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Immunoelectron microscopic localization of monoclonal IgM antibodies in gammopathy associated with peripheral demyelinative neuropathy

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Summary

A sural nerve biopsy from a patient with benign monoclonal IgM kappa gammopathy and sensory-motor demyelinative neuropathy, revealed marked loss of myelinated fibers and focal axonal degeneration as well as widespread demyelination and remyelination with onion-skin formation. Almost all meylinated fibers displayed characteristic widening of the myelin lamellae as well as excessive thickness and/or exuberant outfoldings of myelin, reminiscent of that seen in tomaculous neuropathy. Many endoneurial capillaries were lined by fenestrated endothelium, indicating breakdown of a normal blood-nerve barrier. The endoneurium contained large amounts of extracellular proteinaceous material. Immunofluorescence and immunoelectron microscopy performed on the nerve of the patient, demostrated selective deposition of IgM kappa gammaglobulin, exclusively in the areas of splittings of the myelin lamellae. Schwann cells contained cytoplasmic myelin debris labelled with IgM kappa only. In the indirect immunofloorescence and immunoelectron microscopy, serum of the patient reacted with the whole thickness of compact peripheral myelin of a normal human nerve. There was no immunoreactivity with the central myelin, Schwannoma cells, glial cells, axons or neurons. Demonstration of the selective presence of monoclonal IgM in widened lamellae of myelinated fibers, as well as bound to the internalized myelin debris in Schwann cells and macrophages, indicates a pathogenetic role of monoclonal paraprotein in myelin injury. Demyelination is promoted by development of endothelial fenestrations in the endoneurial capillaries and breakdown of the blood-nerve barrier.

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Authors and Affiliations

  1. Department of Laboratory Medicine (Neuropathology), Ottawa Civic Hospital, 1053 Carling Ave., K1Y 4E9, Ottawa, Ontario, Canada

    B. Lach, P. Rippstein & A. Gregor

  2. Department of Neurology, Ottawa Civic Hospital, 1053 Carling Ave., K1Y 4E9, Ottawa, Ontario, Canada

    D. Atack

  3. Department of Biochemistry and Medicine, University of Ottawa, Ottawa, Canada

    D. E. H. Afar

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  1. B. Lach
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  2. P. Rippstein
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  3. D. Atack
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  4. D. E. H. Afar
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  5. A. Gregor
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Presented in part at Canadian Congress of Neuroscience, Ottawa, Canada September, 1989

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Lach, B., Rippstein, P., Atack, D. et al. Immunoelectron microscopic localization of monoclonal IgM antibodies in gammopathy associated with peripheral demyelinative neuropathy. Acta Neuropathol 85, 298–307 (1993). https://doi.org/10.1007/BF00227726

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  • DOI: https://doi.org/10.1007/BF00227726

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