The role of auto-antibodies and paraproteinemia in polyneuropathy

Polyneuropathy associated with IgM monoclonal gammopathy is a predominantly sensory, slowly progressive neuropathy for which treatment options are limited. In about 10% of patients antibodies against gangliosides or ganglioside complexes can be found. These antibodies do not always arise from a monoclonal B cell population. Different anti-ganglioside antibody specificities are associated with different clinical phenotypes. IL-6 and IL-10 serum concentrations differ between patients with neuropathy and controls and between those with or without anti-MAG antibodies. For both patients with anti-MAG or anti-ganglioside antibodies Fcγ-receptor polymorphisms may predict the response to treatment with rituximab, a monoclonal therapeutic antibody against CD20. Careful selection of patients for treatment with rituximab is necessary as it may lead to paradoxical deteriotation of the neuropathy during treatment.