Kappa/lambda Ratios of IgG, IgA and IgM in the Cerebrospinal Fluid of Patients

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1 Original Article Kappa/lambda Ratios of IgG, IgA and IgM in the Cerebrospinal Fluid of Patients with Syndrome Shigeru ARAGA, Hiroshi KAGIMOTO, Akiko ADACHI, Koji FUNAMOTO,Kazuhiko INOUE and Kazuro TAKAHASHI The ( re /X ) ratios of IgG, IgA and IgM in the cerebrospinal fluid (CSF) and in the sera of 10 patients with syndrome were analyzed. The k/ X ratios of IgG, IgA and IgM in the CSFand in the serum were not significantly different between the acute and the late stages of syndrome nor between syndrome and the normal controls. In the CSF, however, the concentration of albumin, IgG, IgA and IgM in the acute phases of syndrome were significantly higher than in the normal controls. These results suggest that in syndrome, the increase of immunoglobulins may not be due to intrathecal synthesis and therefore there are no significant changes in the k /X ratios inthecsf. Key words: ELISA, Immunoglobulins The (k/x ) ratio has been measured in several neurological diseases, including multiple sclerosis (MS) (1), syndrome (2), aseptic meningitis and encephalitis (3). Link et al have reported that in syndrome, the k/ X ratios were low, indicative of an increase of predominant lambda type immunoglobulin, although they did not show that the abnormal k / X ratios are restricted to a specific immunoglobulin component (2). The ic/x ratios in IgG, IgA and IgMin syndrome patients have never been investigated before. Here, we investigated the k/x ratios of IgG, IgA and IgM in the CSF and sera of patients with syndrome. MATERIALS AND METHODS Samples Ten patients with syndrome (mean age 36.6 yr of age) and 29 normal controls (13 men and 16 women), ranging in age of 16 to 55 yr old (mean age, 33.0 yr of age), were examined. The patients were assessed using the grading scale of functional ability introduced by Hughes et al (4). The clinical data of the patients with syndrome are listed in Table 1. Regarding Guillain- Barre patients, CSF and serum samples were simultaneously obtained in the acute (within a wk after the onset) and the late (1 month after the onset) stages, and stored at -80 C until use. Assay of k/1 ratios Enzyme-linked immunosorbent assays for the From The Division of Neurology, Institute of Neurological Sciences, Tottori University School of Medicine, Yonago Received for publication September 18, 1989; Accepted for publication November 22, 1990 Reprint requests should be addressed to Shigeru Araga, MD, Division of Neurology, Institute of Neurological Science, Tottori University School of Medicine, 86 Nishimachi, Yonago 683, Japan This work was partly supported by a grant from the Neurological Disorders Research Committee of the Ministry of Health and Welfare of Japan. 118

2 K/L Ratios in Syndrome Table 1. Clinical Data for 10 Patients with Syndrome N o. Sex Age Disability Treatment grade 1 F 25 3 methylprednisolone g/day, 2 cools 2 F 51 4 prednisolone mg/day 3 F 33 4 prednisolone mg/day 4 F 42 4 prednisolone 70 5 M 20 2 methylprednisolone 78 1g/day 6 M 70 4 prednisolone M 18 4 prednisolone mg/day 8 M 17 4 prednisolone M 15 3 prednisolone M 78 4 prednisolone 135 The disability grades were measured on a scale of 1 to 6, as follows: Grade 1 indicated minor symptomsor signs; grade 2, able to walk 5 mwithout a walker or support; grade 3, able to walk 5 m with a walker or support; grade 4, bedbound; grade 5, requires assisted ventilation; and grade 6, dead. Methyprednisolone pulse therapy was scheduled as follows: pulse dose (lg/day) for three consecutive days. k/x ratios of IgG, IgA and IgM have been reported elsewhere (5). In brief, each well of a flat microplate was coated with 50 y\ of goat antihuman IgG (gamma chain specific), antihuman IgA (alpha chain specific) and antihuman IgM (mu chain specific) (Cappel, Malvern, U.S.A.), which were diluted to 1 :300 with phosphate buffer saline (PBS, ph 7.4), and kept at 37 C for 3 h. After washing with PBS-Tween (PBS, containing 0.05% (w/v) Tween 20), 50 p\ of sample and standards [kappa type of IgG, IgA and IgM, and lambda type of IgG, IgA and IgM (Gelco Inc., Schreveport, U.S.A.)] was added to each well and kept at 37 C for 30 min. Serum samples for IgG, IgA and IgM k /A ratio measurements were diluted to 1 :36,000, 1 :8,000 and 1 :4,000, respectively. CSF samples for IgG, IgA and IgM k /1 ratio measurements were diluted to 1 :200, 1 :20 and 1 :4, respectively. After washing with PBS-Tween, 50 \x\ of biotinylated goat antihuman kappa or antihuman lambda solution, which was diluted to 1:2,000 with PBS-Tween, was added to each well and kept at 37 C for 30 min. After washing with PBS-Tween, 50 ^1 of peroxidaselabeled streptavidin (Bethesda Labs, Gaithersburg, U.S.A.), which was diluted to 1:1,000 with PBS- Tween, was added to each well and kept at 37 C 119

3 Araga et al for 15 min. After washing with PBS-Tween, 100^1 of substrate solution, which had been prepared by dissolving 30 mg of 2,2' Azino-bis (3-ethlybenzthiazine-6-sulfonic acid) diammonium salt (Sigma, St. Louis, U.S.A.) in 100 ml of phosphate citrate buffer, ph 4.0, containing 10 fj\ of 30% H2O2, was added to each well and left at roomtemperature for an hour. Color development was stopped by adding 25^1 of 0.1% (w/v) NaN3. The intensity of color development was read by EIA reader, model 2550 (Bio-Rad, Richmond, U.S.A.). Other assays The concentrations of albumin, IgG, IgA and IgM were measured by microplate enzyme assay (6). Statistical analyses Statistical analyses were performed using Student's t-test. RESULTS The concentrations IgM in the CSF of of albumin, IgG, IgA and patients with syndrome in the early than those of the stages were significantly higher normal controls (p<0.001, p<0.05, p<0.05 concentrations and p<0.001, of albumin respectively). and IgM in the The early stages of syndrome were significantly higher than in the late stages. Only the concentrations of IgMin the late stages were significantly higher than in the normal controls (p <0.01) (Table 2). In the CSF, the k/1 ratios of IgG, IgA and IgM in the early and the late stages of syndrome demonstrated no significant differences from the normal controls (Table 3). In the sera, there were no differences between the k / X ratios of IgG, IgA and IgM in both stages of Table 2. Concentrations of Albumin and Immunoglobulins in CSF No. Albumin(mg/dl) IgG(mg/dl) IgA( pg/dl) IgM( ug/dl) Earlystage ±31.50ac 3.20±1.77b ±171.15b ±76.99ac Latestage ± ± ± ±23.83d Normal ± ± ±11.93 Significantly different from GBS late (p <0.001), Significantly different from the controls (p <0.05), Significantly different from the controls (p <0.001), Significantly different from the controls (p <0.05). Table 3. Kappa/lambda Ratios in the CSF ratios Total No. IgG IgA IgM Early stage ± ± ±0.051 ( ) ( ) ( ) ( ) Latestage ± ± l.oo5±o.o53 ( ) ( ) ( ) ( ) Controls ± ± ± ±0.241 ( ) ( ) ( ) ( ) Total means ratio of immunoglobulins (IgG, IgA and IgM). Numbersin parenthesis indicate the range of the values. 120

4 K/L Ratios in Syndrome Table 4. Kappa/lambda Ratios in Serum ratios No. Total IgG IgA IgM Earlystage ± ± ±0.104 ( ) ( ) ( ) ( ) Latestage ± ± ± ±0.113 ( ) ( ) ( ) ( ) Normal ± ± ± ±0.177 ( ) ( ) ( ) ( ) In the sera, there were no significant differences in the ratios of total, IgG, IgA and IgM between the patients with syndrome and the normal controls. Numbers in parentheses indicate the range of the values. Table 5. Clinical Stage and Kappa/lambda Ratios in Sera and CSF ratio No. Total IgG IgA IgM In the CSF Early Ambulatory ± ± ± ±0.025 Bedridden ± ± ± ±0.054 Late Ambulatory ± ± ± ±0.025 Bedridden ± ± ± In the serum Early Ambulatory ± ± ± ±0.080 Bedridden ± ± ±0.085 Late Ambulatory ± ± ± ±0.101 Bedridden ± ± ± ±0.092 The patients with syndrome were divided into the following two groups: (1) ambulatory groups of disability scales of 2 or 3 and (2) bedridden group, disability scales of4. There were no significant correlations in the k/x ratio between the two groups. 121

5 Araga et al syndrome and the normal controls (Table 4). The patients with syndrome were divided into the following two groups: The ambulatory group with a disability grading scale of 2 or 3, and the bedridden group, 4. There was no significant correlation between the k /X ratios and disability grading scales of the disease (Table 5). DISCUSSION Abnormal k/x ratios in MS (1) and Guillain- Barre syndrome (2) have already been reported. Recently, we developed an ELISA system for the measurement of the k/x ratios of IgG, IgA and IgM, and have reported that in the CSF of patients with MS, abnormal k/x ratios were restricted to only the IgG component (5). Using this ELISA system, we measured the k/x ratios in the CSF and in the sera of patients with syndrome. The pattern of k/k ratio changes with age (7). An increase in the k/x ratios may depend upon specific clones generated against some viral infection. Link et al reported that 25% of the patients with syndromehave an abnormally low k/x ratio in CSF and/or in serum, and that all of these patients have or subsequently develop antibodies to Epstein-Barr virus (2). They pointed out that an abnormal low k/x ratio and oligoclonal IgG bands on electrophoresis indicate intrathecal immunoglobulin synthesis (mainly lambda light-chain type). The present patients did not show an abnormally low k/x. ratio in the CSF or serum. As calculated by the formula of IgG synthesis (8), there was no IgG synthesis in these patients of syndrome (data not shown). Taken together, these results suggest that the increase of immunoglubulins in the CSFmay not be due to intrathecal synthesis and therefore, there are no significant changes in the k/x ratios in CSF of syndrome patients. ACKNOWLEDGEMENTS: We would like to thank Miss S. Itoh for the manuscript preparation. REFERENCES 1) Zettervall O, Link H. Electrophoretic distribution of kappa and lambda immunoglobulin light chain determinants in serum and cerebrospinal fluid in multiple sclerosis. Clin Exp Immunol 7: 365, ) Link H, Wahren B, Norrby E. Pleocytosis and immunoglobulin changes in cerebrospinal fluid and herpes virus serology in patients with syndrome. J Clin Microbiol 9: 305, ) Bollengier F, Karcher D, Rabinovitch N. Imbalance of k / X ratios associated with high measles antibody titers in fractionated serum immunoglobulins of patients affected with subacute sclerosing panencephalitis. Ann Microbiol 128: 89, ) Hughes RAC, Newson-Davis JM, Perkin GD, et al. Controlled trial of prednisolone in acute polyneuropathy. Lancet 2: 750, ) Araga S, Kagimoto H, Wada A, et al. Kappa/lambda ratios in IgG, IgA and IgM of cerebrospinal fluid and of sera in patients with multiple sclerosis. Autoimmunity 5: 133, ) Araga S, Irie H, Takahashi K. Analysis of immunoglobulin G/albumin ratios by a competitive ELISAin the serum and in the cerebrospinal fluid of rabbits with experimental allergic encephalomyelitis. Jpn J Exp Med 55: 67, ) Brandun S, SkvarilF, MorellA. Imbalance of the a/ X ratio of human immunoglobulins. in: Clinical Immunology, Back FH, Good RA, Eds. Academic Press, New York, 1976, p.57. 8) Tibbling G, Link H, Ohman S. Principle of albumin and IgG analyses in neurological disorders. I. Establishment of reference values. Scand J Clin Lab Invest 37: 385,