Neuromuscular

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NEUROMUSCULAR CLINICAL LABORATORY

Contact Information
Address
  MSC 8111-0009-04
  660 South Euclid Avenue
  St. Louis, MO 63110
Phones
  Test Questions: 314-362-2406
  Billing-Financial: 314-273-2009
Fax: 314-362-3413
e-mail
  Tests: nmlab@wustl.edu
  Billing: nllabbilling@wustl.edu

Laboratory certifications
    CAP Lab # 19233-16
    Medicare Provider # 26-8235
    CLIA Certificate # 26D0652044
    New York State 3499
    California COS 00800679
    Florida 800028650
    Pennsylvania 37448
    CDC
Testing at Washington University
  Laboratory: Specific tests
  Requisition forms & Information
    Serum (Antibody & Antigen)
      Sending samples: Instructions
    Biopsies: Muscle, Nerve & Skin
      Muscle instructions
        Freezing; Other
      Nerve instructions
        General; Surgery;
        Freezing; Other technical
      Skin instructions

Antibodies
  General principles
  Classification
  Binding to oligosaccharides
    Glycoproteins & Glycolipids
  Specific types
  Testing methods
  Survey
Instructions for: Sending
  Antibody tests
, or
  Biopsies: Muscle or Nerve
Phone: 314-362-2406



Charcot's clinic
Charcot's clinic


Testing at Washington University Neuromuscular Laboratory


Antibodies
Muscle biopsies
Nerve biopsies
Neuromuscular Pathology Training Program

LAB TESTING IN NEUROMUSCULAR DISORDERS
Antibodies Biopsies WU Testing
IgM
  Decorin (BJ)
  Disaccharides
    NS6S
    TS-HDS
  Glycolipids
    GalC
    GalNAc-GD1a
    GALOP
    GD1a
    GD1b
    GM1
    GM1b
    GM2
    NP9
    SGPG
    Sulfatide
  Heparan sulfate
  MAG
  Neurofascin-155
  Neurofilaments
  Tubulin
IgG
  Acetylcholine receptors
    Muscle
    Neuronal (α3)
    Other
  NMJ
    LRP4
    MuSK
  Channels
    Calcium
    Potassium complex
      Lgi1
      Caspr2
  Paranodal
    Caspr
    Contactin-1
    Neurofascins
      140; 155
  Cortactin

  CRMP-5
  DPPX
  FGFR-3
  FHL1
  GAD
  Glutamate, Glycine &
    GABA Receptor

  Glycolipids
    GalC
    GM1
    GD1a
    GalNAc-GD1a
    Disialosyl
      GD1b
      GQ1b
      GT1a
    Lysoganglioside-GM1
    Sulfatide
  Mitochondria

  Myopathy
    HMGCR
    Jo-1
    MDA5
    Muscle striations
    NT5C1A
    Ro
  Myositis
  MPP1
  Neuronal glia
    SOX1
  Neuronal nuclei
    Hu
    Ri
  Plexin D1
  Purkinje cells
    PCA-2
    Tr
    Yo
Antibodies: General
Testing methods
CNS-related
Connective tissue disorders
  Myositis-associated
  Myositis-overlap
  Other antibodies
  Vasculitis
Diabetes
M-proteins
Myopathies
Myositis
Neuropathies
NMJ disorders
  Myasthenia Gravis
  LEMS
Oligosaccharide antigens
Paraneoplastic
Stiffman
Transglutaminase
Types
  Polyspecific IgM & IgG
  IgG4

Other Tests
Neurofilament Heavy Chain (CSF)
Neurofilament Light Chain (Serum)
Muscle

Nerve

Skin
Antibodies
  Requisition
  Instructions

Biopsies
  Requisition
Laboratory testing at Washington University, St. Louis

Neuromuscular Autoantibodies: Classification & Features

Antibody Antigen Disease
Class Location Type Pathogenic
properties
Features Antigen
Examples
Neuromuscular
Disease Examples
Associations,
Systemic
Common
treatments
IgG Serum Polyclonal Often Protein
  Cell surface
    membrane
Receptors: AChRs
  Muscle; Neuron
Ca++ ion channels
K+ channel complex
Myasthenia gravis
Autonomic PN
LEMS
Isaac's
Neoplasms
  Thymoma
  Adeno Ca
  Small cell lung
Corticosteroids
T-cell suppressants
IVIg
Plasma Exchange
IgG Serum Polyclonal Possible Carbohydrate
  Glycolipid
Gangliosides
  GM1
  GQ1b
  GD1b

AMAN
Miller-Fisher
Sensory, Acute
Infection,
    Prodromal
Disease often
    monophasic
IgG Serum Polyclonal Few Protein
  Intracellular
tRNA synthetases
SRP
ANCA
FGFR3
IMPP
Polymyopathy, immune
Vasculitis
Neuropathy, Sensory
Organ system
  disease, or
Neoplasm, or
None
Corticosteroids
T-cell suppressants
Rituximab
IgG Serum +
  CSF
Polyclonal No Protein
  Intracellular
Hu (Neuron nuclei)

CRMP5
Neuronopathy
  Sensory; Autonomic
Polyneuropathy
Neoplasms
  Small cell lung
  Gynecologic
Screen for & Treat
  associated Neoplasm
IgG4 Serum Polyclonal Possible Protein
  Cell surface, or
  Extracellular
MuSK
Neurofascins
  140
  155
Contactin-1
Lgi1
Caspr2
MG-MuSK
PN
  Sensory ataxia, subacute
  Demyel +: Tremor; CNS
Demyel PN: IVIg resistant
Encephalopathy ± PN
Neuromyotonia; Autonomic
None Rituximab (q 1-6 mo)
Corticosteroids
IgM Serum Monoclonal
  or
Polyclonal
Possible Carbohydrate
  Glycolipid or
  Glycoproteins
Protein
GM1
MAG
TS-HDS
GD1b

Neurofascin-155
Motor PN
Demyelinating PN
Sensory PN
Sensory PN, Ataxic

SM-PN, Demyel + Tremor
Neoplasms
  M-protein
No
Rituximab (IgM ↓)
Intravenous Ig
  (Conduction block)
Cyclophosphamide

Intravenous Ig
IgM, IgG,
  or IgA
Serum Monoclonal Some Not identified Polyneuropathy POEMS
Cryoglobulins
Waldenström's
Radiate; Chemo; Stem cell

Rituximab; Chemo

Print

AUTOANTIBODIES AND IMMUNE POLYNEUROPATHIES

Introduction

AUTOANTIBODIES with BINDING TO OLIGOSACCHARIDES:
  Glycoproteins or Glycolipids

GalNAc-GD1a ganglioside
GALOP antigen
GD1b ganglioside
GD1a ganglioside
GD3 ganglioside
GM1 ganglioside
    Co-GM1; GM1; NP-9
GM1b ganglioside
GM2 ganglioside
GQ1b ganglioside
GT1a ganglioside
Heparan sulfate
Lysoganglioside-GM1
MAG
NS6S
SGPG
Sulfatide
    GALOP antigen
TS-HDS

Anti-GM1 Ganglioside Antibodies

Galβ1-3GalNAcβ1-4Galβ1-4Glcβ1-1'Ceramide
                  3
                  |
           Neu5Acα2
GM1 ganglioside
Galβ1-3GalNAcβ1-4Galβ1-X
                  3
                  |
           Neu5Acα2
Target epitope: GM1


Anti-GM1 antibodies: Clinical associations Testing for anti-GM1 antibodies

Anti-Sulfatide antibodies

SO4-3Galactose-X
Target epitope: Sulfatide


Anti-MAG antibodies

SO4-3Glucuronate-X
Target epitope: MAG & SGPG

Anti-SGPG antibodies

SO4-3GlcAβ1-3Galβ1-4GlcNAcβ1-3Galβ1-4Glcβ1-1'Ceramide
SGPG
SO4-3Glucuronate-X
Target epitope: SGPG & MAG

Anti-GQ1b & GT1a antibodies

                Galβ1-3GalNAcβ1-4Galβ1-X
                 3                3
                 |                |
Neu5Acα2-8Neu5Acα2                |
                 Neu5Acα2-8Neu5Acα2
Target epitope: GQ1b
                Galβ1-3GalNAcβ1-4Galβ1-X
                 3                3
                 |                |
Neu5Acα2-8Neu5Acα2                |
                           Neu5Acα2
Target epitope: GT1a


Anti-GD1b antibodies

Galβ1-3GalNAcβ1-4Galβ1-4Glcβ1-1'Ceramide
                  3
                  |
 Neu5Acα2-8Neu5Acα2
GD1b ganglioside
             Y-4Galβ1-X
                 3
                 |
Neu5Acα2-8Neu5Acα2
Target epitope: GD1b

Anti-GM1b antibodies

      Galβ1-3GalNAcβ1-4Galβ1-4Glcβ1-1'Ceramide
       3                
       |                
Neu5Acα2
GM1b ganglioside

Anti-GD1a antibodies

      Galβ1-3GalNAcβ1-4Galβ1-4Glcβ1-1'Ceramide
       3                3
       |                |
Neu5Acα2         Neu5Acα2
GD1a ganglioside
      Galβ1-X
       3
       |
Neu5Acα2
Target epitope: GD1a

Anti-GalNAc-GD1a & GM2 ganglioside antibodies

GalNAcβ1-4Galβ1-X
           3
           |
    Neu5Acα2
Target epitope:
  GalNAc-GD1a and GM2

Anti-Galactocerebroside (GalC) antibodies 39

Gal-Ceramide
Galactocerebroside

Anti-Heparan Sulfate antibodies



GALOP Syndrome


Anti-Decorin (BJ) antibodies


OTHER NEUROLOGICAL- or NEUROPATHY-ASSOCIATED AUTOANTIBODIES



Anti-Tubulin Antibodies



Anti-Hu antibodies



Anti-Yo antibodies, IgG



Lysoganglioside-GM1 (Lyso-GM1) antibodies



M-phase phosphoprotein-1 (Mphosph1; MPP1 ) antibodies 36



Polyspecific antibodies



Polyneuropathies associated with serum M-proteins



DETECTION OF ANTIBODIES: METHODOLOGIES

General principles

Enzyme-linked immunosorbent assays (ELISA)
Immunocytochemistry
Immunofixation
Thin layer chromatography (TLC)
Western blot



Antibody Testing Methods: General Principles



ELISA Methods



Western Blotting Methods



Immunocytochemical Methods


Thin Layer Chromatography Methods


Immunofixation Electrophoresis Methods



Sydenham chorea


CNS Syndrome Antibodies


Alan Pestronk MD: Neuromuscular Pathology Certification


Muscle pathology



Nerve Pathology



Neuromuscular Pathology



Neuromuscular Pathology Training Program



Neuromuscular Laboratory Certifications

Print


College of American Pathologists (CAP)



CLIA



New York





California


Pennsylvania



Return to Neuromuscular Home Page

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2/26/2024