The Multiple Sclerosis Cooperative Etiological Study in Italy: preliminary analysis of CSF findings

295 newly diagnosed Multiple Sclerosis (MS) patients were investigated for interdependence of CSF abnormalities: leukocyte count, CSF/serum albumin ratio, CSF IgG index and intrathecal synthesis of oligoclonal IgG. Only 7% of patients had no CSF abnormality. The most frequent abnormal finding was the presence of intrathecal synthesis of oligoclonal IgG. Polyacrylamide isoelectric focusing appeared more sensitive than agarose electrophoresis for the detection of abnormal CSF fractions. CSF IgG index had low negative and high positive predictive value when compared with electrophoretic methods. Suspected MS had the lowest frequency of abnormal CSF parameters. Patients with oligoclonal CSF bands (OB+) did not differ in age, sex, disease duration or annual bout rate from patients without oligoclonal bands (OB-). CSF leukocyte count was higher in OB+ than in OB- patients. Low CSF cell count was a hallmark of progressive disease. In OB+ patients CSF cell count correlated with CSF IgG index during the first five years of disease and declined with increasing disease duration. In later disease phases CSF IgG index correlated negatively with CSF/serum albumin ratio. 5 years follow-up of this series of patients is in progress to assess the diagnostic and prognostic values of CSF abnormalities in Multiple Sclerosis.

Prognostic value of cerebrospinal fluid electrophoresis in optic neuritis and suspected multiple sclerosis

The prognostic significance of cerebrospinal fluid electrophoresis and IgG-index has been investigated in 44 patients, of whom 10 had optic neuritis and 34 suspected, possible or probable multiple sclerosis. The predictive value of CSF oligoclonal banding for future disease dissemination is very high in the suspected multiple sclerosis subgroup, where after a follow-up of 4.4 years, 7 out of 7 band-positive patients displayed further disease activity. The absence of CSF oligoclonal bands seems to carry a relatively benign short-term (follow-up 3.4 years) prognosis in suspected MS cases.

Routine detection of IgG oligoclonal bands and free light chains patterns by means of agarose isoelectric focusing and avidin-biotin-peroxidase complex staining in multiple sclerosis unconcentrated cerebrospinal fluid

We demonstrate the possibility of a complete routine study on unconcentrated CSF from patients with Multiple Sclerosis (MS) using agarose isoelectric focusing (AIEF) followed by avidin-biotin-peroxidase complex staining to detect IgG oligoclonal bands (OB) and free light chains (FLC). The oligoclonal IgG patterns were demonstrated by loading the gel with only 225 ng of IgG. All the specimens were then diluted to a final concentration of 15 ng/L. The method also proved to be very sensitive for the detection of FLC patterns that were an interesting feature of the CSF from MS patients in active phases of the disease. The routine detection of abnormal IgG components synthetized inside the Central Nervous System (CNS) is really improved by the application of this method.

Contribution of CSF studies to diagnosis of multiple sclerosis

Current principles for optimal examination of CSF regarding cell counting, evaluation of blood-brain barrier (BBB) function, intra-BBB synthesis of IgG, IgA and IgM, demonstration of oligoclonal IgG bands, determination of immune complexes and levels of myelin basic protein are reviewed. The importance for clinical as well as research purposes of accurately performed examinations regarding these variables is underlined. Multiple sclerosis (MS) is characterized by elevated mononuclear cell count in about one third of the patients, elevated CSF/serum albumin ratio as evidence of BBB damage in around 10%, elevated CSF IgG index, equal to (CSF/serum IgG): (CSF/serum albumin), in about 70% and presence of oligoclonal bands demonstrable by electrophoresis or isoelectric focusing in almost every patient. These variables are recommended for the routine evaluation of CSF, especially when a diagnosis of MS is suspected. Additional tests advisable for the well-equipped laboratory include determination of CSF IgM index, which is elevated in about 50%, and of myelin basic protein level, which is frequently increased during clinical exacerbations. CSF abnormalities are registered more frequently than abnormal evoked potentials, and at a frequency similar to that found by advanced neuroimaging, but only CSF studies have the potential to disclose the inflammatory character of nervous system lesions and intra-BBB immune response which are characteristic for MS. Documentation of an intra-BBB immune response by CSF studies will thus also in the future have diagnostic implications, and continue to be highly relevant for research regarding etiology and pathogenesis of MS.

Value of visual evoked response and oligoclonal bands in cerebrospinal fluid in diagnosis of spinal multiple sclerosis

To assess the predictive value of prolongation of visual evoked response (VER) plus the presence of oligoclonal bands in the cerebrospinal fluid (CSF) in the diagnosis of multiple sclerosis (MS) in patients with isolated cord lesions, the false-positive rate for the two tests combined was determined by a prospective analysis of 42 patients with a structural spinal cord lesion. The false-positive rate for the combination of VER and CSF abnormalities was zero, but the individual false-positive rates were 10% for VER and 12% for CSF protein oligoclonal bands. According to Bayes' theorem, and taking into account the false-positive rates of the tests in the population studied and the prevalence of MS and the true-positive rates for the tests as derived from published reports, abnormalities of VER and CSF protein together gave a probability of MS of 100%. However, if only either the VER or the CSF were abnormal, the probability of MS was 44% or 49%, respectively. An abnormal result for both tests thus indicates a sufficiently high probability of MS to exclude myelography, but a positive result in only one test warrants the procedure.

Comparison of polyacrylamide and agarose support media for detection of oligoclonal IgG bands in CSF

Parallel samples of cerebrospinal fluid (CSF) from 120 patients clinically suspected of having multiple sclerosis were electrophoresed using agarose or 7% polyacrylamide. 57 samples showed oligoclonal IgG patterns in polyacrylamide but only 34 showed bands after concentration and electrophoresis in agarose. The concentrations of IgG and albumin were also measured in each sample and IgG/albumin ratios calculated. The sensitivities of the three methods for the detection of intrathecally synthesised IgG were compared. Electrophoresis in 7% polyacrylamide gave the highest proportion of significant results. In an attempt to increase the sensitivity of the agarose method, silver staining was performed on unconcentrated samples run in agarose. This did not alter the pattern of electrophoresis in samples containing oligoclonal IgG, but the sensitivity of the technique was lower than that of polyacrylamide.

A case of multiple sclerosis with an onset mimicking the Kleine-Levin syndrome

A 20 years old patient is described, who presented two episodes of day-time hypersomnia, orthostatic hypotension and psychotic behavior. Compulsive masturbation and abnormalities of the eating habits were also present. Both episodes cleared up spontaneously in about one week. From the clinical point of view of Kleine-Levin syndrome, was suspected. However a CSF examination showed IgG oligoclonal bands and an increased IgG index. A NMR showed multiple area of increased signal intensity, suggestive of a demyelinating disease. On these elements a final diagnosis of MS was made, in spite of a normal neurological examination. This case was compared to other cases of MS in which the disease begins with acute remitting psychiatric symptoms. However cases of MS with complex episodes as observed in our patient were not found in the Literature.

Oligoclonal "fingerprint" of CSF IgG in multiple sclerosis patients is not modified following intrathecal administration of natural beta-interferon

The IgG pattern in CSF was studied in 11 patients with multiple sclerosis who exhibited an oligoclonal banding upon thin-layer polyacrylamide gel isoelectric focusing followed by silver stain of unconcentrated CSF. Each patient received beta-interferon intrathecally during a 2 month period. No modification was observed over a 6 month period. In addition, the oligoclonal pattern was remarkably unique for each individual representing a typical "fingerprint" which allowed the identification of any single CSF.

Demonstration of intrapleural immunoglobulin synthesis by agarose gel isoelectric focusing. A new specific method for the diagnosis of pleural effusions of inflammatory origin?

In order to demonstrate an intrapleural immunoglobulin (Ig) synthesis, pleural effusions and serum from 14 patients with pleural effusions of various causes (inflammatory condition, malignancies, primary lung cancers, pleural metastasis, and congestive heart failure) were investigated by agarose gel isoelectric focusing (AIEF), antiserum immunofixation with monospecific antiserum against IgG and IgA, and quantitative estimation of IgG and IgA. Intrapleural immunoglobulin synthesis was assumed to occur in patients with oligoclonal Ig limited to the pleural compartment or in patients with a raised IgG index, equal to (pleura/serum IgG):(pleura/serum albumin), or a raised IgA index, equal to (pleura/serum IgA):(pleura/serum albumin). Two of 3 patients with rheumatoid pleuritis had a polyclonal intrapleural immunoglobulin synthesis demonstrated by the presence of a raised IgG and IgA index without any signs of oligoclonal Ig production on AIEF. Two of 3 patients with assumed tuberculous pleuritis had, despite a normal IgG and IgA index, an oligoclonal intrapleural IgG production detected by AIEF. This oligoclonal reaction was shown by absorption studies with Mycobacterium tuberculosis antigen to be directed against M. tuberculosis. No signs of intrapleural immunoglobulin synthesis were found in the other 10 patients investigated.

Asymptomatic oligoclonal CSF IgG and progressive increase of intrathecal IgG synthesis in a patient with myasthenia gravis treated with thymectomy--a 4-years follow-up

A young woman is described who had myasthenia gravis which was favourably influenced by thymectomy. Although there was no evidence for another neurological disease over 7.5 years of clinical observation and computed tomography as well as visual evoked response were normal, CSF studies over 0.5 years prior to and 3.5 years after thymectomy revealed persistent mononuclear pleocytosis, high CSF IgG index, oligoclonal IgG bands in CSF, and increasing IgG synthesis rate within the CNS, reflecting a continuous local humoral immune response. CSF/serum ratios of antibodies to acetylcholine receptors (AChR) were continuously lower than CSF/serum IgG ratios, contradicting intrathecal AChR antibody production. Proportion of total T cells was slightly higher in CSF than peripheral blood, while active T cells were lower in CSF. CSF lymphocytes did not proliferate on PHA stimulation but responded in allogeneic mixed lymphocyte culture. B cells were 4% in CSF and 4.5% in peripheral blood, but 227 IgG, 0 IgA and 0 IgM producing cells were detected among 20 X 10(3) CSF lymphocytes, compared to 5, 4 and 0 in 20 X 10(3) peripheral blood lymphocytes. This patient represents an in vivo 'experiment' regarding influence of thymectomy on CSF compartment constituents. The present study also shows that an individual can be clinically healthy despite continuous and pronounced intrathecal immune response.

Demonstration in children of oligoclonal IgG bands in unconcentrated CSF using agarose isoelectric focusing and immunolabeling

Agarose isoelectric focusing, followed by protein transfer to cellulose nitrate membrane and double-antibody avidin-biotin peroxidase staining (avidin-biotin agarose isoelectric focusing), was used to demonstrate oligoclonal IgG bands in unconcentrated cerebrospinal fluid (CSF) and serum; 161 consecutive pediatric patients, ages 6 months to 16 years with a variety of mainly neurologic disorders, were studied. The procedure was standardized for agarose isoelectric focusing (AIF) using 5 microliter specimens containing 125 ng of IgG. Oligoclonal bands were found in the CSF of 12% of the patients; bands were found simultaneously in the CSF and serum of 10% of the patients, mostly those with nervous system infections, but also those with central nervous system tumors, seizures, or migraine. In about 50% of positive cases, oligoclonal bands constituted the only CSF abnormality, reflecting an abnormal humoral immune response within the CSF-central nervous system compartment. Avidin-biotin AIF can be recommended as an integrated part of routine CSF examinations in children.

Specificity of CSF antibodies against components of Borrelia burgdorferi in patients with meningopolyneuritis Garin-Bujadoux-Bannwarth

The specificity of immunoglobulin (Ig) for components of Borrelia burgdorferi was investigated in cerebrospinal fluid (CSF), serum and in CSF oligoclonal bands from nine patients with meningopolyneuritis Garin-Bujadoux-Bannwarth (MPN-GBB). All patients showed specific IgG and IgM antibodies in serum and CSF when incubated with a lysate of B. burgdorferi strain B 31. Specific antibody was detected in CSF but not in paired serum samples, indicating intrathecal synthesis. Investigation of the specificity of oligoclonal Ig in the CSF revealed oligoclonal bands with specificity for B. burgdorferi in one of the nine patients.

Clinical significance of serum and CSF findings in the Guillain-Barré syndrome and related disorders

Clinical data and the serum and cerebrospinal fluid (CSF) findings of 71 patients with Guillain-Barré syndrome (GBS), 7 with Fisher syndrome and 24 with chronic inflammatory polyradiculoneuropathy (CIP), were analysed. Isoelectric focusing of serum and CSF together with different formulae and diagrams were applied to study blood-CSF barrier (BCB) function and possible intrathecal IgG synthesis. The CSF total protein concentration and its IgG percentage depended mainly on the degree of BCB damage, which correlated with the clinical course. Our investigations suggest that oligoclonal IgG of CSF from these patients comes essentially from serum. In the group of GBS patients, oligoclonal IgG was transitory and correlated significantly with the development of BCB damage, cranial neuritis and severity of the disease. CIP patients showed a stable IgG pattern, which varied slightly after immunosuppressive therapy.

[Oligoclonal immunoglobulin M in the cerebrospinal fluid of patients with Garin-Bujadoux-Bannwarth meningopolyneuritis]

Paired cerebrospinal fluid (CSF) and serum samples from 15 patients with meningopolyneuritis Garin-Bujadoux-Bannwarth (MPN-GBB) were investigated by agarosegel electrophoresis (AE) and consecutive immunofixation (IF). Oligoclonal immunoglobulin (Ig) was detected in the CSF in 13 cases, 8 of which showed oligoclonal IgM; oligoclonal Ig was not found in the respective serum samples. Local CSF synthesis of IgM is a characteristic feature in patients with MPN-GBB. Further serological testing for borreliosis is mandatory in such cases.

Detection of oligoclonal IgG bands in unconcentrated CSF by isoelectric focusing in agarose gel and silver staining

We analyzed 102 unconcentrated cerebrospinal fluids from a variety of neurologic diseases for oligoclonal IgG bands by isoelectric focusing in agarose gel followed by staining with silver. Ten to 12 microliter of cerebrospinal fluid containing 0.4-0.8 microgram of IgG was found to be optimum. Cerebrospinal fluid from 38 of 40 patients with clinically definite multiple sclerosis, 6 of 9 with suspected multiple sclerosis and 8 of 53 patients with other neurologic diseases had oligoclonal IgG bands by IEF in agarose followed by immunofixation. The commercial system employed here is a simple sensitive and rapid method for detection of oligoclonal bands in unconcentrated cerebrospinal fluid of patients with multiple sclerosis.

An unusual form of motor neuron disease following a cat bite

A case of motor neuron disease with clinical and pathological resemblance to amyotrophic lateral sclerosis (ALS) in a woman who was severely bitten on the ankle by a cat is described. Weakness first appeared at the ankles and relentlessly advanced proximally, terminating in death from pulmonary failure in a year. A number of unusual features that are uncharacteristic of ALS were found that included a markedly elevated antinuclear antibody titre in the serum and the presence of prominent oligoclonal bands in the cerebrospinal fluid. The spinal cord showed loss of anterior horn cells and pyramidal degeneration that are characteristic of ALS, but an extraordinary finding was the presence of transmural granulomatous inflammation of numerous small and medium sized vessels, especially veins, in the subarachnoid space around the cord. There were also inflammatory changes in the brainstem and spinal cord consisting of microglial and astrocytic nodules and perivenous cuffing by mononuclear cells. Ill-defined hyaline eosinophilic cytoplasmic inclusions were seen in some remaining anterior horn cells. No viral particles were found by electron microscopy despite an extensive search. Virological studies were inconclusive but there is reason to believe that this patient's illness was caused by an as yet unidentified virus.

Multimodal evoked responses and cerebrospinal fluid oligoclonal immunoglobulins in patients with multiple sclerosis

One hundred patients with possible, probable and definite multiple sclerosis (MS) were examined with somatosensory (SER), visual (VER) and brain stem auditory (BAER) evoked responses. Paired samples of cerebrospinal fluid (CSF) and serum were examined with agarose gel electrophoresis to detect intrathecally synthesized oligoclonal immunoglobin bands. Comparison of the number of abnormal CSF and evoked response tests showed that the CSF examination was slightly more sensitive in all diagnostic groups when compared to the results of multimodal evoked responses but that the two sets of test were in part supplementary. Oligoclonal immunoglobulin bands in the CSF were present in all patients with a duration of the disease of less than six months. VER seemed to be the most sensitive of the evoked tests in this particular group of patients.

Oligoclonal immunoglobulin bands in cerebrospinal fluid of a patient with lymphocytic choriomeningitis

We describe a patient with meningitis caused by lymphocytic choriomeningitis virus. Oligoclonal IgG bands were found in the patient's cerebrospinal fluid during acute and convalescent stages of the illness, and results of liver function tests were abnormal. Acute attacks of lymphocytic choriomeningitis virus infection in humans can be added to the list of diseases associated with cerebrospinal fluid oligoclonal IgG.

Serial immunological studies in multiple sclerosis patients treated systemically with human alpha interferon

A battery of immunological functions was studied over a 2-year period in conjunction with a placebo-controlled trial of natural human alpha interferon in patients with multiple sclerosis. IgG synthesis was increased both systemically and intrathecally by administration of interferon; however, there were only minor changes in cerebrospinal fluid oligoclonal bands. Levels of helper and suppressor T lymphocytes fluctuated independently of clinical exacerbations, although mean helper/suppressor ratios were higher in multiple sclerosis patients than in controls and increased further during interferon treatment. Cerebrospinal fluid myelin basic protein and antibodies to basic protein were not affected by exacerbations or by interferon administration. Circulating IgG antibodies induced by interferon treatment appeared to be directed at a non-interferon contaminant of the preparation. None of the assays was a consistent indicator of disease activity or of clinical response to interferon.

Cerebrospinal fluid in multiple sclerosis: relationships between immunoglobulins, leucocytes and clinical features

Cerebrospinal fluid (CSF) from 120 patients with multiple sclerosis was analyzed by polyacrylamide gel electrophoresis, as well as routine laboratory microscopy and assays of total protein and immunoglobulin G (IgG). Negative correlations were found between leucocyte counts and patient age, duration of disease and time from last clinical relapse. There was a positive correlation between the leucocyte count and amount of gammaglobulin. A correlation between gammaglobulin content and degree of disability was found. With increasing duration, the gammaglobulin concentration rose only if there was increasing disability. In terms of correlations with clinical features, differences existed depending on whether IgG was assayed immunologically or by electrophoresis and densitometry. Evidence of increased blood: CSF barrier permeability (transudation of high molecular weight proteins) was found in patients with progressive disease. The presence of oligoclonal bands was the CSF abnormality most frequently encountered.

The hot bath test in multiple sclerosis: comparison with visual evoked responses and oligoclonal bands

We studied 50 patients with definite, probable, and possible multiple sclerosis (MS), prospectively (20 patients) and retrospectively (30 patients), to determine the value of the hot bath test for diagnosing MS and to compare it to visual evoked responses and oligoclonal bands. The hot bath test was abnormal in 8 of the 23 patients with definite MS (35%), and 4 of the 27 patients with probable or possible MS (15%). Only one patient with an abnormal hot bath test did not also have other evidence of definite multiple sclerosis. Our results suggest that the hot bath test seldom adds diagnostic information, especially when tests for evoked responses and oligoclonal bands are available.

Monitoring and tentative diagnosis of herpetic encephalitis by protein analysis of cerebrospinal fluid. Particular relevance of the assays of ferritin and S-100

The cerebrospinal fluid (CSF) of 9 patients with herpetic encephalitis was analyzed by particle counting immunoassay of ferritin, S-100, immunoglobulins, anti-herpes antibodies and immune complexes and by electrophoresis for the detection of oligoclonal bands. The main conclusions are: first, the simultaneous increase of both ferritin and S-100 in the presence of symptoms of encephalitis suggests strongly the infection is herpetic; second, high and increasing levels of S-100, probably related to the extent of the necrotic process, indicate a poor prognosis. In addition, 8-14 days after onset, locally produced anti-herpes antibodies were detectable, the IgG index increased and oligoclonal bands became visible.

Oligoclonal IgG bands in the CSF of a patient with progressive familial myoclonus

An oligoclonal IgG pattern was found in the CSF of a patient who is known to suffer from progressive familial myoclonus. In view of this finding the possibility arises that immunological mechanisms participate in the etiopathogenesis of this disease.

Altered white cell count, protein concentration and oligoclonal IgG bands in the cerebrospinal fluid of many patients with acute psychiatric disorders

In a prospective study, an abnormal white cell count and/or elevated protein concentration in the cerebrospinal fluid (CSF) was observed in 14/54 patients (26%) with acute psychiatric disorders, but in none of the 46 control subjects (p less than 0.001). In addition, electrophoretic analysis of immunoglobulin G (IgG) showed an oligoclonal pattern in the CSF of 22 psychiatric patients (41%). No such pattern could be detected in the control group (p less than 0.001). These findings reinforce the value of lumbar puncture and CSF analysis in acute psychiatric disorders.

The current status of multiple sclerosis intra-blood-brain-barrier IgG synthesis

The status of the central nervous system as an immunologic organ synthesizing IgG in several neurological diseases has been established convincingly in the past two decades. The measurement of intra-BBB IgG synthesis has been accomplished. It has been demonstrated that this synthesis is a potential marker for an abnormal immunologic process within the CNS which if manipulated may be a quantifiable aspect of disease modulation. Modulation of intra-BBB IgG synthesis is feasible, but there is no evidence yet that modulation of this synthesis is an index of effective disease control in MS. Only ACTH and corticosteroids lead to a significant and lasting depression of intra-BBB IgG synthesis, even though clonal eradication is not achieved. Based on our immunopharmacologic studies in MS we have proposed an immunokinetic model. The qualitative analysis of the specificity of IgG synthesized intra-BBB in MS has not led to the etiology of MS, but utilization of quantitative methods may. Questions raised by this review with suggested experiments to advance further our understanding of intra-BBB IgG synthesis as it relates to the etiopathogenesis of MS are included.

Detection and identification of virus-specific, oligoclonal IgG in unconcentrated cerebrospinal fluid by immunoblot technique

A technique is described which allows the detection of virus-specific oligoclonal IgG in unconcentrated cerebrospinal fluid (CSF) from patients with virus infections of the central nervous system. CSF is isoelectrically focused in agarose gels and immunoglobulins are blotted to nitrocellulose filters, passively loaded with either anti-human IgG or viral antigen. Transferred total IgG, as well as virus-specific IgG, is identified by the use of peroxidase-labelled anti-human IgG and 4-chloro-1-naphthol as a precipitating peroxidase substrate. Application of this assay in cases of SSPE, mumps meningitis and herpes simplex encephalitis demonstrates sensitivity and possible suitability of this technique for use in diagnosis of virus infections of the CNS.

CFS oligoclonal bands in MS and other neurological diseases detected by agarose isoelectric focusing and electrophoresis

Agarose gel isoelectric focusing (IEF) and electrophoresis (EF) were compared for detection of CSF oligoclonal bands in multiple sclerosis (MS) and other neurological diseases. The CSF IgG/albumin ratio, the IgG-Index and the IgG synthesis per day in the CNS were also considered. IEF was highly sensitive, revealing oligoclonal bands in 100% of CSF from 40 clinically definite MS, while EF had a sensitivity of 70%. In 90 patients with other neurological diseases, IEF revealed oligoclonal bands in 25.5%, EF in 11.1%. The IgG-index was the most sensitive of the quantitative parameters.

Synthesis of electrophoretically restricted IgG by cultured rheumatoid synovium

IgG synthesized by excised rheumatoid (RA) synovia was separated according to isoelectric point using chromatofocusing and isoelectric focusing. Over 30% of the IgG synthesized by 9 of 11 synovia had an isoelectric point greater than 8 (cathodal shift), while 55% of the synovia secreted IgG showing oligoclonal banding by isoelectric focusing. Oligoclonal serum IgG was seen in 17% of RA patients and in only 3% of hospitalized patients without RA. These results emphasize the selective character of the antigenic stimulus of the RA synovial lymphoid infiltrate.

Detection of oligoclonal IgG bands in cerebrospinal fluid by isoelectric focusing on thin layer agarose gels

The detection of oligoclonal bands of IgG in cerebrospinal fluid by isoelectric focusing is a useful aid in the diagnosis of multiple sclerosis. At present, this test is performed on polyacrylamide gels which are technically very difficult to prepare and are not suitable for the routine laboratory. A technique is described for isoelectric focusing on thin layer agarose gels which permits oligoclonal banding detection in the routine laboratory in four hours. The advantages of this procedure over isoelectric focusing on polyacrylamide gels include: (a) it takes less time (four hours compared with at least 24 hours); (b) it requires less specimen (2.5 ml compared with reference laboratory requirements of at least 4 ml); (c) it is technically easier to perform; and (d) it can be done routinely in the clinical laboratory.

Multiple sclerosis: subclasses of intrathecally synthesized IgG and measles and varicella zoster virus IgG antibodies

Paired samples of serum and concentrated cerebrospinal fluid (CSF) from 20 multiple sclerosis (MS) patients and 10 controls with no central nervous system disease were electrofocused and analysed for IgG and measles and varicella zoster virus IgG antibodies by imprint immunofixation using IgG subclass specific monoclonal antibodies. All but one of the MS patients had intrathecally synthesized bands of oligoclonal IgG in the CSF. In fifteen of the MS patients the oligoclonal IgG bands were restricted to the IgG1 subclass. Intrathecal synthesis of both IgG1 and IgG3 bands was observed in three, and of IgG1, IgG2 and IgG3 bands in one patient. Fourteen and 15 of the MS patients displayed intrathecal synthesis of oligoclonal varicella zoster and measles virus specific IgG1 antibodies, respectively, and no serum or CSF sample contained antibodies of other IgG subclasses to these viruses. Low levels of polyclonal IgG1 antibodies to measles or varicella zoster viruses were detected in serum and CSF from the controls; none displayed evidence of intrathecal antibody synthesis. These findings are discussed in relation to theories of specific and non-specific intrathecal immune responses in MS.

A comparison of cellulose acetate immunofixation with polyacrylamide gel electrophoresis for the detection of oligoclonal bands in unconcentrated cerebrospinal fluid

Two methods of electrophoresis for the detection of oligoclonal bands in unconcentrated CSF were compared. A sample of 98 routine CSFs yielded 18 positives by polyacrylamide gel electrophoresis (PAGE) while cellulose acetate electrophoresis with immunofixation (CAIF) gave 13 positives (72% of the PAGE findings). Despite the loss of sensitivity the cellulose acetate electrophoresis was easier to interpret and more suited to a routine hospital laboratory.

Silver staining of cerebrospinal fluid IgG in isoelectric focusing gels

A silver staining technique to be used on isoelectric focusing (IEF) gels for cerebrospinal fluid (CSF) oligoclonal IgG bands is described. The technique provides a sensitivity for detection of greater than 0.17 micrograms of IgG. The additional use of immunofixation with anti-human IgG antiserum rather than chemical fixation improves the sensitivity two-fold and permits identification of the oligoclonal bands as IgG. The technique enables one to focus small volumes of unconcentrated CSF (less than 40 microliters) and provides a powerful research tool.

Optic neuritis: oligoclonal bands increase the risk of multiple sclerosis

In 1974 we examined 30 patients 0.5-14 (mean 5) years after acute unilateral optic neuritis (ON), when no clinical signs of multiple sclerosis (MS) were discernible. 11 of the patients had oligoclonal bands in the cerebrospinal fluid (CSF). Re-examination after an additional 6 years revealed that 9 of the 11 ON patients with oligoclonal bands (but only 1 of the 19 without this CSF abnormality) had developed MS. The occurrence of oligoclonal bands in CSF in a patient with ON is--within the limits of the present observation time--accompanied by a significantly increased risk of the future development of MS. Recurrent ON also occurred significantly more often in those ON patients who later developed MS.

Electrophysiological tests and CSF examination in patients with optic neuritis

Electrophysiological tests (visual and somatosensory evoked potentials, flicker fusion test) and electrophoretic examination of cerebrospinal fluid were performed in 17 patients who previously suffered from one or more attacks of optic neuritis. The association of the tests revealed the demyelinating inflammatory pathogenesis in eight cases. In the remaining nine cases the CSF oligoclonal pattern was absent. The evidence that a bilateral delayed VEP, suggesting a subclinical contralateral involvement of optic pathways, could be related to multiple sclerosis, is discussed. A case was finally ascertained as being affected by Leber's optic atrophy.

Oligoclonal IgG bands with and without measles antibody activity in sera of patients with subacute sclerosing panencephalitis (SSPE)

Oligoclonal IgG bands from SSPE sera were isolated by combination of Protein A-Sepharose 4B column and preparative isoelectric focusing gel procedures. Each eluted fraction, when examined in analytic IEF, showed two or three individual bands with isoelectric points close to one another, compared to approximately fifteen IgG bands seen in whole serum. When the bands were tested for measles antibody activity in immunofixation with measles virus followed by peroxidase staining, the bands eluted in pH region 8.5 to 9.3 were found to be measles specific, whereas those in pH 7.0 to 8.4 lacked significant measles activity. When eluted fractions containing groups of bands were absorbed with measles virus, the bands in pH region 8.5 to 9.3 were removed, whereas those in pH 7.0 to 8.4 region remained unchanged; this indicated that a number of oligoclonal IgG bands without measles virus activities are present in SSPE. The bands lacking measles-specific activity may be synthesized against other infectious agents or they may represent nonspecific activation of B cell clones.