Clinical Insights Into Anti‐Sulfatide Antibodies in Peripheral Neuropathies: A Retrospective Study

Background: Sulfatide, synthesized from glycosphingolipids via sulfation of the hydroxyl group, is a prominent lipid antigen in both the peripheral and central nervous systems. Anti‐sulfatide antibodies are detected in axonal and demyelinating neuropathies and are generally regarded as concomitant antibodies. However, their pathogenic role and precise diagnostic relevance remain unclear. Methods: This double‐center retrospective observational study tested anti‐sulfatide and antiganglioside antibodies using immunoblot assays in serum and/or cerebrospinal fluid (CSF) from patients suspected of having peripheral neuropathy. Clinical symptoms, laboratory findings, and electrophysiological results were reviewed for patients with anti‐sulfatide antibodies. Results: The most common symptoms in adult‐onset patients with anti‐sulfatide antibody included motor weakness (81.25%) and superficial sensory disturbances (68.75%). Patients with anti‐sulfatide antibodies in the CSF exhibited a higher frequency of CSF albuminocytological dissociation. Positive blood rheumatic antibodies and factors were more prevalent in seropositive patients. Electrophysiological findings revealed both axonal and demyelinating changes in these patients. Intravenous corticosteroids, immunoglobulins, and plasmapheresis proved effective treatments. Conclusions: The clinical manifestations of patients with anti‐sulfatide antibodies are highly heterogeneous. Anti‐sulfatide antibodies cause axonal and demyelinating damage in autoimmune peripheral neuropathy, presenting distinct clinical and electrophysiological features.