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Huang X, Ying S, Luo L, Li L, Li D, Xie Y. Intrathecal immunoglobin synthesis and its role in patients with neurosyphilis. Front Public Health 2022; 10:1008595. [PMID: 36419997 PMCID: PMC9677103 DOI: 10.3389/fpubh.2022.1008595] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022] Open
Abstract
Background Intrathecal protein synthesis (ITS) occurs in various central nervous system disorders, but few quantitative studies have focused on ITS for neurosyphilis (NS) in southwestern China. We made a study to quantitatively assess the ITS in patients with NS and to investigate the association between ITS and the stages of NS. Methods CSF-serum specimen pairs from 142 patients (66 NS and 76 non-NS/syphilis) were collected for routine CSF and serum tests. The NS group was divided into slight and severe subgroups according to the NS stages. Three formulas for the quantitative determination of the intrathecal synthesis were calculated to characterize the specimens, including the Ig index (QIg/Qalb), Ig extended index (Ig_EI), and intrathecally synthesized fraction (IgIF) using the hyperbolic function. The role of QTPPA/QIgG as an antibody index (AI = Q specific Ig/QIgG) was also explored. Results Sero_TRUST titres (1:16, 1:1-1:256), sero_TPPA titres (1:163840, 1:1280-1:1310720), total protein (MTP), and CSF_Igs (p < 0.05) were found to be significantly elevated in the NS group. Intrathecal Ig synthesis can be identified using all three formulas in the NS group. The pattern of Ig intrathecal synthesis was IgIF-G (48.62%) > IgIF-A = IgIF-M (p < 0.05), with the dominant intrathecal fraction being IgG (median, 48.62%), which was also verified by QIgG> Qalb> QIgM = QIgA. In the slight NS group, the intrathecal fractions of IgM (>0 in 4 out of 20 cases) and IgG (>0 in 16 out of 20) were lower than the intrathecal fractions of IgM (>0 in 19 out of 35 cases) and IgG (>0 in 33 out of 38) in the severe group (p < 0.05). The area under the curve (AUC) of the CSF_TPPA antibody index was 0.867 (0.792, 0.922), with an optimal cutoff point of 0.81, providing a sensitivity of 88.91% and specificity of 84.62%. Conclusion Although the intrathecal synthesis pattern is IgG dominant in patients with NS, brain-derived IgM and IgA can also be found. Moreover, intrathecal IgM and IgG were associated with a parenchymatous type of neurosyphilis. Syphilis-specific antibodies are a new potential tool for NS diagnosis.
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Affiliation(s)
- Xiyue Huang
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shanshan Ying
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China,Department of Laboratory Medicine, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Lan Luo
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lixin Li
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Dongdong Li
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Dongdong Li
| | - Yi Xie
- Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
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Prognostic value of intrathecal IgM synthesis determined by various laboratory methods in patients with early multiple sclerosis - a prospective observational study. Mult Scler Relat Disord 2022; 63:103847. [DOI: 10.1016/j.msard.2022.103847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 02/06/2023]
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Zeman D, Kušnierová P, Všianský F, Reguliová K, Škutová M, Woznicová I, Zapletalová O, Hradílek P. Cerebrospinal fluid oligoclonal IgM test in routine practice: Comparison with quantitative assessment of intrathecal IgM synthesis. Clin Chim Acta 2020; 508:137-145. [PMID: 32416174 DOI: 10.1016/j.cca.2020.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intrathecal IgM synthesis demonstrated either as cerebrospinal fluid (CSF)-restricted oligoclonal (o-) IgM bands or calculated using various formulas has been linked to more aggressive multiple sclerosis (MS) course. However, the proportion of MS patients showing intrathecal IgM synthesis varies largely between studies. We aimed to explore the relation between different formulas and results of o-IgM, and to assess the frequency of o-IgM bands in an unselected series of samples. METHODS 432 samples were analyzed for o-IgM, o-IgG and quantitative measures of IgM and IgG synthesis. IgM index and formulas of Reiber, Auer and Öhman were compared to the result of the o-IgM test. RESULTS At the cut-off commonly used, the non-linear formulas for intrathecal synthesis were specific (>94%) but rather insensitive (<40% even at a cut-off of 4 CSF-restricted bands) compared to o-IgM. No significant difference was noted in the performance of different formulas. At a cut-off of 4 bands, 61% of MS patients, but none of the controls were positive for o-IgM. CONCLUSIONS Formulas for intrathecal IgM synthesis are insensitive compared to o-IgM. We propose to evaluate samples with 2 or 3 extra-CSF IgM bands as borderline and only samples with 4 or more as definitely positive.
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Affiliation(s)
- David Zeman
- Institute of Laboratory Diagnostics, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Dept. of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.
| | - Pavlína Kušnierová
- Institute of Laboratory Diagnostics, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Dept. of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - František Všianský
- Institute of Laboratory Diagnostics, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Katarína Reguliová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Monika Škutová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Ivana Woznicová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Olga Zapletalová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Dept. of Neurology and Psychiatry, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Pavel Hradílek
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
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Vrethem M, Fernlund I, Ernerudh J, Ohman S. Prognostic value of cerebrospinal fluid IgA and IgG in multiple sclerosis. Mult Scler 2016; 10:469-71. [PMID: 15327048 DOI: 10.1191/1352458504ms1052sr] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IgA antibodies do not activate complement and may compete with and protect against myelin degradation caused by IgM and IgG in multiple sclerosis (MS). We retrospectively evaluated cerebrospinal fluid (CSF) IgA and IgG (as indices and extended indices) from 1980 to 1988 in 68 patients with definitive MS. Sixty-one of them had survived since the time of sampling (11- 19 years). IgA Extended Index was significantly higher for surviving patients (median 0.65) than for the dead patients (median 0.33). CSF IgA or IgG indices did not correlate with disability, walking distance, or time from onset of symptoms to the need of walking aid. The retrospective experimental design allowed an unusually long follow-up time, but it also had the disadvantages of such a study. Thus the results warrant a prospective study to verify the prognostic vale of CSF IgA in MS.
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Affiliation(s)
- Magnus Vrethem
- Divisions of Neurology and Neurophysiology, Department of Neuroscience and Locomotion, Linköping University Hospital, S-581 85 Linköping, Sweden.
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Sellebjerg F, Christiansen M, Rasmussen LS, Jaliachvili I, Nielsen PM, Frederiksen JL. The cerebrospinal fluid in multiple sclerosis. Quantitative assessment of intrathecal immunoglobulin synthesis by empirical formulae. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1996.tb00272.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pupo-Antúnez M, Dorta-Contreras AJ, Vazquez Y, González-Hernández M, Noris-García E, Padilla-Docal B, Bu-Coifiu-Fanego R. Detection of intrathecal IgM, IgG and IgA in a Cuban West Nile virus confirmed case. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:572-4. [PMID: 18813726 DOI: 10.1590/s0004-282x2008000400030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Maritza Pupo-Antúnez
- Tropical Medicine Institute Pedro Kourí, Facultad de Ciencias Médicas Dr. Miguel Enríquez, Habana, Cuba.
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Mturi N, Keir G, MacLennan C, Ross A, Willis A, Elford B, Berkley J, Newton C. Cerebrospinal Fluid Studies in Kenyan Children with Severe Falciparum Malaria. THE OPEN TROPICAL MEDICINE JOURNAL 2008; 1:56-62. [PMID: 20396606 PMCID: PMC2854806 DOI: 10.2174/1874315300801010056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The pathogenesis of the neurological complications of Plasmodium falciparum malaria is unclear. We measured proteins and amino acids in paired plasma and cerebrospinal fluid (CSF) samples in children with severe falciparum malaria, to assess the integrity of the blood brain barrier (BBB), and look for evidence of intrathecal synthesis of immunoglobulins, excitotoxins and brain damage. METHODS: Proteins of different molecular sizes and immunoglobulins were measured in paired CSF and plasma samples in children with falciparum malaria and either impaired consciousness, prostrate, or seizures. RESULTS: The ratio of CSF to plasma albumin (Q(alb)) exceeded the reference values in 42 (51%) children. The CSF concentrations of the excitotoxic amino acid aspartate and many non-polar amino acids, except alanine, were above the reference value, despite normal plasma concentrations. IgM concentrations were elevated in 21 (46%) and the IgM index was raised in 22 (52%). Identical IgG oligoclonal bands were found in 9 (35%), but only one patient had an increase in the CSF IgG without a concomitant increase in plasma indicating intrathecal synthesis of IgG. CONCLUSIONS: This study indicates that the BBB is mildly impaired in some children with severe falciparum malaria, and this impairment is not confined to cerebral malaria, but also occurs in children with prostrate malaria and to a lesser extent the children with malaria and seizures. There is evidence of intrathecal synthesis of immunoglobulins in children with malaria, but this requires further investigation. This finding, together with raised level of excitotoxic amino acid aspartate could contribute to the pathogenesis of neurological complications in malaria.
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Affiliation(s)
- N. Mturi
- Kenya Medical Research Institute, Centre for Geographic Medicine Research (Coast), P. O. Box 230, Kilifi, Kenya
| | - G. Keir
- Department of Neuroimmunology, Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - C.A. MacLennan
- MRC Centre for Immune Regulation, Division of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - A. Ross
- Kenya Medical Research Institute, Centre for Geographic Medicine Research (Coast), P. O. Box 230, Kilifi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, The John Radcliffe Hospital, Oxford OX3 9DY, UK
- Swiss Tropical Institute, Socinstrasse 57, CH-4002 Basel, Switzerland
| | - A.C. Willis
- MRC Immunochemistry Unit, Biochemistry, University of Oxford, Oxford, UK
| | - B.C. Elford
- Molecular Parasitology Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford OX3 9DS, UK
| | - J.A Berkley
- Kenya Medical Research Institute, Centre for Geographic Medicine Research (Coast), P. O. Box 230, Kilifi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, The John Radcliffe Hospital, Oxford OX3 9DY, UK
| | - C.R.J.C Newton
- Kenya Medical Research Institute, Centre for Geographic Medicine Research (Coast), P. O. Box 230, Kilifi, Kenya
- Clinical research Unit, London School of Hygiene and Tropical Medicine, London, UK
- Neurosciences Unit, Institute of Child Health, University College London, The Wolfson Centre, Mecklenburgh Square, London, WC1N 2AP, UK
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Deisenhammer F, Bartos A, Egg R, Gilhus NE, Giovannoni G, Rauer S, Sellebjerg F. Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force. Eur J Neurol 2006; 13:913-22. [PMID: 16930354 DOI: 10.1111/j.1468-1331.2006.01493.x] [Citation(s) in RCA: 221] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A great variety of neurological diseases require investigation of cerebrospinal fluid (CSF) to prove the diagnosis or to rule out relevant differential diagnoses. The objectives were to evaluate the theoretical background and provide guidelines for clinical use in routine CSF analysis including total protein, albumin, immunoglobulins, glucose, lactate, cell count, cytological staining, and investigation of infectious CSF. The methods included a Systematic Medline search for the above-mentioned variables and review of appropriate publications by one or more of the task force members. Grading of evidence and recommendations was based on consensus by all task force members. It is recommended that CSF should be analysed immediately after collection. If storage is needed 12 ml of CSF should be partitioned into three to four sterile tubes. Albumin CSF/serum ratio (Qalb) should be preferred to total protein measurement and normal upper limits should be related to patients' age. Elevated Qalb is a non-specific finding but occurs mainly in bacterial, cryptococcal, and tuberculous meningitis, leptomingeal metastases as well as acute and chronic demyelinating polyneuropathies. Pathological decrease of the CSF/serum glucose ratio or increased lactate concentration indicates bacterial or fungal meningitis or leptomeningeal metastases. Intrathecal immunoglobulin G synthesis is best demonstrated by isoelectric focusing followed by specific staining. Cellular morphology (cytological staining) should be evaluated whenever pleocytosis is found or leptomeningeal metastases or pathological bleeding is suspected. Computed tomography-negative intrathecal bleeding should be investigated by bilirubin detection.
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Affiliation(s)
- F Deisenhammer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Bisser S, Lejon V, Preux PM, Bouteille B, Stanghellini A, Jauberteau MO, Büscher P, Dumas M. Blood-cerebrospinal fluid barrier and intrathecal immunoglobulins compared to field diagnosis of central nervous system involvement in sleeping sickness. J Neurol Sci 2002; 193:127-35. [PMID: 11790393 DOI: 10.1016/s0022-510x(01)00655-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Diagnosis of central nervous system (CNS) involvement in sleeping sickness is crucial in order to give an appropriate treatment regimen. Neurological symptoms occur late, therefore field diagnosis is based on white blood cell count, total protein concentration and presence of trypanosomes in cerebrospinal fluid (CSF). More sensitive and specific parameters are now available. Blood-CSF barrier (B-CSFB) dysfunction, intrathecal total and specific immunoglobulin synthesis were evaluated in 95 patients with and without obvious meningoencephalitis, and compared to field criteria.B-CSFB dysfunction is a rather late event in the course of CNS involvement and correlates with the presence of trypanosomes, neurological signs and intrathecal polyspecific and specific immune response. IgM intrathecal response and particularly IgM antibody index are early markers of CNS invasion. We showed that 29% of patients with CSF abnormalities but without trypanosome detection in the field had no neuro-immunological response. In contrast, patients with normal CSF according to field diagnosis showed an intrathecal immune response in 31% of the cases.Field diagnosis can therefore fail to determine neurological involvement but can also provide false positive results. Improved criteria including B-CSFB dysfunction and IgM detection are needed in order to provide an adapted treatment regimen.
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Affiliation(s)
- S Bisser
- Institut d'Epidémiologie Neurologique et de Neurologie Tropicale (EA3174), Faculté de Médecine, 2 rue du Docteur Raymond Marcland, 87025 Limoges Cédex, France.
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Sellebjerg F, Christiansen M, Nielsen PM, Frederiksen JL. Cerebrospinal fluid measures of disease activity in patients with multiple sclerosis. Mult Scler 1998; 4:475-9. [PMID: 9987755 DOI: 10.1177/135245859800400603] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The potential of magnetic resonance imaging to serve as a surrogate marker of disease activity in patients with multiple sclerosis (MS) is increasingly recognised. In contrast, the use of cerebrospinal fluid analysis has received less attention. We analysed the correlation between clinical data and cerebrospinal fluid parameters in 75 patients with acute optic neuritis (ON) as a possible first symptom of MS, as a symptom of clinically definite MS, and in patients with an attack of MS other than ON. The samples were obtained within 30 days from the onset of an exacerbation. The concentration of myelin basic protein (MBP) in cerebrospinal fluid was significantly correlated with the visual acuity in patients with ON and the Kurtzke EDSS score in patients with MS. The concentration of MBP in CSF also correlated positively with the CSF leukocyte count, intrathecal IgG synthesis, and the CSF-serum albumin concentration quotient. The concentration of MBP in CSF correlated negatively with intrathecal IgA synthesis. The results support the use of the concentration of MBP in CSF as a surrogate marker of disease activity during acute exacerbations of MS; the data also link the presence of MBP in CSF to neuroimmunological parameters.
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Affiliation(s)
- F Sellebjerg
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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Krakauer M, Schaldemose Nielsen H, Jensen J, Sellebjerg F. Intrathecal synthesis of free immunoglobulin light chains in multiple sclerosis. Acta Neurol Scand 1998; 98:161-5. [PMID: 9786611 DOI: 10.1111/j.1600-0404.1998.tb07287.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The detection of oligoclonal immunoglobulin free light chains (FLC) in the diagnosis of multiple sclerosis (MS) was compared to IgG isoelectric focusing. MATERIAL AND METHODS Cerebrospinal fluid and serum samples from 69 patients with possible first attacks of MS, 50 patients with clinically definite MS (CDMS), and 118 patients with other neurological diseases (OND) were analyzed. IgG and FLC oligoclonal bands were detected by isoelectric focusing and immunoperoxidase staining. RESULTS Intrathecal synthesis of IgG, kappa FLC, and lambda FLC oligoclonal bands, respectively, was seen in 92%, 92%, and 86% of MS patients; in 61%, 62%, and 64% of patients with possible first attacks of MS; and in 3%, 3%, and 8% of the patients with OND. In control patients without IgG synthesis intrathecal lambda FLC synthesis was more common than kappa FLC synthesis (P=0.03). CONCLUSION Kappa FLC detection proved as useful as IgG analysis for the laboratory diagnosis of MS whereas the presence of intrathecal lambda FLC synthesis was less specific.
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Affiliation(s)
- M Krakauer
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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Petersen AA, Sellebjerg F, Frederiksen J, Olesen J, Vejlsgaard GL. Soluble ICAM-1, demyelination, and inflammation in multiple sclerosis and acute optic neuritis. J Neuroimmunol 1998; 88:120-7. [PMID: 9688333 DOI: 10.1016/s0165-5728(98)00103-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We measured sICAM-1 in paired samples of serum and cerebrospinal fluid (CSF) from patients with an attack of multiple sclerosis (MS) (n = 50) and patients with acute monosymptomatic optic neuritis (ON) as a possible first attack of MS were also included (n = 25). Based on calculations of extended indices we found evidence of intrathecal synthesis of sICAM-1 both in patients with clinically definite MS and in patients with idiopathic ON compared to neurological control subjects. The amount of intrathecally synthesized sICAM-1 correlated significantly to the CSF leukocyte count and to the concentration of myelin basic protein in the CSF. The serum concentrations of sICAM-1 were not increased in patients with demyelinating disease compared to the neurological control subjects.
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Affiliation(s)
- A A Petersen
- Institute for Inflammation Research, IIR-RHIMA 7544, The National University Hospital, Rigshospitalet, Copenhagen, Denmark
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Sellebjerg F, Christiansen M, Garred P. MBP, anti-MBP and anti-PLP antibodies, and intrathecal complement activation in multiple sclerosis. Mult Scler 1998; 4:127-31. [PMID: 9762660 DOI: 10.1177/135245859800400307] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intrathecal immunoglobulin synthesis and activation of the complement cascade occurs in patients with multiple sclerosis (MS). The present study aimed at further studying the relation between intrathecal immunoglobulin synthesis and complement activation. We compared total intrathecal synthesis of IgA, IgG, and IgM, the number of cells secreting anti-myelin basic protein (MBP) and anti-proteolipid protein (PLP) antibodies of the IgG isotype and intrathecal activation of the complement cascade in patients with possible onset symptoms of MS (n = 18) or clinically definite MS (n = 30). Early activation of the complement cascade correlated with intrathecal synthesis of IgM. Intrathecal IgG, IgA and IgM synthesis also correlated weakly with the presence of cells secreting anti-MBP or anti-PLP autoantibodies. Full activation of the complement cascade did not correlate with any measures of intrathecal antibody synthesis. These findings suggest a complex relation between different immunoglobulin isotypes and complement activation which may have similarly complex roles in the pathogenesis of MS.
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Affiliation(s)
- F Sellebjerg
- MS Clinic Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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Günther G, Haglund M, Lindquist L, Sköldenberg B, Forsgren M. Intrathecal IgM, IgA and IgG antibody response in tick-borne encephalitis. Long-term follow-up related to clinical course and outcome. CLINICAL AND DIAGNOSTIC VIROLOGY 1997; 8:17-29. [PMID: 9248655 DOI: 10.1016/s0928-0197(97)00273-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Tick-borne encephalitis (TBE) of western subtype causes long-term morbidity and is considered a health problem in Scandinavia, eastern and central parts of Europe and Russia. The pathophysiology is not fully elucidated. As TBE RNA is rarely demonstrable in cerebrospinal fluid (CSF) the kinetics of the CSF antibody response to the disease has attracted attention. OBJECTIVES To investigate the intrathecal TBE-specific antibody response and to correlate its intensity and persistence to the clinical course. To compare indirect, commercially-based ELISA methods indexed against albumin ratio or IgG ratio with the capture ELISA method for the establishment of CSF response. STUDY DESIGN The specific IgM, IgG and IgA antibody responses in serum and CSF were analysed in 69 Swedish patients included in a prospective study of TBE from the acute phase up to 11-13 months after onset. RESULTS Antibody response by all three classes was demonstrable in serum and CSF. All methods were useful, but capture technique was the most sensitive and results were easiest to interpret. Peak IgM activity was seen early during the disease and persisted after 6 weeks. Maximum IgG levels were encountered in late convalescent samples (median 6 weeks). Intrathecal antibody production was demonstrable in nearly all patients: in 41% days 0-6, in 97% days 7-19, in 98% days 21-61 and-at lower levels-in 84% of the patients after 1 year (50/52 of CSF-serum sampled in the interval 11-61 days). Day 9 after onset, patients with dominating encephalitic symptoms showed significantly lower intrathecal IgM activity. The persistence of serum and CSF antibodies did not correlate to severity of disease. CONCLUSIONS Capture IgM and IgG assays were superior to indirect ELISA. Low early CSF IgM response correlated to encephalitic symptoms, otherwise the intensity and duration of intrathecal antibody response were of limited value for the prediction of clinical course and long-term outcome.
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Affiliation(s)
- G Günther
- Department of Infectious Diseases, Karolinska Institute, Danderyd Hospital, Sweden
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Ohman S, Ernerudh J, Roberg M, Forsberg P. Determination of total and herpes simplex virus specific monomeric and dimeric IgA in serum and cerebrospinal fluid by ultracentrifugation. Ann Clin Biochem 1995; 32 ( Pt 6):550-6. [PMID: 8579287 DOI: 10.1177/000456329503200606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
An improved method is described for differentiating between monomeric and dimeric total and herpes simplex virus (HSV) specific IgA by ultracentrifugation in sucrose gradient, using recovery and quantitative analysis of the fractions obtained. Calculation of monomeric and dimeric IgA was based on IgG as an internal standard. Intrathecally produced monomeric and dimeric IgA were judged by calculating IgA indices for each form. A new type of formula indicating relative over-production of dimeric compared with monomeric IgG (IgA dimeric-monomeric index) is suggested. The method was applied to serum and cerebrospinal fluid (CSF) from three patients with HSV encephalitis. The index for monomeric as well as dimeric IgA was high during the acute phase of the disease, indicating intrathecal synthesis of both molecular forms. One year after onset, there was no detectable HSV-specific IgA in CSF: both molecular forms, however, remained in serum. The amount of dimeric compared with monomeric IgA was high during the acute phase, and subsequently decreased after successful treatment. A new finding was the detection of HSV-specific IgA heavier than dimeric IgA in serum one year after onset of the disease. These components may be tetrameric IgA, or immune complexes containing IgA.
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Affiliation(s)
- S Ohman
- Department of Clinical Chemistry, Faculty of Health Sciences, University Hospital of Linköping, Sweden
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Ohman S, Ernerudh J, Forsberg P, Roberg M, Vrethem M. Lower values for immunoglobulin M in cerebrospinal fluid when sampled with an atraumatic Sprotte needle compared with conventional lumbar puncture. Ann Clin Biochem 1995; 32 ( Pt 2):210-2. [PMID: 7785952 DOI: 10.1177/000456329503200215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Immunoglobulin M (IgM) has a very low concentration in cerebrospinal fluid (CSF) compared with serum, and therefore determinations of IgM in CSF are highly sensitive to pre-analytical errors caused by contamination with serum or interstitial fluid. Capillary attraction causes a thin layer of liquid containing serum proteins to be formed inside a conventional (Quincke) needle during penetration of tissue. To investigate this source of pre-analytical error, 35 patients had lumbar punctures using a 22 G atraumatic (Sprotte) or 25 G conventional (Quincke) needle according to a randomized scheme, and the IgM concentrations in CSF and serum were determined. The CSF IgM concentrations for samples taken with a Sprotte needle were significantly lower than those taken with a Quincke needle (P < 0.05), whereas the corresponding serum IgM concentrations and CSF erythrocyte counts did not differ significantly. The difference indicates that CSF IgM concentrations determined after conventional sampling may be falsely increased by contamination. We conclude that IgM concentrations in CSF samples taken with the atraumatic technique are more accurate, and recommend the use of this technique when CSF IgM is to be determined.
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Affiliation(s)
- S Ohman
- Department of Clinical Chemistry, University Hospital of Linköping, Sweden
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Ohman S. Points of view concerning the diffusion theory for blood-CSF barrier function and dysfunction. J Neurol Sci 1994; 126:240-5. [PMID: 7853034 DOI: 10.1016/0022-510x(94)90282-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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