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傍腫瘍性神経症候群(PNS)は腫瘍の遠隔効果を原因とする神経症候群の総称である。PNSに関連する神経由来抗原と腫瘍抗原を標的とした抗神経抗体が多数同定されている。抗神経抗体は免疫学的機序と治療反応の観点から,神経細胞内抗原に対する抗体と神経細胞表面抗原に対する抗体に大別される。今後も新規抗神経抗体が発見される可能性が高く,PNSの免疫学的機序と治療開発の両面で期待の持てるステージに到達しつつある。
Abstract
Paraneoplastic neurological syndromes (PNS) are caused by immune responses against neuronal antigens expressed by the tumor. Based on the immunological pathomechanisms and responsiveness of treatments, onconeuronal antibodies are divided into two categories: 1) antibodies against neural intracellular antigens and 2) antibodies against neuronal surface or synaptic antigens. The recent discovery of onconeuronal antibodies have radically changed concepts of CNS autoimmunity, including PNS. The recognition of PNS provides a foundation for the early detection of underlying tumors and initiations of prompt treatments, which can result in substantial improvement. We here review the characteristic onconeuronal antibodies, including anti-Hu, anti-Ma2, and anti-N-methyl-D-aspartate receptor, and discuss the algorithm for the diagnosis of PNS.
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