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Test Code CYPAN Cytokine Panel, Plasma


Specimen Required


Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Collection Container/Tube: Lavender-top (EDTA)

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Collection Instructions:

1. Immediately after specimen collection, place the tube on wet ice.

2. Centrifuge at 4° C, 1500 x g for 10 minutes.

3. Aliquot plasma into plastic vial.

4. Freeze specimen within 2 hours of collection.


Useful For

Understanding the etiology of infectious or chronic inflammatory diseases, when used in conjunction with clinical information and other laboratory testing

 

Research studies in which an assessment of cytokine responses is needed

Method Name

Bead-Based Multiplex Immunoassay

Reporting Name

Cytokine Panel, P

Specimen Type

Plasma EDTA

Specimen Minimum Volume

0.3 mL

Specimen Stability Information

Specimen Type Temperature Time
Plasma EDTA Frozen 21 days

Reject Due To

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject
Heat-treated specimen Reject

Clinical Information

Cytokines are important mediators of cell-to-cell communication within the innate and adaptive immune systems. The expression of most cytokines is highly regulated and generally occurs in response to foreign or self-antigenic stimulation. The functions of cytokines are extremely varied, with many cytokines also displaying pleiotropic effects, depending on their cellular target. Some cytokines, such as tumor necrosis factor (TNF), interleukin (IL)-1 beta, IL-6, interferon (IFN)-alpha and beta, IL-10, and IL-18 are particularly important in the innate immune response. For example, TNF, IL-1 beta, and IL-6 induce expression of acute phase proteins in the liver. TNF and IL-1 beta also lead to endothelial activation and are critical regulators of the hypothalamus, which can result in elevated body temperature. IL-6, in comparison, is a bridge to the adaptive immune response, by acting on B cells to induce proliferation. In contrast, IFN-alpha and IFN-beta (members of the type I IFN family) are key components of the innate immune response to viral infections. IFN-gamma, which is a type II IFN, has roles in both the innate and adaptive immune responses, including macrophage activation, induction of B-cell isotype switching, and T helper type 1 cell differentiation. Other cytokines, such as monocyte chemoattractant protein-1 and macrophage inflammatory protein-1 alpha, are categorized as chemokines because they function primarily to attract leukocytes to the site of inflammation. Further, some cytokines act on hematopoietic stem cells to induce differentiation of various leukocytes. For example, granulocyte-monocyte colony stimulating factor induces myeloid progenitor cells to differentiate into neutrophils and monocytes. Lastly, for some cytokines, soluble forms of the receptor can be found in the peripheral circulation. The IL-2 soluble receptor is produced from proteolytic cleavage of the membrane-bound receptor, which occurs during T-cell activation. As a group, cytokines and their receptors represent a highly complex and critical regulator of a normal immune response.

Reference Values

Tumor necrosis factor: <10.0 pg/mL

Interleukin (IL)-6: <5.0 pg/mL

Interferon (IFN)-beta: <20.0 pg/mL

IL-10: <7.0 pg/mL

Monocyte chemoattractant protein-1: ≤198 pg/mL

IL-1 beta: <20.0 pg/mL

IFN-gamma: <60.0 pg/mL

Macrophage inflammatory protein-1 alpha: <220 pg/mL

Granulocyte-monocyte colony stimulating factor: <15.0 pg/mL

IL-2 receptor alpha soluble: ≤959 pg/mL

IFN-alpha: <20.0 pg/mL

IL-18: ≤468 pg/mL

Interpretation

Elevated cytokine concentrations could be consistent with the presence of infection or other inflammatory process.

Cautions

Results from cytokine testing should not be used to establish or exclude a specific diagnosis.

 

Cytokine testing should only be used in conjunction with clinical information and other laboratory testing as part of a patient's overall assessment.

 

Normal concentrations of cytokines do not exclude the possibility of infection or other inflammatory condition.

 

Cytokine concentrations could be affected by immunomodulatory agents.

 

Interleukin-6 (IL-6) concentrations may be elevated in patients receiving IL-6 receptor inhibitors, such as tocilizumab, due to receptor blockade and reduced clearance of IL-6. As a result, IL-6 concentrations are not reflective of adequate tocilizumab response. Additionally, patients receiving anti-IL-6 monoclonal antibodies such as siltuximab may also exhibit interference in IL-6 measurements. For both patient cohorts, a more reliable assessment of IL-6-mediated inflammation can be obtained by measuring downstream acute-phase reactants, such as C-reactive protein.

Clinical Reference

1. Bozza FA, Salluh JI, Japiassu AM, et al. Cytokine profiles as markers of disease severity in sepsis: a multiplex analysis. Crit Care. 2007;11(2):R49. doi:10.1186/cc5783

2. Milman N, Karsh J, Booth RA. Correlation of a multi-cytokine panel with clinical disease activity in patients with rheumatoid arthritis. Clin Biochem. 2010;43(16-17):1309-1314. doi:10.1016/j.clinbiochem.2010.07.012

3. Teijara JR. Type I interferons in viral control and immune regulation. Curr Opin Virol. 2016;16:31-40. doi:10.1016/j.coviro.2016.01.001

4. Tisoncki JR, Korth MJ, Simmons CP, Farrar J, Martin TR, Katze MG. Into the eye of the cytokine storm. Microbiol Mol Biol Rev. 2010;76(1):16-32. doi:10.1128/MMBR.05015-11

5. Garcia Borrega J, Godel P, Ruger MA, et al. In the eye of the storm: Immune-mediated toxicities associated with CAR-T cell therapy. Hemasphere. 2019;3(2):e191. doi:10.1097/HS9.0000000000000191

Day(s) Performed

Wednesday

Report Available

2 to 8 days

Specimen Retention Time

14 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

83520 x 10

83529

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CYPAN Cytokine Panel, P 82335-1

 

Result ID Test Result Name Result LOINC Value
610307 TNF 3074-2
610308 IL-6 26881-3
610309 IFN-beta 97051-7
610310 IL-10 26848-2
610311 MCP-1 97052-5
610312 IL-1 beta 13629-1
610313 IFN-gamma 27415-9
610314 MIP-1 alpha 97053-3
610315 GM-CSF 97054-1
610316 IL-2 receptor alpha soluble 76039-7
610317 IFN-alpha 33820-2
610318 IL-18 33823-6