The detection of activated cerebrospinal fluid B lymphocytes by peroxidase conjugated antibodies

Analysis of cerebrospinal fluid cell populations with monoclonal antibodies

Sixty-five samples of cerebrospinal fluid (CSF) were evaluated using an automated cytoflow method with the CD-Sapphire hematology analyzer in order to investigate possible relationships between cell population patterns and diagnostic groups and better understand the biology of neurological disease. A basic panel of CD markers, including CD3/4/8/19/138/HLA-DR, was used to analyze CSF samples from clinical and laboratory confirmed cases of multiple sclerosis, neuroborreliosis, viral and bacterial neuroinfective diseases, malignant infiltrations of meninges and scavenger macrophagic reactions of the central nervous system. The principles of immune response and the contribution of cytological 'disease-related patterns' for these nosological entities are described. The distinct patterns of lymphocyte subpopulations in neuroborreliosis appear to be characteristic and could possibly serve as diagnostic indicators. Further verification and research will be necessary to clarify the significance and nature of CD4+ CD8+ positive subset in cerebrospinal fluid.

Flow cytometric analysis of lymphocytes in cerebrospinal fluid in patients with tick-borne encephalitis

INTRODUCTION

Cerebrospinal fluid (CSF) lymphocyte subsets were examined by flow cytometry in 33 patients with tick-borne encephalitis (TBE) in order to determine their values.

PATIENTS AND METHODS

Lymphocytes were isolated from CSF and lymphocyte subsets were determined: lymphocytes T (CD3+), lymphocytes B (CD19+), NK cells (CD3-CD56+), helper T cells (CD3+CD4+) and cytotoxic T cells (CD3+CD8+). The expression of IL-2 receptors (CD25+) and transferrin receptors (CD71+) on T cells and HLA-DR molecules on T cell subsets was examined. Furthermore, possible relationships among different TBE patient population variables (gender, age, severity of disease, duration of meningitis) were considered.

RESULTS

The analyses of the CSF lymphocyte population subsets are presented. Lymphocytes T (CD3+) were significantly higher in the CSF than in the peripheral blood as was the case with the T cells that expressed transferrin receptors (CD71). Lymphocytes B (CD19+) and NK cells (CD3-CD56+) prevailed in the peripheral blood. In the early course of the disease, a higher expression of HLA-DR molecules on T lymphocytes was observed, while later a higher expression of IL-2 receptors (CD25+) was observed.

DISCUSSION

Significant differences in lymphocyte subsets between the CSF and the peripheral blood were found. Significant time-dependent changes of CSF lymphocyte subsets during course of infection were observed. The results of the present study give us deeper insight into CNS cellular immunopathogenic mechanisms in patients with TBE.

The proliferation rate of T and B lymphocytes in cerebrospinal fluid

An immunocytochemical method is presented by which individual proliferating T and B lymphocytes can be detected in the cerebrospinal fluid (CSF) of patients with inflammatory and neoplastic diseases of the central nervous system. The absolute numbers of proliferating T and B lymphocytes were approximately equal, so that only a minority of the strongly prevailing T-cell population proliferates in the CSF during the immune process. The highest proliferation (25.7%) was found within the small subset of activated, i.e. cytoplasmic immunoglobulin-containing, B lymphocytes. This provides further evidence that these cells are not the terminally differentiated plasma cells of classical cytology but progenitor cells capable of further proliferation. B-cell lymphomas could be easily identified. The detection of abnormally proliferating cell subsets could help in the differentiation of opportunistic infection from leukaemic infiltration.

Class differentiation of immunoglobulin-containing cerebrospinal fluid cells in inflammatory diseases of the central nervous system

An immunocytochemical technique allowing repeated use of antisera is applied to identify immunoglobulin-containing cells (ICC) of the IgG, IgA, and IgM class in the cerebrospinal fluid (CSF) of 298 patients with various neurological disorders. The demonstration of ICC in the CSF is highly indicative of an inflammatory disease (p less than 0.0001; Chi-square test). In the group of noninflammatory disorders ICC are only found in three cases of lymphomas, two dysgerminomas, and one glioblastoma. ICC of all classes are seen in acute viral and bacterial infections of the CNS including tick-borne meningopolyneuritis Bannwarth. IgG-positive ICC predominate in chronic inflammatory disorders like multiple sclerosis and HIV encephalitis. In HIV-positive patients IgA- or IgM-positive cells are strongly indicative of an opportunistic infection of the brain. Persistent high levels of ICC in three patients with bacterial meningitis are associated with a fatal outcome.

Demonstration of zoster virus antibodies in cerebrospinal fluid cells

A method is presented that allows the immunocytochemical detection of varicella zoster virus antigen-binding cerebrospinal fluid cells in zoster ganglionitis. Antigen-binding cells were found only in patients suffering from this disease. The technique is sensitive, specific, inexpensive and relatively fast, and is potentially applicable to other inflammatory central nervous system diseases with immunoglobulin-containing cells (ICC) in CSF. The detection of antigen-binding CSF cells may represent a very early diagnostic test comparable with the early IgM antibodies of the systemic immune response.

Immunocytochemical analysis of immunoglobulin-containing cells in CSF and blood in inflammatory disorders of the central nervous system

Cells containing immunoglobulins G, A, and M were evaluated in paired cerebrospinal fluid (CSF) and peripheral blood (PB) samples. These were obtained from 12 patients with bacterial meningitis, 14 patients with viral meningitis, 6 cases of lymphocytic meningoradiculitis (LMR), 10 cases of multiple sclerosis (MS), 6 cases of herpes zoster ganglionitis and 27 patients with non-infectious disorders of the CNS. PB cells from 20 healthy donors served as controls. Using alkaline phosphatase (AP)-conjugated antibodies to human immunoglobulin (Ig) G, A, and M in a carrageenan solution it was possible to demonstrate repeatedly intracytoplasmic Igs over more than 1 year without any detectable loss of specificity and staining intensity. Immunoglobulin-containing cells (ICC) could be detected in the CSF of 96% of patients with inflammatory diseases of the central nervous system (CNS) or with MS but not in the control cases.

Scanning electron microscopy of the subarachnoid space in the dog: inflammatory response after injection of defibrinated chicken erythrocytes

The leptomeningeal reaction and the cerebrospinal fluid reaction of the canine inflammatory response were investigated concurrently. One-half milliliter cerebrospinal fluid (CSF) was withdrawn from the cisterna magna of 17 anesthetized mongrel dogs and analyzed. Using this same spinal tap, control and experimental animals were injected with 0.5 ml sterile saline and 0.5 ml defibrinated chicken erythrocytes, respectively. A second spinal tap was performed 2 to 168 hr later. The CSF from the first spinal tap contained less than 1 WBC/mm3. The cell population was unchanged in the second spinal tap of control animals. In experimental animals, the WBC population increased more than 100-fold by 24 hr. Polymorphonuclear cells (PMNs) appeared in the CSF first, followed by lymphocytes and monocytes. Injected erythrocytes seemed trapped in the subarachnoid space (SAS), especially in the inner sheet of the arachnoid mater. The leptomeninges had a substantial increase in free cells without fibrosis. Pial and leptomeningeal cells of the arachnoid trabeculae appeared swollen. Two hours after injection, chicken erythrocytes were phagocytosed by pial cells, macrophages, and free cells adherent to the leptomeninges. The epiplexus cell populations for saline-control and erythrocyte-experimental animals were similar, suggesting that the choroid plexuses were not a gateway for PMN, lymphocyte, or monocyte infusion into the SAS.

Diagnostic significance of IgG-synthesizing activated B cells in acute inflammatory diseases of the central nervous system

An immunohistological technique was used to identify activated, i.e. IgG-synthesizing, B cells in cerebrospinal fluid. A total of 177 patients suffering from inflammatory diseases of the central nervous system were investigated. Activated B cells were found in 61% of patients with bacterial meningitis, especially in lethal or prolonged cases. The number of activated B lymphocytes was low in most cases of viral meningitis, whereas in tick-borne meningopolyneuritis Bannwarth, a very strong B cell activation was detectable. In all inflammatory diseases investigated, the B cell response was restricted to the mononuclear phase. Comparing the number of activated B cells and the amount of locally synthesized IgG, there was a loose correlation between these inflammation parameters in meningopolyneuritis Bannwarth. In acute viral and bacterial meningitis more than 50% of the patients exhibited activated B cells without any detectable intrathecal IgG synthesis.

OKT8-binding lymphocytes in diseases of the nervous system

OKT8-binding lymphocytes, which consist mainly of suppressor-cytotoxic T cells, were demonstrated in blood and CSF by an immunochemical method. In patients with non-inflammatory diseases, the mean value was 18% in blood and 19% in CSF. In acute viral infections of the CNS, on the other hand, the percentage was significantly lower in the initial days of the disease but then increased up to the 5th week. Eleven patients suffering from multiple sclerosis had similar percentages of OKT8-binding cells, whether or not they had acute symptoms.

Immunoglobulin-producing cells in CSF and blood from patients with multiple sclerosis and other inflammatory neurological diseases enumerated by protein-A plaque assay

Using the Protein-A plaque assay, numbers of IgG + IgA + IgM producing cells determined in patients with multiple sclerosis (MS) were 0.1-5% in CSF and 0.1-0.7% in peripheral blood; interestingly, 7 of 11 MS patients had IgM producing cells in CSF. In patients with aseptic meningitis (AM), the corresponding values were 0.04-7.5% in CSF and 0.4-2.4% in peripheral blood. There were more Ig producing cells in peripheral blood from patients with AM and MS than in healthy subjects. A correlation between numbers of IgG producing cells in CSF and the concentrations of intrathecally produced IgG (CSF IgG index) was registered in patients with AM; the same was the true for IgA. The Protein-A plaque method, adopted for 20 X 10(3) lymphocytes, makes possible enumeration of Ig-producing cells in CSF and discrimination among cells secreting different Ig classes, thereby being a powerful tool for studying immune reactions in the CNS-CSF compartment.