Monitoring patients who have previously tested positive for 1 or more antibodies within the past 5 years in a Mayo Clinic Neuroimmunology Laboratory spinal fluid evaluation
Test Id | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
AMPCC | AMPA-R Ab CBA, CSF | No | No |
AMPIC | AMPA-R Ab IF Titer Assay, CSF | No | No |
AMPHC | Amphiphysin Ab, CSF | No | No |
ABLTC | Amphiphysin Western Blot, CSF | No | No |
AGN1C | Anti-Glial Nuclear Ab, Type 1 | No | No |
ANN1C | Anti-Neuronal Nuclear Ab, Type 1 | No | No |
ANN2C | Anti-Neuronal Nuclear Ab, Type 2 | No | No |
ANN3C | Anti-Neuronal Nuclear Ab, Type 3 | No | No |
CS2CC | CASPR2-IgG CBA, CSF | No | No |
CRMWC | CRMP-5-IgG Western Blot, CSF | No | No |
CRMC | CRMP-5-IgG, CSF | No | No |
GABCC | GABA-B-R Ab CBA, CSF | No | No |
GABIC | GABA-B-R Ab IF Titer Assay, CSF | No | No |
LG1CC | LGI1-IgG CBA, CSF | No | No |
NMDCC | NMDA-R Ab CBA, CSF | No | No |
NMDIC | NMDA-R Ab IF Titer Assay, CSF | No | No |
WBNC | Paraneoplas Autoantibody WBlot,CSF | No | No |
PCTRC | Purkinje Cell Cytoplasmc Ab Type Tr | No | No |
PCA1C | Purkinje Cell Cytoplasmic Ab Type 1 | No | No |
PCA2C | Purkinje Cell Cytoplasmic Ab Type 2 | No | No |
VGKCC | VGKC-complex Ab IPA, CSF | No | No |
DPPCC | DPPX Ab CBA, CSF | No | No |
DPPIC | DPPX Ab IFA, CSF | No | No |
DPPTC | DPPX Ab IFA Titer, CSF | No | No |
GL1CC | mGluR1 Ab CBA, CSF | No | No |
GL1IC | mGluR1 Ab IFA, CSF | No | No |
GL1TC | mGluR1 Ab IFA Titer, CSF | No | No |
ANN1C, ANN2C, ANN3C, AGN1C, PCA1C, PCA2C, PCTRC, AMPHC, CRMC, NMDIC, AMPIC, GABIC, DPPIC, DPPTC, GL1CC, GL1TC: Indirect Immunofluorescence (IFA)
NMDCC, AMPCC, GABCC, LG1CC, CS2CC, DPPCC, GL1CC: Cell-Binding Assay (CBA)
WBNC, ABLTC: Western Blot
VGKCC: Radioimmunoassay (RIA)
CSF
This test is only appropriate for follow-up in patients who have previously tested positive in a spinal fluid test. If patients have not previously been positive in a spinal fluid test, order 1 of the following:
-PAC1 / Paraneoplastic, Autoantibody Evaluation, Spinal Fluid
-DMC1 / Dementia, Autoimmune Evaluation, Spinal Fluid
-ENC1 / Encephalopathy, Autoimmune Evaluation, Spinal Fluid
-EPC1 / Epilepsy, Autoimmune Evaluation, Spinal Fluid
-MDC1 / Movement Disorder Evaluation, Spinal Fluid
Container/Tube: Sterile vial
Specimen Volume: 4 mL
If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.
2 mL
Gross hemolysis | Reject |
Gross lipemia | Reject |
Gross icterus | Reject |
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
CSF | Refrigerated (preferred) | 28 days | |
Frozen | 28 days | ||
Ambient | 72 hours |
Monitoring patients who have previously tested positive for 1 or more antibodies within the past 5 years in a Mayo Clinic Neuroimmunology Laboratory spinal fluid evaluation
Paraneoplastic autoimmune neurological disorders reflect a patient's humoral and cellular immune responses to cancer. The cancer may be new or recurrent, is usually limited in metastatic volume, and is often occult by standard imaging procedures. Autoantibodies specific for onconeural proteins found in the plasma membrane, cytoplasm, and nucleus of neurons or muscle are generated in this immune response, and serve as serological markers of paraneoplastic autoimmunity. The most commonly recognized cancers in this context are small-cell lung carcinoma (SCLC), thymoma, ovarian (or related mullerian) carcinoma, breast carcinoma, and Hodgkin lymphoma. Pertinent childhood neoplasms recognized thus far include neuroblastoma, thymoma, Hodgkin lymphoma, and chondroblastoma. An individual patient's autoantibody profile can predict a specific neoplasm with 90% certainty, but not the neurological syndrome.
Three classes of autoantibodies are recognized in the spinal fluid analysis:
-Neuronal nuclear (antineuronal nuclear antibody-type 1 [ANNA-1], ANNA-2, ANNA-3)
-Neuronal and muscle cytoplasmic (Purkinje cell cytoplasmic antibody, type 1 [PCA-1]; PCA-2; PCA-Tr, CRMP-5, and amphiphysin)
-Glial nuclear (antiglial nuclear antibody: AGNA)
Seropositive patients usually present with subacute neurological symptoms and signs. The patient may present with encephalopathy, cerebellar ataxia, myelopathy, radiculopathy, plexopathy, sensory, sensorimotor, or autonomic neuropathy, with or without coexisting evidence of a neuromuscular transmission disorder: Lambert-Eaton syndrome (LES), myasthenia gravis, or neuromuscular hyperexcitability. Initial signs may be subtle, but a subacute multifocal and progressive syndrome usually evolves. Sensorimotor neuropathy and cerebellar ataxia are common presentations, but the clinical picture in some patients is dominated by striking gastrointestinal dysmotility, limbic encephalopathy, basal ganglionitis, or cranial neuropathy (especially loss of vision, hearing, smell, or taste). Cancer risk factors include past or family history of cancer, history of smoking, or social/environmental exposure to carcinogens. Early diagnosis and treatment of the neoplasm favor less neurological morbidity and offer the best hope for survival.
Test ID | Reporting Name | Reference Value |
AMPCC | AMPA-R Ab CBA, CSF | Negative |
AMPIC | AMPA-R Ab IF Titer Assay, CSF | <1:2 |
AMPHC | Amphiphysin Ab, CSF | <1:2 |
ABLTC | Amphiphysin Western Blot, CSF | Negative |
AGN1C | Anti-Glial Nuclear Ab, Type 1 | <1:2 |
ANN1C | Anti-Neuronal Nuclear Ab, Type 1 | <1:2 |
ANN2C | Anti-Neuronal Nuclear Ab, Type 2 | <1:2 |
ANN3C | Anti-Neuronal Nuclear Ab, Type 3 | <1:2 |
CS2CC | CASPR2-IgG CBA, CSF | Negative |
CRMC | CRMP-5-IgG, CSF | <1:2 |
GABCC | GABA-B-R Ab CBA, CSF | Negative |
GABIC | GABA-B-R Ab IF Titer Assay, CSF | <1:2 |
LG1CC | LGI1-IgG CBA, CSF | Negative |
VGKCC | Neuronal (V-G) K+ Channel Ab, CSF | <0.02 |
NMDCC | NMDA-R Ab CBA, CSF | Negative |
NMDIC | NMDA-R Ab IF Titer Assay, CSF | <1:2 |
NMOTC | NMO/AQP4 FACS Titer, CSF | <1:2 |
WBNC | Paraneoplastic Autoantibody WBlot, CSF | Negative |
PCA1C | Purkinje Cell Cytoplasmic Ab Type 1 | <1:2 |
PCA2C | Purkinje Cell Cytoplasmic Ab Type 2 | <1:2 |
PCTRC | Purkinje Cell Cytoplasmic Ab Type Tr | <1:2 |
Antibodies directed at onconeural proteins shared by neurons, muscle, and certain cancers are valuable serological markers of a patient's immune response to cancer. They are not found in healthy subjects, and are usually accompanied by subacute neurological symptoms and signs. Several autoantibodies have a syndromic association, but no known autoantibody predicts a specific neurological syndrome. Conversely, a positive autoantibody profile has 80% to 90% predictive value for a specific cancer. It is not uncommon for more than 1 paraneoplastic autoantibodies to be detected, each predictive of the same cancer.
This test should only be utilized when the presence of paraneoplastic
This test should not be requested in patients who have recently
Lancaster E, Martinez-Hernandez E, Dalmau J: Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology 2011;77(2):179-189
Indirect Immunofluorescence Assay (IFA):
After applying patient's prepared specimen to a composite substrate of frozen mouse tissues (brain, kidney, and gut) and washing, fluorescein-conjugated goat-antihuman IgG is applied to detect the distribution and pattern of patient IgG binding.(Pittock SJ, Kryzer TJ, Lennon VA: Paraneoplastic antibodies coexist and predict cancer, not neurological syndrome. Ann Neurol 2004;56:715-719)
Radioimmunoprecipitation (RIA):
Goat-antihuman IgG and IgM is used as precipitant in all assays. Cation channel protein antigens are solubilized from neuronal or muscle membrane, in nonionic detergent, and complexed with a selective high-affinity ligand labeled with (125)I.(Griesmann GE, Kryzer TJ, Lennon VA: Autoantibody profiles of myasthenia gravis and Lambert-Eaton myasthenic syndrome. In Manual of Clinical and Laboratory Immunology, Sixth edition. Edited by NR Rose, RG Hamilton, et al. Washington, DC, ASM Press, 2002, pp 1005-1012)
Cell-Binding Assay (CBA):
Patient specimen is applied to a composite slide containing transfected and nontransfected HEK-293 cells. After incubation and washing, fluorescein-conjugated goat-antihuman IgG is applied to detect the presence of patient IgG binding.(Package insert: EUROIMMUN AG. Stocker W, et al. Differenzierte Autoantikorper-Diagnostik mit BIOCHIP-Mosaiken. U Conrad, K. (Hrsg) Autoantikorper. Pabst-Verlag 1998, 78-99)
Western Blot (WB):
A mixture of neuronal antigens extracted aqueously from adult rat cerebellum is denatured, reduced, and separated by electrophoresis on 10% polyacrylamide gel. Full-length recombinant human CRMP-5 antigen is used to confirm CRMP-5-IgG.(Yu Z, Kryzer TJ, Griesmann GE, et al: CRMP-5 neuronal autoantibody: marker of lung cancer and thymoma-related autoimmunity. Ann Neurol 2001;49[2]:145-154)
ANN1C, ANN2C, ANN3C, AGN1C, PCA1C, PCA2C, PCTRC, AMPHC, CRMC, NMDIC, AMPIC, GABIC, DPPIC, DPPTC, GL1CC, GL1TC, VGKC:
AMPCC, GABCC, NMDCC, LG1CC, CS2CC, DPPCC, GL1CC:
WBNC, ABLTC:
This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
84182-Paraneoplastic autoantibody Western blot confirmation (if appropriate)
84182-Amphiphysin Western blot confirmation (if appropriate)
86255-Amphiphysin (if appropriate)
86255-ANNA-1 (if appropriate)
86255-ANNA-2 (if appropriate)
86255-ANNA-3 (if appropriate)
86255-CRMP-5-IgG (if appropriate)
86255-PCA-1 (if appropriate)
86255-PCA-2 (if appropriate)
86255-PCA-Tr (if appropriate)
86255-AGNA-1 (if appropriate)
86256-AMPIC (if appropriate)
86256-GABIC (if appropriate)
86256-NMDIC (if appropriate)
86255-DPPIC (if appropriate)
86256-DPPTC (if appropriate)
86255-GL1IC (if appropriate)
86256-GL1TC (if appropriate)
86255-AMPCC (if appropriate)
86255-GABCC (if appropriate)
86255-NMDCC (if appropriate)
83519-VGKCC (if appropriate)
86255-LG1CC (if appropriate)
86255-CS2CC (if appropriate)
86255-DPPCC (if appropriate)
86255-GL1CC (if appropriate)
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
PNEFC | Neuroimmunology Ab Follow-up, CSF | 80615-8 |
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.
|
---|---|---|
84299 | Neuroimmunology Ab Follow-up, CSF | 80615-8 |