The basis of intra‐blood‐brain‐barrier IgG synthesis

Tourtellotte, Wallace W.; Staugaitis, Susan M.; Walsh, Michael J.; Shapshak, Paul; Baumhefner, Robert W.; Potvin, Alfred R.; Syndulko, Karl

doi:10.1002/ana.410170107

Cited by 103 publications

(26 citation statements)

References 27 publications

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“…O LCR é fiel sinalizador destas reações inflamatórias expressadas, entre outros sinais, pela eosinofilorraquia observada em 90% dos nossos casos e pela positividade das reações imunológicas específicas para esquistossomose podendo ser acompanhada de síntese intratecal de imunoglobulina G 13,29,30,31,33,36 .…”

Section: Resultsunclassified

Esquistossomose medular: análise de 80 casos

Peregrino

Puglia

Nobrega

et al. 2002

Arq. Neuro-Psiquiatr.

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RESUMO -O objetivo deste estudo é analisar dados clínicos e laboratoriais de 80 casos de esquistossomose medular (EM) que possam contribuir para melhorar o diagnóstico e tratamento dessa doença. Em 59 pacientes o estudo foi de maneira prospectiva, em 79 pacientes o diagnóstico foi catalogado como altamente provável, presuntivo, baseado em critérios clínico e laboratoriais. Em um paciente houve confirmação anatomo-patológica. Houve predominância do sexo masculino (63,7%), faixa etária entre 21 e 40 anos (63,7%), procedência nordestina (85%), trabalhador em construção civil (31,2%), esforço abdominal prévio (57,5%), início subagudo (61,2%), forma clínica mielorradiculítica e lesão no cone medular e cauda equina (72,5%). O estudo do líquido cefaloraquidiano mostrou pleocitose e taxas elevadas de proteínas em 100% dos casos, da gamaglobulina em 76.5%, positividade de reações imunológicas específicas (imunofluorescência e/ou ELISA) em 100% dos casos (titulo médio de 1/16 e 61u/dl, respectivamente). Costicosteróides e drogas esquistossomicidas foram administrados em todos os pacientes com evolução satisfatória em 80% dos casos. ABSTRACT -To outline through cinical-laboratorial analysis a profile of schistosomiasis of the spinal cord (SSC) that contributes to the diagnosis and treatment of this disease. 80 patients were studied (59 prospectively), and epidemiological, clinical,laboratorial, treatment and outcome data extracted. In 79 patients the diagnosis was presumptive and obeyed rigorous criteria. There was a predominance of male sex (68.7%), age group from 21 to 40 years (63.7%), Northeasterners (85%), building construction workers (31.2%), previous abdominal effort (57.5%), subacute beginning (61.2%), myeloradiculitis form and lesion in conus and cauda equina (72.5%). Cerebral spinal fluid showed lymphomononuclear pleocytosis and protein increase in 100% of the cases as well as gamma globulin in 76.5%, positiveness of immunofluorescence reaction and/or ELISA for schistosomiasis in 100% of the cases with average titles of 1/16 and 61 u/dl, respectively. Corticosteroids and antischistosomal drugs were given to all patients with a satisfactory outcome in 80% of the cases. We emphasize the importance of a precocious treatment to avoid irreversible deficits such as paraplegia or sexual impotence. PALAVRAS-CHAVE

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Section: Resultsunclassified

Esquistossomose medular: análise de 80 casos

Peregrino

Puglia

Nobrega

et al. 2002

Arq. Neuro-Psiquiatr.

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“…Intrathecal production of Ig can be documented in ‫ف‬ 90% of MS patients, as calculated by formulae dependent on relative concentrations of serum and CSF Ig (14). The CSF Ig shows restricted heterogeneity as determined by electrophoresis (oligoclonal bands).…”

Section: Introductionmentioning

confidence: 99%

Clonal expansion and somatic hypermutation of V(H) genes of B cells from cerebrospinal fluid in multiple sclerosis.

Qin¹,

Duquette²,

Zhang³

et al. 1998

J. Clin. Invest.

302

162

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“…In addition, if BBB damage is present, a common complication in long-standing MS, oligoclonal bands that may be present in the CSF can be obscured and lead to false negative results. 8 Nevertheless, because such a high percentage of patients with MS demonstrate oligoclonal bands upon CSF electrophoresis, this method can provide valuable information in support of a diagnosis of MS. Moreover, to avoid bias in the interpretation of the presence or absence of oligoclonal bands by electrophoretic methods, this decision should be made independently of the assessment of values for CSF indices.…”

Section: Csf Electrophoresis and The Identification Of Oligoclonal Bandsmentioning

confidence: 99%

“…These indices rely on the measurement of CSF and serum IgG and albumin concentrations and formulas ( Table 1) designed to provide values that represent the integrity of the BBB and the magnitude of intrathecal IgG synthesis. These formulas [7][8][9][10][11][12][13][14][15] have been developed to correct CSF IgG concentration for the contribution from serum, especially in cases where the BBB is significantly impaired or damaged, in order to determin the amount produced locally (or intrathecally) in the CNS. We focus here on only those formulas used in our institution.…”

Section: Csf Indicesmentioning

confidence: 99%

A Guide to the Interpretation of CSF Indices

Ziadie¹,

Wians²

2005

Laboratory Medicine

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Multiple sclerosis (MS) is a disorder of the central nervous system attributed to an autoimmune reaction against myelin protein.The most recent diagnostic criteria for MS combine clinical presentation, laboratory test data, and radiological findings.We review the laboratory tests that contribute to the diagnosis of MS, including identification of oligoclonal bands by cerebrospinal fluid (CSF) electrophoresis, quantification of CSF immunoglobulin G and albumin concentrations, and the interpretation of CSF indices.After reading this article, the reader should understand the novel pattern recognition guide as an aid in the interpretation of CSF indices. C Ch he em mi is st tr ry y e ex xa am m 2 20 05 50 02 2 questions and corresponding answer form are located after the CE update on p. 563. Multiple sclerosis is the most common of the demyelinating disorders and occurs in approximately 1/1,000 individuals in the United States population. 1 Moreover, MS is more prevalent in women and young adults. The diagnosis of MS is based on history and physical examination findings indicative of multiple demyelinating lesions of the CNS that occur separately in time and anatomic site. 2,3 However, due to its highly variable clinical presentation, additional evidence from neuroimaging and laboratory studies is often required to diagnose MS. The most recent diagnostic criteria for MS combine clinical presentation, laboratory test data, and radiological findings. 4 We review the laboratory tests that contribute to the diagnosis of MS, including identification of oligoclonal bands by CSF electrophoresis, quantification of CSF immunoglobulin G and albumin concentrations, the interpretation of CSF indices (ie, Albumin Index, IgG Index, IgG Synthesis Rate, and Local IgG Synthesis), and the use of a novel pattern recognition guide to aid in the interpretation of these indices. CE Update CSF Proteins and MSCerebrospinal fluid is an ultrafiltrate of plasma composed primarily of water, electrolytes, glucose, and protein. Although derived from the blood, the CSF is separated from it by an anatomic barrier -the "blood-brain barrier" (BBB) -that limits the exchange of substances between these 2 compartments (ie, the spinal canal and the bloodstream) and creates a protective environment around the CNS. Due to this limited exchange, the protein concentration of the CSF is relatively low (mg/dL quantities) compared to that of serum (g/dL quantities). When the BBB is intact (ie, undamaged by disease or trauma), the CSF concentration of its constituent proteins is inversely related to the protein's molecular weight and linearly related to the serum concentration of the protein. Therefore, albumin, a protein of relatively low molecular weight (~69 KDa) that constitutes nearly 50% of the total protein concentration in serum from healthy individuals, is the major protein found in the CSF of these individuals. Conditions (eg, autoimmune inflammatory disorders) that compromise the integrity of the BBB or those (eg, MS) that result in increased local s...

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The basis of intra‐blood‐brain‐barrier IgG synthesis

Cited by 103 publications

References 27 publications

Esquistossomose medular: análise de 80 casos

Esquistossomose medular: análise de 80 casos

Clonal expansion and somatic hypermutation of V(H) genes of B cells from cerebrospinal fluid in multiple sclerosis.

A Guide to the Interpretation of CSF Indices

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