Neurology

Anti–DNER (Tr) Antibodies

Test details

Paraneoplastic neurological syndromes (PNS) are immune-mediated neurological disorders that occur in association with cancer and are often supported by the presence of specific neuronal autoantibodies.

Neuronal autoantibodies are classified as high-, intermediate-, or low-risk for paraneoplastic aetiology. The high-risk group (cancer association >70%) typically recognises intracellular antigens and is not directly pathogenic. The tumour type depends on patient demographics and on the specific autoantibody identified.

 

Two naming conventions are used: one based on the index patient’s initials (e.g., Hu) and another describing the immunohistochemical staining pattern (e.g., ANNA = anti-neuronal nuclear antibodies).

 

DNER (Tr) antibodies are markers of autoimmune neuronal disease such as rapidly progressive cerebellar syndrome, with an association with Hodgkin lymphoma of ~90%.

 

For PNS with a high risk of underlying tumour, autoantibody testing should be performed using at least two independent methods.

Sample type

Serum, EDTA plasma, heparin plasma, citrate plasma, CSF

Method

Immunoblot, IFA cells

Preparation

Fasting for at least 8-12 hours before sampling

Storage conditions

Refer to the Health Service Charter to check storage conditions

Shipping

+2/+8°C

References

Graus F, Vogrig A, Muñiz-Castrillo S, Antoine JG, Desestret V, Dubey D, Giometto B, Irani SR, Joubert B, Leypoldt F, McKeon A, Prüss H, Psimaras D, Thomas L, Titulaer MJ, Vedeler CA, Verschuuren JJ, Dalmau J, Honnorat J. Updated Diagnostic Criteria for Paraneoplastic Neurologic Syndromes. Neurol Neuroimmunol Neuroinflamm. 2021 May 18;8(4):e1014. doi: 10.1212/NXI.0000000000001014. PMID: 34006622; PMCID: PMC8237398.

de Graaff E, Maat P, Hulsenboom E, van den Berg R, van den Bent M, Demmers J, Lugtenburg PJ, Hoogenraad CC, Sillevis Smitt P. Identification of delta/notch-like epidermal growth factor-related receptor as the Tr antigen in paraneoplastic cerebellar degeneration. Ann Neurol. 2012 Jun;71(6):815-24. doi: 10.1002/ana.23550. Epub 2012 Mar 23. PMID: 22447725.

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