PERIPHERAL NEUROPATHY ASSOCIATED WITH MONOCLONAL IGM ANTI-PR2 COLD AGGLUTININS

A patient with a chronic, large fibre sensory neuropathy had an immuno globulin Mlambda monoclonal paraprotein reactive at titres in excess o f 1/10(5) with NeuNAc(alpha2-8)NeuNAc(alpha2-3)Gal configured disialos yl groups present on the gangliosides GD1b, GT1b, GQ1b, and GD3. The p araprotein showed weaker reactivity with GD1a, GM3, and LM1 but no rea ctivity with GM2, GM1, or asialo-GM1. In addition, the paraprotein had cold agglutinating activity with anti-Pr2 specificity, Pr2 being an a ntigenic determinant on membrane glycoproteins or glycolipids in eryth rocytes or both. A large fibre sensory neuropathy with monoclonal anti -disialosyl antibodies is an increasingly recognised form of paraprote inaemic neuropathy.