Peripheral neuropathy associated with monoclonal gammopathy. Studies of intraneural injections of monoclonal immunoglobulin sera

E. Peter Bosch, Linda E. Ansbacher, James A. Goeken, Pasquale A. Cancilla

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

A causal relationship between paraproteinemia and neuropathies has been suggested. We studied three patients with chronic sensorimotor polyneuropathy associated with plasma cell dyscrasia and monoclonal gammopathies (IgGK, IgMK, IgAX). Sural nerve biopsies showed mild (2 cases) to moderate loss of myelinated fibers (1 case). Teased single fiber studies showed segmental dcmyelination-remyelination in two patients. Direct immunofluorescence demonstrated immune deposits of the myelin sheath of the same specificity as the serum paraprotein, IgGK (1 of 3 cases). Treatment with prednisone, melphalan or chlorambucil, and plasmapheresis resulted in remission (1 case), partial improvement (1 case), or had no effect (1 case), although reduction of monoclonal immunoglobulin occurred in all. To investigate the role the paraproteins might play in the pathogenesis of the neuropathy, patients' serum was injected intraneurally into rat sciatic nerves. None of the animals developed weakness, slowing of in vitro conduction of sciatic nerve, or significant evidence of dcmyclination by light- or electron-microscopy or teased single fiber studies 48 hours postinjeetion. Similar injections of rabbit serum with experimental allergic neuritis (EAN) produced focal segmental dcmyclination. Our studies employing an in vivo bioassay technique failed to establish antimyelin activity of monoclonal immunoglobulin sera.

Original languageEnglish (US)
Pages (from-to)446-459
Number of pages14
JournalJournal of Neuropathology and Experimental Neurology
Volume41
Issue number4
DOIs
StatePublished - Jul 1982

    Fingerprint

Keywords

  • Intraneural injections
  • Monoclonal gammopathy
  • Peripheral neuropathy

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Neurology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience

Cite this