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Soluble IL-2 Receptor (sIL-2R) Serum

Test Code: 30057
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Clinical Utility

sIL-2Ra appears in serum, concomitant with its increased expression on cells and correlates with increased activation of T and B cells. Studies suggest a correlation of levels of sIL-2Ra in serum with the onset of rejection episodes in allograft recipients, with activity of autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus (SLE) and with the course of some leukemias and lymphomas.

About Graft versus Host Disease (GvHD)

Graft versus host disease (GvHD) is one of the major causes of morbidity and mortality associated with allogeneic stem cell transplants. GvHD occurs in 30 – 50% of HLA-matched sibling transplants and 60 – 90% of matched unrelated donors.1,2 GvHD often manifests in the skin, liver and/or gastrointestinal (GI) tract, and is caused by immune dysregulation that is initiated when allogeneic donor T cells recognize host tissues as foreign. GvHD may be either acute or chronic. Acute GvHD (aGvHD), which typically occurs in the first 3 months post-transplant, has an incidence of 19 – 66% and carries a poor prognosis if the disease is severe. Chronic GvHD (cGvHD) occurs 3 months to > 1 year post-transplant and has a pathophysiology that is distinct from aGvHD, although poorly understood. The overall incidence of cGvHD is 40 – 50%.3

Pre-transplant conditioning regimens may damage host tissue, which in turn leads to inflammatory cytokine release (TNF-α, INF-γ, IL-1 and IL-6) directly from damaged tissues. The inflammatory cytokines stimulate antigen presenting cells which present host antigens to donor lymphocytes. In response, donor T cells proliferate, differentiate and undergo activation. Once donor T cells are activated, pro-inflammatory cytokines are produced in large quantities resulting in additional inflammation, recruitment of neutrophils to the site, and ultimately severe tissue damage. Administration of immunosuppressive agents are commonly used to treat cases of GvHD.

In skin, aGvHD frequently manifests as a maculopapular skin rash due to cellular/tissue damage. In the GI tract, aGvHD which frequently manifests as nausea, vomiting, anorexia, secretory diarrhea and in severe cases abdominal pain and at times hemorrhage, is caused by cellular damage to the mucosal epithelial barrier of the small intestines. The occurrence of aGvHD in the liver results in elevated bilirubin levels, indicative of liver damage.

Diagnosis of aGvHD has traditionally been based on the clinical presentation and ruling out other etiologies through differential diagnosis. In some cases biopsies of the liver, skin or GI tract are performed. In recent years, measurement of specific biomarkers, some of which are cytokines, has been shown to provide improved aGvHD diagnostic and prognostic approaches while utilizing in vitro methods and readily available samples such as serum. Recent research has identified several key biomarkers useful for aGvHD diagnosis and prognosis.4

Procedure

Sandwich ELISA technique. sIL-2Ra binds to the specific monoclonal antibody that is pre-coated on a microplate. Bound sIL-2Ra is detected by an enzyme-linked sIL-2Ra specific monoclonal antibody. Substrate solution is added and color develops in proportion to the amount of sIL-2Ra bound. This test has not been cleared or approved for diagnostic use by the U.S. Food and Drug Administration.

7 business days from receipt of specimen

Specimen Type Order Code CPT Code NY Approved Volume Assay Range Special Instructions
serum 30057 84238 Yes 1 mL (min. 100 uL) 622-1619 pg/mL
  • Collect 1 mL, blood should be allowed to clot prior to centrifugation.
  • Specimens should be frozen (-70 C).
  • Ship overnight on dry ice.
  • Stability, not stable ambient or refrigerated.

The result is reported in pg/mL. The reference range for a healthy population is 622 - 1,619 pg/mL. However it should be noted that these ranges are obtained from a limited population of apparently healthy adults and are not diagnostic thresholds.

Specimens are approved for testing in New York only when indicated in the Specimen Information field above.

The CPT codes provided are based on Viracor Eurofins' interpretation of the American Medical Association's Current Procedural Terminology (CPT) codes and are provided for general informational purposes only. CPT coding is the sole responsibility of the billing party. Questions regarding coding should be addressed to your local Medicare carrier. Viracor Eurofins assumes no responsibility for billing errors due to reliance on the CPT codes illustrated in this material.

References

1 Ball LM, Egeler RM, EBMT Paediatric Working Party. Acute GvHD: pathogenesis and classification. Bone Marrow Transplant. 2008 Jun;41 Suppl 2:S58-64.

2 Deeg HJ, Henslee-Downey PJ. Management of acute graft-versus-host disease. Bone Marrow Transplant. 1990 Jul;6(1):1-8.

3 Atkinson K. Chronic graft-versus-host disease. Bone Marrow Transplant. 1990 Feb;5(2):69-82.

4 Paczesny S, Krijanovski OI, Bruan TM, et al. A biomarker panel for acute graft-versus-host disease. Blood. 2009 Jan 8;113(2):273-8.

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