Cerebrospinal fluid immunoglobulin

Ernerudh, J., Olsson, T, Lindstrom, R, and Skogh, T, Cerebrospinal fluid immunoglobulins abnormalities in systemic lupus erythematosus. J. Neurol. Neurosurg. Psychiatry 48, 807-813 (1985). 

KIO. Kostic, A., VujoSevic, M., Svirtlih, N., and Kanjuh, B., Cerebrospinal fluid immunoglobulins in acute aseptic meningitis and meningoencephaUtis. Period. Biol. 81, 477-480 (1979). 

Immunoglobulin G index The ratio of immunoglobulin G to protein in the serum or cerebrospinal fluid. 

Oligoclonal bands Two to five bands of immunoglobulins on protein electrophoresis of cerebrospinal fluid. 

Immunoglobulins in the Cerebrospinal Fluid (CSF) of Patients with Burkitt s Lymphoma ... 

The calculated intrathecal synthesis of IgG based on Reiber s formula is more precise in its latest version (see the recommended literature) and is recommended for the examination of cerebrospinal fluid in many countries. Physiological values for this formula are negative or equal to zero (software used for this purpose is able to recognize this). Negative values are considered to be equal to zero. Positive values indicate evidence of intrathecal synthesis of immunoglobulins (F3, R7). 

Although the examination of total protein in cerebrospinal fluid is quite valuable, it is necessary to mention that this parameter does not provide exact information on the function of the blood-CSF barrier. This is easy to understand. The increased concentration of total protein in cerebrospinal fluid can be based both on the failure of the barrier with a subsequent increase in the concentration of albumin and of other proteins originating from serum and on a more significant intrathecal synthesis of immunoglobulins, especially in levels of IgG. 

Antithrombin HI in cerebrospinal fluid can be easily denoted as an inflammatory marker. Correlations with levels of immunoglobulins, their intrathecal oligo-clonal synthesis, complement components, and acute-phase reactants confirm such concepts. Correlations with apolipoproteins and with the presence of lipophagic macrophages in cytological preparations confirm the elevation of CSF AT III levels when a destructive lesion of the CNS is present. 

The most characteristic abnormality in patients with multiple sclerosis is certainly the intrathecal synthesis of IgG. It can be demonstrated—with different sensitivity— by various methods, which can be divided into qualitative and quantitative methods. The gold standard for the demonstration of intrathecal synthesis of IgG is the detection of oligoclonal bands, which are not present in CSF, in the appropriately diluted serum (i.e., to the same concentration of IgG) by isoelectric focusing. This is a qualitative method and the description of its different modifications and interpretations goes beyond the scope of this chapter. This method is by far the most sensitive, and its sensitivity is reported between 90 and 100%. Here it is suitable to repeat that the detection of plasmocytic forms in cerebrospinal fluid may also be regarded as qualitative proof of intrathecal synthesis of immunoglobulins— although in this case the proof is obviously not specific for IgG from the theoretical point of view. 

In patients with multiple sclerosis, a qualitative cytological examination should always be carried out. Besides the finding of plasmocytic forms, which are considered to be one of the proofs of intrathecal synthesis of immunoglobulins, this examination also provides invaluable information concerning the reaction of the monocyte-macrophage system in the CSF compartment. It should be noted on the scope of biochemical examinations of cerebrospinal fluid in multiple sclerosis that it is most important to return to the simple and inexpensive method. 

Changes of immunoglobulin concentrations in cerebrospinal fluid are very common. In neuroborreliosis the increase occurs very frequently in the IgM class, for which it is possible (using Reiber s formula) to demonstrate the presence of intrathecal synthesis. 

We investigated 53 samples of cerebrospinal fluid (CSF) in patients with neuroborreliosis. The clinical diagnosis of neuroborreliosis was confirmed by positive antibody titers and intrathecal synthesis of immunoglobulins in CSF examined in the IgM and IgG classes by the EFISA method or Western blot or confirmed by direct detection by PCR. 

C6. Christenson, R. H., Russell, M. E., and Hassett, B. J., Cerebrospinal fluid Electrophoresis and methods for determining immunoglobulin G compared. Clin. Biochem. 11,429-432 (1989). 

Spence, A. M., Immunoglobulins in cerebrospinal fluid in multiple sclerosis. Hurru Pathol. 14, 99-103 (1983). 

Staugaitis, S. M., Shapshak, R, Tourtellotte, W. W., etal. Isoelectric focusing of unconcentrated cerebrospinal fluid Applications to ultrasensitive analysis of oligoclonal immunoglobulin G. Electrophoresis 6, 287-291 (1985). 

T4. Tourtellotte, W. W., Tavolato, B., Parker, J. A., and Cotniso, P, Cerebrospinal fluid electroimmunodiffusion. An easy, rapid, sensitive, and valid method for the simultaneous determination of immunoglobulin G and albumin. Arch. Neurol. 25, 345-350 (1971). 

IgG Immunoglobulin G is present in lymph fluid, blood, cerebrospinal fluid and peritoneal fluid. It is composed of 2 y chains of 50 kDa and 2 L chains (k or ) of 25 kDa with a total molecular weight of 150 kDa. The functions of IgG include agglutination and formation of precipitate, passage through placenta and thus conferring immunity to fetus, opsonization, antibody-dependent cell-mediated cytotoxicity (ADCC), activation of complement, neutralization of toxins, immobilization of bacteria and neutralization of virus. 

The authors thought it unlikely that aseptic meningitis had been caused by an allergic reaction. They proposed that the mechanism of aseptic meningitis involved the entry of immunoglobulin molecules into the cerebrospinal fluid, causing an inflammatory reaction. 

Two children with idiopathic thrombocytopenic purpura developed aseptic meningitis after receiving intravenous immunoglobulin 1 g/kg/day, with unusual large numbers of leukocytes in the cerebrospinal fluid (62). 

Obando I, Duran I, Martin-Rosa L, Cano JM, Garcia-Martin FJ. Aseptic meningitis due to administration of intravenous immunoglobulin with an unusually high number of leukocytes in cerebrospinal fluid. Pediatr Emerg Care 2002 18(6) 429-32. 

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