Aktuelle Neurologie 2009; 36 - V128
DOI: 10.1055/s-0029-1238375

CSF-CXCL13 (B-Lymphocyte Chemoattractant): diagnostic and follow-up marker in early neuroborreliosis?

M Senel 1, T Rupprecht 1, V Lehmensiek 1, H Pfister 1, J Brettschneider 1, H Tumani 1
  • 1Ulm, München

Objective: Acute neuroborreliosis (NB) is diagnosed by the combined analysis of basic cerebrospinal fluid (CSF) parameters (lymphocytic pleocytosis, intrathecal synthesis of IgM and/or blood-CSF barrier dysfunction) and Borrelia antibody index. Recent studies have shown a diagnostic relevance of CXCL13 in NB. Our aim was to confirm the clinical relevance of CXCL13 in the CSF of NB patients and to evaluate CXCL13 as a putative follow-up marker in comparison to other CSF variables.

Methods: CXCL13 was measured using an immunoassay in 201 CSF and serum samples. For comparison of CXCL13 levels in different neurological diseases, sample pairs of first diagnostic lumbar punctures were used from patients with definite acute NB (d-NB, n=28), possible acute NB (p NB, n=9), Guillain-Barré syndrome (GBS, n=11), facial nerve palsy (FNP, n=19), cranial nerve paresis other than FNP (CNP, n=5), cephalgia (C, n=20), bacterial CNS infections (B-CNS-I, n=16) and from patients with viral CNS infections (V-CNS-I, n=18). For follow-up studies serial sample pairs were evaluated from 25 patients with d-NB (n=58), 11 with B-CNS-I (n=25) and 14 with V-CNS-I (n=36) over the course of about three weeks.

Results: CSF-CXCL13 was significantly elevated in d-NB compared to other neurological diseases (p<0,001). Serum-CXCL13 was similar to d-NB and other neurological diseases but was elevated in B-CNS-I (p<0,001). ROC analysis was performed to determine cut-off values of CSF-CXCL13 for diagnosis of d-NB. Sensitivity and specificity were 100 and 79,6%, using a cut-off value of 35ng/g. Using 337ng/g as cut-off sensitivity and specificity were found to be 96,4 and 96,9%. Over follow-up, CXCL13 showed a significant decrease within one week (p=0.008). Total leukocyte count decreased significantly (p=0,009) during the second week. In contrast, Bb-AI showed no significant (p=0,356) change during disease course.

Conclusion: CSF-CXCL13 was found to be reliable for the diagnosis of NB with highest sensitivity and specificity values at a cut-off of 337ng/g. It can be used as screening parameter in order to exclude patients without d-NB. In NB-mimicking cases and those cases with Bb antibodies not related to disease activity (sero-prevalence with no clinical relevance). CXCL13 could be used as a differentiating marker and is more suitable than Bb-AI and basic CSF findings for monitoring therapy response in early stages and over follow-up.