Class differentiation of immunoglobulin-containing cerebrospinal fluid cells in inflammatory diseases of the central nervous system

Cerebrospinal fluid biomarkers in multiple sclerosis

In patients with multiple sclerosis (MS) intensive efforts are directed at identifying biomarkers in bodily fluids related to underlying disease mechanisms, disease activity and progression, and therapeutic response. Besides MR imaging parameters cerebrospinal fluid (CSF) biomarkers provide important and specific information since changes in the CSF composition may reflect disease mechanisms inherent to MS. The different cellular and protein-analytical methods of the CSF and the recommended standard of the diagnostic CSF profile in MS are described. A brief update on possible CSF biomarkers that might reflect key pathological processes of MS such as inflammation, demyelination, neuroaxonal loss, gliosis and regeneration is provided.

Cerebrospinal fluid analysis: disease-related data patterns and evaluation programs

Cerebrospinal fluid (CSF) analysis is a basic tool for diagnosis of neurological diseases. Knowledge regarding blood-CSF barrier function (molecular flux/CSF flow theory) and neuroimmunology is reviewed to aid understanding and evaluation of CSF data. Disease-related immunoglobulin patterns (IgG, IgA, IgM with reference to albumin) are described in CSF/serum quotient diagrams with the hyperbolic reference range for blood-derived protein fractions in CSF. Clinical relevance of complementary analyses (cytology, PCR, oligoclonal IgG, antibody detection and brain-derived proteins) is briefly discussed. Integrated CSF data reports are shown with numerical and graphical data representation, reference range-related interpretation and diagnosis-related comments. The principles and rationale of general CSF analysis reported in this review should enable the reader to accurately interpret CSF data profiles, and to plan a proper evaluation of new brain- or blood-derived analytes in CSF.

The intrathecal, polyspecific and oligoclonal immune response in multiple sclerosis

We report an extended set of neuroimmunological data detected in cerebrospinal fluid (CSF) from n = 267 patients with definite multiple sclerosis (MS). Known frequencies of oligoclonal IgG (98%), frequencies of intrathecal fractions of IgG, IgA and IgM (72%, 9% and 20%, respectively) were confirmed and quantitated as intrathecal fractions, IgIF or CSF concentrations, IgLOC. Eighty-nine per cent of the patients had a combined 'MRZ-reaction', i.e. intrathecal antibody synthesis (Antibody Index, AI > 1.4) against measles, rubella and/or varicella zoster virus. Frequencies of single antibodies decreased from measles (78%) to rubella (60%), VZV (55%) and HSV (28%). This MRZ-reaction, indicating a chronic autoimmune type disease already at time of first clinical symptoms, is less sensitive but more specific than detection of oligoclonal IgG. With increasing intrathecal IgG synthesis the number of different locally synthesized antibody species were increased as well as the amount per species (increased mean AI values). The concentration of MRZ antibodies in CSF represents together about 2% of intrathecally synthesized total IgG. But, as a very particular result the ratio of intrathecally synthesized specific antibody/intrathecally synthesized JgG was 5-fold higher (0.24-0.85%) compared to the corresponding ratio in blood (0.06-0.17%) of MS patients. This difference between brain ratio and blood ratio is discussed to be indicative for the anti-MRZ antibody forming B-lymphocyte subset in blood migrating into brain at earlier time of pathophysiological start of disease. These results give a concise explanation of neuroimmunological aspects in MS, not understood so far.