|Values are valid only on day of printing.|
Indirect Immunofluorescence Assay (IFA):
Before screening for neuronal nuclear and cytoplasmic autoantibodies, patient's serum is preabsorbed with liver tissue extract to remove nonorgan-specific autoantibodies. After application to a composite substrate of frozen mouse tissues (brain, kidney, and gut), washing, fluorescein-conjugated goat antihuman IgG is applied to detect the distribution and pattern of the patient's bound IgG.(Vernino S, Lennon VA: New Purkinje cell antibody [PCA 2]: marker of lung cancer related neurological autoimmunity. Ann Neurol 2000;47:297-305;Lennon VA: The case for a descriptive generic nomenclature: classification of immunostaining criteria for PCA-1, ANNA-1, and ANNA-2 autoantibodies. Neurology 1994;44:2412-2415; Chan KH, Vernino S, Lennon VA: ANNA-3 anti-neuronal nuclear antibody: marker of lung cancer-related autoimmunity. Ann Neurol 2001 September;50:301-311; Yu Z, Kryzer TJ, Griesmann GE, et al: CRMP-5 neuronal autoantibody: marker of lung cancer and thymoma-related autoimmunity. Ann Neurol 2001 February;49:146-154)
Goat antihuman IgG and IgM is used as precipitant in all assays. Cation channel protein antigens are solubilized from neuronal or muscle membranes, in nonionic detergent and complexed with a selective high-affinity ligand that is labeled with (125)I. (125)I recombinant human GAD65 is used as antigen to confirm GAD65 autoantibody (when suspected from immunofluorescent staining pattern).(Griesmann GE, Kryzer TJ, Lennon VA: Autoantibody profiles of myasthenia gravis and Lambert-Eaton myasthenic syndrome. In Manual of Clinical and Laboratory Immunology. Sixth edition. Edited by NR Rose, RG Hamilton, et al. Washington, DC, ASM Press 2002, pp 1005-1012; Walikonis JE, Lennon VA: Radioimmunoassay for glutamic acid decarboxylase [GAD65] autoantibodies as a diagnostic aid for stiff-man syndrome and a correlate of susceptibility to type 1 diabetes mellitus. Mayo Clin Proc 1998 December;73:1161-1166)
Acetylcholine receptor modulating antibodies (muscle AChR) are detected by incubating the patient's serum for 14 hours with viable, noninnervated, monolayer cultures of human muscle cells. Percent loss of surface AChR is then quantitated by probing with (125)I-alpha-bungarotoxin.(Howard FM Jr, Lennon VA, Finley J, et al: Clinical correlations of antibodies that bind, block, or modulate human acetylcholine receptors in myasthenia gravis. Ann NY Acad Sci 1987;505:526-538)
Enzyme Immunoassay (EIA):
A mixture of sarcomeric proteins extracted from innervated rat skeletal muscle is used as antigen to detect striational antibodies (IgG, IgM, and IgA).(Cikes N, Momoi MY, Williams CL, et al: Striational autoantibodies: quantitative detection by enzyme immunoassay in myasthenia gravis, thymoma, and recipients of D-penicillamine or allogeneic bone marrow. Mayo Clin Proc 1988;63:474-481)
Western Blot (WB):
WB is performed when IFA screening is not interpretable due to interfering autoantibodies. A mixture of neuronal antigens extracted aqueously from adult rat cerebellum is denatured, reduced, and separated by electrophoresis on 10% polyacrylamide gel (5% for PCA-2 and ANNA-3). Full-length recombinant human CRMP-5 antigen is used to confirm CRMP-5-IgG. Denatured full-length recombinant human amphiphysin protein is used to confirm amphiphysin antibody.(Yu Z, Kryzer TJ, Griesmann GE, et al: CRMP-5 neuronal autoantibody: marker of lung cancer and thymoma-related autoimmunity. Ann Neurol 2001 February;49:145-154)
Cell Binding Assay (CBA):
Patient serum is applied to a composite slide containing HEK293 cells: 1) transfected with AQP4 (M1 isoform); 2) nontransfected. After incubation and washing, fluorescein-conjugated goat IgG reactive with human IgG is applied to detect bound patient IgG.(Package Insert: EUROIMMUN AG. Stocker W. et al. Differenzierte Autoantikorper-Diagnostik mit BIOCHIP-Mosaiken. U Conrad, K. (Hrsg) Autoantikorper. Pabst-Verlag  78-99)
ANNA-1, ANNA-2, ANNA-3, AGNA-1, PCA-1, PCA-2, PCA-Tr, Amphiphysin, CRMP-5-IgG, NMDIS, AMPIS, GABIS: Monday through Thursday, Sunday; 12:00 p.m. and 5:00 p.m.
Striational (striated muscle) antibodies: Monday through Friday; 2:00 p.m.
P/Q-type calcium channel antibody, N-type calcium channel antibody: Monday through Friday; 6:00 a.m.
ACh receptor (muscle) binding antibody: Monday through Friday, Sunday; 2:00 p.m.
AChR ganglionic neuronal antibody, neuronal (V-G) K+ channel autoantibody: Sunday through Thursday; 10:00 p.m.
Paraneoplastic autoantibody Western blot, CRMP-5-IgG Western blot, Amphiphysin Western blot: Monday through Friday; 8:00 a.m.
GAD65 antibody assay: Monday through Friday; 2:00 a.m.
ACh receptor (muscle) modulating antibodies: Monday through Thursday, Saturday; 12:00 p.m.
NMO/AQP4-IgG CBA, NMDCS, AMPCS, GABCS: Monday through Friday; 4:00 a.m.