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Anti-MAG IgM: differences in antibody tests and correlation with clinical findings

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Anti-myelin-associated glycoprotein (MAG) antibody is associated with clinically heterogeneous polyneuropathies. Our purpose was to compare neuropathy phenotypes identified by different anti-MAG tests’ results.


Cohort study: Sera from 40 neuropathy anti-MAG EIA positive patients were tested for anti-MAG by Western blot (WB), for anti-peripheral nerve myelin (PNM) on monkey nerve by immunofluorescence assay (IFA), and for anti-HNK1 on rat CNS slices by IFA. Anti-sulfatide antibodies, for comparison, were also tested by EIA.


Among 40 anti-MAG EIA positive sera, 85% also had anti-PNM IFA reactivity and 67.5% bind HNK1 on rat CNS. Anti-HNK1 positive patients had the classical predominantly distal acquired demyelinating symmetric (DADS) neuropathy with a benign course, while anti-PNM positive but anti-HNK1 negative patients had predominantly axonal neuropathy with a high frequency of anti-sulfatide reactivity and the worst long-term prognosis. Anti-MAG EIA positive patients without anti-PNM or anti-HNK1 IFA reactivity had a CIDP-like polyneuropathy.


Different methods to test for anti-MAG antibodies identify different clinical and electrophysiological findings, as well as long-term outcome. HNK1 reactivity is the strongest marker of DADS.

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Fig. 1

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Myelin-associated glycoprotein


Enzyme immunosorbent assay


Immunofluorescence assay


Western blot


Human natural killer-1


Distal acquired demyelinating symmetric neuropathy


Chronic inflammatory demyelinating polyneuropathy


Peripheral nerve myelin


Sulfate-3-glucuronyl paragloboside


Modified Rankin disease


Intravenous immunoglobulin


Plasma exchange


Motor conduction velocity


Distal latency


Compound motor action potential


Sensory conduction velocity


Sensory nerve action potential


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Correspondence to Matà Sabrina.

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All procedures involving experiments on human subjects have been done in accordance with the ethical standards of the Committee on Human Experimentation of the institution in which the experiments were done or in accordance with the Helsinki Declaration of 1975. Specific national laws have been observed.

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Matà, S., Ambrosini, S., Saccomanno, D. et al. Anti-MAG IgM: differences in antibody tests and correlation with clinical findings. Neurol Sci 41, 365–372 (2020).

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