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Monoclonal proteins in neuropathy.

R A Kyle1

  • 1Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minnesota.

Neurologic Clinics
|August 1, 1992
PubMed
Summary

Monoclonal gammopathy of undetermined significance (MGUS) with neuropathy involves antibodies targeting myelin-associated glycoprotein (MAG) or other antigens. Further investigation is needed for associated conditions like amyloidosis or POEMS syndrome.

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Area of Science:

  • Neurology
  • Immunology
  • Oncology

Background:

  • Monoclonal proteins in serum can indicate serious conditions like amyloidosis, POEMS syndrome, macroglobulinemia, multiple myeloma, or lymphoma.
  • When these conditions are ruled out, it's classified as monoclonal gammopathy of undetermined significance (MGUS) with neuropathy.
  • Peripheral neuropathy is a significant clinical manifestation associated with monoclonal gammopathies.

Purpose of the Study:

  • To explore the antigenic targets in patients with monoclonal gammopathy and peripheral neuropathy.
  • To differentiate MGUS-associated neuropathy from other monoclonal gammopathies.
  • To understand the immunological basis of neuropathy in MGUS.

Main Methods:

  • Serum protein electrophoresis and immunofixation to detect monoclonal proteins.
  • Neurological examination and electrophysiological studies to characterize neuropathy.
  • Immunological assays to identify antibodies against myelin-associated glycoprotein (MAG), glycolipids, and gangliosides.

Main Results:

  • Approximately 50% of patients with peripheral neuropathy and IgM monoclonal gammopathy exhibit IgM antibodies targeting myelin-associated glycoprotein (MAG).
  • Other identified target antigens include glycolipids and gangliosides.
  • Sensorimotor peripheral neuropathy is observed in about 15% of primary amyloidosis patients, but rarely in multiple myeloma.

Conclusions:

  • Peripheral neuropathy in the context of monoclonal gammopathy often involves immune responses targeting neural antigens, particularly MAG.
  • MGUS with neuropathy requires careful immunological workup to identify specific antibody targets.
  • Distinguishing MGUS-associated neuropathy from other plasma cell disorders is crucial for appropriate management.

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