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Toll-Like Receptor Function
0051589
Ordering Recommendation

Assist in diagnosis of innate immunodeficiencies when genetic defects of the innate immune system are suspected in individuals negative for other immunodeficiencies (eg, no detectable abnormality of antibody function, complement activity, neutrophil function, or cell-mediated immunity).

Mnemonic
TLR
Methodology
Cell Culture/Quantitative Multiplex Bead Assay
Performed
Tue-Fri
Reported
9-10 days
New York DOH Approval Status
This test is New York DOH approved.
Submit With Order
ARUP Consult®
Disease Topics
Specimen Required
Patient Preparation
Collect control specimen from a healthy individual unrelated to patient at approximately the same time as and under similar conditions to the patient. 
Collect
Green (sodium heparin) (patient) AND green (sodium heparin) (control). Also acceptable: Yellow (ACD solution A) (patient) AND yellow (ACD solution A) (control). Patient and control specimens must be collected within 48 hours of test performance. 
Specimen Preparation
Transport 10 mL whole blood (patient) AND 10 mL whole blood (control) in original collection tubes. (Min: 7 mL (patient) AND 7 mL (control)) Do not refrigerate or freeze. LIVE CELLS REQUIRED.
Infant Minimum: 3 mL whole blood (patient) AND 7 mL whole blood (control). 
Storage/Transport Temperature
CRITICAL ROOM TEMPERATURE. 
Unacceptable Conditions
Yellow (ACD Solution B). Refrigerated or frozen specimens. 
Remarks
 
Stability
Ambient: 48 hours; Refrigerated: Unacceptable; Frozen: Unacceptable
New York State Clients: Ambient 24 hours; Refrigerated: Unacceptable; Frozen: Unacceptable 
Reference Interval
By report
Interpretive Data
Toll-like receptors (TLR) are tested independently by stimulation with TLR-specific ligands in a peripheral blood mononuclear cell (PBMC) culture. PBMC production of IL-1 beta, IL-6, and TNF alpha is determined by multiplex bead assay for TLR1-8. In addition, PBMC production of CXCL10 is determined for TLR3.

TLR-specific ligands include Pam3CSK4, a synthetic bacterial lipoprotein (TLR2-TLR1 ligand); zymosan cell wall particles from Saccharomyces cerevisiae (TLR6-TLR2 ligand); poly (I:C), a synthetic analog of dsRNA (TLR3 ligand); lipopolysaccharide (LPS) ultra-pure S. minnesota LPS (TLR4 ligand); flagellin purified from S. typhimurium (TLR5 ligand); and CL097 imidazoquinoline compound (TLR7-TLR8 ligand).

Compliance Statement B: This test was developed and its performance characteristics determined by ARUP Laboratories. The U.S. Food and Drug Administration has not approved or cleared this test; however, FDA clearance or approval is not currently required for clinical use. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions.

Note
Results for TNF alpha, IL-1 beta, IL-6, and CXCL10 are reported as pg/mL. Interpretation comparing the patient results to the simultaneously collected client normal control and the laboratory normal control will be provided by an ARUP medical director.

Limitation: Defects in TLR3 associated with Herpes Simplex Encephalitis may not be detected in this assay based on the reported instance of a patient with compound heterozygous mutations in TLR3 leading to decreased cytokine production in response to Poly I:C in fibroblasts but not PBMCs1.
Proteins IRAK-4 and MyD88 play essential roles in TLR-mediated signaling. Defects in IRAK-4 and MyD88 result in compromised TLR signaling. Exceptions are , TLR3 and endosomal TLR4, which, are IRAK-4 and MyD88 independent.

     1. Guo Y, Audry M, Ciancanelli M, Alsina L, Azevedo J, Herman M, et al. Herpes simplex virus encephalitis in a patient with complete TLR3 deficiency: TLR3 is otherwise redundant in protective immunity. J Exp Med. 2011;208(10):2083-98.
CPT Code(s)
86353 x6; 83520 x3
Components
Component Test Code*Component Chart NameLOINC
0051589Toll-Like Receptor Function
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.
Aliases
  • TLR Function