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The basis of intra‐blood‐brain‐barrier IgG synthesis
Author(s) -
Tourtellotte Wallace W.,
Staugaitis Susan M.,
Walsh Michael J.,
Shapshak Paul,
Baumhefner Robert W.,
Potvin Alfred R.,
Syndulko Karl
Publication year - 1985
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410170107
Subject(s) - cerebrospinal fluid , multiple sclerosis , asymptomatic , blood–brain barrier , albumin , medicine , immunoglobulin g , immunology , pathology , antibody , central nervous system
We hold that the intra‐blood‐brain‐barrier (BBB) IgG synthesis (SYN) rate can be quantitated reliable and validly. Although several formulas distinguish patients with sclerosis from normal controls equally well, only the SYN rate formula has been validated in humans using isotopic tradcer techniques. Our formula for the IgG SYN rate is reducible to Reiber's formula; therefore, both can be used to quantify the IgG SYN rate in a manner not possible using the IgG index. Although our SYN rate formula has been validated for a modest range of BBB abnormalities (cerebrospinal fluid/serum albumin ratios), there is evidence to suggest that it may be used even in patients having severe BBB damage. We question the acceptance of unique cerebrospinal fluid IgG bands as indisputable evidence of intra‐BBB IgG SYN in the presence of a modest to severely damaged BBB. Finally, the utility of quantitation and detection of intra‐BBB IgG SYN by standardized methods in a group of asymptomatic, normal individuals compared with a group of patients with clinical definite multiple sclerosis is presented.