Importance of the quotient of albumin, quotient of immunoglobulin G and Reibergram in inflammatory neurological disorders with disease‐specific patterns of blood–brain barrier permeability

Abstract

Background: There are still insufficient quantitative comparisons of phase-dependent blood-brain barrier permeability among inflammatory central nervous system disorders. Aim: By using the Reibergram (2-D diagram of the quotient of albumin and quotient of immunoglobulin G), we visually compared the extent of blood-brain barrier permeability among inflammatory central nervous system disorders. Methods: Both the quotient of albumin and that of immunoglobulin G in the acute and chronic phase were calculated in non-herpetic meningitis, septic meningitis, multiple sclerosis and neuromyelitis optica, and were plotted on the Reibergram. As controls, samples from non-inflammatory patients without pleocytosis were collected. The correlation coefficient between each cerebrospinal fluid biomarker and disease severity index in each disorder was also studied. Results: In the controls, the distribution differed between males and females, suggesting a sex-dependent difference in blood-brain barrier-function, in addition to the age-related compromise. A compromised blood-brain barrier was confirmed in the acute phase of meningitis and neuromyelitis optica, but not in the acute phase of multiple sclerosis. However, blood-brain barrier permeability significantly correlated with the severity and disability in multiple sclerosis. In meningitis, a compromised blood-brain barrier correlated well with the length of hospitalization rather than cerebrospinal fluid cell count. Conclusion: Visualization of the blood-brain barrier permeability with a Reibergram indicated distinct pathophysiology in each disorder. The quotient of albumin and quotient of immunoglobulin G would be useful for estimating the pathophysiology in each disorder, and the severity of ongoing inflammation or damage in the central nervous system.

Quotient of cerebrospinal fluid/serum immunoglobulin G as a predictive factor for non‐responders to intravenous methylprednisolone therapy in patients with relapsing neuromyelitis optica spectrum disorder: Implication for early initiation of plasmapheresis

“…In relapsing NMOSD, the intrathecal production of IgG, including AQP4Ab might not be common, as described previously . According to the Reibergram in the present study, the intrathecal production of CSF‐IgG was not evident, except for one patient with positive oligoclonal IgG bands and mild intrathecal IgG synthesis.…”

Increased albumin quotient (QAlb) in patients after first clinical event suggestive of multiple sclerosis is associated with development of brain atrophy and greater disability 48 months later

“…In spite of the few studies that explored relationship between the CSF outcomes and disease activity, they did not investigate QAlb, did not include brain atrophy measures, were of a limited sample size, cross-sectional nature or employed a short follow-up period. [17][18][19][20][21][22] The results showed a relationship between baseline QAlb and increased T2-LV, T2 lesion and CEL number at clinical onset supporting the association between BBB permeability and inflammatory processes in MS.…”

Soluble CD146, a cerebrospinal fluid marker for neuroinflammation, promotes blood-brain barrier dysfunction

“…The homeostasis of the central nervous system (CNS) microenvironment requires blood-brain barrier (BBB) integrity 1. The quiescent BBB is a physical and functional structure organized by brain endothelial cells (ECs) that are in contact with various CNS cell types, such as pericytes and astrocytes 2. All the components form a multilayered membrane structure and constitute an extremely low-rate permeability barrier.…”