Kappa/lambda ratios in IgG, IgA and IgM of cerebrospinal fluid and of sera in patients with multiple sclerosis

Kappa/lambda (kappa/lambda) ratios of each immunoglobulin, i.e. IgG, IgA and IgM in cerebrospinal fluid (CSF) and in sera of patients with multiple sclerosis (MS) were analysed by sandwich enzyme linked immunosorbent assay. In CSF kappa/lambda ratios of IgG of MS patients were significantly (p less than 0.05) higher than those of normal controls, whereas the values of IgA and IgM did not differ significantly from those of normal controls. In sera kappa/lambda ratios of IgG, IgA and IgM did not differ significantly from those of normal controls. Our results suggest that in MS patients abnormal kappa/lambda ratios are also restricted to IgG components in CSF, as oligoclonal IgG bands are.     

IgM- and IgD-bearing peripheral blood lymphocytes differentiate to IgM but not IgG or IgA immunoglobulin-secreting cells

Human peripheral blood mononuclear cells were depleted of surface IgM⁺ or IgD⁺ cells and assayed for mitogen-induced differentiation to immunoglobulin-secreting cells (ISC) of IgM, IgG and IgA classes. Stimulatory agents included T cell-dependent poke weed mitogen, B cell mitogen Staphylococcus aureus bacteria strain Cowan I, and a combination of the two which gives uniform, high levels of ISC from all normal donors. Depletion of either IgM- or IgD-bearing B lymphocytes resulted in loss of cells bearing the other Ig class and blocked most of the mitogenic reactivity to anti-IgM and anti-IgD. Proliferative responses to Cowan I in these depleted populations were about 20% that of unfractionated mononuclear cells. Depletion of T cells increased the mitogenic response to Cowan I and to the two antibody preparations, showing that they are T-independent mitogens. Depletion of IgD⁺ cells caused partial loss of mitogen-induced IgM ISC (22%-60% of unseparated controls) but no loss of IgG or IgA ISC. Depletion of IgM-bearing cells caused complete loss of IgM ISC, but no loss of IgG or IgA ISC. We previously demonstrated that anti-IgM antibody blocked mitogen induction of Ig secretion of these three classes in spleen cells, but only IgM secretion in blood mononuclear cells. Together, the results suggest that the majority of cells in normal blood responding to mitogens to mature to IgG or IgA production belong to IgM^?, IgD^? B cell subsets, in contrast to precursors of secreting cells for these isotypes in the spleen. Thus, these blood precursors appear to be more mature than the corresponding spleen cells.     

In vivo activated T lymphocytes in the peripheral blood and cerebrospinal fluid of patients with multiple sclerosis

We found an increase in peripheral-blood lymphocytes bearing the T-cell-specific activation antigen Ta1 in 20 of 35 patients with progressive multiple sclerosis, 4 of 18 patients with stable or improving multiple sclerosis, 1 of 17 patients with other neurologic diseases, and 1 of 14 normal controls (P less than 0.0002, Fisher's exact test). No increases in two other markers of T-cell activation, T113 and the interleukin-2 receptor, were found. In the cerebrospinal fluid, patients with progressive multiple sclerosis (pleocytosis, 3.9 +/- 1.6 cells per cubic millimeter) had 42 +/- 3.0 per cent Ta1+ cells. In contrast, patients with other inflammatory central nervous system diseases (36 +/- 13 cells per cubic millimeter) had 9.6 +/- 1.8 per cent Ta1+ cells (P less than 0.01). In patients with other neurologic diseases without inflammation (0.7 +/- 0.16 cells per cubic millimeter), the percentage of Ta1+ cells was equivalent to that in patients with multiple sclerosis (39 +/- 5.4 per cent), although the absolute number was lower. There was a positive correlation between the presence of Ta1+ cells in the spinal fluid and blood of patients with other neurologic diseases, but not patients with multiple sclerosis. Less than 1 per cent of lymphocytes from the spinal fluid of patients with multiple sclerosis expressed interleukin-2 receptors, as compared with 9.8 per cent of cells from subjects with other inflammatory neurologic diseases (P less than 0.01). These results suggest that the T cells in the spinal fluid of patients with multiple sclerosis may be activated by a different mechanism or in a different temporal sequence from that in patients with other nervous system diseases. Furthermore, the increase in Ta1+ cells in the peripheral blood of patients with multiple sclerosis demonstrates systemic immune activation in the disease; monitoring such cells may provide an objective measure of abnormal immunologic activity.     

In vitro synthesis of IgG by cells from the cerebrospinal fluid in a patient with multiple sclerosis

Mononuclear cells of the cerebrospinal fluid from a patient with multiple sclerosis were maintained in vitro for 5 days. Synthesis of IgG occurred and was significantly higher during a relapse of the disease than during remissions. The electrophoretic IgG species that were found in the cerebrospinal fluid of the patient were also synthesized in vitro.     

Cells producing antibody to measles and herpes simplex virus in cerebrospinal fluid and blood of patients with multiple sclerosis and controls.

The B cell response against measles and herpes simplex virus (HSV) was evaluated in cerebrospinal fluid (CSF) and peripheral blood from patients with multiple sclerosis (MS) and controls by enumeration of cells secreting anti-measles and anti-HSV antibodies of IgG, IgA and IgM isotypes. We used a nitrocellulose immunospot assay which enables parallel enumeration of numbers of cells secreting total IgG, IgA and IgM. Anti-measles IgG antibody-secreting cells were present in CSF from 21 of 24 MS patients (mean 24 cells/10(4) mononuclear cells), and against HSV in CSF from seven of eight patients (mean 23/10(4) cells). No antibody-secreting cells were detectable in the patients' blood. Ten MS patients examined were negative for cells in CSF and blood producing anti-measles antibodies of IgA and IgM isotypes. Anti-measles IgG antibody secreting cells were also found in CSF from four of 18 controls, and anti-HSV IgG antibody-secreting cells in six of 13, especially in patients with subacute or chronic inflammatory nervous system diseases. Our results confirm that viral antibodies in MS are produced within CSF and that this B cell response is preferentially sequestered to this compartment. Whether this viral B cell response in MS reflects specific activation due to persistence of viral antigens or an epiphenomenon remains to be clarified.     

West Nile virus immunoglobulin A (WNV IgA) detection in cerebrospinal fluid in relation to WNV IgG and IgM reactivity.

BACKGROUND: Diagnostic criteria for neurologic involvement in WNV infection include WNV IgM detection in CSF; however, WNV IgM can persist in CSF >6 months. CSF IgA characterizes other flavivirus infections, but WNV IgA in CSF has not been evaluated. WNV IgM in CSF correlates with IgM in serum but the presence of WNV IgA in CSF compared to serum is unknown. OBJECTIVES: Evaluate WNV IgA detection in CSF as a marker of WNV neuroinvasive infection, initially with samples pre-selected based on WNV IgG and IgM reactivity and subsequently with all available CSF samples submitted for WNV antibody testing over an entire WNV season. STUDY DESIGN: Selected CSF samples and CSF/serum pairs previously tested for WNV IgG and IgM were assayed for WNV IgA. Subsequently, all available CSF samples tested for WNV antibodies during the 2005 season were tested for WNV IgA, including those where paired sera were available and tested for IgA, IgG and IgM. RESULTS: For most samples, including paired CSF and serum, the IgA result qualitatively agreed with the IgM result, regardless of the IgG result. CONCLUSION: IgA detection is equivalent to IgM detection as a marker of WNV infection in CSF.     

Monoclonal IgM, IgA and IgG in the serum of a single individual: immunofluorescence identification of cells producing the immunoglobulins.

Monoclonal IgM(?) and IgA(?) in the serum of patient CM were previously shown to share identical, individually specific (Ind) or idiotypic antigenic determinants. A component in the IgG fraction of CM's serum was shown by one of the assay systems to also share Ind determinants with the IgA and IgM. Recent experiments have indicated that the CM IgG monoclonal protein also shares identical Ind determinants with the other two CM immunoglobulins (Ig). These results suggested that the variable regions of the heavy and light chains of the three different classes of Ig were very similar. A direct immunofluorescence assay was used in this study on bone marrow smears of patient CM obtained at two different dates to identify the cells producing these Ig. The reaction of antisera specific for Ind determinants demonstrated that most plasma cells, whether containing IgM, IgA, or IgG, stained with the anti-Ind antisera; this occurred irrespective of whether the anti-Ind antisera were generated to the patient's IgM or IgA. The reaction with isotypic antisera revealed cell populations containing either IgM, IgA, or IgG and a significant cell population containing both IgM and IgA. The common occurrence of IgM and IgA-containing cells which synthesize monoclonal Ig with shared Ind determinants provides evidence consistent with the IgM-IgA pathway of differentiation of antibody-producing cells. Further, the tendency toward decreasing numbers of IgM-staining cells with concomitant increasing numbers of IgA and IgG-containing cells suggests that the clones of cells producing these Ig were derived from a single precursor cell.     

The significance of blood levels of IgM,IgA, IgG and IgG subclasses in Sudanese visceral leishmaniasis patients

We developed an ELISA test using leishmania antigenic extracts to detect antigen-specific antibody responses, including subclass and isotype analysis, in visceral leishmaniasis (VL) patients from the Sudan. A total of 92 parasitologically proven patients were compared with cutaneous leishmaniasis, schistosomiasis, malaria, onchocerciasis and tuberculosis patients, as well as with healthy endemic and non-endemic controls. Some VL patients were examined before and after chemotherapy. VL patients showed significantly higher IgG responses compared with all other groups (93·4% sensitivity, 93·7% specificity), and higher (but not significantly) IgM responses. All groups showed low IgA levels. All groups showed low IgA levels. All IgG subclasses, IgG1, 2, 3, and 4, showed higher levels in patients than all other groups, with IgG1 and IgG3 levels being significantly reduced following treatment. The rank order for specificity and sensitivity for IgG subclasses was IgG3 > IgG I> IgG2> IgG4.     

HLA-DR antigen expression on T cells from cerebrospinal fluid in multiple sclerosis and aseptic meningo-encephalitis.

HLA-DR expression on T lymphocytes in cerebrospinal fluid (CSF) from patients with multiple sclerosis (MS) and acute aseptic meningo-encephalitis (AM), and from blood only from healthy controls was examined by a new double-immunofluorescence labelling assay using species-specific second layers on prefixed cell samples. Thirteen of 16 patients with AM (81%) had an elevated percentage of DR positive T cells in CSF against only two of 20 patients with MS (10%). Our data indicate that AM, an acute infection of the central nervous system (CNS), is accompanied by accumulation in CSF of activated, DR positive T cells as a reflection of actively involved cellular immunity within the CNS, while this accumulation of DR positive T cells is not seen in MS, a chronic inflammatory CNS disease, despite some of the patients being examined during clinical exacerbations.     

IL-15 mRNA expression is up-regulated in blood and cerebrospinal fluid mononuclear cells in multiple sclerosis (MS)

IL-15, produced by monocytes and epithelial cells, is a novel cytokine with actions similar to IL-2. IL-15 induces T cell proliferation, B cell maturation and natural killer (NK) cell cytotoxicity, and is a chemoattractant for T cells. We investigated the expression of IL-15 mRNA in blood and cerebrospinal fluid (CSF) mononuclear cells (MNC) in MS, an inflammatory disease of the central nervous system where cytokines are involved. MS patients had higher numbers of IL-15 mRNA-expressing blood MNC than patients with aseptic meningo-encephalitis (AM) and healthy controls. In CSF, MS patients had even higher numbers of IL-15 mRNA-expressing cells than in blood. This discrepancy between IL-15 mRNA expression between blood and CSF MNC was not seen in AM patients. Patients examined during the secondary chronic-progressive phase of MS had higher numbers of IL-15 mRNA-expressing blood MNC compared with patients examined during the relapsing-remitting phase. Levels of IL-15 mRNA-positive blood MNC were similar in patients with AM, myasthenia gravis, non-inflammatory neurological diseases and healthy controls. Taken together these data indicate that IL-15 mRNA expression is up-regulated in MS, further suggesting a role for proinflammatory cytokines in the pathogenesis of MS.     

Cerebrospinal fluid oligoclonal bands in the diagnosis of multiple sclerosis. Isoelectric focusing with IgG immunoblotting compared with high-resolution agarose gel electrophoresis and cerebrospinal fluid IgG index

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. We compared the diagnostic performance of isoelectric focusing (IEF) combined with IgG immunoblotting to high-resolution agarose gel electrophoresis for the detection of intrathecal synthesis of IgG due to the MS disease process. In 20 patients with definite MS, IEF and high-resolution agarose gel electrophoresis had sensitivities of 90% and 60%, respectively. In the 51 patients with no evidence of MS, the methods had specificities of 94% and 96%, respectively. With a prevalence of 15% in this test population, IEF and high-resolution agarose gel electrophoresis had positive predictive values of 73% and 73% and negative predictive values of 98% and 93%, respectively. The IEF method improves the sensitivity and the negative predictive value of the oligoclonal-banding assay, the IEF gels are easier to interpret, and the IEF assay requires a smaller cerebrospinal fluid volume.     

Antitrichomonas IgG,IgM, IgA,and IgG subclass responses in human intravaginal trichomoniasis

Trichomoniasis, caused by the protozoan parasite Trichomonas vaginalis, is a major nonviral sexually transmitted disease. Clinical spectrum varies from an asymptomatic state to mild, moderate, or severe symptoms. However, the exact factors leading to the variations in symptoms have not been well elucidated. Host’s immune response to the parasite may be playing a role in varied symptomatology. The present study reports antitrichomonas IgM, IgA, IgG and its subclasses in doubling dilutions of serum and diluted vaginal washes of six T. vaginalis-infected symptomatic and four T. vaginalis-infected asymptomatic women and uninfected controls by enzyme-linked immunosorbent assay (ELISA). No significant difference was observed in serum IgG ELISA absorbance values from symptomatic compared to asymptomatic subjects (p > 0.05) while a significant difference (p < 0.05) was noted in serum IgM in all the tested dilutions and IgA up to a dilution of 400. This is the first report of the detection of specific IgG subclass response in T. vaginalis-infected female patients, and quantitative analysis of the antibody responses indicated that the production of local IgG particularly IgG1 in vaginal secretions may be playing a significant role in establishing symptomatic infection. The interesting observation of the present study is that the specific IgM was detected in 2 (33.3%) symptomatic and T. vaginalis-infected patients in ≥800 dilutions and in 1 (16.6%) up to 200 dilutions in serum, while it was not detectable in the vaginal secretions of symptomatic patients or in the serum and vaginal secretions of asymptomatic T. vaginalis-infected patients.     

B cells capable of spontaneous IgG secretion in cerebrospinal fluid from patients with multiple sclerosis: dependency on local IL-6 production.

Cerebrospinal fluid (CSF) from multiple sclerosis (MS) patients contains B cells capable of spontaneous IgG secretion in vitro. This study analyses the function and regulation of these cells. CSF cells obtained from nine MS patients actively produced IgG during 2-3 days in culture, and the activity decreased when CSF cells were cultured in serum-free medium. CSF cells from four controls did not secrete detectable IgG in vitro. Further experiments revealed that IL-6 played a role on MS CSF IgG-secreting cells, as can be deduced from the following findings: (i) the addition of exogenous IL-6, but not of other cytokines, to serum-free cultures restored missing CSF cell IgG secretion (ii) the inclusion of anti-IL-6, but not of control, blocking MoAb reduced IgG secretion by CSF cells in fetal calf serum (FCS)-containing cultures; and (iii) CSF cells were capable of active IL-6 production in the presence of FCS. These results suggest that endogenous IL-6 production by MS CSF cells seems to be responsible for inducing CSF IgG-secreting B cells to reach terminal differentiation.     

B cells expressing CD5 are increased in cerebrospinal fluid of patients with multiple sclerosis.

By two-colour flow cytometric analysis, we found increased numbers of B cells co-expressing the pan-T cell marker CD5 and the B cell marker CD19 in cerebrospinal fluid (CSF) of 21 patients with multiple sclerosis (MS), compared with 17 control subjects with muscular tension headache. Only one patient with MS, but nine controls lacked CD5+ B cells in CSF. This difference was not observed in peripheral blood. Numbers of CD5+19+ B cells were increased in CSF compared with blood in MS, but not in the controls. In both groups, CD5+19+ B cells were not restricted to small resting lymphocytes, but were also found among larger-sized lymphocytes. The relative density of CD5 molecules and of CD19 molecules was lower in CD5+19+ than in CD5-19+ B cells and CD5+19- T cells. CD5+ B cells are assumed to be responsible for autoantibody production, and our results suggest a pathogenetic role of such cells, predominantly within the central nervous system, in MS.     

Amylolytic activity of IgM and IgG antibodies from patients with multiple sclerosis

IgG and IgM antibodies from the sera of patients with multiple sclerosis (MS) were found to possess amylolytic activity hydrolyzing alpha-(1-->4)-glucosyl linkages of maltooligosaccharides, glycogen, and several artificial substrates. Individual IgM fractions isolated from 54 analyzed patients with the clinically definite diagnoses of MS had approximately three orders of magnitude higher specific amylolytic activity than that for healthy donors, whereas IgG from only a few patients had high amylolytic activity. Strict criteria were used to prove that the amylolytic activity of IgMs and IgGs is their intrinsic property and is not due to any enzyme contamination. Fab fragments produced from IgM and IgG fractions of the MS patients displayed the same amylolytic activity. IgMs from various patients demonstrated different modes of action in hydrolyzing maltooligosaccharides.     

Distribution of IgM, IgA and IgG secreting cells in the tissues of normal and tumour-bearing mice.

The levels of IgM, IgA and IgG secreting cells were examined in control, Corynebacterium parvum-stimulated and tumour-bearing, normal and athymic (Nu/Nu) mice. The percentage of IgA to IgM or IgG secreting cells is relatively higher in peripheral blood than in the spleen or peritoneum of normal mice. Within tumours, irrespective of their degree of vascularization and immunogenicity, the pattern of Ig secreting cells in similar to that seen in peripheral blood and different from that in spleen and peritoneum even in athymic mice. Intraperitoneal injection of C. parvum changes the relative percentages of Ig secreting cells in the peritoneal cavity to resemble that seen in the peripheral blood and tumours. It appears that Ig secreting cells extravasate from peripheral blood in a non-isotype specific manner into sites of chronic stimulation.