Eletroforese das proteínas do líqüido cefalorraquidiano na cisticercose do sistema nervoso central

Spina-França, A.

doi:10.1590/S0004-282X1960000400001

Resumo

In order to analyse the paper strip electrophoresis contribution to the knowledge of cerebrospinal fluid (CSF) proteins in cysticercosis of the central nervous system (CNS) 40 patients were studied (identification data in table 1); the clinical forms and diagnostic data of 30 of them, who had CNS cysticercosis (cases 1 to 30) are summarized in the table 2; cysticercosis of the CNS might play a role in the pathologic condition presented by the remaining 10 patients. CSF protein fractions were examined in all the cases (results in tables 4 and 7) and those of blood sera in cases from 1 to 15 (results in table 5) by paper strip electrophoresis under the specifications previously reported54. A second examination of CSF protein fractions was made some time later in 4 cases (results in table 6). CSF samples were analysed also in respect to cytology, total protein content, Pandy and colloidal benzoin reactions and complement fixation tests for syphillis and cysticercosis (results in table 3). The values obtained for CSF protein fractions were compared to norma) values found in 30 control subjects; these normal values were detailed in a prior publication55 and are summarized in table 8. This comparison shows that CNS cysticercosis produces changes in the electrophoretic prophiJe of CSF proteins (table 9); an increased y-globulin fraction was the main change observed, commonly associated to a low j8-globulin relative concentration. An inversion of a1/a2 quocient was found in 4 cases. The contributions to the study of CNS cysticercosis resulting from the electrophoretic analysis of CSF proteins are discussed in three groups: 1 - Informations obtained by paper electrophoresis of CSF proteins are independent from those resulting from the other laboratory aspects studied. Thus, if the protein fractions of blood sera are considered, although the changes found have mean values similar to those found to the CSF protein fractions (table 10), it was observed that there are individual differences in the protein fraction relative concentrations in blood and CSF (table 11), no correlation being found between them. Considering CSF itself, changes in its protein fractions induced by CNS cysticercosis are similar in ventricular and subarachnoid samples (lumbal and cisternal) (table 13); their intensity is related to the intensity of the whole of CSF changes (table 12). Informations obtained by electrophoretic analysis of CSF proteins, however, differ from those resulting from the other examinations conducted in the CSF sample as was shown in the analysis of cytology (tables 14 and 15), total protein content (table 16), colloidal benzoin reaction and positivity of complement fixation test for cysticercosis. 2 - The clinical value of data achieved by CSF proteins electrophoresis is discussed. Results may have an important role in diagnosis, in the knowledge of its clinical forms (table 17) and in the control of evolution if pathogenetic mechanisms involved in disease are considered. Cases 31 to 40 illustrate the clinical aspects of contributions given by CSF electrophoresis. 3 - The CSF protein fractions changes found in CNS cysticercosis justify their classification among those changes commonly observed in subchronic and chronic inflammatory diseases of the CNS and/or its leptomeningeal coverings. It is assumed in the literature that there occurs a local production of globulins, specially the y-globulin fraction, in such pathologic conditions. Concerning CNS cysticercosis, if CSF total protein content and electrophoretic data on its fractions are considered together (table IS and 19; graph. 1), it is possible to evidence that at least two mechanisms participate in the origin of protein changes (tables 20 and 21; graph. 2) : blood-CSF barrier disturbances are able to explain data concerning albumin, a and globulin changes, which are similar; the local production of y-globulin is the hypothesis most reliable to explain the peculiar changes of this fraction. This hypothesis agrees with literature data concerning other chronie inflammatory diseases of the CNS. The probable role of y-globulin in carrying specific antibodies is pointed out through correlative exploration of its concentration in the CSF sample and the corresponding positivity of complement fixation test for cysticercosis.

A. Spina-França

Tese de doutoramento apresentada à Faculdade de Medicina da Universidade de São Paulo em outubro de 1960

SUMMARY

In order to analyse the paper strip electrophoresis contribution to the knowledge of cerebrospinal fluid (CSF) proteins in cysticercosis of the central nervous system (CNS) 40 patients were studied (identification data in table 1); the clinical forms and diagnostic data of 30 of them, who had CNS cysticercosis (cases 1 to 30) are summarized in the table 2; cysticercosis of the CNS might play a role in the pathologic condition presented by the remaining 10 patients.

CSF protein fractions were examined in all the cases (results in tables 4 and 7) and those of blood sera in cases from 1 to 15 (results in table 5) by paper strip electrophoresis under the specifications previously reported⁵⁴. A second examination of CSF protein fractions was made some time later in 4 cases (results in table 6). CSF samples were analysed also in respect to cytology, total protein content, Pandy and colloidal benzoin reactions and complement fixation tests for syphillis and cysticercosis (results in table 3).

The values obtained for CSF protein fractions were compared to norma) values found in 30 control subjects; these normal values were detailed in a prior publication⁵⁵ and are summarized in table 8. This comparison shows that CNS cysticercosis produces changes in the electrophoretic prophiJe of CSF proteins (table 9); an increased y-globulin fraction was the main change observed, commonly associated to a low j8-globulin relative concentration. An inversion of a₁/a₂ quocient was found in 4 cases.

The contributions to the study of CNS cysticercosis resulting from the electrophoretic analysis of CSF proteins are discussed in three groups:

1 - Informations obtained by paper electrophoresis of CSF proteins are independent from those resulting from the other laboratory aspects studied. Thus, if the protein fractions of blood sera are considered, although the changes found have mean values similar to those found to the CSF protein fractions (table 10), it was observed that there are individual differences in the protein fraction relative concentrations in blood and CSF (table 11), no correlation being found between them. Considering CSF itself, changes in its protein fractions induced by CNS cysticercosis are similar in ventricular and subarachnoid samples (lumbal and cisternal) (table 13); their intensity is related to the intensity of the whole of CSF changes (table 12). Informations obtained by electrophoretic analysis of CSF proteins, however, differ from those resulting from the other examinations conducted in the CSF sample as was shown in the analysis of cytology (tables 14 and 15), total protein content (table 16), colloidal benzoin reaction and positivity of complement fixation test for cysticercosis.

2 - The clinical value of data achieved by CSF proteins electrophoresis is discussed. Results may have an important role in diagnosis, in the knowledge of its clinical forms (table 17) and in the control of evolution if pathogenetic mechanisms involved in disease are considered. Cases 31 to 40 illustrate the clinical aspects of contributions given by CSF electrophoresis.

3 - The CSF protein fractions changes found in CNS cysticercosis justify their classification among those changes commonly observed in subchronic and chronic inflammatory diseases of the CNS and/or its leptomeningeal coverings. It is assumed in the literature that there occurs a local production of globulins, specially the y-globulin fraction, in such pathologic conditions. Concerning CNS cysticercosis, if CSF total protein content and electrophoretic data on its fractions are considered together (table IS and 19; graph. 1), it is possible to evidence that at least two mechanisms participate in the origin of protein changes (tables 20 and 21; graph. 2) : blood-CSF barrier disturbances are able to explain data concerning albumin, a and globulin changes, which are similar; the local production of y-globulin is the hypothesis most reliable to explain the peculiar changes of this fraction. This hypothesis agrees with literature data concerning other chronie inflammatory diseases of the CNS. The probable role of y-globulin in carrying specific antibodies is pointed out through correlative exploration of its concentration in the CSF sample and the corresponding positivity of complement fixation test for cysticercosis.

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Nota do autor - Êste estudo foi elaborado na Clinica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, cujo ambiente de trabalho constituiu o melhor estímulo para a sua feitura. A todos os seus componentes o agradecimento pela parcela da sua contribuição; aos seus dirigentes, pela acolhida amiga e pela orientação pródiga. É inestimável a contribuição devida ao introdutor da eletroforese em papel em nosso meio - o Dr. Günter Hoxter - a quem consignamos nosso profundo agradecimento.

Clínica Neurológica - Hospital das Clínicas da Fac. Med. da Univ. de São Paulo - Caixa Postal 3461 - São Paulo, Brasil.

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2. ASKONAS, B. A.; HUMPHREY, J. H. - Formation of specific antibodies and gamma-globulin. A study of the synthetic ability of various tissues from rabbits immunized by different methods. Biochem. J., 68:252-261 (fevereiro) 1958.
3. ASKONAS, B. A.; WHITE, R. G. - Sites of antibody production in the Guinea pig. The relation between in vitro synthesis of anti-ovalbumin and gamma-globulin and distribution of antibody containing plasmacells. Brit. J. Exper. Path. 37:61-74 (fevereiro) 1956.
4. BAUER, H. - Zur Frage der Identität der Liquorproteine mit den Eiweisskörper des Blutserums. I. Besonderheiten der Liquorproteine hinsichtlich der Vorfraktion der Gamma-globuline und der proteingebundenen Lipide. Deutsche Ztschr. f. Nervenh., 175:354-377 (novembro) 1956.
5. BIAGI, F. F.; TAY, J. - A precipitation reaction for the diagnosis of cysticercosis. Am. J. Trop. Med. a. Hyg., 7:63-65 (janeiro) 1958.
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9. DAVIS, B. D.; MOORE, D. H.; KABAT, E. A.; HARRIS, A. - Electrophoretic, ultracentrifugal and immunochemical studies on Wassermann antibody. J. Immunol., 50:1-20 (janeiro) 1945.
10. DEUTSCH, H. F.; ALBERTY, R. A.; GOSTING, L. J. - Biophysical studies of blood plasma proteins. IV. Separation and purification of a new globulin from normal human plasma. J. Biol. Chem., 165:21-35 (setembro) 1946.
11. ENDERS, J. F. - The concentrations of certain antibodies in globulin fractions derived from human blood plasma. J. Clin. Investigation, 23:510-530 (julho) 1944.
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16. GEINERT, F.; MATIAR, H. - Das elektrophoretische Proteinspektrum in verschiedener Höhe des Liquorsystems. Deutsche Ztschr. F. Nervenh., 179:111-119 (abril) 1959.
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Eletroforese das proteínas do líqüido cefalorraquidiano na cisticercose do sistema nervoso central

Paper strip electrophoresis of cerebrospinal fluid proteins in cysticercosis of the central nervous system

Datas de Publicação

Publicação nesta coleção
05 Dez 2013
Data do Fascículo
Dez 1960

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ARNHOLD, R. G.; ZETTERSTRÖM, R. - Proteins in the cerebrospinal fluid in the newborn. An electrophoretic study including hemolytic disease of the newborn. Pediatrics, 21:279-287 (fevereiro) 1958.

[2] 2. ASKONAS, B. A.; HUMPHREY, J. H. - Formation of specific antibodies and gamma-globulin. A study of the synthetic ability of various tissues from rabbits immunized by different methods. Biochem. J., 68:252-261 (fevereiro) 1958.

[3] 3. ASKONAS, B. A.; WHITE, R. G. - Sites of antibody production in the Guinea pig. The relation between in vitro synthesis of anti-ovalbumin and gamma-globulin and distribution of antibody containing plasmacells. Brit. J. Exper. Path. 37:61-74 (fevereiro) 1956.

[4] 4. BAUER, H. - Zur Frage der Identität der Liquorproteine mit den Eiweisskörper des Blutserums. I. Besonderheiten der Liquorproteine hinsichtlich der Vorfraktion der Gamma-globuline und der proteingebundenen Lipide. Deutsche Ztschr. f. Nervenh., 175:354-377 (novembro) 1956.

[5] 5. BIAGI, F. F.; TAY, J. - A precipitation reaction for the diagnosis of cysticercosis. Am. J. Trop. Med. a. Hyg., 7:63-65 (janeiro) 1958.

[6] 6. BIAGINI, R.; RADICCHI, M. - Studio elettroforetico sul liquor e sul sangue in soggetti affetti da lues cerebri. Rassegna di studi psichiat., 44:674-686 (setembro-outubro) 1955.

[7] 7. BROTTO, W. - Aspectos neurológicos da cisticercose. Arq. Neuro-Psiquiat. (São Paulo), 5:258-294 (setembro) 1947.

[8] 8. CERVOS-NAVARRO, J.; MATIAR, H. - Zur Frage der intrathekalen Regulation und Genese der Liquorproteine. Deutsche Ztschr. f. Nervenh., 179:614-638 (outubro) 1959.

[9] 9. DAVIS, B. D.; MOORE, D. H.; KABAT, E. A.; HARRIS, A. - Electrophoretic, ultracentrifugal and immunochemical studies on Wassermann antibody. J. Immunol., 50:1-20 (janeiro) 1945.

[10] 10. DEUTSCH, H. F.; ALBERTY, R. A.; GOSTING, L. J. - Biophysical studies of blood plasma proteins. IV. Separation and purification of a new globulin from normal human plasma. J. Biol. Chem., 165:21-35 (setembro) 1946.

[11] 11. ENDERS, J. F. - The concentrations of certain antibodies in globulin fractions derived from human blood plasma. J. Clin. Investigation, 23:510-530 (julho) 1944.

[12] 12. ESSER, H. - Die Liquoreiweisskörper des Menschen. Zentralbl. f. d. ges. Neurol, U. Psychiat., 122:68 (março) 1953.

[13] 13. FIELD, E. O. - The production of gamma-globulin in the central nervous system. J. Neurol., Neurosurg. a. Psychiat., 17:228-232, 1954.

[14] 14. FISHMAN, R. A.; RANSONHOFF, J.; OSSERMAN, E. F. - Factors influencing the concentration gradient of protein in cerebrospinal fluid. J. Clin. Investigation, 37:1419-1424 (outubro) 1958.

[15] 15. FRICK, E.; SCHEID-SEYDEL, L. - Untersuchungen mit J₁₃₁-Markiertem Gamma-Globulin zur Frage der Abstammung der Liquoreiweisskörper. Klin. Wchnschr., 36:857-863 (setembro, 15) 1958.

[16] 16. GEINERT, F.; MATIAR, H. - Das elektrophoretische Proteinspektrum in verschiedener Höhe des Liquorsystems. Deutsche Ztschr. F. Nervenh., 179:111-119 (abril) 1959.

[17] 17. HANZAL, F.; VYMAZAL, J. - The significance of electrophoretic investigation in inflammatory diseases of the nervous system. Acta Psychiat. et Neurol. Scandinav., 33:283-295, 1958.

[18] 18. HANZAL, F.; VYMAZAL, J.; HOVORKOVA, - Zmeny bilkovin u tuberkulosního zánetu mozkomísních plen (Alterações protéicas na inflamação tuberculosa das meninges cerebrospinais). Resumo em inglês in Ceskoslovenská Neurologie, 19:15-23, 1956.

[19] 19. HUHN, A. - Die Zystizerkose des Gehirns und Rückenmarks. Fortschr. D. Neurol., Psychiat., 24:7-27 (janeiro) 1956.

[20] 20. KABAT, E. A.; MOORE, D. H.; LANDOW, H. - An electrophoretic study of the protein components in cerebrospinal fluid and their relationship to the serum proteins. J. Clin. Investigation, 21:571-577 (setembro) 1942.

[21] 21. KAFKA, V. - Zur Frage der Herkunft der Liquoreiweisskörper. Deutsche Ztschr. f. Nervenh., 168:77-83 (maio) 1952.

[22] 22. KAFKA, V. - Liquor cerebrospinalis und Immunitätsforschung. Fortschr. d. Neurol., Psychiat., 21:311-339 (julho) 1953.

[23] 23. KAFKA, V. - Stehen wir vor einer Krise der Liquordiagnostik? Deutsche Ztschr. f. Nervenh., 173:103-110 (abril) 1955.

[24] 24. KIKUCHI, J. - Electrophoretic analysis of protein in spinal fluid by meningitis. Folia Psychiat. et Neurol. Japónica, suplemento 2 (Proceedings XIV Annual Meeting of Japan Neurosurgical Society), págs. 2-3, 1955.

[25] 25. KITAMURA, K.; KATSUKI, T.; HARÁ, H. - Studies on protein in cerebrospinal fluid in neurosurgical diseases by paper-electrophoresis. Folia Psychiat. et Neurol. Japónica, suplemento 2 (Proceedings XIV Annual Meeting of Japan Neurosurgical Society), págs. 1-2, 1955.

[26] 26. KNAPP, A. - Über die Papierelektrophorese des Liquor cerebrospinalis. Arch. f. Klin. U. experiment. Dermat., 201:446-477, 1955.

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