The most abundant immunoglobulin in human serum is immunoglobulin G (IgG) (approximately 80% of the total). IgG protein is comprised of molecules of 4 subclasses designated IgG1 through IgG4. Each subclass contains molecules with a structurally unique gamma heavy chain. Of total IgG, approximately 65% is IgG1, 25% is IgG2, 6% is IgG3, and 4% is IgG4. Molecules of different IgG subclasses have somewhat different biologic properties (eg, complement fixing ability and binding to phagocytic cells), which are determined by structural differences in gamma heavy chains. Clinical interest in IgG subclasses concerns potential immunodeficiencies (eg, subclass deficiencies) and IgG4-related diseases (eg, IgG4 elevations). The IgG subclass assay (IGGS / IgG Subclasses, Serum) is best for deficiency testing, and the IgG4 assay (IGGS4 / Immunoglobulin Subclass IgG4, Serum) is best for IgG4-related disease testing.

Immunoglobulin M (IgM), which is found mainly in the blood and lymph fluid, is the first antibody to be made by the body to fight a new infection. Expressed on the surface of B cells (monomer) and in a secreted form (pentamer) with very high avidity (forms multiple binding sites with antigen). Eliminates pathogens in the early stages of B-cell mediated (humoral) immunity before there is sufficient IgG. 

Immunoglobulin M (IgM) is the first antibody produced by the immune system in response to infection, playing a crucial role in early defense against bacteria and viruses. A blood test measuring IgM levels helps doctors evaluate immune health, diagnose immune deficiencies, distinguish between recent and past infections, and investigate autoimmune diseases or certain blood cancers. Elevated IgM may indicate a recent infection, autoimmune disorder, liver disease, or plasma cell cancer, while low IgM can signal immune deficiency, protein loss, or bone marrow problems. Results should always be interpreted alongside other tests and clinical symptoms, as IgM levels alone do not confirm a diagnosis.

IgG immunoglobulins are composed of four subtypes named IgG1, IgG2, IgG3 and IgG4. Each subclass is present in the serum in different concentrations, varies with age, and has different roles for immune response. Abnormal levels of one or more subclasses may be associated with certain conditions.

This marker helps to evaluate sinopulmonary infections, asthma; immunotherapy hyposensitization; and allergies.

Indican is an indole produced when bacteria in the intestine act on the amino acid, tryptophan. Most indoles are excreted in the feces. The remainder is absorbed, metabolized by the liver, and excreted as indicanin the urine.

Indican is an indole produced when bacteria in the intestine act on the amino acid, tryptophan. Most indoles are excreted in the feces.

The remainder is absorbed, metabolized by the liver, and excreted as indicanin the urine.

Accumulated levels of Indican in the urine may suggest gastrointestinal dysbiosis or malabsorption.

Indican is a byproduct of tryptophan putrefaction by microbes in the gut. Accumulated levels of indican in the urine suggest higher levels of tryptophan putrefaction from gastrointestinal dysbiosis or malabsorption.

Production of indican occurs when tryptophan creates indoles in the colon. No other endogenous indoles are metabolized in this way, so when we see indican in the urine, it is directly related to gut production and a direct reflection of gut health. When there is concern of dysbiosis, there may be poor metabolism of sex hormones (including estrogen) along with chronic low-grade inflammation that can impact cortisol production and metabolism.

Indole is a byproduct of the microbial degradation of tryptophan that can be utilized in a variety of ways in the gut microbiome. Indole can bind to serotonin receptors in order to regulate behavior, gut motility, and food intake, and it can support immune and intestinal health by interacting with gut microbes, scavenging free radicals, and increasing the expression of xenobiotic-metabolizing enzymes like cytochrome P450. Indole also functions as a signaling molecule that may be increased during latent infections. Indole production must be balanced, as too much indole may produce unwanted changes in mood or cognition, yet insufficient indole production may damage the gut barrier.

Indoleacetic acid (IAA), or indole-3-acetate, is produced by the bacterial fermentation of the amino acid tryptophan.

IAA can be formed from several common gut microbes such as Clostridia species, Escherichia coli, and Saccharomyces species.

Indoleacetic acid (IAA), or indole-3-acetate, is produced by the bacterial fermentation of the amino acid tryptophan.

IAA can be formed from several common gut microbes such as Clostridia species, Escherichia coli, and Saccharomyces species.

- A product of tryptophan fermentation. If elevated, decrease protein intake and address digestion and GI issues. Bacteroides, Clostridia, and E. coli ferment tryptophan to produced indoleacetic acid.

- It has been found elevated in liver disease, ASD, and cancer, and has been noted as a marker of microbial activity.

- Indoleacetic acid can be degraded by Bacillus subtilis, or Pseudomonas aeruginosa.

- Indoleacetic acid has been found in many foods, such as lettuce, cherry tomato, Chinese bayberry, and okra.

Produced from bacterial degradation of unabsorbed tryptophan.

Biomarkers:

- Parasitic Infection Pathogenic and potentially pathogenic parasites i.e., Cryptosporidium, Giardia, Entamoeba histolytica, all others)

- Pathogenic Bacteria (Clostridium difficile toxin, Helicobacter pylori, Campylobacter spp., Shiga toxin E. coli)

- PP Bacteria/Yeast (Known Pathogen i.e., Salmonella, Aeromonas, all others)

- Total Abundance: The total commensal abundance is a sum-total of the reported commensal bacteria compared to a healthy cohort. Low levels of commensal bacteria are often observed after antimicrobial therapy, or in diets lacking fiber and/or prebiotic-rich foods and may indicate the need for microbiome support. Conversely, higher total commensal abundance may indicate potential bacteria overgrowth or probiotic supplementation.

Infection Score:

This is where common infectious microorganisms are reported and includes pathogenic bacteria and intestinal parasites.

Therapeutic Support Options: 

Therapeutic support options are static to serve as potential treatment ideas. Clinician discretion is advised when selecting appropriate therapeutics for individual patients.

- Antibiotics (if warranted)

- Antimicrobial Herbal Therapy

- Antiparasitic Herbal Therapy (if warranted)

- Saccharomyces boulardii

Interferon-gamma (IFN-γ or IFNG) is a critical cytokine in the immune system, essential for both innate and adaptive immunity. It is the only member of the type II interferon family and is primarily produced by natural killer (NK) cells, T helper 1 (Th1) cells, and cytotoxic T lymphocytes.

Biomarkers:

- Calprotectin is a marker of neutrophil-driven inflammation. Produced in abundance at sites of inflammation, this biomarker has been proven clinically useful in differentiating between Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). [1,2]

- Eosinophil Protein X is a marker of eosinophil-driven inflammation and allergic response.

- Fecal Secretory IgA is a marker of gut secretory immunity and barrier function.

- Fecal Occult Blood Test detects hidden blood; fecal immunochemical testing (FIT) has been recommended by the American College of Gastroenterology as the preferred noninvasive test for colorectal cancer screening/detection.

Score explanation:

The functional imbalance scores are generated using weighted algorithms that incorporate biomarkers belonging to each functional category. 

0 to 2: This represents a low need for support.

2 to 3: This represents an optional need for support.

4 to 6: This represents moderate need for support.

7 to 10: This represents high need for support.

Therapeutic Support Options: 

Therapeutic support options are static to serve as potential treatment ideas. Clinician discretion is advised when selecting appropriate therapeutics for individual patients.

- Elimination Diet/ Food Sensitivity Testing

- Mucosa Support: Slippery Elm, Althea, Aloe, DGL, etc.

- Zinc Carnosine

- L-Glutamine

- Quercetin

- Turmeric

- Omega-3's

The Inflammation-Associated Dysbiosis (IAD) score serves as a crucial metric for evaluating the interplay between gut inflammation and microbiota composition. This score holds significance as it illuminates how inflammation within the gastrointestinal tract impacts the delicate balance between beneficial and harmful gut bacteria.

Derived from a pattern-based algorithm, the Inflammation-Associated Dysbiosis score categorizes patients based on their scores, revealing a negative correlation between mean IAD score and commensal bacteria abundance, alongside positive associations with fecal calprotectin, EPX, and sIgA levels. Validation studies, encompassing Genova’s database of IBD patients and an independent UCLA study with IBD cohorts, underscore its reliability.

The causal relationship between inflammation-associated dysbiosis and inflammation remains uncertain. A low IAD score coupled with elevated inflammatory markers suggests that the gut microbiome might not be a contributing factor to the inflammatory condition, warranting exploration of alternative etiologies. Longitudinal investigations are imperative to unravel the implications of a high IAD score in the absence of elevated inflammatory markers. It's plausible that an inflammatory microbiome pattern may precede the onset of elevated inflammatory markers, underscoring the need for further research.

Influenza Type A antibody serum refers to the specific antibodies present in the blood serum that are directed against Influenza virus Type A, a highly variable virus responsible for seasonal flu epidemics and occasional pandemics. These antibodies are part of the body's adaptive immune response, produced by B cells as a defense mechanism following exposure to the virus or vaccination. The presence and concentration of these antibodies can be quantified through serological assays, such as hemagglutination inhibition (HI) assays, neutralization tests, and enzyme-linked immunosorbent assays (ELISA). The detection and quantification of Influenza Type A antibodies are crucial for several purposes: epidemiological surveillance, to assess the spread and impact of the virus in populations; vaccine efficacy studies, to evaluate the immune response elicited by flu vaccines; and individual diagnosis, to understand a person's immune status or history of exposure to the virus.

The marker "Influenza Type B Antibody Serum" refers to the presence of specific antibodies in the serum that are produced in response to infection with Influenza Type B virus or following vaccination against this virus. These antibodies are a crucial component of the immune response and serve as indicators of an individual's exposure to the virus or their immunization status. Influenza Type B is one of the three main types of influenza viruses (alongside Types A and C) that infect humans and can cause seasonal epidemics of disease. The presence of these antibodies is detected through serological assays, which are laboratory tests that measure the concentration of antibodies in the blood serum.

Function: An essential nutrient, inositol is found in cell membranes and is needed for proper function of hormones. Inositol, similar to choline, is a component of phospholipids (phosphatidyl inositols). Phosphatidyl inositols function as cell membrane components and as regulators of cell membrane transport by acting as a calcium-mobilizing system (the “PI effect”). Thus, inositol status interacts with a wide variety of hormonal and regulatory events in cells. Lipotropic activity (reduction of blood or tissue lipid levels) of inositol centers around the role of phosphatidyl inositol in lipoproteins. Since inositol is widely available from dietary sources, endogenous synthesis and gut microfloral synthesis, inositol is not classified as a vitamin. Nevertheless, inositol has been considered as a component of the B vitamin complex.