Summary
A set of observations made on a patient with IgMλ monoclonal gammopathy and neuropathy implicate humoral immunity in the pathogenesis of the neuropathy.
A sural nerve biopsy from the patient showed a characteristic increase in the width of the intraperiod lines. Deposits of μ-heavy chains and λ-light chains were found in myelin sheaths of the nerve biopsy. Immunohistochemically, it was demonstrated that μ-heavy chains and λ-light chains from the patient's serum bound to myelin sheaths of normal peripheral nerves and to a lesser extent to myelin sheaths in the central nervous system (CNS). By immunoblots it was demonstrated that μ-heavy chains and λ-light chains from the patient's serum bound to myelin associated glycoprotein but to no other antigens from the peripheral and central nervous systems. γ and α heavy chains and ϰ light chains from the patient's serum were also shown to bind to myelin-associated glycoprotein but not as distinctly as the μ and λ chains. It is postulated that the monoclonal gammopathy may have arisen on the background of polyclonal autoimmune attack directed against myelin-assoiated glycoprotein.
Similar content being viewed by others
References
Besinger JA, Toyka KV, Anzil AP, Fateh-Moghadam A, Rauscher R, Heininger K (1981) Myeloma neuropathy: Passive transfer from man to mouse. Science 213:1027–1030
Bornstein MB, Raine CS (1976) The initial structural lesion in seruminduced demyelination in vitro Lab Invest 35:391–401
Braun PE, Frail DE, Latov N (1982) Myelin-associated glycoprotein is the antigen for a monoclonal IgM in polyneuropathy. J Neurochem 39:1261–1265
Davison C, Basler BH (1937) Myeloma and its neural complication. Arch Surg 35:913
Eichner ER (1980) The plasma cells dyscrasias: Diverse presentations, pathophysiology and management. Postgrad Med 67:44–58
Fairbanks G, Steck TL, Wallach DH (1971) Electrophoretic analysis of the major polypeptides of the human erythrocyte membrane. Biochemistry 10:2606–2607
Fossmann O, Bjorkman G, Hollander A, England N-E (1973) IgM producing lymphocytes in peripheral nerve in a patient with benign monoclonal gammopathy. Scand J Haematol 11:332–335
Guilbert B, Dighiero G, Avrameas S (1982) Naturally-occurring antibodies against nine common antigens in human sera. I. Detection, isolation and characterization. J Immunol 128:1982
Hirano A, Cook SD, Whitaker JN, Dowling PC, Murry MR (1971) Fine structural aspects of demyelination in vitro. The effects of Guillain-Barre serum. J Neuropathol Exp Neurol 30:249–265
Hsu SM, Raine L (1981) Protein A, avidin and biotin immunohistochemistry. J Histochem Cytochem 29:1349–1353
Julien J, Vital C, Vallat JM, Lagueny A, Deminiere C, Jarriet D (1978) Polyneuropathy in Waldenstrom's macroglobulinemia: a deposition of M-component on myelin sheaths. Arch Neurol 35:423–425
Lampert PW (1967) Electromicroscopic studies in ordinary and hyperacute experimental allergic encephalomyelitis. Acta Neuropathol (Berl) 4:99–126
Latov N, Sherman WH, Nemni R, Galassi G, Shuong JS, Penn AS, Chess L, Olarte M, Rowland LP, Osserman EF (1980) Plasmacell dyscrasia and peripheral neuropathy with monoclonal antibody to peripheral nerve myelin. N Engl J Med 303:618–621
Latov N, Gross RB, Kastelman J, Flanagan T, Lamme S, Alkatitis DA, Olarte M, Sherman WH, Chess L, Penn AS (1981a) Complement-fixing antiperipheral nerve myelin antibodies in patients with inflammatory polyneuritis and polyneuropathy and paraproteinemia. Neurology 31:1530–1534
Latov N, Braun PE, Gross RB, Sherman WH, Penn AS, Chess L (1981b) Plasma cell dyscrasia and peripheral neuropathy: identification of the myelin antigens that react with human paraproteins. Proc Natl Acad Sci 78:7139–7142
Mendell JR, Sahenk Z, Whitaker JN, Pittman G (1982) Monoclonal IgM and peripheral neuropathy: studies on passive transfer and antibody characterization. Neurology 32:183 [Abstract]
Propp RP, Means E, Deibel K, Sherer G, Barron K (1975) Waldenström's macroglobulinemia and neuropathy: deposition of M-component on myelin sheaths. Neurology (Minn) 25:980–988
Raine CS, Bornstein MB (1979) Experimental allergic neuritis. Ultrastructure of serum-induced myelin aberrations in peripheral nervous system cultures. Lab Invest 40:423–432
Sato S, Quarles RH, Brady RO (1982) Susceptibility of the myelinassociated glycoprotein and basic protein to neutral protease in highly purified myelin from human and rat brain. J Neurochem 39:97–105
Stefansson K, Marton L, Roos RP, Helgason C, Yu R, Antel JP, Arnason BGW (1982) Heterogeneity of neuropathies accompanying monoclonal gammopathies. Ann Neurol 12:107
Sternberger LA (1979) Immunocytochemistry. Wiley, New York, pp 24–50
Sternberger NH, Quarles RH, Itoyama Y, Webster Henry DeF (1979) Myelin-associated glycoprotein demonstrated immunocytochemically in myelin and myelin-forming cells of developing rat. Proc Natl Acad Sci (USA) 76:1510–1514
Trapp BD, Quarles RH (1982) Presence of the myelin-associated glycoprotein correlates with alterations in the periodicity of peripheral myelin. J Cell Biol 92:877–882
Viktor M, Banker BQ, Adams RD (1958) The neuropathy of multiple myeloma. J Neurol Neurosurg Psychiat 21:73–78
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Stefansson, K., Marton, L., Antel, J.P. et al. Neuropathy accompanying IgMλ monoclonal gammopathy. Acta Neuropathol 59, 255–261 (1983). https://doi.org/10.1007/BF00691490
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00691490