Neurology Autoimmune Neurology Antibody Comprehensive ......The Autoimmune Neurology Antibody...
Transcript of Neurology Autoimmune Neurology Antibody Comprehensive ......The Autoimmune Neurology Antibody...
Neurology
Autoimmune Neurology Antibody Comprehensive Panel with Reflexes
The more you know about autoimmune disease, the more you can do to treat it
Autoantibody testing services for autoimmune neurology disorders
When patients present with a range of neurological symptoms, it can be difficult to identify what is causing them and select the best treatment. In most cases, early detection and prompt therapy can improve patient outcomes.1
Recent research has provided new insight into the causes of autoimmune diseases, making a specific diagnosis more possible than ever—one that can inform treatment.
The new Autoimmune Neurology Antibody Comprehensive Panel with Reflexes from Quest Diagnostics is built around a data-driven selection of neuronal-specific antibodies known to be associated with disease.
Comprehensive testing can:
• Identify idiopathic neurological disease in the absence of tumor
• Identify a malignancy early to optimize early treatment and help improve outcomes for both cancer and neurological disease
• Inform targeted immunosuppressive therapy for immunological disease
Knowing where to look first
Autoimmune neurological disorders can present a diagnostic challenge. Patients often manifest a variety of clinical syndromes that can be caused by one or more autoantibodies. To complicate the evaluation, a given autoantibody can exhibit a variety of clinical appearances and a given neurological presentation can often be caused by several different autoantibodies. The complexity of the neurological system and the absence of a specific clinical presentation make it difficult to know where to look first.
In a clinical study involving over 16,700 samples, approximately 50% tested positive for autoantibodies other than those included in the initial testing order2
With recent advances, comprehensive screening can accelerate the diagnostic process to initiate appropriate and often life-saving therapy as early as possible.2 By screening patients for multiple autoantibodies, the detection rate for diagnostically relevant autoantibodies increased by 87%, compared to single testing of requested analyte.2
Introducing the Autoimmune Neurology Antibody Comprehensive Panel with ReflexesAt Quest Diagnostics, we have designed the Autoimmune Neurology Antibody Comprehensive Panel with Reflexes to increase the detection rate of clinically relevant autoantibodies to help identify which one or which combination of autoantibodies are causing the disorder. With more definitive information, you and your patients can make more informed treatment decisions.
After specific analytes test positive, reflex titering is performed to provide a complete comprehensive profile in a timely manner.
46.6%53.4%
positive for unrequested parameters
positive for requested parameters
Neurology
Autoantibodies/analytes tested*
Paraneoplastic
Acetylcholine Receptor Ganglionic (Alpha 3) Antibody
AGNA/SOX1
Amphiphysin
AMPAR1
AMPAR2
ANNA1 (Hu)
ANNA2 (Ri)
ANNA3
CRMP5/CV2
GABABR
Ma2/Ta
Myelin
PCA1 (Yo)
PCA2
Recoverin
Titin
Zic4
Paraneoplastic or non-paraneoplastic
CASPR2
CRMP5/CV2
NMDAR1
PCA-Tr (DNER)
Voltage-Gated Calcium Channel (VGCC) Type P/Q Antibody
Voltage-Gated Calcium Channel (VGCC) Type N Antibody
Usually non-paraneoplastic
Acetylcholine Receptor Binding Antibody
Aquaporin 4 (NMO)
DPPX Receptor Antibody
GAD65
LGI1
Voltage-Gated Potassium Channel (VGKC) Antibody
Anti-Striated Muscle Antibody
*Data on file, Quest Diagnostics
Our combination of autoantibodies and testing methodologies combine to enable an Autoimmune Neurology Antibody Comprehensive Panel that improves sensitivity and expands specificity.
When it comes to autoimmune neurology, Quest Diagnostics provides an unparalleled level of insight, which can help you make more informed treatment decisions.
For the Autoimmune Neurology Antibody Comprehensive Panel with Reflexes, we test each sample for 31 neuronal specific and non-specific autoantibodies, including antibodies to intraneural proteins and those against neuronal cell surface/synaptic proteins
Target tissues and/or cells are specifically selected for optimal diagnostic detection:
• Neurological tissues include primate (monkey) cerebellum, rat hippocampus, primate (monkey) sural nerve, and primate (monkey) nucleus caudatus.
• Other tissues are used to help define antibody immunoflourescent staining patterns: primate (monkey) intestine, primate (monkey) kidney, primate (monkey) testis, and primate (monkey) pancreas.
• The HEp-2 cells line is a human epithelial cell line used as the standard substrate to define antinuclear antibodies (ANA) (and anticytoplasmic antibodies) in the ANA assay.
Our comprehensive testing methodologies maximize sensitivity by factoring in variables that acknowledge antibody presence dependent upon certain antigen targets or differences in presentation and context.3 The Autoimmune Neurology Antibody Comprehensive Panel with Reflexes includes fixed tissue immunofluorescence assay (IFA), transfected cell IFA via cell staining, western line blot analysis, and ELISA. In addition, serum concentration is calibrated specifically for each method.
Neurology Antibody Screen, IFA with Reflexes
1 - IFA Observation(s)2 - ANNA1 (Hu) Abs IFA3 - ANNA2 (Ri) Abs IFA4 - ANNA3 Abs IFA5 - PCA1 (Yo) Abs, IFA6 - PCA2 Abs, IFA7 - PCA-Tr Abs IFA8 - AGNA/SOX1 Abs, IFA
9 - Amphiphysin Abs IFA10 - CRMP5/CV2
Abs IFA11 - GAD65 Abs IFA12 - Ma2/Ta Abs IFA13 - Myelin Abs IFA14 - Aquaporin 4
(NMO) Abs IFA
Neurology Antibody, Line Blot with Reflex
1 - ANNA1 (Hu) Abs LB2 - ANNA2- (Ri) Abs LB3 - PCA1 (Yo) Abs LB4 - Ma2/Ta Abs LB5 - CRMP5/CV2 Abs LB6 - Amphiphysin Abs LB7 - GAD65 Abs, LB
8 - Recoverin Abs LB9 - AGNA/SOX1 Abs LB10 - Titin Abs LB11 - Zic4 Abs LB12 - PCA-Tr (DNER)
Abs LB
Neurology Antibody, CBA IFA with Reflexes
1 - NMDAR1 Abs CBA2 - AMPAR1 Abs CBA3 - AMPAR2 Abs CBA4 - GABABR Abs CBA5 - LGI1 Abs CBA6 - CASPR2 Abs CBA
DPPX Receptor Antibody, CBA IFA (VGKC associated protein)
Anti-Striated Muscle Ab Screen
Acetylcholine Receptor Binding Antibody
Acetylcholine Receptor Ganglionic (Alpha 3) Antibody
Voltage-Gated Calcium Channel (VGCC) Type P/Q Antibody
Voltage-Gated Calcium Channel (VGCC) Type N Antibody
Voltage-Gated Potassium Channel (VGKC) Antibody
If Tissue IFA pattern suggests ANNA3
If NMDAR1 Abs CBA is positive
If Acetylcholine Receptor Binding Antibody is negative
If AMPAR1 Abs CBA is positive
If Acetylcholine Receptor Binding Antibody is equivocal
If AMPAR2 Abs CBA is positive
If Acetylcholine Receptor Binding Antibody is positive
If GABABR Abs CBA is positive
If LGI1 Abs CBA is positive
If CASPR2 Abs CBA is positive
If DPPX Abs CBA is positive
If Striated Muscle Antibodies is positive
If Positive
If Positive
If Positive
Neuronal Nuclear Antibody Type 3 (ANNA-3), Titer
NMDAR1 Antibody, CBA IFA, Titer
AMPAR1 Antibody, CBA IFA, Titer
Acetylcholine Receptor Blocking Antibody
Acetylcholine Receptor Modulating Antibody
AMPAR2 Antibody, CBA IFA, Titer
GABABR Antibody, CBA IFA, Titer
LGI1 Antibody, CBA IFA, Titer
CASPR2 Antibody, CBA IFA, Titer
DPPX Antibody, CBA IFA, Titer
Anti-Striated Muscle Ab Titer
Purkinje Cell Cytoplasmic Antibody Type 2 (PCA-2), Titer
Purkinje Cell Cytoplasmic Antibody Type Tr (DNER), CBA IFA
Aquaporin-4 (AQP4) Antibody (IgG), CBA IFA
Aquaporin-4 (AQP4) Antibody (IgG), CBA IFA, Titer
PCA-Tr (DNER) Antibody, CBA IFA, Titer
MAG-SGPG Antibody (IgM), EIA
Myelin-Associated Glycoprotein (MAG) Antibody (IgM), EIA
MAG Antibody (IgM), Western Blot
Myelin Antibody, IFA, Titer
If Tissue IFA pattern suggests PCA2
If Tissue IFA pattern suggests PCA-Tr
AND
Line Blot shows DNER negative
AND
Line Blot shows Yo negative
If Tissue IFA pattern suggests NMO-5-IgG
If Tissue IFA pattern suggests Myelin
Autoimmune Neurology Antibody Comprehensive Panel with Reflexes, Serum
Always Performed Reflex Tests
Test ordering information
Test code Test name Specimen volume Turnaround time
93888 Autoimmune Neurology Antibody Comprehensive Panel with Reflexes, Serum
7mL (4.5mL minimum) serum 7-16 days
References
1. Vincent A, Bien CG, Irani SR, et al. Autoantibodies associated with diseases of the CNS: new developments and future challenges. Lancet Neurol. 2011:10:759-772.
2. Stocker W, Probst C, Teegen B, et al. Multiparameter autoantibody screening in the diagnosis of neurological autoimmune diseases. Paper presented at: 1st Congress of the European Academy of Neurology (EAN); June 2015; Berlin, Germany.
3. Tampoia M, Zucano A, Antico A, et al. Diagnostic accuracy of different immunological methods for the detection of antineuronal antibodies in paraneoplastic neurological syndromes. Immunol Invest. 2010:39:186-195.
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Vital information you need
• As new discoveries are made in neurology, Quest Diagnostics is at the forefront with the tests you need to make informed decisions—decisions that can lead to better outcomes.
• Our comprehensive menu of tests was built with your patients’ needs in mind. We are committed to improving patient health through diagnostic insights.
Expert review and consultation
• Quest Diagnostics is a leader in autoantibody testing services. The Autoimmune Neurology Antibody Comprehensive Panel with Reflexes is supported by a team of PhDs, MDs, and other medical experts.
• We offer one-on-one consultations and professional reviews with our team of medical experts to support your decision-making.
For more information on our neurology testing services, call 1.866.MY.QUEST (1.866.697.8378) or visit QuestDiagnostics.com/Neurology