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Axonal neuropathy in a patient with IgM M-protein reactive with nerve endoneuriurn

From the Departments of Neurology (Drs. Freddo and Latov), Neuropathology (Dr. Hays), and Medicine (Dr. Sherman), Columbia University, College of Physicians and Surgeons, New York, NY.

IgM M-proteins have been found in patients with axonal neuropathies, but it is not known whether these M-proteins bind to nerve components or actually cause the neuropathy. In one patient with axonal neuropathy studied, the IgM M-protein bound to chondroitin sulfate, and there were deposits of IgM in the endoneurium of the patient's nerve. A monoclonal anti-idiotype antibody generated against that M-protein was used to study the binding of the M-protein to normal nerve and to distinguish it from binding of other IgM species that might be present in the patient's serum. In immunofluorescence studies, the M-protein bound to the endoneurium in normal nerve and to connective tissue in other organs. In immunoblot studies, the M-protein bound to several protein bands in nerve and other tissues. The data suggest that the M-protein bound to mucopolysac-charides in nerve endoneurium and connective tissue.

Address correspondence and reprint requests to Dr. Latov, Department of Neurology, Columbia University, College of Physicians and Surgeons, 630 West l68th Street, New York, NY 10032.

Supported by grants NS18016 and NS00659 from the National Institutes of Health and by grants from the Muscular Dystrophy Association. Dr. Lorenza Freddo is a visiting fellow from the Department of Neurology, University of Padova, Italy, and is supported by a fellowship from the Muscular Dystrophy Association.

Accepted for publication December 7, 1984.

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