Abstract
Background. The presence of CSF oligoclonal bands (OBs) is an independent prognostic factor for multiple sclerosis (MS), but the difficulties in the standardization of the test and the interlaboratory variation in reporting have contributed to its limited use in the diagnosis of the disease. Standard nephelometric assays to measure free light chains (FLC) levels have been recently developed and the test may improve the detection of intrathecal B cells activity. Methods. The presence of OBs, kappa and lambda FLC levels, and standard indices of intrathecal inflammation were assessed in 100 consecutive patients, including patients with MS, clinically isolated syndromes (CIS), other inflammatory diseases of the CNS, and other noninflammatory diseases. Results. Both KFLC and LFLC correlated strongly with the presence of OCBs and with all common tests for intrathecal inflammation (p < 0.001 for all comparisons). KFLC and LFLC were significantly different in patients with MS and CIS compared to the other groups (p < 0.001 and p < 0.001, resp.) and had a better diagnostic accuracy than all the other tests (area under the curve 82.3 % for KFLC index and 79.3 % for LFLC index). Conclusion. Nephelometric assays for KFLC in CSF reliably detect intrathecal immunoglobulin synthesis and discriminate MS patients.
Highlights
Various studies on the pathogenesis of multiple sclerosis (MS) have indicated that B cells, as the humoral component of the adaptive immune system, are active participants in the pathogenesis and lesion maintenance throughout the disease process [1]
According to their final diagnosis, we established several diagnostic subgroups: 34 patients fulfilled the criteria of dissemination in space and time for the diagnosis of relapsingremitting multiple sclerosis according to latest criteria [21]; patients presented a clinical isolated syndrome with typical MRI alterations but did not fulfil the diagnostic criteria; patients presented with other CNS inflammatory diseases; 21 patients presented no major clinical or paraclinical sign of inflammation
oligoclonal bands (OCB), immunoglobulins generated by plasma blasts and plasma cells in the CSF or CNS compartment [9], have long been considered the gold standard sign of intrathecal inflammation, and their presence has been shown to be an independent prognostic factor in clinically isolated syndromes (CIS) patients [5,6,7] and associated with a more
Summary
Various studies on the pathogenesis of multiple sclerosis (MS) have indicated that B cells, as the humoral component of the adaptive immune system, are active participants in the pathogenesis and lesion maintenance throughout the disease process [1]. This hypothesis has been confirmed by the positive results of recent clinical trials of anti-B cells drugs in the disease [2]. It has been shown that the presence OCB in the CSF of patients with clinically isolated syndromes (CIS) is an independent prognostic factor for the subsequent development of the disease [5,6,7]. Nephelometric assays for KFLC in CSF reliably detect intrathecal immunoglobulin synthesis and discriminate MS patients
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