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CXCL13

CXCL13 is a B-cell chemoattractant and has recently been described as a very good biomarker for neuroborreliosis and neuro-lues.

The diagnostic sensitivity for the diagnosis of neuroborreliosis based on CXCL13 concentration in CSF or the CXCL13 CSF / serum ratio is very high as described in several recently published studies(94 - 100% (Ljøstad, 2008; Senel, 2010, Tjernberg, 2011, Schmidt, 2011), with only 1 article in which a slightly lower sensitivity of 88% is reported (van Burgel, 2011). The specificity for the exclusion of other neurological disorders is very high (96-97%, Senel, 2010; Tjernberg , 2011; Schmidt, 2011), again with only one study in which a slightly lower sensitivity of 89% is reported (van Burgel, 2011).

In pediatric patients with neuroborreliosis, the CSF CXCL13 concentration was also significantly increased with 100% sensitivity (Wutte, 2011; Tjernberg, 2011).

The CXCL13 concentration in CSF decreases rapidly after adequate treatment with antibiotics (Senel, 2010).

Based on these studies it is justified to say that the analysis of CXCL13 in CSF (whether or not combined with serum analysis and calculation of CSF / serumratio CXCL13) is a very good biomarker for identifying acute neuroborreliosis in general, but particularly in cases where anti-borrelia antibody analysis is negative, where it concerns an atypical presentation of neuroborreliosis or to distinguish between acute infection and infection in the past. Moreover, the analysis of CSF CXCL13 also very useful as a biomarker for response to (antibiotic) therapy

The CXCL13 analysis is now part of our routine program of CSF analyses. Our reference values ​​are set at <800 pg/ml. For the analysis of CXCL13 we require 0.5 to 1.0 ml of centrifuged CSF. In combination with other parameters for analysis in CSF (cells, protein, glucose, lactate, IgG, IgM, IgA, IgG oligoclonal bands) a few milliliters of CSF is needed (in combination with 1.0 ml serum). CSF for analysis of CXCL13 can be sent, preferably frozen and shipped on dry ice, to our laboratory.Contact us for more information.

 

Literature:

Kaiser R. Variable CSF findings in early and late Lyme neuroborreliosis: a follow-up study in 47 patients. J. Neurol. 1994, 242:26-36 

Kaiser R. Neuroborreliosis. J. Neurol. 1998, 245:247-255

Ljøstad U, Mygland A, CSF B-lymphocyte chemoattractant (CXCL13) in the early diagnosis of acute Lyme neuroborreliosis. J Neurol 2008, 255:732-737.

Reiber H, Peter JB. Cerebrospinal fluid analysis: disease-related patterns and evlauation programs. J Neurol Sci 2001, 184:101-122

Reiber H. Cerebrospinal fluid – physiology, analysis and interpretation of protein patterns for diagnosis of neurological diseases. Multiple Sclerosis 1998, 4;99-107.

Senel M, et al. The chemokines CXCL13 in acute neuroborreliosis. J Neurol Neurosurg Psychiatr 2010, 81:929-933

Schmidt U, et al. A prospective study on the role of CXCL13 in Lyme neuroborreliosis. Neurology, 2011, 76:1051-1058

Tjernberg I, et al. Diagnostic performance of cerebrospinal fluid chemokine CXCL13 and antibodies to the C6-peptide in Lyme neuroborreliosis. J Infect 2011, 62:149-158.

Tumani H, Nölker G, Reiber H. Relevance of cerebrospinal fluid variables for early diagnosis of neuroborreliosis. Neurology, 1995, 45:1663-1670.

Van Burgel ND, et al. Discriminating Lyme neuroborreliosis from other neuro-inflammatory diseases by levels of CXCL13 in cerebrospinal fluid. J Clin Microbiol 2011, 49(5):2027-2030.

Wutte N, et al. CXCL13 chemokine in pediatric and adult neuroborreliosis. Acta Neurol Scand 2011, 124:321-328.

 

CSF CXCL13 in (suspected) Neuroborreliosis

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