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

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Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusion

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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Abbreviations

MAG:

Myelin-associated glycoprotein

EIA:

Enzyme immunosorbent assay

IFA:

Immunofluorescence assay

WB:

Western blot

HNK1:

Human natural killer-1

DADS:

Distal acquired demyelinating symmetric neuropathy

CIDP:

Chronic inflammatory demyelinating polyneuropathy

PNM:

Peripheral nerve myelin

SGPG:

Sulfate-3-glucuronyl paragloboside

mRD:

Modified Rankin disease

IVIg:

Intravenous immunoglobulin

PE:

Plasma exchange

MCV:

Motor conduction velocity

DL:

Distal latency

CMAP:

Compound motor action potential

SCV:

Sensory conduction velocity

SNAP:

Sensory nerve action potential

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Author information

Authors and Affiliations

  1. Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy

    Matà Sabrina, Stefano Ambrosini, Alessandro Barilaro, Monica Del Mastio & Sandro Sorbi

  2. Department of Pathophysiology and Transplantation (DEPT), Neurology Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Domenica Saccomanno & Giacomo Pietro Comi

  3. General Laboratory, Careggi University Hospital, Florence, Italy

    Tiziana Biagioli

  4. Neurology Unit, Ospedale Treviglio, Bergamo, Italy

    Marinella Carpo

  5. Department NeuroMuscolar Scheletric and Sensory Organs, SOD Neurophysiology, Florence, Italy

    Aldo Amantini

  6. Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy

    Fabio Giannini

  7. Neurology Unit, S.M. Annunziata Hospital, Florence, Italy

    Lucia Toscani

  8. IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy

    Sandro Sorbi

Authors
  1. Matà Sabrina
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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). https://doi.org/10.1007/s10072-019-04089-7

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