The chemokine CXCL13 in acute neuroborreliosis.
OBJECTIVE
Recent studies have suggested an important role of the B cell chemoattractant CXCL13 in acute neuroborreliosis (NB). Our aim was to confirm the diagnostic role of CXCL13 and to evaluate its relevance as a therapy response and disease activity marker in NB.


METHODS
CXCL13 was measured in cerebrospinal fluid (CSF) and serum of patients with NB (n=28), systemic borreliosis (SB, n=9), Guillain-Barré syndrome (GBS, n=11), Bell's palsy (BP, n=19), other cranial nerve palsies (CNP, n=5), cephalgia (C, n=20), bacterial CNS infections (B-CNS-I, n=16) and viral CNS infections (V-CNS-I, n=18). For follow-up studies, serial sample pairs were evaluated from 25 patients with NB (n=56), 11 with B-CNS-I (n=25) and 14 with V-CNS-I (n=36).


RESULTS
CSF-CXCL13 was significantly elevated in NB compared with other neurological diseases (p<0.001). Using receiver operating characteristic analysis, 337 ng/g was determined as a cut-off with a sensitivity of 96.4% and a specificity of 96.9%. Of all the parameters investigated, CSF CXCL13 showed the fastest response to antibiotic therapy, decreasing significantly (p=0.008) within 1 week. In untreated patients, CSF CXCL13 was elevated in patients with a short duration of disease. Borrelia burgdorferi antibody index showed no significant (p=0.356) change over follow-up.


CONCLUSIONS
The study confirms the relevance of CXCL13 as a diagnostic biomarker of NB and suggests that CSF CXCL13 in NB is linked to duration of disease and could be a marker of disease activity and response to antibiotic therapy.
Senel
Makbule
M
Department of Neurology, University of Ulm, Ulm, Germany.
Rupprecht
Tobias A
TA
Tumani
Hayrettin
H
Pfister
Hans W
HW
Ludolph
Albert C
AC
Brettschneider
Johannes
J
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000942:Antigens, Bacterial / Q000032:analysis; D015415:Biomarkers; D025065:Borrelia burgdorferi / Q000276:immunology; D054382:Chemokine CXCL13 / Q000097:blood / Q000134:cerebrospinal fluid*; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D009422:Nervous System Diseases / Q000134:cerebrospinal fluid / Q000175:diagnosis; D013129:Spinal Puncture; D014777:Virus Diseases / Q000175:diagnosis
D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D015415:Biomarkers; D054382:Chemokine CXCL13