Vial

INDIVIDUAL TEST 220

Hu (ANNA-1) antibodies

Indication Suspicion of paraneoplastic syndrome. 

Method Immunoblot and indirect immunofluorescence (IIF). 

According to guidelines, anti-neuronal antibodies should be detected by at least two independent methods. At Wieslab IIF and immunoblot are used. According to European guidelines, a positive result should be obtained with both methods to be reliable.  

Result
Serum: The result is reported as negative, borderline or positive with a IIF titer and blot intensity
CSF: The result is reported as negative, borderline or positive 

Interpretation Antibodies against Hu are also called ANNA-1 (anti-neuron-specific cell nuclear antibodies) and occur in paraneoplastic subacute sensory neuronopathy and/or paraneoplastic encephalomyelitis. The antibody prevalence is strongly associated to small cell lung cancer but can also be seen in other tumor types (e.g. breast cancer, Hodgkin's lymphoma, melanoma, ovarian cancer, testicular cancer, thymoma). Neurological symptoms can precede cancer diagnosis by up to 5 year. 

Antibodies against Hu are graded as High-risk antibodies with a frequency of 85% of underlying cancer and a positive result yield 3 points PNS score, according to Updated Diagnostic Criteria for Paraneoplastic Neurologic Syndromes. 

References 
  • Lancaster E, Martinez-Hernandez E, Dalmau J. Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology. 2011 Jul 12;77(2):179-89. PMID: 21747075 
  • Balint B, Vincent A, Meinck HM, Irani SR, Bhatia KP. Movement disorders with neuronal antibodies: syndromic approach, genetic parallels and pathophysiology. Brain. 2018 Jan 1;141(1):13-36. PMID: 29053777 
  • Graus F, et al. Updated Diagnostic Criteria for Paraneoplastic Neurologic Syndromes. Neurol Neuroimmunol Neuroinflamm. 2021 May 18;8(4):e1014. PMID: 34006622 
  • Garza M, Piquet AL. Update in Autoimmune Movement Disorders: Newly Described Antigen Targets in Autoimmune and Paraneoplastic Cerebellar Ataxia. Front Neurol. 2021 Aug 18;12:683048. PMID: 34489848 

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Vial

ENSKILD ANALYS 220

Hu (ANNA-1) -antikroppar

Indikation Misstanke om paraneoplastiska syndrom. 

Metod Immunoblot samt indirekt immunofluorescens (IIF).  

Enligt riktlinjer ska anti-neuronala antikroppar detekteras med minst två oberoende metoder. På Wieslab används IIF och immunoblot. Enligt europeiska riktlinjer ska positivt resultat uppnås med båda metoderna för att vara tillförlitligt.  

Svar
Serum: Resultatet anges som negativt, gränsvärde eller positivt med IIF titer och blot intensitet. 
Likvor: Resultatet anges som negativt, gränsvärde eller positivt. 

Tolkning Antikroppar mot Hu kallas också ANNA-1 (anti-neuronspecifika cell nukleära antikroppar) och förekommer vid paraneoplastisk subakut sensorisk neuronopati och/eller paraneoplastisk encephalomyelit. Antikropparnas förekomst är starkt kopplat till småcellig lungcancer men kan även ses vid andra tumörformer (bröstcancer, Hodgkins lymfom, malignt melanom, ovariecancer, testikelcancer, thymom). Neurologiska symtom kan föregå cancerdiagnosen med upp till 5 år. 

Antikropparna riktade mot Hu bedöms vara High-risk antibodies med en förekomst på 85% för en underliggande cancer och positivitet ger 3 poäng i PNS score enligt Updated Diagnostic Criteria for Paraneoplastic Neurologic Syndromes. 

Referenser 
  • Lancaster E, Martinez-Hernandez E, Dalmau J. Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology. 2011 Jul 12;77(2):179-89. PMID: 21747075 
  • Balint B, Vincent A, Meinck HM, Irani SR, Bhatia KP. Movement disorders with neuronal antibodies: syndromic approach, genetic parallels and pathophysiology. Brain. 2018 Jan 1;141(1):13-36. PMID: 29053777 
  • Graus F, et al. Updated Diagnostic Criteria for Paraneoplastic Neurologic Syndromes. Neurol Neuroimmunol Neuroinflamm. 2021 May 18;8(4):e1014. PMID: 34006622 
  • Garza M, Piquet AL. Update in Autoimmune Movement Disorders: Newly Described Antigen Targets in Autoimmune and Paraneoplastic Cerebellar Ataxia. Front Neurol. 2021 Aug 18;12:683048. PMID: 34489848 

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