CD 57 Test Info
CDC States- Other Types of Laboratory Testing
Some laboratories offer Lyme disease testing using assays whose accuracy and clinical usefulness have not been adequately established. Unvalidated tests available as of 2011 include:
• Capture assays for antigens in urine
• Culture, immunofluorescence staining, or cell sorting of cell wall-deficient or cystic forms of B. burgdorferi
• Lymphocyte transformation tests
• Quantitative CD57 lymphocyte assays
• “Reverse Western blots”
• In-house criteria for interpretation of immunoblots
• Measurements of antibodies in joint fluid (synovial fluid)
• IgM or IgG tests without a previous ELISA/EIA/IFA
A CD 57 could be in normal range with terminal Borreliosis although Borreliosis is not usually terminal in a direct fashion. Acute carditis or complete heart block for example could be terminal without significant immune dysregulation of innate specific CD cell counts. My experience is that in overwhelming or severe immune dysregulation especially with multiple tbds the CD 57 is in low ranges and slow or never responds.
Likewise, a patient can clinically respond after compliant, complex, long treatment plans yet maintain a low level. These patients are in remission but usually closer to relapsing than recovered patients who also recover their CD 57 response. Obviously the CD 57 is not a black and white, yes or no test, although a zero CD 57 is an ominous sign at the start of rx.
The recent article on CD 57 counts which found no difference in those recovered after treating Lyme disease from those who did not have Lyme disease had questionable methodology. The baseline CD 57 counts before rx and then after rx are very important and I don't think this was in the study/ ;and in those who recover completely ( especially when the sample is such a small number, 12 ) one is more likely to find matching normal CD 57 counts. It seems an oxymoron that the methodology would have included those who did not respond to short term "appropriate" treatment- because there likely is a study position that that is a very rare event if at all.
Comment to above blog by LLPA
I would recommend that he/she come to ILADS in October, and discuss his views on testing with the testing experts, including Nick Harris, Jyotsna Shah, Ray Stricker and Ginger Savely. It's grossly unfair, and I believe unprofessional, for a doctor to put something out anonymously on a blog, challenging the dedicated work of those who have done so much to shed a bit of light on testing.
I get the impression from several ILADS docs that to the best of our knowledge, a low CD57+ natural killer T-cell count may be specific to Lyme and/or coinfections, but is not particularly sensitive. In other words, some people with Lyme/coinfections have a low count, but some people symptomatic for Lyme/coinfections have a count within normal ranges. Although an increased count from low to normal range is a likely indicator of improved immune functioning, a count within normal range is not necessarily a good indicator of treatment outcome.
In my opinion, the best explanation for this is that in Lyme disease, chronic activation of inflammatory cytokines activates IFN-gamma, which excessively stimulates IDO and tryptophan catabolism, resulting in tryptophan depletion and neurotoxically high levels of tryptophan catabolites.
This phenomenon is known to reduce proliferation of cytotoxic CD8+ T-cells in HIV infection, cancer, chronic hep B, and chronic hep C. It also significantly strips CD8+ T-cells of their cytotoxic capacity, even when those T cells remain viable, and proliferation rates are only moderately reduced. If this also occurs with CD57+ natural killer T-cells, it would explain the clinical observations I’ve been hearing about.
The 60-360 normal range was established based upon results of 1000 random "healthy" subjects. Dr. Ed Winger who is the one who first started doing the test at LabCorp is the one who told me this.
The CD57 study XXX presented at ILADS a few years ago showed the normal diurnal and day to day variation to be quite large - as much as a 50% variation in any given day (in both sick and well subjects). It also showed that asymptomatic subjects had levels consistently above 100 ( which I have since used as my cut off for normal, rather than 60).
Ray Stricker tried for years to get Quest to do the test exactly like LabCorp did but for some reason they wouldn't do it. I hate to be a skeptic, but based on our past experience with Quest, I'll "believe it when I see it" that they will consistently perform the test according to the Winger/Stricker guidelines. But, hopefully they will!
We have all been aware for several years that LabCorp was the only lab that provided CD57 reports that were reproducible and matched the clinical picture. Specifically, Quest Labs did not even include the specific "CD57+, CD3 -, CD8 -" cell in their lymphocyte subset analyses.
That specific cell is a surrogate marker for Lyme activity -- (when it is down the disease is active, and with recovery it returns to normal.) (Yes, that's just like the HIV marker -- CD4 or T4 Helper cell -- which also reliably estimates the patient's status.)
Almost a year ago, after more than half a dozen phone calls to the Nichols/Quest Lab in California, I persuaded them to add it to their report. It was easy to add it, since the instrument was counting all of those markers, it just wasn't reporting this group.
I have a small number of patients who do not get reimbursed for LabCorp and they are covered by Quest. It took this long for me to realize that i had never seen a "normal" CD57 from Quest. In fact, they don't even print a reference range! I used the LabCorp 60 - 360, since I knew that the technology was very accurate, and there should not be a significant difference from one lab to another. Well, recently my wife was not her old energetic self, and I ordered a CD57 from LabCorp, and sent a split from the same specimen to Quest. I was delighted with the 96 from LabCorp, but very distressed by the 23 reported by Quest.
Both labs reported both the % and the absolute counts, and they didn't match! I went back to the Nichols branch, and spoke to one of the physicians, who implied that this variation was within reasonable limits! I refused to accept that, and she agreed to perform another, at no charge -- as did the LabCorp person. Shortly later, I got a call from the Quest doctor.
She had discovered that LabCorp was giving the % OF TOTAL LYMPHS, while the Quest computer was calculating the % OF TOTAL WBC"S !!! When recalculated the results were deliciously similar, in favor of the healthy result. They have promised me that the program will be changed, since the LabCorp method was adopted from the discovery team, and the Quest method was simply an incorrect assumption.
Now, all we have to figure out is what is the OPTIMUM RANGE, because the classical analysis of the results by the Bell-shaped curve MUST BE SERIOUSLY SKEWED TO THE LOW END, SINCE THE ONLY PEOPLE BEING TESTED UP TO NOW EITHER HAVE LYME OR ARE SUSPECTED OF HAVING IT. IF WE WATCH THE RESULTS FROM QUEST FOR A FEW MONTHS, ONCE THEY HAVE CHANGED THE PROGRAM, THEY WILL BE ABLE TO PROVIDE A BETTER REFERENCE RANGE, SINCE THEY NOW REPORT IT ON ALL THEIR TESTS, WHILE IT STILL REQUIRES SPECIAL ORDER AT LABCORP.