Onconeuronal and antineuronal antibodies in patients with neoplastic and non-neoplastic pulmonary pathologies and suspected for paraneoplastic neurological syndrome

Abstract

ObjectiveOnconeuronal antibodies are important diagnostic tool in patients with suspicion of paraneoplastic neurological syndromes (PNS). However, their role in PNS pathophysiology and specificity for particular neurological manifestation remains unclear. The aim of this study was to evaluate onconeuronal and antineuronal antibodies in patients with pulmonary pathologies and suspected for PNS.Materials and methodsTwenty one patients with pulmonary pathologies were selected from the database of 525 consecutive patients with suspicion of PNS. Patients' sera were screened for the presence of onconeuronal and antineuronal antibodies by means of indirect immunofluorescence; the presence was confirmed by Western blotting. Clinical data were obtained from medical records, hospital data base, and questionnaire-based direct telephone contact with patients.ResultsAmong 21 patients, aged 54 ± 11, with pulmonary pathologies, the most frequent neurological manifestations were neuropathies. Typical PNS included paraneoplastic cerebellar degeneration (PCD) and limbic encephalitis (LE). We found cases with multiple onconeuronal antibodies (anti-Ri and anti-Yo) and coexisting PNS (PCD/LE). Well-defined onconeuronal antibodies were identified in 23.8% of patients. Among antineuronal antibodies, the most frequent were anti-MAG (23.8%). ROC curves analysis revealed high sensitivity of onconeuronal and antineuronal antibodies for typical PNS and lower for pulmonary malignancies.ConclusionsTests for antibodies are highly sensitive for the diagnosis of typical paraneoplastic neurological syndromes. Anti-myelin and anti-MAG antibodies are associated with non-neoplastic pulmonary diseases. Patients with well-defined onconeuronal antibodies require careful screening and follow-up, because the PNS diagnosis indicates a high probability of an underlying malignancy.

Is peripheral paraneoplastic neurological syndrome possible in primary brain tumors?

“…; Michalak et al. ; Smeenk ). PNSs are typically present in the course of different types of cancer localized outside the central nervous system.…”

“…They could have typical or nontypical clinical appearances (classical and nonclassical PNSs), and onconeuronal antibodies are thought to have a crucial role in their diagnosis (Michalak et al. ; Graus and Dalmau ). Malignant diseases outside the central nervous system cause the induction of autoimmunity, and therefore many other antibodies could be found in these cases, among them antibodies detected in autoimmune rheumatic diseases (antinuclear antibodies, rheumatoid factor, antiphospholipid antibodies) (Abu‐Shakara et al.…”

Phagocytosis of neuronal debris by microglia is associated with neuronal damage in multiple sclerosis

“…Neurons and axons are also vulnerable to autoimmune-mediated damage, as is observed in other neurodegenerative diseases (Michalak et al, 2009;T€ uz€ un et al, 2011). In MS, antibodies and T cells are also directed to neuroaxonal antigens (Derfuss et al, 2009;Forooghian et al, 2007;Huizinga et al, 2009;Mathey et al, 2007;Silber et al, 2002), and axon-reactive B cells are present in the cerebrospinal fluid (CSF; Zhang et al, 2005).…”

Neurological manifestations of celiac disease

“…Поэтому диагноз «паранеопластическая энцефалополинейропатия» на данный момент не подтвержден [8][9][10]. Однако учитывая, что развитие паранеопластических неврологических синдромов может предшествовать выявлению опухоли на несколько лет, целесообразно провести повторное обследование [11].…”