CSF/SERUM RATIOS: MODERN APPROACH TO ASSESS INTRATHECAL RESPONSE



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Abstract

Abstract

CSF/serum ratios are the quotients of protein concentrations between the cerebrospinal fluid and blood serum. This method provides an objective assessment of proteins amount and origin in the cerebrospinal fluid. The cerebrospinal fluid protein composition consists of blood proteins passing through the blood-brain barrier and those synthesized within the central nervous system (intrathecally). Increased concentrations of proteins such as specific antibodies or autoantibodies in cerebrospinal fluid do not always mirror intrathecal synthesis or the presence of a pathological process in the intrathecal space. Elevated protein levels in the cerebrospinal fluid may be due to the higher blood protein influx through the blood-brain barrier. Quantification of CSF/Serum ratios according to German liquor specialist Hansotto Reiber allows distinguishing between blood and brain protein origin. This method is recognized as relevant for distinguishing between blood-derived and brain-derived protein fractions by the German Society for Liquor Diagnostics and Clinical Neurochemistry (Deutsche Gesellschaft für Liquordiagnostik und Klinische Neurochemie e.V.). The review is based on analyzing main literature databases (PubMed, CyberLeninka, Google Scholar,  Scopus) and the latest publications on liquor diagnostics. Principles of CSF/Serum ratios, specific antibody indices calculation, and Reibergram structure are described. The classification of intrathecal inflammation and disease-related data patterns of immunoglobulin synthesis typical for diseases of the central and peripheral nervous system are presented. Thus, this literature review provides a detailed insight into the general principles of the modern approach for assessing cerebrospinal fluid protein composition and improves intrathecal humoral response comprehension. Additionally, the latest data on intrathecal immune response features in multiple sclerosis, neuromyelitis optica spectrum disorders, encephalitis associated with anti-MOG, anti-NMDAR antibodies, rheumatological diseases with CNS involvement, and neuroinfections are summarized. 

About the authors

Alexandra M. Deomkina

Pirogov Russian National Research Medical University

Author for correspondence.
Email: sasha.deomkina@mail.ru
ORCID iD: 0000-0002-2137-2749
SPIN-code: 4685-9220
Scopus Author ID: 58638733900

Assistant Professor, Department of Infectious Diseases in children

Россия, 117513, Russian Federation, Moscow, Ostrovityanova str., 1.

Ruslan F. Sayfullin

Pirogov Russian National Research Medical University

Email: ppsaifullin@rambler.ru
ORCID iD: 0000-0003-0191-3728
SPIN-code: 9701-3600
Scopus Author ID: 57216796584

PhD (Medicine), Associate Professor, Department of Infectious Diseases in children

Россия, 117513, Russian Federation, Moscow, Ostrovityanova str., 1.

Armen K. Shakaryan

Pirogov Russian National Research Medical University;
Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences (RAS)

Email: armen2@mail.ru
ORCID iD: 0000-0003-3417-3631
SPIN-code: 9069-2474
Scopus Author ID: 55697513300

Researcher; Assistant Professor, Department of Infectious Diseases in children

Россия, 108819, Russian Federation, Moscow, settlement Moskovskiy, village of the Institute of Poliomyelitis 8, bld. 1.; 117513, Russian Federation, Moscow, Ostrovityanova str., 1.

Olga V. Shamsheva

Pirogov Russian National Research Medical University

Email: ch-infection@mail.ru
ORCID iD: 0000-0002-6033-6695
Scopus Author ID: 6507525958

DSc (Medicine), Professor, Head of the Department of Infectious Diseases in children

Россия, 117513, Russian Federation, Moscow, Ostrovityanova str., 1.

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