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Test Code LAB1889 Ganglioside Antibody Panel, Serum

Additional Codes

 

Test Name in EPIC EPIC Test Code Mnemonic Mayo Test ID
GANGLIOSIDE AB PANEL, S LAB1889 GANGP GM1B

 

Reporting Name

Ganglioside Ab Panel, S

Useful For

Supporting diagnosis of neurological diseases-primarily motor neuron disease and motor neuropathies

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

Method Name

Quantitative Enzyme-Linked Immunosorbent Assay (ELISA)

Performing Laboratory

Mayo Medical Laboratories in Rochester

Specimen Type

Serum


Specimen Required


Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Specimen Volume: 1 mL


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Frozen (preferred) 14 days
  Refrigerated  14 days

Reject Due To

Hemolysis

Mild OK; Gross reject

Lipemia

Mild OK; Gross reject

Icterus

Mild OK; Gross OK

Other

NA

Reference Values

99% of Normals Fall at or Below This Titer

IgG monosialo GM1

1:500

IgM monosialo GM1

1:1,000

IgG asialo GM1

1:4,000

IgM asialo GM1

1:4,000

IgG disialo GD1b

1:1,000

IgM disialo GD1b

1:1,000

 

Borderline Ranges

IgG monosialo GM1

=1:1,000

IgM monosialo GM1

=1:2,000

IgG asialo GM1

=1:8,000

IgM asialo GM1

No borderline range (normal: ≤4,000)

IgG disialo GD1b

No borderline range (normal: ≤1,000)

IgM disialo GD1b

No borderline range (normal: ≤1,000)

 

Abnormal Results

IgG monosialo GM1

>1:1,000

IgM monosialo GM1

>1:2,000

IgG asialo GM1

>1:8,000

IgM asialo GM1

>1:4,000

IgG disialo GD1b

>1:1,000

IgM disialo GD1b

>1:1,000

Day(s) and Time(s) Performed

Tuesday, Thursday; 3 p.m.

CPT Code Information

83516 x 6

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 46969-2
4416 IgG Disialo. GD1b 13662-2
4412 IgG Monos. GM1 43240-1
4415 IgM Asialo. GM1 43179-1
4417 IgM Disialo. GD1b 13661-4
4413 IgM Monos. GM1 43241-9
4418 Comment 48767-8

Analytic Time

3 days

Cautions

Titer values of 1:250 to 1:2,000 (modest elevations) are found in 5% of patients with motor neuron disease.

 

Patients with amyotrophic lateral sclerosis may have modest elevations of antiganglioside antibody titer.  

 

High titers have been found only in patients with multifocal motor neuron neuropathy.

Method Description

Anti-ganglioside antibodies in serum are detected by enzyme-linked immunosorbent assays (ELISA). Ganglioside antigens (GM1, asialo GM1, and GD1b) adsorbed to wells of ELISA plates are incubated with patient’s serum or controls. The plates are washed and alkaline phosphatase conjugated anti-human IgG or IgM are added in a second incubation. The wash step is repeated and enzyme substrate is added. Absorbance is measured and results are expressed as antibody titer, ie, the greatest dilution at which the absorbance of wells that contain patient’s serum is >2.0 times the mean absorbance of normal sera tested simultaneously.(Taylor BV, Gross L, Windebank AJ: The sensitivity and specificity of anti-GM1 antibody testing. Neurology 1996 October;47:951-955)

Interpretation

High titers (>1:2,000) have been found only in patients with multifocal motor neuropathy and not with motor neuron disease. About 30% to 50% of patients with these clinical syndromes or the pure motor variant of chronic inflammatory demyelinating polyneuropathy have increased antibody titers. Increased antibody titers, therefore, appear to be a specific but not sensitive marker of those related disorders.

 

Borderline elevation of titers against ganglioside epitopes may be seen in patients with motor neuron disease or motor neuropathy

 

For IgG and IgM antibodies directed against monosialo GM1 and disialo GD1b, 99% of 182 age- and sex-stratified normal individuals had titers <1:1,000; 99% of 121 patients with well-defined motor neuron disease had titers <1:2,000; and all patients with titers >1:2,000 had motor neuropathy.

Specimen Retention Time

Negatives - 1 week ; Positives - 6 months

Clinical Information

Peripheral neuropathies are a group of disorders that results from lesions on peripheral nerves. Patients with a peripheral neuropathy can have symptoms of weakness, sensory loss, and/or autonomic dysfunction. The causes of acquired peripheral neuropathies are varied, and include vitamin deficiencies, metabolic abnormalities, infections, malignancies (paraneoplastic disorders), and autoimmune diseases. A subset of the autoimmune-mediated peripheral neuropathies is associated with the presence of circulating autoantibodies that bind to specific gangliosides. Gangliosides are glycosphingolipids that contain sialic acid residues. Although present in the plasma membranes of many cell types, gangliosides are particularly abundant in neural tissue.

 

Guillain-Barre syndrome 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 based significantly on clinical evaluation and electrophysiologic studies, assessment of ganglioside antibodies, particularly against GM1, asialo GM1, and GD1b, can provide useful information. It is thought that the Guillain-Barre syndrome disorders are triggered by an infection, which results in production of infection-associated lipooligosaccharide-specific antibodies. These antibodies subsequently bind to endogenous gangliosides, due to molecular mimicry, which leads to immune-mediate damage to the peripheral nerves, ultimately resulting in the clinical symptoms associated with the disorders.(1)

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.

Forms

If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen (http://www.mayomedicallaboratories.com/it-mmfiles/neurology-request-form.pdf)