Antineural antibody activity is the implicated pathogenic mechanism in polyneuropathy associated with monoclonal gammopathy. Recognition of antigen depends on immunoglobulin variable regions, encoded by V genes. We studied VHDJH and VLJL gene use in monoclonal B cells by clonal analysis in 20 patients with polyneuropathy and IgM monoclonal gammopathy. V genes associated with bacterial responses appear over-represented and VH3-23 was preferentially used, without association with specific D, JH or VLJL. V genes revealed somatic mutation and intraclonal variation was found in 9 of 20 patients. Polyneuropathy associated with monoclonal gammopathy may be caused by an immune response to bacterial antigens, which recruit somatically mutated autoreactive B cells.

Anti-MAG, Antiganglioside, Monoclonal gammopathy, Polyneuropathy, V gene analysis,
Journal of Neuroimmunology
Department of Neurology

Eurelings, M, Notermans, N.C, Lokhorst, H.M, van Kessel, B, Jacobs, B.C, Wokke, J.H.J, … Bloem, A. (2006). Immunoglobulin gene analysis in polyneuropathy associated with IgM monoclonal gammopathy. Journal of Neuroimmunology, 175(1-2), 152–159. doi:10.1016/j.jneuroim.2006.02.008