ArticleJournal of neurology2026
Gastrointestinal dysfunction associated with autoimmune glial fibrillary acidic protein astrocytopathy.
Article in Journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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15 authors.
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Abstract
BACKGROUND AND
objectivesGastrointestinal (GI) dysfunction has been reported in autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A). However, GI dysfunction in GFAP-A has not been sufficiently investigated. This study aimed to analyze the clinical features of GFAP-A patients with GI dysfunction and explore potential pathogenic mechanisms.
methodsFrom January 1, 2016, to April 30, 2024, patients diagnosed with GFAP-A based on CSF GFAP-IgG positivity at the Third Affiliated Hospital of Sun Yat-sen University were enrolled. Clinical parameters and GI dysfunction assessed by the I-FEED scoring system were collected. Pathological examination was performed in a subset of patients. And the preliminary role of GFAP-IgG in the enteric plexus was investigated.
resultsAmong 92 enrolled individuals (male:female = 68:24; median age 39.5 years), gastrointestinal dysfunction occurred in 72 cases (78.3%). Manifestations included constipation in 38 cases (41.3%), paralytic ileus in 30 cases (32.6%), fecal incontinence in 3 cases (3.26%), and diarrhea in 1 case (1.09%). Severe GI dysfunction (I-FEED score ≥ 6) was associated with higher disease severity (admission mRS 5.0 vs. 3.0, p < 0.001), longer hospitalization (21.5 vs. 15.5 days, p = 0.029), increased ICU admission (50.0% vs. 10.5%, p < 0.001), higher rates of respiratory failure, autonomic dysfunction, and infections, worse CSF profiles (elevated protein, leukocytosis, hypoglycorrhachia). Pathological analysis revealed prominent CD8⁺ and CD4⁺ T-cell infiltration in the colonic wall and a specific loss of GFAP⁺ enteric glia. Furthermore, we demonstrated that anti-GFAP-IgG derived from the cerebrospinal fluid (CSF) of GFAP-A patients binds specifically to the enteric plexus within mouse colonic tissues.
conclusionsOur findings collectively suggest that severe GI dysfunction could be a marker of disease severity and poor prognosis in GFAP-A, and indicate that its potential mechanism may involve the specific binding of anti-GFAP-IgG to the enteric plexus and subsequent enteric glia loss.
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