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Martínez-Martínez L, Lacruz AC, Querol L, Cortés-Vicente E, Pascual E, Rojas-García R, Reyes-Leiva D, Álvaro Y, Moltó E, Ortiz E, Gallardo E, Juárez C, Mariscal A. Inter-laboratory comparison of routine autoantibody detection methods for autoimmune neuropathies and myasthenia gravis. J Neurol 2024:10.1007/s00415-024-12317-0. [PMID: 38578496 DOI: 10.1007/s00415-024-12317-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 04/06/2024]
Abstract
Serological tests are important to detect autoantibodies (autoAbs) in patients with autoimmune neuropathies (AN) and myasthenia gravis (MG) as they are biomarkers for diagnosis, stratification, treatment selection, and monitoring. However, tests to detect autoAbs frequently lack proper standardization and results differ across diagnostic laboratories. We compared results for tests routinely performed in Spanish diagnostic laboratories to detect AN and MG autoAbs. In the Spanish Society of Immunology Autoimmunity Group national workshop, serum samples from 13 patients with AN or MG were tested for anti-ganglioside, anti-myelin-associated glycoprotein (MAG), anti-nicotinic acetylcholine receptor (AChR), and anti-muscle-specific kinase (MuSK) autoAbs using reference methods and were distributed for analysis to 27 participating laboratories using their routine methods. Overserved were inter-laboratory variability and worryingly low sensitivity, especially for anti-ganglioside immunoglobulin G and anti-MAG autoAb detection. This pilot study reflects autoAbs detection state of the art in AN and MG testing in leading diagnostic laboratories in Spain, highlighting the need for standardization prior to clinical use.
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Affiliation(s)
- Laura Martínez-Martínez
- Immunology Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Anna Calvet Lacruz
- Immunology Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Luis Querol
- Neurology Department, Neuromuscular Diseases Unit, Hospital de La Santa Creu I Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Neuromuscular Diseases Unit, Centre for Networked Biomedical Research in Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Cortés-Vicente
- Neurology Department, Neuromuscular Diseases Unit, Hospital de La Santa Creu I Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Neuromuscular Diseases Unit, Centre for Networked Biomedical Research in Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Elba Pascual
- Neurology Department, Neuromuscular Diseases Unit, Hospital de La Santa Creu I Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Neuromuscular Diseases Unit, Centre for Networked Biomedical Research in Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Ricard Rojas-García
- Neurology Department, Neuromuscular Diseases Unit, Hospital de La Santa Creu I Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Neuromuscular Diseases Unit, Centre for Networked Biomedical Research in Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - David Reyes-Leiva
- Neurology Department, Neuromuscular Diseases Unit, Hospital de La Santa Creu I Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Yolanda Álvaro
- Immunology Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Elisabeth Moltó
- Immunology Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Esther Ortiz
- Immunology Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Eduard Gallardo
- Neurology Department, Neuromuscular Diseases Unit, Hospital de La Santa Creu I Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Neuromuscular Diseases Unit, Centre for Networked Biomedical Research in Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Cándido Juárez
- Immunology Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Anaís Mariscal
- Immunology Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.
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Rojas-García R, Gallardo E, Illa I. Paraproteinemic neuropathies. Presse Med 2013; 42:e225-34. [PMID: 23618626 DOI: 10.1016/j.lpm.2013.02.329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/04/2013] [Accepted: 02/12/2013] [Indexed: 12/13/2022] Open
Abstract
The term paraproteinemic neuropathy refers to a heterogeneous group of neuropathies, which share the common feature of a homogeneous immunoglobulin in the serum. The presence of a monoclonal gammopathy indicates an underlying clonal B-cell expansion, which may appear in the context of a lymphoproliferative disorder. If a neoplastic origin of the gammopathy is identified, the treatment should be targeted to the neoplasm. In most patients, however, the monoclonal gammopathy is not associated with malignant haematological disorders, and is defined as monoclonal gammopathy of undetermined significance.
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Affiliation(s)
- Ricard Rojas-García
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
The association of neuropathy with monoclonal gammopathy has been known for several years, even if the clinical and pathogenetic relevance of this association is not completely defined. This is not a marginal problem since monoclonal gammopathy is present in 1-3% of the population above 50 years in whom it is often asymptomatic, and in at least 8% of patients is associated with a symptomatic neuropathy, representing one of the leading causes of neuropathy in aged people. Monoclonal gammopathy may result from malignant lymphoproliferative diseases including multiple myeloma or solitary plasmocytoma, Waldenström's macroglobulinemia (WM), other IgM-secreting lymphoma or chronic lymphocytic leukemia, and primary systemic amyloidosis (AL). In most instances it is not associated with any of these disorders and is defined monoclonal gammopathy of undetermined significance (MGUS) for its possible, though infrequent, evolution into malignant forms. Several data support the pathogenetic role of the monoclonal gammopathy in the neuropathy particularly when of IgM isotype where IgM reactivity to several neural antigens has been reported. Increased levels of VEGF have been implicated in POEMS syndrome. However, there are as yet no defined therapies for these neuropathies, as their efficacy has not been confirmed in randomized trials.
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Affiliation(s)
- Eduardo Nobile-Orazio
- 2nd Neurology, Department of Translational Medicine, Milan University, IRCCS Humanitas Clinical Institute, Rozzano, Milan, Italy.
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Nobile-Orazio E. Update on neuropathies associated with monoclonal gammopathy of undetermined significance (2008-2010). J Peripher Nerv Syst 2011; 15:302-6. [PMID: 21199101 DOI: 10.1111/j.1529-8027.2010.00283.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Studies on paraproteinemic neuropathies have appeared in the last 2 years improving the diagnosis of these neuropathies, clarifying their pathogenesis, and informing practice by randomized clinical trial publications. Two recent randomized controlled trials with rituximab failed to provide evidence of efficacy in primary outcome measures, despite the fact that anti-myelin-associated glycoprotein (MAG) antibodies were reduced in most treated patients. This discrepancy, besides inducing the search for more effective therapy for this neuropathy, indicates that some aspects on the pathogenesis of this neuropathy probably need further clarification.
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Affiliation(s)
- Eduardo Nobile-Orazio
- 2nd Neurology, Department of Translational Medicine, IRCCS Humanitas Clinical Institute, Milan University, Rozzano, Milan, Italy.
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