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A large screen for paraneoplastic neurological autoantibodies; diagnosis and predictive values.
Clin Immunol. 2019 02; 199:29-36.CI

Abstract

BACKGROUND

Paraneoplastic neurological syndromes (PNS) are a group of syndromes that affect the central and peripheral neuromuscular system in association with cancer. Specific antibodies may assist in the diagnosis of PNS. The antibodies tested can be classified into those directed against intracellular neuronal proteins ("well characterized" PNS: Hu, Yo, RI, CV2, amphiphysin, Ma1, Ma2) and those directed against neural surface antigens (autoimmune encephalitis syndromes: NMDA, AMPA, LGI1, CASPR2, GABAR). We aimed to characterize patients with unexplained neuropsychiatric symptoms, in whom positive PNS antibodies were detected in the Sheba medical center, a large referral hospital.

METHODS

Clinical and demographic data of patients with positive PNS antibodies were collected during the years 2002-2016. Antibodies were tested by either Line immunoassay or by cell-based indirect immunofluorscent assay.

RESULTS

During the follow up of 14 years, 4010 PNS tests were performed in patients with unexplained neuropsychiatric symptoms. Seventy-two were found to be positive; among them we had full clinical data access to 44. The most frequent antibodies were anti-Hu (31.8%), anti-Yo (18.2%), anti-CV2 (13.6%), and anti-NMDA (9.1%), and the most common cancers were small-cell lung (SCLC) and ovarian cancers. In the well characterized paraneoplastic group, cancer was diagnosed in 55.9% of the patients, and in the autoimmune encephalitis group, 40.0% were diagnosed with cancer. A positive correlation between antibody titer and the presence of cancer was found. Ninety percent of the tests in patients who were found positive were ordered by a neurologist or neuro-oncologist.

CONCLUSIONS

The titers of PNS auto-antibodies can predict cancer in patients whom anti-PNS antibodies are tested. In addition, consultation with a specialist should be considered before this test is ordered.

Authors+Show Affiliations

Department of Medicine A, Tel Hashomer, Israel.Neurology Department, Tel Hashomer, Israel.Department of Medicine A, Tel Hashomer, Israel; Danek Gertner Institute of Human Genetics, Tel Hashomer, Israel; Sackler School of Medicine, Ramat Aviv, Israel.The Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel.Sackler School of Medicine, Ramat Aviv, Israel; The Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel; Department of Medicine B, Tel Hashomer, Israel.Sackler School of Medicine, Ramat Aviv, Israel; The Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel; Incumbent of the Laura Schwarz-Kip Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Israel.Department of Medicine A, Tel Hashomer, Israel; Sackler School of Medicine, Ramat Aviv, Israel; The Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Sheba Medical Center, Tel-Hashomer, Israel. Electronic address: shai.kiviti@sheba.health.gov.il.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30543927

Citation

Seluk, Lior, et al. "A Large Screen for Paraneoplastic Neurological Autoantibodies; Diagnosis and Predictive Values." Clinical Immunology (Orlando, Fla.), vol. 199, 2019, pp. 29-36.
Seluk L, Taliansky A, Yonath H, et al. A large screen for paraneoplastic neurological autoantibodies; diagnosis and predictive values. Clin Immunol. 2019;199:29-36.
Seluk, L., Taliansky, A., Yonath, H., Gilburd, B., Amital, H., Shoenfeld, Y., & Kivity, S. (2019). A large screen for paraneoplastic neurological autoantibodies; diagnosis and predictive values. Clinical Immunology (Orlando, Fla.), 199, 29-36. https://doi.org/10.1016/j.clim.2018.12.007
Seluk L, et al. A Large Screen for Paraneoplastic Neurological Autoantibodies; Diagnosis and Predictive Values. Clin Immunol. 2019;199:29-36. PubMed PMID: 30543927.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A large screen for paraneoplastic neurological autoantibodies; diagnosis and predictive values. AU - Seluk,Lior, AU - Taliansky,Alisa, AU - Yonath,Hagith, AU - Gilburd,Boris, AU - Amital,Howard, AU - Shoenfeld,Yehuda, AU - Kivity,Shaye, Y1 - 2018/12/10/ PY - 2018/12/14/pubmed PY - 2019/12/4/medline PY - 2018/12/14/entrez KW - Autoantibodies KW - Autoimmune diseases KW - Autoimmunity KW - Cancer KW - Paraneoplastic neurological syndromes KW - Small cell lung cancer SP - 29 EP - 36 JF - Clinical immunology (Orlando, Fla.) JO - Clin. Immunol. VL - 199 N2 - BACKGROUND: Paraneoplastic neurological syndromes (PNS) are a group of syndromes that affect the central and peripheral neuromuscular system in association with cancer. Specific antibodies may assist in the diagnosis of PNS. The antibodies tested can be classified into those directed against intracellular neuronal proteins ("well characterized" PNS: Hu, Yo, RI, CV2, amphiphysin, Ma1, Ma2) and those directed against neural surface antigens (autoimmune encephalitis syndromes: NMDA, AMPA, LGI1, CASPR2, GABAR). We aimed to characterize patients with unexplained neuropsychiatric symptoms, in whom positive PNS antibodies were detected in the Sheba medical center, a large referral hospital. METHODS: Clinical and demographic data of patients with positive PNS antibodies were collected during the years 2002-2016. Antibodies were tested by either Line immunoassay or by cell-based indirect immunofluorscent assay. RESULTS: During the follow up of 14 years, 4010 PNS tests were performed in patients with unexplained neuropsychiatric symptoms. Seventy-two were found to be positive; among them we had full clinical data access to 44. The most frequent antibodies were anti-Hu (31.8%), anti-Yo (18.2%), anti-CV2 (13.6%), and anti-NMDA (9.1%), and the most common cancers were small-cell lung (SCLC) and ovarian cancers. In the well characterized paraneoplastic group, cancer was diagnosed in 55.9% of the patients, and in the autoimmune encephalitis group, 40.0% were diagnosed with cancer. A positive correlation between antibody titer and the presence of cancer was found. Ninety percent of the tests in patients who were found positive were ordered by a neurologist or neuro-oncologist. CONCLUSIONS: The titers of PNS auto-antibodies can predict cancer in patients whom anti-PNS antibodies are tested. In addition, consultation with a specialist should be considered before this test is ordered. SN - 1521-7035 UR - https://www.unboundmedicine.com/medline/citation/30543927/A_large_screen_for_paraneoplastic_neurological_autoantibodies L2 - https://linkinghub.elsevier.com/retrieve/pii/S1521-6616(18)30716-2 DB - PRIME DP - Unbound Medicine ER -