Neuronal Antibodies
Paraneoplastic disorders are characterised by the presence of neuronal autoantibodies in patient serum.
The detection of these autoantibodies is useful for the clinician, as it suggests the presence of an underlying tumour.
Tumours that have been known to initiate paraneoplastic disorders include small cell lung carcinoma (SCLC), thymoma, neuroblastoma, and breast, ovarian, and testicular cancers.
The following autoantibodies can be found in paraneoplastic syndromes:
Anti-Hu: Type I anti-neuronal nuclear antibody (ANNA-1) is associated with SCLC, resulting in paraneoplastic encephalomyelitis
Anti-Ri: Type II anti-neuronal nuclear antibody (ANNA-2) is associated with neuroblastoma (children) and fallopian or breast cancer (adults), resulting in paraneoplastic opsoclonus myoclonus ataxia (POMA)
Anti-Yo: Anti-Purkinje cell antibody is associated with gynaecological tumours and breast cancer, resulting in PCD
Anti-Tr: Anti-purkinje cell antibody is associated with Hodgkin's disease, resulting in cerebellar degeneration
Anti-Ta (Ma2): Anti-neuronal antibody is associated with testicular tumours, and can lead to limbic or brain stem encephalomyelitis
Amphiphysin: Associated with tumours of the breast or SCLC leading to opsoclonus, ataxia
RMP/CV2: Associated with various tumours, including thymoma, leading to variety of clinical presentations
Zic4: Autoantibodies to Zic4 are associated with paraneoplastic cerebellar degeneration and the underlying tumor is often a small cell lung cancer
SOX1: In up to 50 percent of patients with Lambert-Eaton myasthenic syndrome (LEMS) - if cancer is detected, almost always a small cell lung cancer (SCLC). In 43 percent of patients with LEMS and SCLC the detectable antibodies are directed to SOX1
Titin: Autoantibodies to Titin can be seen in patients with Myasthenia Gravis and can be associated with the presence of thymoma
Recoverin: Autoantibodies to Recoverin have been associated with cancer-associated retinopathy (CAR), a paraneoplastic blinding disease.
Specimen requirements
Serum 1ml; plasma is acceptable but CSF not required although can be tested.
Cost
- Slide testing - £18
- Immunoblot testing - £35
Laboratory turnaround time
14 days
Laboratory method
Users can choose to have initial screening for Hu/Ri/Yo only, performed by immunofluorescent slide with any positive signal detected on the slide further tested by Immunoblot method.
Alternatively, users can request the immunoblot panel as a first line test.
If immunoblot testing is requested first line, any positive Hu/Ri/Yo results will be confirmed by secondary testing by immunfluorescent slide.
GAD65 antibody testing is performed on the immunoblot panel. Anti-GAD65 antibodies will not be formally measured by this method.
If a sample produces an equivocal or positive result for Anti-GAD65, a comment will be added to the report to highlight this to the user and to recommend requesting GAD antibody testing by the preferred method.
Reference range/units
Immunofluorescence - positive signal determined from 1:100 starting dilution
Immunoblot, measured via EuroBlot one scanning. Results reported as Negative/Equivocal/Positive
Associated tests
Not applicable
Shipping and storage
UK and Ireland
Ambient temperature and first class post. Hays DX users please enquire via email below.
International
Ambient temperature if courier will deliver within 72 hours otherwise consider refrigerated transport. Freezing is not a requirement.
Ensure delivery Monday to Friday 7.00am - 5.30pm.
Further information and contact details
For further information, email immunology.office@nhs.net