Differential serum concentrations of the presynaptic protein Piccolo were also identified, suggesting their potential relevance as molecular indicators of disease progression and recovery.

The BioGBS study aims to validate these five candidate biomarkers through longitudinal analysis and integration with clinical, functional, pain-related, and neurophysiological data.

The study will employ an observational, retrospective and prospective longitudinal design, including at least 70 patients diagnosed with GBS and 70 healthy controls. Patients will be assessed at four clinically defined stages: initial diagnosis before immunomodulatory treatment (T0), maximum clinical severity or nadir (T1), onset of sustained functional recovery (T2), and advanced recovery or discharge from rehabilitation (T3). Healthy controls will undergo a single baseline molecular assessment.

Gene expression levels of EGR1, EGR2, GBP1, and miR-29c will be quantified in PBMCs using qRT-PCR. Serum Piccolo concentrations will be determined using ELISA or validated immunoassays.

Functional outcomes will be assessed using the GBS Disability Scale, MRC Sum Score, and FIM. Pain severity and interference will be evaluated using the Brief Pain Inventory-Short Form (BPI-SF), while neuropathic pain will be assessed using the Neuropathic Pain Symptom Inventory (NPSI). Electrophysiological findings will be incorporated when available.

Statistical analyses will include longitudinal mixed-effects models, multivariable regression, principal component analysis, unsupervised clustering, and receiver operating characteristic curve analysis. Predictive models will be developed to identify molecular signatures associated with favorable or unfavorable functional recovery and persistent pain. Internal cross-validation and correction for multiple comparisons will be performed when appropriate.

The study will integrate the existing Spanish TOSGB biological collection and collaborative research activities in Mexico. External validation in Mexican patients is planned to evaluate the transferability of the prognostic biomarkers across different populations and healthcare settings.

No experimental treatment will be assigned. All participants with GBS will receive standard medical care and rehabilitation according to routine clinical practice.

• Study Type: Observational
• Enrollment (Estimated): 140

Contacts and Locations

• Study Contact: Name: Antonio Ibarra, PhD; Phone Number: 52 5554197603; Email: jose.ibarra@anahuac.mx

Study Locations

• Mexico
  • Mexico City, Mexico
    • Recruiting
    • Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez
    • Contact: Antonio Ibarra, PhD; Phone Number: 52 5554197603; Email: jose.ibarra@anahuac.mx
• Spain
  • Toledo, Spain
    • Recruiting
    • Hospital Nacional de Parapléjicos
    • Contact: Ernesto Doncel Perez, PhD; Phone Number: 52 55 54197603; Email: ernestod@sescam.jccm.es

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The study population will consist of patients aged 16 years or older with clinically and neurophysiologically confirmed Guillain-Barré syndrome, recruited from participating hospitals in Spain and Mexico. A comparison group of healthy volunteers aged 18 years or older, with a comparable age and sex distribution, will be included to establish reference biomarker measurements. Patients will undergo longitudinal follow-up, whereas healthy controls will undergo a single baseline assessment.

Description

Inclusion Criteria:

• Diagnosis of Guillain-Barré syndrome based on clinical and neurophysiological criteria.
• Age 16 years or older.
• Availability of biological samples for molecular analysis.
• Written informed consent.
• Availability of longitudinal clinical data.

Exclusion Criteria:

• Alternative diagnosis explaining the neurological manifestations.
• Concomitant active autoimmune disease.
• Severe systemic infection.
• Previous unrelated immunosuppressive treatment.
• Incomplete clinical data or absence of informed consent.

Study Plan

How is the study designed?

Design Details

• Observational Models: COHORT
• Time Perspectives: OTHER

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Patients With Guillain-Barré Syndrome; Patients with clinically and neurophysiologically confirmed GBS undergoing longitudinal molecular, functional, pain-related, and neurophysiological assessments across different stages of the disease.	Diagnostic test: Blood Biomarker Panel Assessment (EGR1, EGR2, GBP1, miR-29c, and Piccolo); Peripheral blood samples will be collected from patients with Guillain-Barré syndrome and healthy controls to evaluate a panel of molecular biomarkers. Expression levels of EGR1, EGR2, GBP1, and miR-29c will be quantified in peripheral blood mononuclear cells using quantitative reverse transcription polymerase chain reaction (qRT-PCR). Serum Piccolo concentrations will be measured using ELISA or validated immunoassays. Patients with Guillain-Barré syndrome will undergo longitudinal assessments at predefined clinical stages, whereas healthy controls will undergo a single baseline assessment. No experimental treatment will be administered, and routine clinical management will remain unchanged.
Healthy Controls; Healthy individuals without neurological or autoimmune disorders, selected to provide reference measurements for the candidate blood biomarkers. Controls will undergo a single baseline blood sample collection.	Diagnostic test: Blood Biomarker Panel Assessment (EGR1, EGR2, GBP1, miR-29c, and Piccolo); Peripheral blood samples will be collected from patients with Guillain-Barré syndrome and healthy controls to evaluate a panel of molecular biomarkers. Expression levels of EGR1, EGR2, GBP1, and miR-29c will be quantified in peripheral blood mononuclear cells using quantitative reverse transcription polymerase chain reaction (qRT-PCR). Serum Piccolo concentrations will be measured using ELISA or validated immunoassays. Patients with Guillain-Barré syndrome will undergo longitudinal assessments at predefined clinical stages, whereas healthy controls will undergo a single baseline assessment. No experimental treatment will be administered, and routine clinical management will remain unchanged.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Guillain-Barré Syndrome Disability Score	Change in functional disability measured using the GBS Disability Scale, ranging from 0 (normal health) to 6 (death). Higher scores indicate greater disability. Longitudinal changes will be assessed in relation to blood biomarker expression. 0 (Baseline): Day 1, before initiation of immunotherapy. T1 (Nadir or prolonged plateau): Up to 6 months after baseline. T2 (Onset of clinical recovery): Up to 12 months after baseline. T3 (Advanced recovery or neurorehabilitation discharge): Up to 12 months after baseline. All assessment intervals are calculated from T0 (baseline). Clinical stages are determined according to the patient's disease progression and recovery status.	Baseline (Day 1), up to 6 months, and up to 12 months after baseline
Change in Muscle Strength Assessed by the MRC Sum Score	Change in muscle strength assessed using the Medical Research Council Sum Score, ranging from 0 to 60. Higher scores indicate better muscle strength. Longitudinal changes will be evaluated in association with molecular biomarker profiles. T0 (Baseline): Day 1, before initiation of immunotherapy. T1 (Nadir or prolonged plateau): Up to 6 months after baseline. T2 (Onset of clinical recovery): Up to 12 months after baseline. T3 (Advanced recovery or neurorehabilitation discharge): Up to 12 months after baseline.	Baseline (Day 1), up to 6 months, and up to 12 months after baseline.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Functional Independence Measure Score	Functional independence measured using the Functional Independence Measure (FIM), ranging from 18 to 126. Higher scores indicate greater independence in activities of daily living. T0 (Baseline): Day 1, before initiation of immunotherapy. T1 (Nadir or prolonged plateau): Up to 6 months after baseline. T2 (Onset of clinical recovery): Up to 12 months after baseline. T3 (Advanced recovery or neurorehabilitation discharge): Up to 12 months after baseline.	Baseline (Day 1), up to 6 months, and up to 12 months after baseline.
Change in Pain Intensity Assessed by the Brief Pain Inventory	Change in pain intensity measured using the Brief Pain Inventory-Short Form (BPI-SF), on a scale from 0 to 10, with higher scores indicating greater pain intensity. T0 (Baseline): Day 1, before initiation of immunotherapy. T1 (Nadir or prolonged plateau): Up to 6 months after baseline. T2 (Onset of clinical recovery): Up to 12 months after baseline. T3 (Advanced recovery or neurorehabilitation discharge): Up to 12 months after baseline.	Baseline (Day 1), up to 6 months, and up to 12 months after baseline.
Change in Pain Interference Assessed by the Brief Pain Inventory	Change in the interference of pain with daily activities, measured using the BPI-SF on a scale from 0 to 10, with higher scores indicating greater interference. T0 (Baseline): Day 1, before initiation of immunotherapy. T1 (Nadir or prolonged plateau): Up to 6 months after baseline. T2 (Onset of clinical recovery): Up to 12 months after baseline. T3 (Advanced recovery or neurorehabilitation discharge): Up to 12 months after baseline.	Baseline (Day 1), up to 6 months, and up to 12 months after baseline.
Change in Neuropathic Pain Symptom Inventory Score	Change in neuropathic pain symptoms assessed using the Neuropathic Pain Symptom Inventory (NPSI), with a total score ranging from 0 to 100. Higher scores indicate greater neuropathic pain severity. T0 (Baseline): Day 1, before initiation of immunotherapy. T1 (Nadir or prolonged plateau): Up to 6 months after baseline. T2 (Onset of clinical recovery): Up to 12 months after baseline. T3 (Advanced recovery or neurorehabilitation discharge): Up to 12 months after baseline.	Baseline (Day 1), up to 6 months, and up to 12 months after baseline.
Longitudinal Change in EGR1, EGR2, GBP1, and miR-29c Expression	Relative expression of EGR1, EGR2, GBP1, and miR-29c in PBMCs measured using qRT-PCR and expressed as 2^-ΔCt or 2^-ΔΔCt. Associations with clinical recovery trajectories will be analyzed. T0 (Baseline): Day 1, before initiation of immunotherapy. T1 (Nadir or prolonged plateau): Up to 6 months after baseline. T2 (Onset of clinical recovery): Up to 12 months after baseline. T3 (Advanced recovery or neurorehabilitation discharge): Up to 12 months after baseline.	Baseline (Day 1), up to 6 months, and up to 12 months after baseline.
Longitudinal Change in Serum Piccolo Concentration	Serum Piccolo concentration quantified using ELISA or a validated immunoassay and expressed in pg/mL or ng/mL, depending on assay specifications. T0 (Baseline): Day 1, before initiation of immunotherapy. T1 (Nadir or prolonged plateau): Up to 6 months after baseline. T2 (Onset of clinical recovery): Up to 12 months after baseline. T3 (Advanced recovery or neurorehabilitation discharge): Up to 12 months after baseline.	Baseline (Day 1), up to 6 months, and up to 12 months after baseline.
Prognostic Performance of the Combined Blood Biomarker Panel	Discriminative performance of a combined panel comprising EGR1, EGR2, GBP1, miR-29c, and Piccolo for identifying unfavorable functional recovery, evaluated using the area under the receiver operating characteristic curve (AUC). T0 (Baseline): Day 1, before initiation of immunotherapy. T1 (Nadir or prolonged plateau): Up to 6 months after baseline. T2 (Onset of clinical recovery): Up to 12 months after baseline. T3 (Advanced recovery or neurorehabilitation discharge): Up to 12 months after baseline.	Baseline (Day 1), up to 6 months, and up to 12 months after baseline.
Requirement for Mechanical Ventilation	Proportion of patients requiring invasive mechanical ventilation during the acute phase of GBS and duration of ventilatory support when applicable.	From baseline (Day 1) through 12 months after baseline.

Collaborators and Investigators

• Sponsor: Anahuac University
• Collaborators: Hospital Nacional de Parapléjicos de Toledo

Study record dates

Study Major Dates

• Study Start (Estimated): December 1, 2027
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: October 21, 2026
• First Submitted That Met QC Criteria: November 10, 2026
• First Posted (Actual): November 13, 2026

Study Record Updates

• Last Update Posted (Actual): November 13, 2026
• Last Update Submitted That Met QC Criteria: November 10, 2026
• Last Verified: November 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Post-Infectious Disorders; Nervous System Diseases; Pathologic Processes; Neuromuscular Diseases; Chronic Disease; Disease Attributes; Autoimmune Diseases; Immune System Diseases; Peripheral Nervous System Diseases; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Polyneuropathies; Polyradiculoneuropathy; Pathological Conditions, Signs and Symptoms; Guillain-Barre Syndrome
• Other Study ID Numbers: 241/2018

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No