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