Test Id : CRMTC
Collapsin Response-Mediator Protein-5 (CRMP-5) Neuronal IgG Titer, Spinal Fluid
Useful For
Suggests clinical disorders or settings where the test may be helpful
Evaluation of neuroautoimmunity, particularly small-cell lung carcinoma and thymoma, in conjunction with other antineuronal antibodies
Reporting an end titer result from cerebrospinal fluid specimens
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
If the indirect immunofluorescence (IFA) pattern suggests collapsin response-mediator protein-5 (CRMP-5) neuronal IgG, then this test will be performed at an additional charge.
Method Name
A short description of the method used to perform the test
Only orderable as a reflex. For more information see:
-DMC2 / Dementia, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-ENC2 / Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-EPC2 / Epilepsy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-MDC2 / Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-MAC1 / Myelopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
Indirect Immunofluorescence Assay (IFA)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Chorea
Cranial Neuropathy
CRMP5
Myelopathy
Vision Loss
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
If the indirect immunofluorescence (IFA) pattern suggests collapsin response-mediator protein-5 (CRMP-5) neuronal IgG, then this test will be performed at an additional charge.
Specimen Type
Describes the specimen type validated for testing
CSF
Ordering Guidance
Serum is preferred. Spinal fluid testing is particularly useful if interfering antibodies are present in the serum.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Only orderable as a reflex. For more information see:
-DMC2 / Dementia, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-ENC2 / Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-EPC2 / Epilepsy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-MDC2 / Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-MAC1 / Myelopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
Container/Tube: Sterile vial
Specimen Volume: 4 mL
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
2 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| CSF | Refrigerated (preferred) | 28 days | |
| Ambient | 72 hours | ||
| Frozen | 28 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Evaluation of neuroautoimmunity, particularly small-cell lung carcinoma and thymoma, in conjunction with other antineuronal antibodies
Reporting an end titer result from cerebrospinal fluid specimens
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
If the indirect immunofluorescence (IFA) pattern suggests collapsin response-mediator protein-5 (CRMP-5) neuronal IgG, then this test will be performed at an additional charge.
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Autoantibodies specific for neurons, glia, and muscle are important serological markers of neurological autoimmunity. Most are highly predictive of specific neoplasms that are metastatic to regional lymph nodes when diagnosed but usually limited in spread.(1,2) The target auto-antigens identified so far include cytoplasmic and nuclear proteins and plasma membrane cation channels.(3)
Collapsin response-mediator protein-5 (CRMP-5)-IgG is currently the second most common autoantibody predictive of small-cell lung carcinoma and, sometimes, occurs with thymoma.
The neurological presentation of CRMP-5-IgG seropositive patients is usually multifocal and can affect any level of the neuraxis. The presentation frequently mimics a stroke or multiple sclerosis. Syndromic manifestations encountered with lung carcinoma include subacute chorea, blindness, other cranial neuropathies (particularly loss of taste or smell), gastrointestinal dysmotility, myelopathy, and radiculoplexopathy. Fourteen percent of patients have thromboembolic phenomena. Seropositive patients who have thymoma (6%) usually present with neurological manifestations other than, or including, myasthenia gravis (eg, encephalopathy, disorders of continuous muscle fiber activity).
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Only orderable as a reflex. For more information see:
-DMC2 / Dementia, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-ENC2 / Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-EPC2 / Epilepsy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-MDC2 / Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-MAC1 / Myelopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
<1:2
Note: Titers lower than 1:2 are detectable by recombinant collapsin response-mediator protein-5 (CRMP-5) Western blot analysis. CRMP-5 Western blot analysis will be done on request on stored spinal fluid (held 4 weeks). This supplemental testing is recommended in cases of chorea, vision loss, cranial neuropathy, and myelopathy. Call the Neuroimmunology Laboratory at 800-533-1710 to request CRMP-5 Western blot.
Neuron-restricted patterns of IgG staining that do not fulfill criteria for CRMP-5-IgG may be reported as "unclassified anti-neuronal IgG." Complex patterns that include nonneuronal elements may be reported as "uninterpretable."
Interpretation
Provides information to assist in interpretation of the test results
Detection of IgG autoantibody specific for the neuronal cytoplasmic antigen collapsin response-mediator protein-5 (CRMP-5) in a patient's serum or spinal fluid confirms that the patient's subacute neurological disorder has an autoimmune basis and predicts a small-cell lung carcinoma or thymoma with 75% to 80% certainty.(1)
CRMP-5-IgG titers generally fall after the neoplasm is treated, and a rising titer is indicative of tumor persistence or recurrence.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Seronegativity does not exclude the presence of a neoplasm.
Testing for a single paraneoplastic autoantibody is not a sufficient screening test for neuroautoimmunity.
Collapsin response-mediator protein-5 (CRMP-5)-IgG is not detectable by immunofluorescence screening if the spinal fluid titer is low (<1:2) or if coexisting autoantibodies (either neuron-specific or nonorgan-specific such as antinuclear and antimitochondrial antibodies) are present, which precludes identification of CRMP-5-IgG with certainty. Interfering antibodies can usually be eliminated by absorption with liver antigens. Western blot analysis using full-length recombinant human CRMP-5 protein can detect CRMP-5-IgG at 1:10 dilution.
An autoantibody independently named anti-CV2 is the same entity as CRMP-5-IgG. Its antigen in adult brain was erroneously reported to be oligodendrocyte-restricted and was misidentified in 1999 as CRMP-3.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Yu Z, Kryzer TJ, Griesmann GE, et al: CRMP-5 neuronal autoantibody: marker of lung cancer and thymoma-related autoimmunity. Ann Neurol. 2001 Feb;49(2):146-154
2. Galanis E, Frytak S, Rowland KM, et al: Neuronal autoantibody titers in the course of small-cell lung carcinoma and platinum associated neuropathy. Cancer Immunol Immunother. 1999 May-June;48(2-3):85-90
3. Lennon VA: Calcium channel and related paraneoplastic disease autoantibodies. In: Peter JB, Schoenfeld Y, eds. Textbook of Autoantibodies. Elsevier Science Publishers, BV, The Netherlands, 1996;139-147
4. Vernino S, Tuite P, Adler CH, et al: Paraneoplastic chorea associated with CRMP-5 neuronal antibody and lung carcinoma. Ann Neuro. 2002 May;51(5):625-630
5. Pittock SJ, Kryzer TJ, Lennon VA: Paraneoplastic antibodies coexist and predict cancer, not neurological syndrome. Ann Neurol. 2004 Nov;56(5):715-719
6. Horta ES, Lennon VA, Lachance DH, et al: Neural autoantibody clusters aid diagnosis of cancer. Clin Cancer Res. 2014 Jul 15;20(14):3862-3869
Method Description
Describes how the test is performed and provides a method-specific reference
The patient's specimen is tested by a standardized immunofluorescence assay that uses a composite frozen section of mouse cerebellum, kidney, and gut tissues. After incubation with the specimen and washing, fluorescein-conjugated goat-antihuman IgG is applied. Neuron-specific autoantibodies are identified by their characteristic fluorescence staining patterns. Specimens that are scored positive for any neuronal nuclear or cytoplasmic autoantibody are titrated. Interference by coexisting non-neuron-specific autoantibodies can usually be eliminated by serologic absorption.(Honorat JA, Komorowski L, Josephs KA, et al. IgLON5 antibody: Neurological accompaniments and outcomes in 20 patients. Neurol Neuroimmunol Neuroinflamm. 2017;4[5]:e385. Published 2017 Jul 18. doi:10.1212/NXI.0000000000000385)
Western blot analysis with recombinant CRMP-5 (done by specific request) may be required to confirm positive results if interfering autoantibodies are present or when the titer is below 1:2.
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Sunday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
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Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
86256
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| CRMTC | CRMP-5-IgG Titer, CSF | 94706-9 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 43445 | CRMP-5-IgG Titer, CSF | 94706-9 |