Study of IgA in the cerebrospinal fluid of neurological patients with special reference to size, subclass and local production.

IgA was assayed by particle counting immunoassay in cerebrospinal fluid (CSF) from non-neurological and neurological patients. Reference values had a logarithmic normal distribution with a mean of 1.54 mg/l and an upper limit of 5 mg/l. To estimate the possible intra-blood-brain barrier (BBB) production of IgA we have calculated an IgA index: CSF-IgA/serum-IgA: CSF-albumin/serum-albumin. Values higher than the upper reference limit of 0.41 were found in 12 out of 67 patients with multiple sclerosis (18%), in 5 out of 11 with aseptic meningitis, in 7 out of 8 with herpetic encephalitis, in 1 out of 8 with Guillain-Barré syndrome and in 2 cases of tuberculous meningitis. However, this index does not take into account the relative proportions of monomeric and polymeric IgA in CSF and serum. We therefore ultracentrifuged 17 paired CSF and serum samples and determined the relative proportions of monomeric and dimeric IgA and calculated the indices for monomeric and dimeric IgA. In controls the proportion of dimeric IgA in CSF was below 5% of total IgA whereas this proportion was increased up to 53.9% in the case of intra-BBB production of IgA, which is thus characterized by a very high dimeric IgA index. In all cases IgA1 remained the predominant subclass. These results had to be compared with those observed in cultures of peripheral blood lymphocytes, which secrete about equal proportions of monomeric and polymeric IgA pertaining to the IgA1 subclass.