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Test ID: GM1B Ganglioside Antibody Panel, Serum

Reporting Name

Ganglioside Ab Panel, S

Useful For

Supporting the diagnosis of an autoimmune neuropathy

Clinical Information

Neuropathy patients have variable sensory disturbance (loss or exaggerated sensation including with pain), weakness and autonomic involvements (sweat abnormalities, gastrointestinal dysfunction, and lightheadedness on standing). These symptoms are a result of injury to the distal nerves, roots, and ganglia or their gathering points (nerve plexus in the thighs and arms). Patients may have symmetric or asymmetric involvements of the extremities, trunk, and head including extraocular muscles. Subacute onsets and asymmetric involvements favor inflammatory or immune causes over inherited or metabolic forms. Depending on the specific inflammatory or immune mediated causes other parts of the nervous system may also be affected (brain, cerebellum, spinal cord). Nerve conductions and needle electromyography can help to classify the neuropathy as either: 1) primary axonal; 2) primary demyelinating; or 3) mixed axonal and demyelinating.

 

Among the immune-mediated peripheral neuropathies, autoantibodies to gangliosides represent an important class of noncancer-associated autoimmune peripheral neuropathies. Gangliosides are glycosphingolipids that contain sialic acid and are present in many cell types most abundantly within neural tissues along their linings (myelin). Depending on the specific ganglioside autoantibody found and the antibody titer, in the appropriate clinical context, these findings may be supportive of a specific clinical diagnosis and may also be prognostic for treatment response.(1,2)

 

Specifically, in multifocal motor neuropathy (MMN) and multifocal acquired demyelinating sensory and motor (MADSAM) neuropathy, also known as Lewis-Sumner syndrome or multifocal chronic immune demyelinating polyradiculoneuropathy (CIDP), the presence ganglioside autoantibodies, particularly high-titer GM1-IgM autoantibodies, maybe supportive of the diagnosis in the correct clinical context. Furthermore, ganglioside seropositivity has been associated with favorable response to immunotherapy amongst patients suspected to have MMN during the initial clinical evaluation.(1)

 

Additionally, the presence of ganglioside antibodies may support a diagnosis of Guillain-Barre syndrome (GBS) in the appropriate clinical context.(3) GBS is one class of autoimmune peripheral neuropathies, and comprises a spectrum of disorders including acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy, and acute motor and sensory axonal neuropathy. This class of autoimmune neuropathies is generally characterized by an acute onset. Although the diagnosis of these disorders is dependent on clinical evaluation and electrophysiologic studies, assessment of ganglioside antibodies can further support the diagnosis.

Interpretation

High titers (>1:8,000) favor the diagnosis of multifocal motor neuropathy (MMN) and multifocal acquired demyelinating sensory and motor (MADSAM) over motor neuron disease. About 30% to 50% of patients with these clinical syndromes or the pure motor variant of chronic inflammatory demyelinating polyneuropathy have ganglioside autoantibodies. High-antibody titers appear to be a specific, but not sensitive, marker of those related disorders.

Profile Information

Test ID Reporting Name Available Separately Always Performed
IGG_M IgG Monos. GM1 No Yes
IGM_M IgM Monos. GM1 No Yes
IGG_A IgG Asialo. GM1 No Yes
IGM_A IgM Asialo. GM1 No Yes
IGG_D IgG Disialo. GD1b No Yes
IGM_D IgM Disialo. GD1b No Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
IGMTS IgG Monos GM1 Titer, S No No
IMMTS IgM Monos GM1 Titer, S No No
IGATS IgG Asialo GM1 Titer, S No No
IMATS IgM Asialo GM1 Titer, S No No
IGDTS IgG Disialo GD1b Titer, S No No
IMDTS IgM Disialo GD1b Titer, S No No

Testing Algorithm

Screening tests are performed for IgG and IgM antibodies to GM1 and GD1b. If positive, the appropriate titer will be performed at an additional charge.

 

See Ganglioside Antibody Panel Algorithm in Special Instructions.

Analytic Time

5 days

Day(s) and Time(s) Performed

Monday, Thursday; 12 p.m.

Clinical Reference

1. Martinez JM, Snyder MR, Ettore M, et al: Composite ganglioside autoantibodies and immune treatment response in MMN and MADSAM. Muscle Nerve 2018;57:1000-1005 doi: 10.1002/mus.26051 2. Taylor BV, Gross L, Windebank AJ: The sensitivity and specificity of anti-GM1 antibody testing. Neurology 1996;47:951-955

3. Kaida K, Ariga T, Yu RK: Antiganglioside antibodies and their pathophysiological effects on Guillain-Barre syndrome and related disorders-a review. Glycobiology 2009;19:676-692 doi: 10.1093/glycob/cwp027

Method Name

Enzyme-Linked Immunosorbent Assay (ELISA)

Specimen Type

Serum


Specimen Required


Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Specimen Volume: 1 mL


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 28 days
  Frozen  28 days
  Ambient  72 hours

Reference Values

Profile Information:

IGG_M: Negative

IGM_M: Negative

IGG_A: Negative

IGM_A: Negative

IGG_D: Negative

IGM_D: Negative

 

Reflex Information:

IGMTS: <1:2000

IMMTS: <1:4000

IGATS: <1:16000

IMATS: <1:8000

IGDTS: <1:2000

IMDTS: <1:2000

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

83516 x 6

83520 x 6 (if applicable)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
GM1B Ganglioside Ab Panel, S 82455-7

 

Result ID Test Result Name Result LOINC Value
4414 IgG Asialo. GM1 63212-5
4416 IgG Disialo. GD1b 94868-7
4412 IgG Monos. GM1 63243-0
4415 IgM Asialo. GM1 63384-2
4417 IgM Disialo. GD1b 94870-3
4413 IgM Monos. GM1 63247-1

Forms

If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.

Mayo Clinic Laboratories | Neurology Catalog Additional Information:

mml-Neuromuscular