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01-08-2019 | Rituximab | Original Communication

Relevance of anti-HNK1 antibodies in the management of anti-MAG neuropathies

Authors: Emilien Delmont, Shahram Attarian, Jean-Christophe Antoine, Stephane Paul, Jean Philippe Camdessanché, Aude-Marie Grapperon, Alexandre Brodovich, Jose Boucraut

Published in: Journal of Neurology | Issue 8/2019

Abstract

Introduction

In peripheral neuropathies with antibodies against Myelin Associated Glycoprotein (MAG), an IgM monoclonal gammopathy recognizes a specific epitope called Human Natural Killer 1 (HNK1) shared by NK lymphocytes and several components of the peripheral nerve myelin. Recently an ELISA test has been developed to detect antibodies against HNK1 epitope. Objectives were to determine the usefulness of this assay in the management of anti-MAG neuropathy.

Methods

Anti-HNK1 antibodies were assessed with the GanglioCombi™ MAG ELISA test (Buhlmann) in 41 anti-MAG neuropathies and in 118 controls: 34 chronic inflammatory demyelinating polyradiculoneuropathies, 3 Miller Fisher syndromes, 12 sensory neuronopathies, 63 length-dependent axonal sensory polyneuropathies, 6 healthy controls. Anti-HNK1 antibody was tested before and 1 year after rituximab therapy in seven patients with anti-MAG neuropathy.

Results

Anti-HNK1 antibodies were positive in 40/41 anti-MAG neuropathies, and in 1/118 controls (sensitivity 98%, specificity 99%). Only considering controls with IgM paraprotein, specificity was 96% (23/24). In anti-MAG neuropathies, anti-HNK1 titre was correlated with sensory deficiency evaluated with the INCAT sensory sum score (r = 0.4, p = 0.01) and with disability evaluated with the Rasch-built Overall Disability Scale (r = \(-\) 0.4, p = 0.01) and Overall Neuropathy Limitation Scale (r = 0.4, p = 0.02). Anti-HNK1 titres were not related to age, disease duration, atypical clinical features and anti-MAG antibodies titres. Anti-MAG titres were not associated with disease severity. Anti-HNK1 titres were decreased by 18% 1 year after rituximab treatment.

Conclusions

Anti-HNK1 antibodies have good sensitivity and specificity for the diagnosis of anti-MAG neuropathy. Interestingly, anti-HNK1 titres are related to the disease severity and decrease after rituximab infusions.

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Title: Relevance of anti-HNK1 antibodies in the management of anti-MAG neuropathies
Authors: Emilien Delmont
Shahram Attarian
Jean-Christophe Antoine
Stephane Paul
Jean Philippe Camdessanché
Aude-Marie Grapperon
Alexandre Brodovich
Jose Boucraut
Publication date: 01-08-2019
Publisher: Springer Berlin Heidelberg
Keywords: Rituximab
Rituximab
Published in: Journal of Neurology / Issue 8/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09367-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Relevance of anti-HNK1 antibodies in the management of anti-MAG neuropathies

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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