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We aimed to determine whether cerebrospinal fluid (CSF) alpha-internexin (AINX) concentrations are associated with disease severity and outcome in GBS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort included 100 GBS patients. AINX concentrations were measured at diagnosis using a sensitive Simoa assay. Disease severity at nadir was assessed with the GBS Disability Scale (GBSDS) and the need for mechanical ventilation. Poor outcome was defined as GBSDS\u2009&gt;\u20092 at 12\u00a0months. Logistic regression with log-transformed AINX assessed associations with severe disease at nadir (GBSDS\u2009&gt;\u20092), need for mechanical ventilation, and poor outcome at 12\u00a0months (GBSDS\u2009&gt;\u20092). ROC curve analysis assessed the ability of AINX to predict poor outcome and compared its performance with previously reported biomarkers re-analyzed in this cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      AINX concentrations at diagnosis were higher in patients with poor outcome and remained associated with poor outcome after adjustment for age (OR 12.48, 95% CI 1.20\u2013129.1,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034). This association remained significant after additional adjustment for axonal subtypes (OR 26.38, 95% CI 1.12\u2013619.77,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.042).\u00a0ROC analysis demonstrated good discriminative performance (AUC of 0.79, 95% CI 0.61\u20130.97,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). The optimal cutoff of 2.9\u00a0ng\/L yielded 50% sensitivity and 95.7% specificity. AINX concentrations were not associated with disease severity at nadir or with need for mechanical ventilation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Elevated CSF AINX at diagnosis was associated with poor long-term outcome in GBS, consistent with a possible contribution of CNS-related injury to recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-13789-y","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T11:42:07Z","timestamp":1775562127000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cerebrospinal fluid alpha-internexin concentrations measured in patients with Guillain\u2013Barr\u00e9 syndrome: a possible prognostic biomarker for disability at 12\u00a0months"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9037-3406","authenticated-orcid":false,"given":"Nina","family":"Gleisner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Meda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Johnsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igal","family":"Rosenstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Alpsten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenka","family":"Novakova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Lycke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Zetterberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hlin","family":"Kvartsberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brynhildur","family":"Hafsteinsdottir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Axelsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"issue":"10045","key":"13789_CR1","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1016\/s0140-6736(16)00339-1","volume":"388","author":"HJ Willison","year":"2016","unstructured":"Willison HJ, Jacobs BC, van Doorn PA (2016) Guillain-Barr\u00e9 syndrome. 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FM has nothing to disclose. MJ has received compensation for lectures from Merck. IR\u00a0has received compensation for lectures from Biogen, Novartis, Merck, and Sanofi, and has served on advisory boards for Sanofi. EA has nothing to disclose. LN has received compensation for lectures from Biogen, Novartis, Teva, Sanofi and Merck, has served on advisory boards for Merck, Janssen,\u00a0ArgenX\u00a0and Sanofi, and has received an unconditional research grant from Novartis and Sanofi. JL has received travel support and\/or lecture honoraria and has served on scientific advisory boards for Alexion,\u00a0Almirall, Biogen, Bristol Myers Squibb, Celgene, Janssen, Merck, Novartis, Roche, Sandoz and Sanofi; and has received unconditional research grants from Biogen and Novartis, and financial research support from Sanofi. HZ is a Wallenberg Scholar and a Distinguished Professor at the Swedish Research Council supported by grants from the Swedish Research Council (#2023-00356, #2022-01018 and #2019-02397), the European Union\u2019s Horizon Europe research and innovation programme under grant agreement No 101053962, Swedish State Support for Clinical Research (#ALFGBG-71320), the Alzheimer Drug Discovery Foundation (ADDF), USA (#201809-2016862), the AD Strategic Fund and the Alzheimer's Association (#ADSF-21-831376-C, #ADSF-21-831381-C, #ADSF-21-831377-C, and #ADSF-24-1284328-C), the European Partnership on Metrology, co-financed from the European Union\u2019s Horizon Europe Research and Innovation Programme and by the Participating States (NEuroBioStand, #22HLT07), the Bluefield Project, Cure Alzheimer\u2019s Fund, the Olav Thon Foundation, the Erling-Persson Family Foundation, Familjen R\u00f6nstr\u00f6ms Stiftelse, Familjen Beiglers Stiftelse, Stiftelsen f\u00f6r Gamla Tj\u00e4narinnor, Hj\u00e4rnfonden, Sweden (#FO2022-0270), the European Union\u2019s Horizon 2020 research and innovation programme under the Marie Sk\u0142odowska-Curie grant agreement No 860197 (MIRIADE), the European Union Joint Programme\u2014Neurodegenerative Disease Research (JPND2021-00694), the National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, the UK Dementia Research Institute at UCL (UKDRI-1003), and an anonymous donor. HZ has served at scientific advisory boards and\/or as a consultant for Abbvie, Acumen, Alector, Alzinova, ALZpath, Amylyx, Annexon, Apellis, Artery Therapeutics, AZTherapies, Cognito Therapeutics, CogRx, Denali, Eisai, Enigma, LabCorp, Merck Sharp & Dohme, Merry Life, Nervgen, Novo Nordisk, Optoceutics, Passage Bio, Pinteon Therapeutics, Prothena, Quanterix, Red Abbey Labs, reMYND, Roche, Samumed, ScandiBio Therapeutics AB, Siemens Healthineers, Triplet Therapeutics, and Wave, has given lectures sponsored by Alzecure, BioArctic, Biogen, Cellectricon, Fujirebio, LabCorp, Lilly, Novo Nordisk, Oy Medix Biochemica AB, Roche, and WebMD, is a co-founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program, and is a shareholder of CERimmune Therapeutics (outside submitted work). HK has nothing to disclose. BH has nothing to disclose. MA has received\u00a0compensation for lectures or advisory boards from Biogen, Novartis, and\u00a0Genzyme.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}],"article-number":"253"}}