Neuroscience Cytokine Profile Test Results.

[Ema]

FWIW, I also had the same cytokines drawn at Labcorp last Monday. I'll be curious to see if those come back elevated as well and how they compare to the Neuroscience testing.

Well, as usual, nothing is simple or straightforward!

My Labcorp results:

IL-6 2.2 pg/ml (0-15.5)
TNF-a 0.7 pg/ml (0-8.1)
IL-8 39 pg/ml (0-66.1)
IL-1b <0.6 (<0.8)

So none of them are high! Ugh.

 

[halcyon]

Well, as usual, nothing is simple or straightforward!

My Labcorp results:

IL-6 2.2 pg/ml (0-15.5)
TNF-a 0.7 pg/ml (0-8.1)
IL-8 39 pg/ml (0-66.1)
IL-1b <0.6 (<0.8)

So none of them are high! Ugh.

Yeah, great. I really don't trust LabCorp for these tests.

 

[drob31]

Well, as usual, nothing is simple or straightforward!

My Labcorp results:

IL-6 2.2 pg/ml (0-15.5)
TNF-a 0.7 pg/ml (0-8.1)
IL-8 39 pg/ml (0-66.1)
IL-1b <0.6 (<0.8)

So none of them are high! Ugh.

Are those the only cytokines they test for? How about IL-17/IL-17A?

 

[halcyon]

Well, as usual, nothing is simple or straightforward!

My Labcorp results:

IL-6 2.2 pg/ml (0-15.5)
TNF-a 0.7 pg/ml (0-8.1)
IL-8 39 pg/ml (0-66.1)
IL-1b <0.6 (<0.8)

So none of them are high! Ugh.

Did the same doctor order both the LabCorp and Neuroscience tests for you? If so I'd be curious how they would interpret such a striking difference in results.

 

[SOC]

Well, as usual, nothing is simple or straightforward!

My Labcorp results:

IL-6 2.2 pg/ml (0-15.5)
TNF-a 0.7 pg/ml (0-8.1)
IL-8 39 pg/ml (0-66.1)
IL-1b <0.6 (<0.8)

So none of them are high! Ugh.

Did the same doctor order both the LabCorp and Neuroscience tests for you? If so I'd be curious how they would interpret such a striking difference in results.

I don't know enough about cytokines to say much intelligent, but I do have a 'wonder' about results like these: I wonder if single-point data is too variable to draw solid conclusions and whether trends might be more useful.

Medicine has (another) bad habit of looking only at single-point data and trying to draw major conclusions from that very limited data. While certainly some parameters stay consistent over longer periods of time and a single point measurement could be considered reflective of the overall situation, the human body is a highly dynamic system so many single-point measurements would not give useful information.

For example, an isolated high IL-6 might be normal as long as the long-term (days, weeks, months?) trend is within normal range, while a consistently high IL-6 could be indicative of something wrong. Taking one data point would not tell you which situation you are in. And two data points would only be confusing. It's like looking at a moving elephant through a pinhole -- you get tiny bits of divergent information and no sense of the bigger picture. If you're taking little snapshots, you may need a lot of them to get the full picture.

Another example of the importance of trends in data is high antibody titres. Antibody titres can be high several years after the original infection and therefore not necessarily be concerning. However, antibody titres that are increasing rather than decreasing over time would not be indicative of a previous infection, but rather an active infection the body is trying to fight. Taking one data point and finding a high titre doesn't indicate whether you had a past infection and antibodies that are slowly decreasing over time (normal), or a current infection with increasing titres (not normal). Then, of course, there's the question of what stable high titres (neither decreasing or increasing) mean.

 

[Ema]

Did the same doctor order both the LabCorp and Neuroscience tests for you? If so I'd be curious how they would interpret such a striking difference in results.

Yes, the same doctor.

No explanation, really, though we've not talked about it in depth and probably won't until my appointment in June. I asked her to call the Neuroscience doctor "hotline" and ask them what they thought about it. We'll see if they have any insights to offer but somehow I feel doubtful.

 

[Ema]

Aren't the stimulated cytokines supposed to be elevated? I think PHA is a lectin and LPS is from gram negative bacteria. Isn't it normal for the immune system to react to these? I guess the question is whether or not the reaction is abnormal.

According to the lab, the reference ranges have been created for a "normal" response to the stimulation. So yes, the cells should react to the stimulation but the "normal" result should fall into the listed reference range.

So the elevations my results show outside of this "normal" reference range are abnormal and reflective of a highly activated immune response. Supposedly.

 

[Jonathan Edwards]

Well, as usual, nothing is simple or straightforward!

My Labcorp results:

IL-6 2.2 pg/ml (0-15.5)
TNF-a 0.7 pg/ml (0-8.1)
IL-8 39 pg/ml (0-66.1)
IL-1b <0.6 (<0.8)

So none of them are high! Ugh.

For what is's worth these look to me like results from a lab that understands assays, the Neuroscience ones do not. A lab that has an understanding of assays is very unlikely to report a result of 14,285.3. Most lab scientists would just laugh at a number like this. Assays of this sort will not have an accuracy to more than three decimal places at the very most. Even two is optimistic. Six decimal places means someone has just read off a computer print out and stuck it on a report - to my mind. Normally, calibration curves for assays like this will not cover more than two orders of magnitude so you need to dilute the sample to get a reading and then you would report to the same numbe of decimal places as for undiluted samples. Add to that the fact that an IL-6 level like this and a normal CRP seems to mean that the textbooks are wrong and the figure becomes pretty hard to take seriously. As discussed on other threads these commercial lab assays look to be rather out of line with what is coming out of research labs.

 

[Ema]

A lab that has an understanding of assays is very unlikely to report a result of 14,285.3. Most lab scientists would just laugh at a number like this. Assays of this sort will not have an accuracy to more than three decimal places at the very most. Even two is optimistic. Six decimal places means someone has just read off a computer print out and stuck it on a report - to my mind.

Where do you see 6 decimal places, @Jonathan Edwards? I see one.

I don't disagree that the results may be inaccurate -from either Labcorp or Neuroscience since they are both commercial labs - but without the units, I don't see how anyone can make any pronouncements.

 

[halcyon]

Under basal conditions, IL-6 in plasma should be close to undetectable. If your IL-6 was actually as high as the first panel says, your CRP should be through the roof as well. With these things in mind, the LabCorp results do make a lot more sense. I think it deserves an explanation from Neuroscience as to how the heck they arrived at such a crazy result.

 

[Ema]

Under basal conditions, IL-6 in plasma should be close to undetectable. If your IL-6 was actually as high as the first panel says, your CRP should be through the roof as well. With these things in mind, the LabCorp results do make a lot more sense. I think it deserves an explanation from Neuroscience as to how the heck they arrived at such a crazy result.

True. IL-6 stimulates liver production of CRP. It doesn't make much sense.

I do wonder if my extremely elevated (from Labcorp) TGF-b1 has anything to do with suppressing some of these other inflammatory markers though.

 

[Jonathan Edwards]

Where do you see 6 decimal places, @Jonathan Edwards? I see one.

I don't disagree that the results may be inaccurate -from either Labcorp or Neuroscience since they are both commercial labs - but without the units, I don't see how anyone can make any pronouncements.

I realise that decimal place is strictly to the right of the dot but the place of the dot is arbitrary according to whether it is micro, pico, femto or whatever. I am used to using the term for the number of digits given irrespective of the dot. If these are valid it is called 'significant figures' but if it is false precision I am not quite sure what the official term is. The point is that no biological assay has sufficient calibration precision to give a figure that looks as if it has six significant figures. It does not matter what the units are, although I have noticed that labs that give implausible numbers of figures also often omit their units or give them in a strange notation. For me those are all signs of unprofessional lab work.

 

[SOC]

Where do you see 6 decimal places, @Jonathan Edwards? I see one.

I believe Jonathan is confusing significant figures and decimal places of accuracy in measurement. Two different things, but easy to confuse. Many of my students confuse the two when first learning about them.

I would agree that the results show a surprising number of significant figures. I doubt they had measurements of sufficient accuracy to warrant that many sig figs in the conclusion. That's another thing we have to teach in math/science, and yet too many people forget -- just because your calculator/computer gives you a result to umpteen figures doesn't mean there's actually that degree of accuracy in your calculations.

 

[Jonathan Edwards]

I believe Jonathan is confusing significant figures and decimal places of accuracy in measurement. Two different things, but easy to confuse. Many of my students confuse the two when first learning about them.

I would agree that the results show a surprising number of significant figures. I doubt they had measurements of sufficient accuracy to warrant that many sig figs in the conclusion. That's another thing we have to teach in math/science, and yet too many people forget -- just because your calculator/computer gives you a result to umpteen figures doesn't mean there's actually that degree of accuracy in your calculations.

But according to Wikipedia they aren't significant figures it they are spurious - so do you know of a correct term here? That was what I found confusing!

 

[Valentijn]

But according to Wikipedia they aren't significant figures it they are spurious - so do you know of a correct term here? That was what I found confusing!

Insignificant figures?

 

[Jonathan Edwards]

Insignificant figures?

Brilliant!

 

[Ema]

This is what I (finally) got back from Neuroscience in terms of their results:

Peripheral blood mononuclear cells (PBMCs) are separated and extracted from the blood sample. The PBMCs are then incubated with a media which is used as a negative control (for the baseline reading) or with the requested stimuli (LPS, PHA, or Candida albicans). Upon stimulation, the cells release certain cytokines into the cell culture supernatant. The supernatant of the cell suspension is then analyzed with a multiplex system from Biorad and quantified for requested cytokines.

The results are reported in pg/mL.

So the units are the same as for the Labcorp testing which is interesting.

They wouldn't speculate on why they are so different though. I'm still waiting to hear back from my doctor on whether or not they are willing to provide more information to her through their doctor hotline though.

 

[Jonathan Edwards]

This is what I (finally) got back from Neuroscience in terms of their results:

So the units are the same as for the Labcorp testing which is interesting.

They wouldn't speculate on why they are so different though. I'm still waiting to hear back from my doctor on whether or not they are willing to provide more information to her through their doctor hotline though.

It was not clear to me originally but it seems that the baseline figures from Neuroscience are concentrations of cytokine resulting from incubating white cells in plain medium. I wonder if the Labcorp figures are just serum levels? Then there is no reason for them to be similar. But there is still the question of what baseline white cell cytokine secretion means - since the idea of the test is to look for responses to cytokines rather than the 'control' baseline figure.