Effects of IVIg treatment on autoantibody testing in neurological patients: marked reduction in sensitivity but reliable specificity.
Antibody
Cell-based assay
IVIg
Immunoblot
Specificity
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
26
08
2019
accepted:
26
10
2019
revised:
10
10
2019
pubmed:
16
11
2019
medline:
24
11
2020
entrez:
16
11
2019
Statut:
ppublish
Résumé
Therapy of autoimmune diseases of the central and peripheral nervous system with intravenous IgG immunoglobulin (IVIg) is well established. Since IVIg is produced from pooled human plasma, autoantibodies can be found in IVIg products and, accordingly, in patient sera after transfusion. The de novo evidence or disappearance of anti-neural autoantibodies after IVIg treatment has so far not been systematically examined. We screened 50 neurological patients before and after IVIg treatment for classical onconeural and the most common neurological surface autoantibodies as well as for ganglioside autoantibodies and 23 different antinuclear autoantibodies using immunoblot or cell-based indirect immunofluorescence assays. Furthermore, we screened 31 neurological patients with previously known seropositivity for disappearance of the corresponding antibody after treatment. After IVIg treatment, 90% of all sera were de novo positive for antinuclear antibodies, especially for Ro-52. In contrast, 94% of all sera did not show any de novo-positive anti-neural antibodies. In the remaining three cases, titers were very low. Importantly, 12.9% of all tested sera of patients with known antibody positivity turned false negative after IVIg treatment and titers were falsely low in 37% of the remaining sera. Here, we present for the first time results of a broad screening for clinically relevant autoantibodies before and after IVIg treatment in neurological patients. We identified a high specificity but reduced sensitivity for anti-neural antibody testing after IVIg transfusion. In contrast, antinuclear antibody testing is not reliable after IVIg treatment. These results are of high practical importance for diagnostic of neuroimmunological diseases.
Sections du résumé
BACKGROUND
BACKGROUND
Therapy of autoimmune diseases of the central and peripheral nervous system with intravenous IgG immunoglobulin (IVIg) is well established. Since IVIg is produced from pooled human plasma, autoantibodies can be found in IVIg products and, accordingly, in patient sera after transfusion. The de novo evidence or disappearance of anti-neural autoantibodies after IVIg treatment has so far not been systematically examined.
METHODS
METHODS
We screened 50 neurological patients before and after IVIg treatment for classical onconeural and the most common neurological surface autoantibodies as well as for ganglioside autoantibodies and 23 different antinuclear autoantibodies using immunoblot or cell-based indirect immunofluorescence assays. Furthermore, we screened 31 neurological patients with previously known seropositivity for disappearance of the corresponding antibody after treatment.
RESULTS
RESULTS
After IVIg treatment, 90% of all sera were de novo positive for antinuclear antibodies, especially for Ro-52. In contrast, 94% of all sera did not show any de novo-positive anti-neural antibodies. In the remaining three cases, titers were very low. Importantly, 12.9% of all tested sera of patients with known antibody positivity turned false negative after IVIg treatment and titers were falsely low in 37% of the remaining sera.
CONCLUSIONS
CONCLUSIONS
Here, we present for the first time results of a broad screening for clinically relevant autoantibodies before and after IVIg treatment in neurological patients. We identified a high specificity but reduced sensitivity for anti-neural antibody testing after IVIg transfusion. In contrast, antinuclear antibody testing is not reliable after IVIg treatment. These results are of high practical importance for diagnostic of neuroimmunological diseases.
Identifiants
pubmed: 31728710
doi: 10.1007/s00415-019-09614-4
pii: 10.1007/s00415-019-09614-4
doi:
Substances chimiques
Autoantibodies
0
Immunoglobulins, Intravenous
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
715-720Références
CMAJ. 2012 Oct 16;184(15):1709-12
pubmed: 22927508
Nervenarzt. 2018 Dec;89(12):1388-1399
pubmed: 30264269
Transfus Med. 1999 Dec;9(4):307-10
pubmed: 10583884
Pediatr Int. 2005 Apr;47(2):172-4
pubmed: 15771695
Acta Clin Belg. 2009 Jul-Aug;64(4):317-23
pubmed: 19810418
Clin Rev Allergy Immunol. 2005 Dec;29(3):255-69
pubmed: 16391401
Clin Neurol Neurosurg. 2009 Sep;111(7):643-4
pubmed: 19442432
Transfus Apher Sci. 2017 Feb;56(1):45-49
pubmed: 28161150
Autoimmun Rev. 2011 Jan;10(3):150-4
pubmed: 20854935
J Infect Dis. 1993 Feb;167(2):392-400
pubmed: 8380611
J Neuroinflammation. 2018 May 3;15(1):134
pubmed: 29724224
MMWR Morb Mortal Wkly Rep. 2018 Feb 09;67(5):161-165
pubmed: 29420464
N Engl J Med. 2001 Sep 6;345(10):747-55
pubmed: 11547745
Mod Rheumatol. 2008;18(2):153-60
pubmed: 18283522
Neurology. 1996 Sep;47(3):678-83
pubmed: 8797464
Sex Transm Infect. 2007 Feb;83(1):57-8
pubmed: 17283361
Neurology. 2019 Mar 12;92(11):501-502
pubmed: 30728306
J Neurol Neurosurg Psychiatry. 1985 Dec;48(12):1246-52
pubmed: 4087000
J Clin Pathol. 1999 Mar;52(3):177-80
pubmed: 10450175
Blood. 2007 May 15;109(10):4376-82
pubmed: 17264299
J Immunol. 2019 Apr 15;202(8):2210-2219
pubmed: 30824481
Clin Neurol Neurosurg. 2010 Nov;112(9):835-6
pubmed: 20619959
Trends Immunol. 2009 Jan;30(1):43-51
pubmed: 19058756
J Allergy Clin Immunol Pract. 2018 Jan - Feb;6(1):260-261
pubmed: 28669890
Clin Transl Immunology. 2015 Oct 02;4(10):e42
pubmed: 26682050
Clin Infect Dis. 2016 Jul 1;63(1):57-63
pubmed: 27076567
J Neurol. 2006 Sep;253 Suppl 5:V25-32
pubmed: 16998751
Transfusion. 2015 Apr;55(4):832-7
pubmed: 25394209
Lancet. 1992 Feb 29;339(8792):558-9
pubmed: 1346912
Lupus. 1999;8(9):705-12
pubmed: 10602441
Rheumatology (Oxford). 2008 May;47(5):646-51
pubmed: 18346976
Mult Scler Relat Disord. 2014 May;3(3):303-20
pubmed: 25876468
Transfusion. 2010 Dec;50(12):2577-81
pubmed: 20576011
Am J Clin Pathol. 1994 Mar;101(3):327-8
pubmed: 8135190