Comprehensive immunophenotyping of cerebrospinal fluid cells in patients with neuroimmunological diseases

J Immunol. 2014 Mar 15;192(6):2551-63. doi: 10.4049/jimmunol.1302884. Epub 2014 Feb 7.


We performed unbiased, comprehensive immunophenotyping of cerebrospinal fluid (CSF) and blood leukocytes in 221 subjects referred for the diagnostic work-up of neuroimmunological disorders to obtain insight about disease-specific phenotypes of intrathecal immune responses. Quantification of 14 different immune cell subsets, coupled with the assessment of their activation status, revealed physiological differences between intrathecal and systemic immunity, irrespective of final diagnosis. Our data are consistent with a model where the CNS shapes intrathecal immune responses to provide effective protection against persistent viral infections, especially by memory T cells, plasmacytoid dendritic cells, and CD56(bright) NK cells. Our data also argue that CSF immune cells do not simply reflect cells recruited from the periphery. Instead, they represent a mixture of cells that are recruited from the blood, have been activated intrathecally and leave the CNS after performing effector functions. Diagnosis-specific differences provide mechanistic insight into the disease process in the defined subtypes of multiple sclerosis (MS), neonatal onset multisystem inflammatory disease, and Aicardi-Goutières syndrome. This analysis also determined that secondary-progressive MS patients are immunologically closer to relapsing-remitting patients as compared with patients with primary-progressive MS. Because CSF immunophenotyping captures the biology of the intrathecal inflammatory processes, it has the potential to guide optimal selection of immunomodulatory therapies in individual patients and monitor their efficacy. Our study adds to the increasing number of publications that demonstrate poor correlation between systemic and intrathecal inflammatory biomarkers in patients with neuroimmunological diseases and stresses the importance of studying immune responses directly in the intrathecal compartment.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Autoimmune Diseases of the Nervous System / blood
  • Autoimmune Diseases of the Nervous System / cerebrospinal fluid*
  • Autoimmune Diseases of the Nervous System / immunology
  • CD56 Antigen / immunology
  • CD56 Antigen / metabolism
  • Cell Count
  • Dendritic Cells / immunology
  • Dendritic Cells / metabolism
  • Flow Cytometry
  • Humans
  • Immune System / cytology
  • Immune System / immunology
  • Immune System / metabolism
  • Immunologic Memory / immunology
  • Immunophenotyping / methods*
  • Inflammation / blood
  • Inflammation / cerebrospinal fluid*
  • Inflammation / immunology
  • Killer Cells, Natural / immunology
  • Killer Cells, Natural / metabolism
  • Leukocytes / immunology
  • Leukocytes / metabolism
  • Middle Aged
  • Multiple Sclerosis, Chronic Progressive / blood
  • Multiple Sclerosis, Chronic Progressive / cerebrospinal fluid*
  • Multiple Sclerosis, Chronic Progressive / immunology
  • Nervous System Malformations / blood
  • Nervous System Malformations / cerebrospinal fluid*
  • Nervous System Malformations / immunology
  • Prospective Studies
  • T-Lymphocytes / immunology
  • T-Lymphocytes / metabolism
  • Young Adult


  • CD56 Antigen

Supplementary concepts

  • Aicardi-Goutieres syndrome