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Toll-Like Receptor Function
Ordering Recommendation
Aids 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). This test does not measure the function of toll-like receptor 3 (TLR3). Molecular testing is the preferred method for detection of defects in TLR3. For patients who are lymphopenic, collection of 10 mL of whole blood, rather than the minimum required volumes, is recommended to increase the likelihood that a sufficient number of lymphocytes can be isolated for testing.
New York DOH Approval Status
Specimen Required
Collect control specimen from a healthy individual unrelated to patient at approximately the same time as and under similar conditions to the patient.
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.
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).
For patients who are lymphopenic, collection of 10 mL of whole blood, rather than the minimum required volumes, is recommended to increase the likelihood that a sufficient number of lymphocytes can be isolated for testing.
CRITICAL ROOM TEMPERATURE.
Yellow (ACD solution B). Refrigerated or frozen specimens.
Ambient: 48 hours; Refrigerated: Unacceptable; Frozen: Unacceptable
New York State Clients: Ambient 24 hours; Refrigerated: Unacceptable; Frozen: Unacceptable
Methodology
Cell Culture/Quantitative Multiplex Bead Assay
Performed
Sun, Tue, Wed, Thu, Fri, Sat
Reported
9-10 days
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 TLR 1,2,4-8.
TLR-specific ligands include Pam3CSK4, a synthetic bacterial lipoprotein (TLR2-TLR1 ligand); zymosan cell wall particles from Saccharomyces cerevisiae (TLR6-TLR2 ligand); lipopolysaccharide (LPS) ultra-pure S. minnesota LPS (TLR4 ligand); flagellin purified from S. typhimurium (TLR5 ligand); and CL097 imidazoquinoline compound (TLR7-TLR8 ligand).
Laboratory Developed Test (LDT)
Note
Results for TNF alpha, IL-1 beta, and IL-6 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 IRAK-4 and MyD88 result in compromised TLR signaling. Exception is endosomal TLR4, which is IRAK-4 and MyD88 independent.
Hotline History
CPT Codes
86353 x5; 83520 x2; 83529
Components
| Component Test Code* | Component Chart Name | LOINC |
|---|---|---|
| 0051589 | Toll-Like Receptor Function |
Aliases
- TLR Function
