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Libri I, Silvestri C, Caratozzolo S, Alberici A, Pilotto A, Archetti S, Trainini L, Borroni B, Padovani A, Benussi A. Association of APOE genotype with blood-brain barrier permeability in neurodegenerative disorders. Neurobiol Aging 2024; 140:33-40. [PMID: 38718740 DOI: 10.1016/j.neurobiolaging.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/06/2024] [Accepted: 04/07/2024] [Indexed: 06/12/2024]
Abstract
Apolipoprotein E (APOE) is recognized for its role in modulating blood-brain barrier (BBB) permeability in vitro, which may have significant implications for the pathogenesis and progression of neurodegenerative disorders. However, evidence in vivo is contrasting. This study explores the impact of APOE genotypes on BBB integrity among 230 participants experiencing cognitive impairment, encompassing cases of Alzheimer's disease (AD) as well as various non-AD neurodegenerative conditions. To assess BBB integrity, we utilized cerebrospinal fluid (CSF)/serum albumin ratios and CSF/serum kappa and lambda free light chains (FLCs) as indirect markers. Our findings show a dose-dependent increase in BBB permeability in individuals carrying the APOE ε4 allele, marked by elevated CSF/serum albumin and FLCs ratios, with this trend being especially pronounced in AD patients. These results highlight the association of APOE ε4 with BBB permeability, providing valuable insights into the pathophysiology of neurodegenerative diseases.
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Affiliation(s)
- Ilenia Libri
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Silvestri
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Salvatore Caratozzolo
- Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili, Brescia, Italy
| | - Antonella Alberici
- Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili, Brescia, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili, Brescia, Italy
| | - Silvana Archetti
- Biotechnology Laboratory and Department of Diagnostics, ASST Spedali Civili, Brescia, Italy
| | - Laura Trainini
- Biotechnology Laboratory and Department of Diagnostics, ASST Spedali Civili, Brescia, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Cognitive and Behavioral Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili, Brescia, Italy; Brain Health Center, University of Brescia, Brescia, Italy
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Neurology Clinic, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital, Trieste, Italy.
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Arneth B, Kraus J. The Use of Kappa Free Light Chains to Diagnose Multiple Sclerosis. Medicina (B Aires) 2022; 58:medicina58111512. [PMID: 36363469 PMCID: PMC9698214 DOI: 10.3390/medicina58111512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The positive implications of using free light chains in diagnosing multiple sclerosis have increasingly gained considerable interest in medical research and the scientific community. It is often presumed that free light chains, particularly kappa and lambda free light chains, are of practical use and are associated with a higher probability of obtaining positive results compared to oligoclonal bands. The primary purpose of the current paper was to conduct a systematic review to assess the up-to-date methods for diagnosing multiple sclerosis using kappa and lambda free light chains. Method: An organized literature search was performed across four electronic sources, including Google Scholar, Web of Science, Embase, and MEDLINE. The sources analyzed in this systematic review and meta-analysis comprise randomized clinical trials, prospective cohort studies, retrospective studies, controlled clinical trials, and systematic reviews. Results: The review contains 116 reports that includes 1204 participants. The final selection includes a vast array of preexisting literature concerning the study topic: 35 randomized clinical trials, 21 prospective cohort studies, 19 retrospective studies, 22 controlled clinical trials, and 13 systematic reviews. Discussion: The incorporated literature sources provided integral insights into the benefits of free light chain diagnostics for multiple sclerosis. It was also evident that the use of free light chains in the diagnosis of clinically isolated syndrome (CIS) and multiple sclerosis is relatively fast and inexpensive in comparison to other conventional state-of-the-art diagnostic methods, e.g., using oligoclonal bands (OCBs).
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Affiliation(s)
- Borros Arneth
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Justus Liebig University, Feulgenstr. 12, 35392 Giessen, Germany
- Correspondence:
| | - Jörg Kraus
- Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Strubergasse 21, 5020 Salzburg, Austria
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Bergische Landstraße 2, 40629 Düsseldorf, Germany
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3
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Hu Y, Xiang J, Luo X, Lu M, Xu D, Chen B, Guan M. Application of cerebrospinal fluid free light chain in diagnosis of primary central nervous system lymphoma and monitoring of associated chemotherapy efficacy. Clin Chim Acta 2022; 533:48-52. [PMID: 35716705 DOI: 10.1016/j.cca.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) free light chain (FLC) detection has been proposed as a tool for diagnosing primary central nervous system lymphoma (PCNSL), but there is no consensus on the appropriate reference range and its value for monitoring chemotherapy efficacy has not been investigated in Chinese PCNSL patients. We assessed the application potential of CSF FLC ratios for diagnosing PCNSL and monitoring associated treatment efficacy. METHODS Kappa (κ) and lambda (λ) FLC were measured by nephelometry in CSF samples of patients with PCNSL (n = 45), other neurological diseases (n = 30), and normal controls (n = 60). Results of κ/λ FLC ratios (FLCr) were correlated with patients' diagnoses and receiver operating characteristic analysis was used to determine accuracy. In PCNSL patients, FLCr analysis was compared between PCNSL before and after treatment. RESULTS κ FLC and FLCr concentrations in PCNSL were significantly higher than in patients without PCNSL (P < 0.05). The optimal cut-off for FLCr was 0.35, with diagnostic sensitivity and specificity of 78% and 72%, respectively. FLCr concentrations decreased after chemotherapy. CONCLUSION CSF FLC is a novel biomarker for diagnosis and chemotherapy efficacy monitoring in PCNSL.
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Affiliation(s)
- Yao Hu
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, 200040 Shanghai, China
| | - Jin Xiang
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, 200040 Shanghai, China
| | - Xiao Luo
- Department of Laboratory Medicine, Shanghai University of Medicine and Health Sciences, 201318, Shanghai, China
| | - Meijuan Lu
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, 200040 Shanghai, China
| | - Dongwen Xu
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, 200040 Shanghai, China
| | - Bobin Chen
- Department of Hematology, Huashan Hospital, Shanghai Medical College, Fudan University, 200040 Shanghai, China.
| | - Ming Guan
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, 200040 Shanghai, China.
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4
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Marlas M, Bost C, Dorcet G, Delourme A, Biotti D, Ciron J, Renaudineau Y, Puissant-Lubrano B. Kappa-index: Real-life evaluation of a new tool for multiple sclerosis diagnosis. Clin Immunol 2022; 241:109066. [PMID: 35705146 DOI: 10.1016/j.clim.2022.109066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
The intrathecal production of oligoclonal immunoglobulin bands (OCB) is a prognostic factor for multiple sclerosis (MS) evolution in clinically isolated syndrome (CIS) patients and a diagnostic factor for MS. The kappa free light chain (K)-index represents a quantitative automated alternative to OCB. We retrospectively evaluated OCB and K-index results in 274 patients with MS (n = 48) or CIS (n = 29) at diagnosis, non-MS inflammatory central nervous diseases (n = 35), and non-inflammatory central/peripheral nervous diseases (n = 162). Several cut-offs were established: a pathophysiological cut-off (K-index: 3.3) useful for differential diagnosis (negative predictive value for MS >99%), an optimised cut-off (K-index: 9.1) with better sensitivity and equivalent specificity than OCB for the diagnosis of MS, and a high-risk cut-off (K-index: >55.0) allowing prediction of MS (specificity 100%). We developed a scaled interpretation of the K-index and we discuss the usefulness of testing OCB only when the K-index is positive >3.3 to obtain a better specificity.
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Affiliation(s)
- Mathilde Marlas
- Laboratoire d'Immunologie, Institut Fédératif de Biologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
| | - Chloé Bost
- Laboratoire d'Immunologie, Institut Fédératif de Biologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INFINITy, Institut Toulousain des Maladies Infectieuses et Inflammatoires, INSERM U1291, CNRS U5051, Université Toulouse III, Toulouse, France.
| | - Guillaume Dorcet
- Laboratoire d'Immunologie, Institut Fédératif de Biologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Département de Neurologie CRC-SEP, Hôpital Paul-Pierre Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Adrien Delourme
- Département de Neurologie CRC-SEP, Hôpital Paul-Pierre Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
| | - Damien Biotti
- INFINITy, Institut Toulousain des Maladies Infectieuses et Inflammatoires, INSERM U1291, CNRS U5051, Université Toulouse III, Toulouse, France; Département de Neurologie CRC-SEP, Hôpital Paul-Pierre Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
| | - Jonathan Ciron
- INFINITy, Institut Toulousain des Maladies Infectieuses et Inflammatoires, INSERM U1291, CNRS U5051, Université Toulouse III, Toulouse, France; Département de Neurologie CRC-SEP, Hôpital Paul-Pierre Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
| | - Yves Renaudineau
- Laboratoire d'Immunologie, Institut Fédératif de Biologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INFINITy, Institut Toulousain des Maladies Infectieuses et Inflammatoires, INSERM U1291, CNRS U5051, Université Toulouse III, Toulouse, France.
| | - Bénédicte Puissant-Lubrano
- Laboratoire d'Immunologie, Institut Fédératif de Biologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INFINITy, Institut Toulousain des Maladies Infectieuses et Inflammatoires, INSERM U1291, CNRS U5051, Université Toulouse III, Toulouse, France.
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Natali P, Bedin R, Bernardi G, Corsini E, Cocco E, Schirru L, Crespi I, Lamonaca M, Sala A, Nicolò C, Di Filippo M, Villa A, Nociti V, De Michele T, Cavalla P, Caropreso P, Vitetta F, Cucinelli MR, Gastaldi M, Trenti T, Sola P, Ferraro D. Inter-Laboratory Concordance of Cerebrospinal Fluid and Serum Kappa Free Light Chain Measurements. Biomolecules 2022; 12:biom12050677. [PMID: 35625604 PMCID: PMC9138559 DOI: 10.3390/biom12050677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/30/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
The kappa index (K-Index), calculated by dividing the cerebrospinal fluid (CSF)/serum kappa free light chain (KFLC) ratio by the CSF/serum albumin ratio, is gaining increasing interest as a marker of intrathecal immunoglobulin synthesis. However, data on inter-laboratory agreement of these measures is lacking. The aim was to assess the concordance of CSF and serum KFLC measurements, and of K-index values, across different laboratories. KFLC and albumin of 15 paired CSF and serum samples were analyzed by eight participating laboratories. Four centers used Binding Site instruments and assays (B), three used Siemens instruments and assays (S), and one center used a Siemens instrument with a Binding Site assay (mixed). Absolute individual agreement was calculated using a two-way mixed effects intraclass correlation coefficient (ICC). Cohen’s kappa coefficient (k) was used to measure agreement on positive (≥5.8) K-index values. There was an excellent agreement in CSF KFLC measurements across all laboratories (ICC (95% confidence interval): 0.93 (0.87–0.97)) and of serum KFLC across B and S laboratories (ICC: 0.91 (0.73–0.97)), while ICC decreased (to 0.81 (0.53–0.93)) when including the mixed laboratory in the analysis. Concordance for a positive K-Index was substantial across all laboratories (k = 0.77) and within S laboratories (k = 0.71), and very good (k = 0.89) within B laboratories, meaning that patients rarely get discordant results on K-index positivity notwithstanding the testing in different laboratories and the use of different platforms/assays.
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Affiliation(s)
- Patrizia Natali
- Department of Laboratory Medicine, Azienda Ospedaliero-Universitaria and Azienda Unità Sanitaria Locale, 41126 Modena, Italy; (P.N.); (M.R.C.); (T.T.)
| | - Roberta Bedin
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Gaetano Bernardi
- Laboratory Medicine Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (G.B.); (E.C.)
| | - Elena Corsini
- Laboratory Medicine Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (G.B.); (E.C.)
| | - Eleonora Cocco
- Multiple Sclerosis Center, ATS Sardegna/University of Cagliari, 09047 Cagliari, Italy; (E.C.); (L.S.)
| | - Lucia Schirru
- Multiple Sclerosis Center, ATS Sardegna/University of Cagliari, 09047 Cagliari, Italy; (E.C.); (L.S.)
| | - Ilaria Crespi
- Clinical Biochemistry Laboratory, Azienda Ospedaliero Universitaria Maggiore della Carità of Novara, 28100 Novara, Italy; (I.C.); (M.L.)
| | - Marta Lamonaca
- Clinical Biochemistry Laboratory, Azienda Ospedaliero Universitaria Maggiore della Carità of Novara, 28100 Novara, Italy; (I.C.); (M.L.)
| | - Arianna Sala
- Neurology Unit, CReSM, Azienda Ospedaliero Universitaria San Luigi Gonzaga, 10043 Orbassano, Italy;
| | - Cinzia Nicolò
- Clinical Chemistry and Microbiology Laboratory, Azienda Ospedaliero Universitaria San Luigi Gonzaga, 10043 Orbassano, Italy;
| | | | - Alfredo Villa
- Clinical Pathology and Haematology Laboratory, Azienda Ospedaliera of Perugia, 06132 Perugia, Italy;
| | - Viviana Nociti
- Multiple Sclerosis Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University, 00168 Rome, Italy;
| | - Teresa De Michele
- Clinical Chemistry, Biochemistry and Molecular Biology Laboratory, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy;
| | - Paola Cavalla
- Multiple Sclerosis Center, Department of Neurosciences and Mental Health, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, 10126 Torino, Italy;
| | - Paola Caropreso
- Clinical Biochemistry Laboratory, Department of Laboratory Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, 10126 Torino, Italy;
| | - Francesca Vitetta
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (F.V.); (P.S.)
| | - Maria Rosaria Cucinelli
- Department of Laboratory Medicine, Azienda Ospedaliero-Universitaria and Azienda Unità Sanitaria Locale, 41126 Modena, Italy; (P.N.); (M.R.C.); (T.T.)
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Tommaso Trenti
- Department of Laboratory Medicine, Azienda Ospedaliero-Universitaria and Azienda Unità Sanitaria Locale, 41126 Modena, Italy; (P.N.); (M.R.C.); (T.T.)
| | - Patrizia Sola
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (F.V.); (P.S.)
| | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy;
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (F.V.); (P.S.)
- Correspondence: ; Tel.: +39-059-396-1678
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Yang Q, Lai C, Meng C, Chang Q, Wang J. Clinical and Cerebrospinal Fluid Characteristics in 55 Cases of Tolosa-Hunt Syndrome: A Retrospective Analytical Study. Eur Neurol 2022; 85:265-272. [PMID: 35263741 DOI: 10.1159/000522187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/20/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several case series of patients with Tolosa-Hunt syndrome have been described in the literature; however, few studies have focused on the cerebrospinal fluid (CSF) characteristics. This study aimed to analyse the CSF characteristics of patients with Tolosa-Hunt syndrome. METHODS Fifty-five patients who fulfilled the 3rd Edition of the International Classification of Headache Disorders diagnostic criteria for Tolosa-Hunt syndrome were included in this study. We retrospectively analysed data on CSF parameters, imaging findings, and clinical characteristics of these patients. RESULTS Oligoclonal bands (OBs) were detected in the CSF of 13 (13/44, 29.5%) patients. The sex ratio was balanced. The mean age at onset of Tolosa-Hunt syndrome was 46.9 ± 10.23 (range 22-72) years. Eight (8/13, 61.5%) patients had multiple cranial nerve palsies. Lesions limited to the cavernous sinus were found on magnetic resonance imaging in 7 (7/13, 53.8%) patients. OBs were significantly detected more frequently in patients whose samples were evaluated less than 30 days after the onset of this diseases (p = 0.026); however, there were no significant differences in the protein level (p = 0.360) and IgG synthesis rate (p = 0.614). CONCLUSIONS The detection of OBs in the CSF of patients with Tolosa-Hunt syndrome was not rare. It would be interesting to follow-up patients with OBs to determine whether they eventually developed an otherwise more specific inflammatory diagnosis.
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Affiliation(s)
- Qinglin Yang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chuntao Lai
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chao Meng
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qinglin Chang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Bernardi G, Biagioli T, Malpassi P, De Michele T, Vecchio D, Repice AM, Lugaresi A, Mirabella M, Torri Clerici V, Crespi I. The contribute of cerebrospinal fluid free light-chain assay in the diagnosis of multiple sclerosis and other neurological diseases in an Italian multicenter study. Mult Scler 2021; 28:1364-1372. [PMID: 34965771 DOI: 10.1177/13524585211064121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) free light chains (FLCs) can be an alternative assay to oligoclonal bands (OCBs) in inflammatory neurological disorders, but threshold has no consensus. OBJECTIVE To assess the diagnostic accuracy of CSF FLCs in multiple sclerosis (MS) and other neurological diseases. METHODS A total of 406 patients from five Italian centers. FLCs were measured in CSF and serum using Freelite MX assays on Optilite. RESULTS A total of 171 patients were diagnosed as MS, 154 non-inflammatory neurological diseases, 48 inflammatory central nervous system (CNS) diseases, and 33 peripheral neurological diseases. Both kFLC and λFLC indices were significantly higher in patients with MS compared to other groups (p < 0.0001). The kFLC index ⩾ 6.4 is comparable to OCB for MS diagnosis (area under the receiver operating characteristic curve (AUC) = 0.876; sensitivity 83.6% vs 84.2%; specificity 88.5% vs 90.6%). λFLC index ⩾ 5 showed an AUC of 0.616, sensitivity of 33.3% and specificity of 90.6%. In all, 12/27 (44.4%) MS patients with negative OCB had kFLC index ⩾ 6.4. Interestingly, 37.5% of 24 patients with a single CSF IgG band showed high kFLC index and 12.5% positive λFLC index. CONCLUSION Our findings support the diagnostic utility of FLC indices in MS and other CNS inflammatory disorders, suggesting a combined use of FLC and OCB to help clinicians with complementary information.
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Affiliation(s)
- Gaetano Bernardi
- Laboratory of Clinical Investigation, Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Tiziana Biagioli
- General Laboratory, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Paola Malpassi
- Laboratorio Unico Metropolitano, Azienda Unità Sanitaria Locale Bologna, Bologna, Italy
| | - Teresa De Michele
- Clinical Biochemistry Laboratory, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domizia Vecchio
- Department of Translational Medicine, Neurology Unit, University of Piemonte Orientale, Novara, Italy/Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale, Novara, Italy
| | - Anna Maria Repice
- SOD Department of Neurology 2, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Alessandra Lugaresi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy/IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Massimiliano Mirabella
- UOS Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Torri Clerici
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ilaria Crespi
- Clinical Biochemistry, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
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8
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Konen FF, Schwenkenbecher P, Jendretzky KF, Gingele S, Sühs KW, Tumani H, Süße M, Skripuletz T. The Increasing Role of Kappa Free Light Chains in the Diagnosis of Multiple Sclerosis. Cells 2021; 10:3056. [PMID: 34831279 PMCID: PMC8622045 DOI: 10.3390/cells10113056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 12/03/2022] Open
Abstract
Free light chains (FLC) are a promising biomarker to detect intrathecal inflammation in patients with inflammatory central nervous system (CNS) diseases, including multiple sclerosis (MS). The diagnostic use of this biomarker, in particular the kappa isoform of FLC ("KFLC"), has been investigated for more than 40 years. Based on an extensive literature review, we found that an agreement on the correct method for evaluating KFLC concentrations has not yet been reached. KFLC indices with varying cut-off values and blood-CSF-barrier (QAlbumin) related non-linear formulas for KFLC interpretation have been investigated in several studies. All approaches revealed high diagnostic sensitivity and specificity compared with the oligoclonal bands, which are considered the gold standard for the detection of intrathecally synthesized immunoglobulins. Measurement of KFLC is fully automated, rater-independent, and has been shown to be stable against most pre-analytic influencing factors. In conclusion, the determination of KFLC represents a promising diagnostic approach to show intrathecal inflammation in neuroinflammatory diseases. Multicenter studies are needed to show the diagnostic sensitivity and specificity of KFLC in MS by using the latest McDonald criteria and appropriate, as well as standardized, cut-off values for KFLC concentrations, preferably considering non-linear formulas such as Reiber's diagram.
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Affiliation(s)
- Franz Felix Konen
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (F.F.K.); (P.S.); (K.F.J.); (S.G.); (K.-W.S.)
| | - Philipp Schwenkenbecher
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (F.F.K.); (P.S.); (K.F.J.); (S.G.); (K.-W.S.)
| | - Konstantin Fritz Jendretzky
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (F.F.K.); (P.S.); (K.F.J.); (S.G.); (K.-W.S.)
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (F.F.K.); (P.S.); (K.F.J.); (S.G.); (K.-W.S.)
| | - Kurt-Wolfram Sühs
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (F.F.K.); (P.S.); (K.F.J.); (S.G.); (K.-W.S.)
| | | | - Marie Süße
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (F.F.K.); (P.S.); (K.F.J.); (S.G.); (K.-W.S.)
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9
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Wienholt L, Kane A, Adelstein S, Richardson A, Kothur K, Brilot F, Dale RC. Cerebrospinal fluid free light chain quantitation is a specific biomarker for inflammatory neurological disorders in a paediatric patient cohort. Pathology 2021; 53:753-758. [PMID: 33745701 DOI: 10.1016/j.pathol.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/24/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022]
Abstract
The analysis of cerebrospinal fluid (CSF) is routinely used in the diagnostic work-up of a range of inflammatory, infective, and congenital neurological conditions. Many diagnostic tests used in this analysis have poor sensitivity; as such, we investigated the utility of CSF free light chain (FLC) analysis as an adjunct to currently used assays in a paediatric population with neurological disorders. Kappa (κ) and lambda (λ) FLC levels were quantitated in blinded CSF samples by two nephelometric platforms. Results were correlated to clinical diagnoses and classified according to inflammatory/infective or non-inflammatory pathogenesis. FLC results were also compared to currently used CSF diagnostic tests including oligoclonal bands (OCB), CSF IgG and albumin levels, and differential cell count. Of 70 samples analysed, 29 (41%) had an inflammatory or infective diagnosis and 41 (59%) presented with a range of non-inflammatory aetiologies. Thirteen patients had elevated κFLC or λFLC as detected on the IMMAGE 800, defined as greater than the detection limit of the assay (0.600 mg/L for CSF κFLC, and 0.490 mg/L for CSF λFLC), and of these 12 (92%) had an inflammatory disease (sensitivity 41.4%, specificity 97.6%). On the BN II using optimal cut-offs of 0.27 mg/L and 0.12 mg/L for CSF κFLC and λFLC respectively, 24 (34%) patients had elevated results, of which 21 (88%) had an inflammatory disease (sensitivity 72.4%, specificity 92.7%). Analysis of FLC correlated better with diagnostic classification of the diseases than OCB, cell counts and CSF IgG levels. The results of this study support the use of CSF FLC analysis in the diagnosis of paediatric neuroinflammatory conditions.
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Affiliation(s)
- Louise Wienholt
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Alisa Kane
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stephen Adelstein
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Alexander Richardson
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kavitha Kothur
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Fabienne Brilot
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Brain Autoimmunity Lab, Kids Neuroscience Centre, Kids Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Russell C Dale
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Brain Autoimmunity Lab, Kids Neuroscience Centre, Kids Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; T.Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Westmead, NSW, Australia
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10
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Intrathecal kappa free light chains as markers for multiple sclerosis. Sci Rep 2020; 10:20329. [PMID: 33230241 PMCID: PMC7683527 DOI: 10.1038/s41598-020-77029-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/29/2020] [Indexed: 11/08/2022] Open
Abstract
Cerebrospinal fluid (CSF) kappa free light chain (KFLC) index has been described as a reliable marker of intrathecal IgG synthesis to diagnose multiple sclerosis (MS). Our aims were: (1) to compare the efficiency of KFLC through different interpretation approaches in diagnosing MS. (2) to evaluate the prognostic value of KFLC in radiologically and clinically isolated syndromes (RIS-CIS). We enrolled 133 MS patients and 240 with other neurological diseases (93 inflammatory including 18 RIS-CIS, 147 non-inflammatory). Albumin, lambda free light chain (LFLC) and KFLC were measured in the CSF and serum by nephelometry. We included two groups of markers: (a) corrected for blood-CSF barrier permeability: immunoglobulin G (IgG), KFLC and LFLC indexes. (b) CSF ratios (not including albumin and serum-correction): CSF KFLC/LFLC, CSF KFLC/IgG, CSF LFLC/IgG. KFLC were significantly higher in MS patients compared to those with other diseases (both inflammatory or not). KFLC index and CSF KFLC/IgG ratio showed high sensitivity (93% and 86.5%) and moderate specificity (85% and 88%) in diagnosing MS. RIS-CIS patients who converted to MS showed greater KFLC index and CSF KFLC/IgG. Despite OB are confirmed to be the gold-standard to detect intrathecal IgG synthesis, the KFLC confirmed their accuracy in MS diagnosis. A “kappa-oriented” response characterizes MS and has a prognostic impact in the RIS-CIS population.
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11
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Hegen H, Walde J, Milosavljevic D, Aboulenein-Djamshidian F, Senel M, Tumani H, Deisenhammer F, Presslauer S. Free light chains in the cerebrospinal fluid. Comparison of different methods to determine intrathecal synthesis. Clin Chem Lab Med 2020; 57:1574-1586. [PMID: 31112501 DOI: 10.1515/cclm-2018-1300] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/12/2019] [Indexed: 12/25/2022]
Abstract
Background Free light chains (FLC) have been proposed as diagnostic biomarkers in the cerebrospinal fluid (CSF) of patients with inflammatory central nervous system (CNS) diseases. However, which method to use for determining an intrathecal FLC synthesis has not yet been clarified. The objective of this study was to compare the diagnostic performance of CSF FLC concentration, FLC quotient (QFLC), FLC index and FLC intrathecal fraction (FLCIF). Methods κ- and λ-FLC were measured by nephelometry under blinded conditions in CSF and serum sample pairs of patients with clinically isolated syndrome (CIS; n = 60), multiple sclerosis (MS; n = 60) and other neurological diseases (n = 60) from four different MS centers. QFLC was calculated as the ratio of CSF/serum FLC concentration, the FLC index as QFLC/albumin quotient and the percentage FLCIF by comparing QFLC to a previously empirically determined, albumin quotient-dependent reference limit. Results CSF FLC concentration, QFLC, FLC index and FLCIF of both the κ- and λ-isotype were significantly higher in patients with CIS and MS than in the control group, as well as in oligoclonal bands (OCB) positive than in OCB negative patients. Each parameter was able to identify MS/CIS patients and OCB positivity, however, diagnostic performance determined by receiver operating characteristic (ROC) analyses differed and revealed superiority of FLC index and FLCIF. Conclusions These findings support the diagnostic value of FLC measures that correct for serum FLC levels and albumin quotient, i.e. blood-CSF barrier function.
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Affiliation(s)
- Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Janette Walde
- Department of Statistics, Faculty of Economics and Statistics, University of Innsbruck, Innsbruck, Austria
| | | | - Fahmy Aboulenein-Djamshidian
- Department of Neurology, SMZ-Ost Donauspital, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Vienna, Austria
| | - Makbule Senel
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | - Hayrettin Tumani
- Department of Neurology, University Hospital Ulm, Ulm, Germany.,Specialty Clinic of Neurology Dietenbronn, Schwendi, Germany
| | | | - Stefan Presslauer
- Department of Neurology, Wilhelminenspital, Montleartstrasse 37, 1160 Vienna, Austria
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12
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Reiber H, Zeman D, Kušnierová P, Mundwiler E, Bernasconi L. Diagnostic relevance of free light chains in cerebrospinal fluid - The hyperbolic reference range for reliable data interpretation in quotient diagrams. Clin Chim Acta 2019; 497:153-162. [PMID: 31351929 DOI: 10.1016/j.cca.2019.07.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Free light chains, type kappa (FLC-K), in cerebrospinal fluid (CSF) were compared to oligoclonal IgG in many studies for sensitive detection of immune reactions in brain. The missing consensus about CSF data interpretation prevents reliable conclusions. This can be overcome by a theory-based hyperbolic reference range in CSF/serum quotient diagrams. METHODS Mean Quotients for FLC-K, QKappa, and albumin, QAlb, of grouped, biochemically defined controls (N = 433) are fitted with the hyperbolic function QKappa(mean) = a/b (QAlb2 + b2)0.5 - c by a generally applicable procedure excluding outliers. RESULTS With QKappa(mean), the coefficient of variation CV (22.5%) and the reference range (QKappa(mean) ± 3 CV) we got the discrimination line QKappa(lim) = (3.27(QAlb2 + 33)0.5-8.2) ×10-3 in a FLC-K Reibergram. Intrathecal FLC-K was found in 8% of another control group without OCB (N = 388) but was missed in 7% of patients with definite Multiple sclerosis (N = 95). In MS the mean intrathecal fraction was threefold larger for FLC-K (95%) compared to total IgG (36%). Similar mean quantities of intrathecal FLC-K contradict an immunological conversion between a Clinically isolated syndrome and MS. DISCUSSION The hyperbolic reference range is superior to linear FLC-K Index (10 to 15% false negatives) and exponential curves (30% false positive interpretations for controls) in the analytical range of MS data, with excellent data fit for up to ten-fold larger QAlb values. Dynamics of the small molecule FLC-K contribute to the understanding of molecular size dependent barrier functions.
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Affiliation(s)
| | - David Zeman
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; Clinic of Neurology, University Hospital Ostrava, Ostrava, Poruba, Czech Republic.
| | - Pavlína Kušnierová
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
| | - Esther Mundwiler
- Institute of Laboratory Medicine, Kantonsspital Aarau, Switzerland.
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau, Switzerland.
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Lo Sasso B, Agnello L, Bivona G, Bellia C, Ciaccio M. Cerebrospinal Fluid Analysis in Multiple Sclerosis Diagnosis: An Update. ACTA ACUST UNITED AC 2019; 55:medicina55060245. [PMID: 31167509 PMCID: PMC6630948 DOI: 10.3390/medicina55060245] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/10/2019] [Accepted: 05/30/2019] [Indexed: 01/11/2023]
Abstract
Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the central nervous system (CNS) with brain neurodegeneration. MS patients present heterogeneous clinical manifestations in which both genetic and environmental factors are involved. The diagnosis is very complex due to the high heterogeneity of the pathophysiology of the disease. The diagnostic criteria have been modified several times over the years. Basically, they include clinical symptoms, presence of typical lesions detected by magnetic resonance imaging (MRI), and laboratory findings. The analysis of cerebrospinal fluid (CSF) allows an evaluation of inflammatory processes circumscribed to the CNS and reflects changes in the immunological pattern due to the progression of the pathology, being fundamental in the diagnosis and monitoring of MS. The detection of the oligoclonal bands (OCBs) in both CSF and serum is recognized as the “gold standard” for laboratory diagnosis of MS, though presents analytical limitations. Indeed, current protocols for OCBs assay are time-consuming and require an operator-dependent interpretation. In recent years, the quantification of free light chain (FLC) in CSF has emerged to assist clinicians in the diagnosis of MS. This article reviews the current knowledge on CSF biomarkers used in the diagnosis of MS, in particular on the validated assays and on the alternative biomarkers of intrathecal synthesis.
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Affiliation(s)
- Bruna Lo Sasso
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy.
| | - Luisa Agnello
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy.
| | - Giulia Bivona
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy.
| | - Chiara Bellia
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy.
| | - Marcello Ciaccio
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy.
- Department Laboratory Medicine, University-Hospital, 90100 Palermo, Italy.
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Ganelin-Cohen E, Golderman S, Yeskaraev R, Rozenberg A, Livneh A, Kaplan B. Search for new biomarkers of pediatric multiple sclerosis: application of immunoglobulin free light chain analysis. Clin Chem Lab Med 2019; 56:1081-1089. [PMID: 29408796 DOI: 10.1515/cclm-2017-0911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Identifying new biomarkers is needed to overcome the diagnostic difficulties of pediatric multiple sclerosis (MS). Recently, we developed a new technique including CSF analysis of free light chain (FLC) monomers and dimers, which can improve diagnosis of adult MS. The present study has been designed to evaluate the utility of our technique for MS diagnosis in children. METHODS Patients with MS (n=21) and non-MS demyelinating or inflammatory neurological disorders (n=35) participated in the study. MS diagnosis was based on clinical and magnetic resonance imaging (MRI) findings. Western blot analysis was applied to examine FLC in the patients' CSF and serum. FLC indices for FLC monomer and dimer levels and κ/λ ratios were estimated. The samples were also analyzed by oligoclonality test. RESULTS The study revealed abnormally elevated levels of κ-FLC monomers and dimers in the CSF of 10 MS patients ("κ-type MS"). Increased amounts of λ dimers were found in six MS cases ("λ-type MS"), while high levels of both κ and λ FLC ("mixed type MS") were documented in three MS cases. MRI and clinical assessment showed a more aggressive disease form for the "mixed" and "λ-type" cases. Our method demonstrated higher sensitivity (90.5%) and specificity (91.4%) for discrimination between MS and non-MS patients, as compared to oligoclonality test (81% and 65.7%, respectively). CONCLUSIONS The proposed method may significantly contribute to diagnosis and prognosis of pediatric MS.
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Affiliation(s)
- Esther Ganelin-Cohen
- Institute of Pediatric Neurology, Schneider Children's Medical Center, Petach Tikva 49202, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sizilia Golderman
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Regina Yeskaraev
- Department of Clinical Biochemistry, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Ayal Rozenberg
- Department of Neuroimmunology, Rambam Health Care Campus, Haifa, Israel
| | - Avi Livneh
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Batia Kaplan
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
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15
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Senel M, Mojib-Yezdani F, Braisch U, Bachhuber F, Lewerenz J, Ludolph AC, Otto M, Tumani H. CSF Free Light Chains as a Marker of Intrathecal Immunoglobulin Synthesis in Multiple Sclerosis: A Blood-CSF Barrier Related Evaluation in a Large Cohort. Front Immunol 2019; 10:641. [PMID: 30984199 PMCID: PMC6449445 DOI: 10.3389/fimmu.2019.00641] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/08/2019] [Indexed: 01/22/2023] Open
Abstract
Objectives: The importance of immunoglobulin G (IgG) oligoclonal bands (OCB) in the diagnosis of multiple sclerosis (MS) was reaffirmed again in the recently revised MS diagnostic criteria. Since OCB testing is based on non-quantitative techniques and demands considerable methodological experience, measurement of CSF immunoglobulin free light chains (FLC) has been suggested as quantitative alternative to OCB. We aimed to establish reference values for FLC measures and evaluate their diagnostic accuracy with regard to the diagnosis of MS. Methods: Immunoglobulin kappa (KFLC) and lambda (LFLC) free light chains were prospectively measured by nephelometry in CSF and serum sample pairs in 1,224 patients. The analyzed cohort included patients with MS, other autoimmune or infectious inflammatory diseases of the nervous system as well as 989 patients without signs for nervous system inflammation. Results: Regarding diagnosis of MS, the diagnostic sensitivity and specificity of intrathecal KFLC ratio were 93.3 and 93.7% using the CSF-serum albumin ratio-dependent reference values, 92.0 and 95.9% for intrathecal KFLC ratio applying the ROC-curve determined cut-off levels, 62.7 and 98.3% for IgG index, 64.0 and 98.8% for intrathecal IgG synthesis according to Reiber diagrams, and 94.7 and 93.3% for OCB. Diagnostic sensitivity and specificity of intrathecal LFLC were clearly lower than KFLC. Conclusions: Intrathecal KFLC and OCB showed the highest diagnostic sensitivities for MS. However, specificity was slightly lower compared to other quantitative IgG parameters. Consequently, CSF FLC may not replace OCB, but it may support diagnosis in MS as a quantitative parameter.
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Affiliation(s)
- Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Ulrike Braisch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Jan Lewerenz
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Hayrettin Tumani
- Department of Neurology, University of Ulm, Ulm, Germany.,Specialty Hospital of Neurology Dietenbronn, Schwendi, Germany
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16
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Kaplan B, Ganelin-Cohen E, Golderman S, Livneh A. Diagnostic utility of kappa free light chains in multiple sclerosis. Expert Rev Mol Diagn 2019; 19:277-279. [DOI: 10.1080/14737159.2019.1586535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Batia Kaplan
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Esther Ganelin-Cohen
- Institute of Pediatric Neurology, Schneider Children’s Medical Center, Petach Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sizilia Golderman
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Avi Livneh
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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17
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Menéndez-Valladares P, García-Sánchez MI, Adorna Martínez M, García De Veas Silva JL, Bermudo Guitarte C, Izquierdo Ayuso G. Validation and meta-analysis of kappa index biomarker in multiple sclerosis diagnosis. Autoimmun Rev 2019; 18:43-49. [DOI: 10.1016/j.autrev.2018.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/19/2018] [Indexed: 01/23/2023]
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18
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The Persisting Significance of Oligoclonal Bands in the Dawning Era of Kappa Free Light Chains for the Diagnosis of Multiple Sclerosis. Int J Mol Sci 2018; 19:ijms19123796. [PMID: 30501024 PMCID: PMC6320811 DOI: 10.3390/ijms19123796] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 11/22/2022] Open
Abstract
The latest revision of the McDonald criteria of 2017 considers the evidence of an intrathecal immunoglobulin (IgG) synthesis as a diagnostic criterion for dissemination in time in multiple sclerosis. While the detection of oligoclonal bands is considered as the gold standard, determination of kappa free light chains might be a promising tool as a less technically demanding and cost saving method. However, data on the direct comparison between kappa free light chains and oligoclonal bands are limited and no study to date has used the highly sensitive method of polyacrylamide gels with consecutive silver staining for the demonstration of oligoclonal bands. Furthermore, the impact of the revised McDonald criteria of 2017 on the role of kappa free light chains as a biomarker has not been investigated. Nephelometry was used to determine kappa free light chains in cerebrospinal fluid (CSF) and serum from 149 patients with their first demyelinating event between 2010 and 2015. Clinical data, kappa free light chains, and oligoclonal band status were compared at the time of initial diagnosis and after follow-up to identify converters from clinically isolated syndrome to multiple sclerosis. An elevated kappa free light chain index (>5.9) was found in 79/83 patients (95%) with multiple sclerosis diagnosed at baseline, slightly less frequent than oligoclonal bands (98.8%). 18/25 (72%) patients who converted from clinically isolated syndrome to multiple sclerosis showed an elevated kappa free light chain index compared to 20/25 (80%) patients with positive oligoclonal bands. In patients with stable clinically isolated syndrome 7/41 (17%) displayed an elevated kappa free light chain index against 11/41 (27%) oligoclonal band positive patients. Only two patients with stable clinically isolated syndrome showed an elevated kappa free light chain index but were oligoclonal bands negative. In conclusion, determination of the kappa free light chain index is a promising diagnostic approach to assess intrathecal immunoglobulin synthesis in multiple sclerosis. Nevertheless, oligoclonal bands are highly prevalent in multiple sclerosis and can detect an intrathecal synthesis of IgG even when the kappa free light chain index is below the threshold. We consider sequential use of both methods as reasonable.
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19
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Intrathecal K free light chain synthesis in multiple sclerosis at clinical onset associates with local IgG production and improves the diagnostic value of cerebrospinal fluid examination. Mult Scler Relat Disord 2018; 25:241-245. [DOI: 10.1016/j.msard.2018.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/16/2018] [Accepted: 08/01/2018] [Indexed: 11/19/2022]
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20
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Bayart JL, Muls N, van Pesch V. Free Kappa light chains in neuroinflammatory disorders: Complement rather than substitute? Acta Neurol Scand 2018; 138:352-358. [PMID: 29900542 DOI: 10.1111/ane.12969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The detection of cerebrospinal fluid (CSF)-specific IgG oligoclonal bands (OCB) by isoelectric focusing (IEF) is widely used to help diagnose inflammatory neurological disorders (IND), including multiple sclerosis. However, the quantification of free light chains (FLC) is increasingly evaluated as a surrogate method to determine the presence of an intrathecal inflammatory process. The objective of this study was to evaluate the diagnostic performance of kappa (κ) FLC measurement in comparison with OCB detection by IEF. MATERIAL AND METHODS We measured serum and CSF κFLCs by turbidimetry using the SPAplus automated analyser and calculated the κ index in 142 samples from OCB-positive and negative MS, as well as from patients with inflammatory and non-inflammatory neurological disorders (IND and NIND). RESULTS The κFLC index was significantly increased in OCB-positive MS and IND patients versus OCB-negative patients. Its performance was relatively comparable to that of IEF for MS diagnosis. When using a κFLC index cutoff value of 6.29, sensitivity increased from 61.2% to 75.7% in comparison with IEF for diagnosing IND (P = .0051), with a slightly lower non-statistically significant specificity (82.1% vs 100%). When considering both OCB status positivity or a κFLC index superior to 6.29 to diagnose IND status, sensitivity raised to 80.6% (P < .05) with an equal specificity. CONCLUSION Our results demonstrate that the κFLC index does not discriminate MS from other IND patients, but is a reliable technique to detect intrathecal inflammation. However, κFLC quantification should probably be considered as a complementary method, rather than a substitute, to OCB detection.
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Affiliation(s)
- J.-L. Bayart
- Cliniques Universitaires Saint-Luc; Department of Laboratory Medicine; Université Catholique de Louvain; Brussels Belgium
| | - N. Muls
- Neurochemistry Unit; Institute of Neuroscience; Université Catholique de Louvain; Brussels Belgium
| | - V. van Pesch
- Cliniques Universitaires Saint-Luc; Department of Laboratory Medicine; Université Catholique de Louvain; Brussels Belgium
- Neurochemistry Unit; Institute of Neuroscience; Université Catholique de Louvain; Brussels Belgium
- Cliniques Universitaires Saint-Luc; Neurology Department; Université Catholique de Louvain; Brussels Belgium
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21
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Kaplan B, Golderman S, Ganelin‐Cohen E, Miniovitch A, Korf E, Ben‐Zvi I, Livneh A, Flechter S. Immunoglobulin free light chains in saliva: a potential marker for disease activity in multiple sclerosis. Clin Exp Immunol 2018; 192:7-17. [PMID: 29194592 PMCID: PMC5842412 DOI: 10.1111/cei.13086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 11/27/2022] Open
Abstract
A new procedure was developed and applied to study immunoglobulin free light chains (FLC) in saliva of healthy subjects and patients with multiple sclerosis (MS). The procedure was based on a Western blot analysis for detection and semiquantitative evaluation of monomeric and dimeric FLCs. The FLC indices accounting for the total FLC levels and for the monomer/dimer ratios of κ and λ FLC were calculated, and the cut-off values of the FLC indices were determined to distinguish healthy state from MS disease. The obtained FLC index values were statistically different in the saliva of three groups: active MS patients, MS patients in remission and healthy subjects groups. Our FLC monomer-dimer analysis allowed differentiation between healthy state and active MS with specificity of 100% and a sensitivity of 88·5%. The developed technique may serve as a new non-invasive complementary tool to evaluate the disease state by differentiating active MS from remission with sensitivity of 89% and specificity of 80%.
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Affiliation(s)
- B. Kaplan
- Heller Institute of Medical Research, Sheba Medical CenterTel‐Hashomer, Ramat GanIsrael
| | - S. Golderman
- Heller Institute of Medical Research, Sheba Medical CenterTel‐Hashomer, Ramat GanIsrael
| | - E. Ganelin‐Cohen
- Institute of Pediatric Neurology, Schneider Children's Medical CenterPetach TikvaIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - A. Miniovitch
- Multiple Sclerosis Clinical Research and Therapy Service, Assaf‐Harofeh Medical CenterTzrifin, Israel
| | - E. Korf
- Dental ClinicsKiryat OnoIsrael
| | - I. Ben‐Zvi
- Heller Institute of Medical Research, Sheba Medical CenterTel‐Hashomer, Ramat GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - A. Livneh
- Heller Institute of Medical Research, Sheba Medical CenterTel‐Hashomer, Ramat GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - S. Flechter
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
- Multiple Sclerosis Clinical Research and Therapy Service, Assaf‐Harofeh Medical CenterTzrifin, Israel
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Basile U, Gulli F, Gragnani L, Napodano C, Pocino K, Rapaccini GL, Mussap M, Zignego AL. Free light chains: Eclectic multipurpose biomarker. J Immunol Methods 2017; 451:11-19. [PMID: 28931470 DOI: 10.1016/j.jim.2017.09.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/21/2017] [Accepted: 09/15/2017] [Indexed: 12/14/2022]
Abstract
The production of antibodies is accompanied by a slight excess of synthesis of κ and λ immunoglobulin light chains; small amounts of them are released in the peripheral blood and can also be found in various body fluids, such as synovial fluid, cerebrospinal fluid, urine and saliva. They are rapidly filtered by the glomerulus and >99% are reabsorbed from the cells of the proximal convoluted tubule, making them present in the urine in only trace amounts. The production of an excess of protein without a reason or a specific function in a biological system is rare. Free light chains, considered for years a waste product of Ig synthesis, are currently known to be very active molecules, able to bind antigens as well as whole immunoglobulin and helping to develop specific antibody affinity. The ability of free light chains to activate mast cells and then become an active part of the pathogenic mechanisms of chronic inflammatory diseases has increased interest in their clinical use, both as an attractive therapeutic target or as a biochemical marker of disease evolution or remission. This is an overview of relevant scientific interest that immunoglobulin light chains κ and λ have attracted over the years, a report on the progress in knowledge about their structure and function, with a special focus on their biological meaning and potential clinical utility in different diseases.
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Affiliation(s)
- Umberto Basile
- Department of Laboratory Medicine of the Catholic University of Sacred Heart, Rome, Italy.
| | - Francesca Gulli
- Department of Laboratory Medicine of the Catholic University of Sacred Heart, Rome, Italy
| | - Laura Gragnani
- Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cecilia Napodano
- Department of Laboratory Medicine of the Catholic University of Sacred Heart, Rome, Italy
| | - Krizia Pocino
- Department of Laboratory Medicine of the Catholic University of Sacred Heart, Rome, Italy
| | | | - Michele Mussap
- Department of Laboratory Medicine, IRCCS-AOU San Martino, Genoa, Italy
| | - Anna Linda Zignego
- Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Assessment of Intrathecal Free Light Chain Synthesis: Comparison of Different Quantitative Methods with the Detection of Oligoclonal Free Light Chains by Isoelectric Focusing and Affinity-Mediated Immunoblotting. PLoS One 2016; 11:e0166556. [PMID: 27846293 PMCID: PMC5112955 DOI: 10.1371/journal.pone.0166556] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/31/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives We aimed to compare various methods for free light chain (fLC) quantitation in cerebrospinal fluid (CSF) and serum and to determine whether quantitative CSF measurements could reliably predict intrathecal fLC synthesis. In addition, we wished to determine the relationship between free kappa and free lambda light chain concentrations in CSF and serum in various disease groups. Methods We analysed 166 paired CSF and serum samples by at least one of the following methods: turbidimetry (Freelite™, SPAPLUS), nephelometry (N Latex FLC™, BN ProSpec), and two different (commercially available and in-house developed) sandwich ELISAs. The results were compared with oligoclonal fLC detected by affinity-mediated immunoblotting after isoelectric focusing. Results Although the correlations between quantitative methods were good, both proportional and systematic differences were discerned. However, no major differences were observed in the prediction of positive oligoclonal fLC test. Surprisingly, CSF free kappa/free lambda light chain ratios were lower than those in serum in about 75% of samples with negative oligoclonal fLC test. In about a half of patients with multiple sclerosis and clinically isolated syndrome, profoundly increased free kappa/free lambda light chain ratios were found in the CSF. Conclusions Our results show that using appropriate method-specific cut-offs, different methods of CSF fLC quantitation can be used for the prediction of intrathecal fLC synthesis. The reason for unexpectedly low free kappa/free lambda light chain ratios in normal CSFs remains to be elucidated. Whereas CSF free kappa light chain concentration is increased in most patients with multiple sclerosis and clinically isolated syndrome, CSF free lambda light chain values show large interindividual variability in these patients and should be investigated further for possible immunopathological and prognostic significance.
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Abstract
Over the past five years, a number of papers have appeared describing the assay of free immunoglobulin light chains in cerebrospinal fluid to assist in the diagnosis of multiple sclerosis. The assay of kappa free immunoglobulin chains is being advocated as a technically simpler and cheaper quantitative alternative to the qualitative detection of oligoclonal bands. This article reviews the analytical and clinical characteristics of these immunoglobulin free light chain assays and places them in their historical context and possible future developments.
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Affiliation(s)
- D B Ramsden
- Institute of Metabolism and Systems Research, The Medical School, University of Birmingham, Birmingham, UK
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25
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Menéndez-Valladares P, García-Sánchez MI, Cuadri Benítez P, Lucas M, Adorna Martínez M, Carranco Galán V, García De Veas Silva JL, Bermudo Guitarte C, Izquierdo Ayuso G. Free kappa light chains in cerebrospinal fluid as a biomarker to assess risk conversion to multiple sclerosis. Mult Scler J Exp Transl Clin 2015; 1:2055217315620935. [PMID: 28607709 PMCID: PMC5433434 DOI: 10.1177/2055217315620935] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/13/2015] [Indexed: 01/21/2023] Open
Abstract
Background Multiple sclerosis (MS) initiates with a first attack or clinically isolated syndrome (CIS). The importance of an early treatment in MS leads to the search, as soon as possible, for novel biomarkers which can predict conversion from CIS to MS. Objective The purpose of this study was to assess the predictive value of the kappa index (κ index), using kappa free light light chains (κFLCs) in cerebrospinal fluid (CSF), for the conversion of CIS patients to MS, and compare its accuracy with other parameters used in clinical practice. Methods FLC levels were analysed in CSF from 176 patients: 70 as control group, 77 CIS, and 29 relapsing–remitting MS. FLC levels were quantified by nephelometry. Results κ Index sensitivity and specificity (93.1%; 95.7%) was higher than those from the immunoglobulin G (IgG) index (75.9%; 94.3%), and lower than those from oligoclonal IgG bands (OCGBs) (96.5%; 98.6%). The optimal cut-off for κ index was 10.62. Most of the CIS patients with κ index >10.62 presented OCGBs, IgG index >0.56 and fulfilled magnetic resonance imaging (MRI) criteria. Conclusion CIS patients above κ index cut-off of 10.62 present 7.34-fold risk of conversion to MS than CIS below this value. The κ index correlated with positive OCGBs, IgG index above 0.56 and MRI criteria.
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Affiliation(s)
- P Menéndez-Valladares
- Unidad de Gestión Clínica Bioquímica Clínica, Hospital Universitario Virgen Macarena, Spain
| | - M I García-Sánchez
- Biobanco Hospitalario Virgen Macarena, Biobanco del Sistema Sanitario Público de Andalucía, Spain
| | - P Cuadri Benítez
- Biobanco Hospitalario Virgen Macarena, Biobanco del Sistema Sanitario Público de Andalucía, Spain
| | - M Lucas
- Departamento de Bioquímica Médica y Biología Molecular, Universidad de Sevilla, Spain
| | - M Adorna Martínez
- Unidad de Gestión Clínica Neurociencias, Hospital Universitario Virgen Macarena, Spain
| | - V Carranco Galán
- Departamento de Bioquímica Médica y Biología Molecular, Universidad de Sevilla, Spain
| | | | - C Bermudo Guitarte
- Unidad de Gestión Clínica Bioquímica Clínica, Hospital Universitario Virgen Macarena, Spain
| | - G Izquierdo Ayuso
- Unidad de Gestión Clínica Neurociencias, Hospital Universitario Virgen Macarena, Spain
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Marron TU, Ramanathan L, Chari A. Diagnostic utility of measuring free light chains in the cerebrospinal fluid of patients with multiple myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:e127-31. [PMID: 25846395 DOI: 10.1016/j.clml.2015.02.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/15/2015] [Accepted: 02/26/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Thomas U Marron
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lakshmi Ramanathan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ajai Chari
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Zeman D, Kušnierová P, Bartoš V, Hradílek P, Kurková B, Zapletalová O. Quantitation of free light chains in the cerebrospinal fluid reliably predicts their intrathecal synthesis. Ann Clin Biochem 2015; 53:174-6. [DOI: 10.1177/0004563215579110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2015] [Indexed: 11/17/2022]
Abstract
Background The results of free light chains quantitation in the cerebrospinal fluid were recently compared with the presence of cerebrospinal fluid-restricted oligoclonal IgG, but not oligoclonal free kappa light chains and oligoclonal free lambda light chains. We therefore aimed to compare the performance of the quantitative tests with the qualitative one for the same molecule. Methods Seventy-five paired cerebrospinal fluid and serum samples were analysed for oligoclonal IgG, oligoclonal free kappa light chains and oligoclonal free lambda light chains. Cerebrospinal fluid and serum free kappa and lambda light chains were quantified using Freelite™ kits on SPA Plus analyzer. ROC curves were analysed for the prediction of intrathecal synthesis and compared for cerebrospinal fluid concentration, cerebrospinal fluid/serum quotient (QfLC) and index (QfLC/QAlbumin). The presence of cerebrospinal fluid-restricted oligoclonal free kappa light chains and oligoclonal free lambda light chains bands was used as reference. Results No statistically significant differences were observed among cerebrospinal fluid concentration, QfLC and index for the prediction of free light chain intrathecal synthesis. Each parameter was able to predict the occurrence of cerebrospinal fluid-restricted oligoclonal free light chain bands (AUCs 0.932–0.999). However, we noted elevated cerebrospinal fluid free light chain concentrations in the absence of cerebrospinal fluid-restricted oligoclonal free light chain bands in two patients with very high serum free light chain values. Conclusions Quantitation of cerebrospinal fluid free light chains reliably predicts their intrathecal synthesis. Yet, cerebrospinal fluid/serum quotient may still be preferred to correct for high serum free light chain concentrations. An appropriate formula should be sought to correct for blood–cerebrospinal fluid barrier status.
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Affiliation(s)
- David Zeman
- Department of Clinical Biochemistry, Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
- Clinic of Neurology, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
| | - Pavlína Kušnierová
- Department of Clinical Biochemistry, Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
| | - Vladimír Bartoš
- Department of Clinical Biochemistry, Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
| | - Pavel Hradílek
- Clinic of Neurology, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
| | - Barbora Kurková
- Clinic of Neurology, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
| | - Olga Zapletalová
- Clinic of Neurology, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
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Zeman D, Hradilek P, Kusnierova P, Piza R, Reguliova K, Woznicova I, Zapletalova O. Oligoclonal free light chains in cerebrospinal fluid as markers of intrathecal inflammation. Comparison with oligoclonal IgG. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 159:104-13. [PMID: 25485529 DOI: 10.5507/bp.2014.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/06/2014] [Indexed: 11/23/2022] Open
Abstract
AIMS To compare the sensitivity and specificity of CSF-restricted oligoclonal IgG and free light chains as markers of multiple sclerosis and other inflammatory neurological diseases. METHODS 196 paired CSF and serum samples were examined for oligoclonal IgG and oligoclonal free light chains. The sensitivity and specificity of the tests were calculated and optimal cut-offs for the number of CSF-restricted oligoclonal bands were then determined by analysis of receiver operating characteristic curves. RESULTS Optimal cut-off values were ≥5 IgG bands for multiple sclerosis, ≥4 IgG bands for inflammatory neurological disease, ≥6 free κ, and ≥2 free λ bands for both purposes. Using these cut-off values, sensitivities and specificities for multiple sclerosis were 83.8% and 91.3% for IgG, 83.8% and 81.0% for free κ, and 67.6% and 75.4% for free λ. For inflammatory neurological disease, sensitivities and specificities were 60.8% and 95.7% for IgG, 69.6% and 92.6% for free κ, and 64.8% and 86.2% for free λ. CONCLUSIONS Although exact cut-off values may vary according to method, reporting borderline results as positive, may compromise the specificity of the test and should be avoided.. The detection of intrathecal free light chain synthesis may be of value especially when the oligoclonal IgG test is negative or borderline, even though its specificity is slightly lower.
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Affiliation(s)
- David Zeman
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Czech Republic
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Senel M, Tumani H, Lauda F, Presslauer S, Mojib-Yezdani R, Otto M, Brettschneider J. Cerebrospinal fluid immunoglobulin kappa light chain in clinically isolated syndrome and multiple sclerosis. PLoS One 2014; 9:e88680. [PMID: 24695382 PMCID: PMC3973621 DOI: 10.1371/journal.pone.0088680] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 01/09/2014] [Indexed: 01/06/2023] Open
Abstract
Background Oligoclonal bands (OCB) are the most widely used CSF test to support the diagnosis of MS and to predict conversion of clinically isolated syndrome (CIS) to multiple sclerosis (MS). Since OCB tests are based on non-quantitative and difficult to standardise techniques, measurement of immunoglobulin kappa free light chains (KFLC) may represent an easier to use quantitative test. Methods KFLC were measured in CSF and serum of 211 patients using ELISA. These include patients without any inflammatory central nervous system reaction (NIND, n = 77), MS (n = 20), viral CNS infections (V-CNS-I, n = 10), neuroborreliosis (NB, n = 17) and other bacterial CNS infections (B-CNS-I, n = 10). Furthermore a cohort of 77 patients with CIS, including 39 patients that remained CIS over follow-up of two years (CIS-CIS) and 38 patients that developed MS over the same follow-up time (CIS-MS). Results CSF-serum ratio of KFLC (Q KFLC) was elevated in all patients with MS, 86.8% of patients with CIS-MS and 61.5% of patients with CIS-CIS. It was significantly elevated in CIS with presence of OCB (p<0.001). Q KFLC significantly correlated with other CSF variables such as CSF leukocyte count (p<0.001, R = 0.46), CSF CXCL13 levels (p<0.001, R = 0.64) and also intrathecal IgG synthesis (p<0.001, R = 0.74) as determined by nephelometry and quotient diagram. OCB were detected in 66.7% of CIS-CIS and in 92.1% of CIS-MS. Conclusions Although the measurement of CSF KFLC is a rapid and quantitative easy to standardize tool, it is almost equal but not superior to OCB with regard to diagnostic sensitivity and specificity in patients with early MS.
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Affiliation(s)
- Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Hayrettin Tumani
- Department of Neurology, University of Ulm, Ulm, Germany
- * E-mail:
| | - Florian Lauda
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
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Messaoudani N, Djidjik R, Ghaffor M. Comments on CSF κFLC assay evaluation in assessing intrathecal synthesis. J Neuroimmunol 2014; 266:89. [DOI: 10.1016/j.jneuroim.2013.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
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Duranti F, Pieri M, Centonze D, Buttari F, Bernardini S, Dessi M. Determination of kFLC and K Index in cerebrospinal fluid: A valid alternative to assessintrathecal immunoglobulin synthesis. J Neuroimmunol 2013; 263:116-20. [DOI: 10.1016/j.jneuroim.2013.07.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/04/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
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Kaplan B, Golderman S, Yahalom G, Yeskaraev R, Ziv T, Aizenbud BM, Sela BA, Livneh A. Free light chain monomer–dimer patterns in the diagnosis of multiple sclerosis. J Immunol Methods 2013; 390:74-80. [DOI: 10.1016/j.jim.2013.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 01/24/2013] [Accepted: 01/25/2013] [Indexed: 11/16/2022]
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Villar LM, Espiño M, Costa-Frossard L, Muriel A, Jiménez J, Álvarez-Cermeño JC. High levels of cerebrospinal fluid free kappa chains predict conversion to multiple sclerosis. Clin Chim Acta 2012; 413:1813-6. [DOI: 10.1016/j.cca.2012.07.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/27/2012] [Accepted: 07/06/2012] [Indexed: 10/28/2022]
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Zeman D, Hradílek P, Svagera Z, Mojžíšková E, Woznicová I, Zapletalová O. Detection of oligoclonal IgG kappa and IgG lambda bands in cerebrospinal fluid and serum with Hevylite™ antibodies. comparison with the free light chain oligoclonal pattern. Fluids Barriers CNS 2012; 9:5. [PMID: 22360869 PMCID: PMC3306208 DOI: 10.1186/2045-8118-9-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 02/23/2012] [Indexed: 11/12/2022] Open
Abstract
Background Oligoclonal IgG bands in cerebrospinal fluid that are absent in serum indicate intrathecal IgG synthesis and are a sensitive marker of CNS inflammatory diseases, in particular multiple sclerosis. It may be of interest to determine whether these bands are predominantly IgGκ or IgGλ. Methods We have used Hevylite™ antibodies and developed a technique for detection of oligoclonal IgGκ and IgGλ bands by means of isoelectric focusing followed by immunoblotting. The same technique was used for oligoclonal free κ and free λ detection. Among several techniques tested, affinity immunoblotting appears to be the most sensitive; it can detect less than 1 ng of IgGκ or IgGλ paraprotein. We compared oligoclonal IgG profiles with those of oligoclonal IgGκ and IgGλ. There was good agreement concerning the presence or absence of intrathecal synthesis. We observed the ratios between oligoclonal IgGκ and IgGλ bands, and they did not always match the ratios between free κ and free λ bands. We were also able to detect antigen-specific CSF-restricted oligoclonal IgGκ and IgGλ bands in neuroborreliosis. It remains to be determined subsequently by a clinically-oriented prospective study, whether predominant IgGκ/IgGλ or free κ/free λ can be observed more frequently in particular diseases with oligoclonal IgG synthesis. Discussion Very sensitive detection of oligoclonal IgGκ and IgGλ bands in cerebrospinal fluid with Hevylite antibodies is feasible; detection of antigen-specific IgGκ or IgGλ is possible as well. In particular situations, e.g. when difficulties arise in distinguishing between oligoclonal and monoclonal pattern, the test may be of considerable clinical value.
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Affiliation(s)
- David Zeman
- Institute of Clinical Biochemistry, University Hospital Ostrava, 17, Listopadu 1790, 708 52 Ostrava-Poruba, Czech Republic.
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Dobson R, Meier UC, Giovannoni G. More to come: humoral immune responses in MS. J Neuroimmunol 2011; 240-241:13-21. [PMID: 22019113 DOI: 10.1016/j.jneuroim.2011.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 09/15/2011] [Accepted: 09/20/2011] [Indexed: 01/14/2023]
Abstract
Interest in the role of B-cells in multiple sclerosis (MS) pathogenesis has increased, and a number of B-cell targeted therapies are currently in clinical trials. B-cells are key mediators of the humoral immune response, with roles including antibody production and acting as antigen presenting cells. Whilst previously, the presence of B-cells within MS plaques has been thought to be secondary to T-cell dysregulation, it is now becoming clear that B-cells play an independent role in disease. In this review we will discuss the potential role of B-cells in MS, how this influences our understanding of the disease, and potential therapeutic implications.
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Affiliation(s)
- Ruth Dobson
- Centre for Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, London E1 2AT, UK.
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Nakano T, Matsui M, Inoue I, Awata T, Katayama S, Murakoshi T. Free immunoglobulin light chain: Its biology and implications in diseases. Clin Chim Acta 2011; 412:843-9. [DOI: 10.1016/j.cca.2011.03.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 02/28/2011] [Accepted: 03/03/2011] [Indexed: 11/16/2022]
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Yap CYF, Aw TC. Revisting Cerebrospinal Fluid (CSF) Examination. PROCEEDINGS OF SINGAPORE HEALTHCARE 2010. [DOI: 10.1177/201010581001900413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Routine cerebrospinal fluid (CSF) examination bears re-visiting as the body of knowledge has expanded and numerous new analytes touted as potential markers of CNS (central nervous system) diseases have emerged. Currently, visual assessment of CSF, microscopic examination for pathologic cells, and biochemical analysis for protein and glucose form the basis for routine CSF analysis. Further investigations that may be warranted include microbiology work-ups for CNS infections and immuno-detection for oligoclonal bands for multiple sclerosis. European guidelines for CSF analyses are available. CSF testing for other neurologic disorders (e.g. Parkinson's disease, Alzheimer's disease, and amyotrophic lateral sclerosis) while promising are not ready for prime time.
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Affiliation(s)
| | - Tar Choon Aw
- Department of Lab Medicine, Changi General Hospital, Singapore
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Comabella M, Fernández M, Martin R, Rivera-Vallvé S, Borrás E, Chiva C, Julià E, Rovira A, Cantó E, Alvarez-Cermeño JC, Villar LM, Tintoré M, Montalban X. Cerebrospinal fluid chitinase 3-like 1 levels are associated with conversion to multiple sclerosis. ACTA ACUST UNITED AC 2010; 133:1082-93. [PMID: 20237129 DOI: 10.1093/brain/awq035] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In most patients with multiple sclerosis, the disease initiates with a first attack or clinically isolated syndrome. At this phase, magnetic resonance imaging is an important predictor of conversion to multiple sclerosis. With the exception of oligoclonal bands, the role of other biomarkers in patients with clinically isolated syndrome is controversial. In the present study, we aimed to identify proteins associated with conversion to multiple sclerosis in patients with clinically isolated syndrome. We applied a mass spectrometry-based proteomic approach (isobaric labelling) to previously collected pooled cerebrospinal fluid samples from patients with clinically isolated syndrome, who subsequently converted to clinically definite multiple sclerosis (n=30) and patients who remained as having clinically isolated syndrome (n=30). Next, three of the most represented differentially expressed proteins, i.e. ceruloplasmin, vitamin D-binding protein and chitinase 3-like 1 were selected for validation in individual cerebrospinal fluid samples by enzyme-linked immunosorbent assay. Only chitinase 3-like 1 was validated and cerebrospinal fluid levels were increased in patients who converted to clinically definite multiple sclerosis compared with patients who continued as clinically isolated syndrome (P=0.00002) and controls (P=0.012). High cerebrospinal fluid levels of chitinase 3-like 1 significantly correlated with the number of gadolinium enhancing lesions and the number of T2 lesions observed in brain magnetic resonance imaging scans performed at baseline, and were associated with disability progression during follow-up and shorter time to clinically definite multiple sclerosis (log-rank P-value=0.003). Cerebrospinal fluid chitinase 3-like 1 levels were also measured in a second validation clinically isolated syndrome cohort and found to be increased in patients who converted to multiple sclerosis compared with patients who remained as having clinically isolated syndrome (P=0.018). Our results indicate that patients who will convert to clinically definite multiple sclerosis could be distinguished from those patients who will remain as clinically isolated syndrome by proteomic analysis of cerebrospinal fluid samples. Although protein levels are also increased in other disorders characterized by chronic inflammation, chitinase 3-like 1 may serve as a prognostic biomarker for conversion to multiple sclerosis and development of disability which may help to improve the understanding of the aetiopathogenesis in the early stages of multiple sclerosis.
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Affiliation(s)
- Manuel Comabella
- Centre d'Esclerosi Múltiple de Catalunya, CEM-Cat, Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron (HUVH), Barcelona 08035, Spain.
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Arneth B, Birklein F. High sensitivity of free lambda and free kappa light chains for detection of intrathecal immunoglobulin synthesis in cerebrospinal fluid. Acta Neurol Scand 2009; 119:39-44. [PMID: 18573131 DOI: 10.1111/j.1600-0404.2008.01058.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND So far, an inflammation of the central nervous system (CNS) is diagnosed by immunoglobulin measurement in cerebrospinal fluid (CSF) and serum as well as by determination of the oligoclonal bands. With the free kappa and lambda light chains, new markers to diagnose intrathecal synthesis are available. METHODS In addition to routine diagnostic tests and the assessment of standard parameters, free immunoglobulin light chains were measured in the CSF of patients with neurological disorders. RESULTS A significant agreement was found between an increase in free kappa light chain CSF serum quotients and results of the currently widely applied method of oligoclonal band measurement for the detection of intrathecal immunoglobulin synthesis. A sensitivity of 95% and 100% specificity for free kappa light chain concentrations at a cut-off of 0.41 mg/l was determined for free kappa light chains compared with oligoclonal bands. However, the free lambda light chains in 20 out of the 110 investigated samples were characterized by inconsistent behaviour. These otherwise unremarkable samples yielded increased CSF quotients, leading to the assumption that free lambda light chains represent a highly sensitive measure of intrathecal immunologlobulin synthesis. Thirteen of the 20 samples described above were obtained from patients with cerebral infarction, 4 samples derived from patients with cerebral paresis (primarily facial paresis), one sample was from a patient with multisystem atrophy and two were obtained from patients with migraine and neuralgia. CONCLUSION These findings suggest that the high sensitivity of lambda light chains for the detection intrathecal immunoglobulin synthesis may be of benefit in establishing clinical diagnoses.
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Affiliation(s)
- B Arneth
- Institute of Clinical Chemistry, University of Mainz, Germany.
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Presslauer S, Milosavljevic D, Brücke T, Bayer P, Hübl W. Elevated levels of kappa free light chains in CSF support the diagnosis of multiple sclerosis. J Neurol 2008; 255:1508-14. [DOI: 10.1007/s00415-008-0954-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 02/22/2008] [Accepted: 03/20/2008] [Indexed: 11/29/2022]
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The Importance of Free Light Chains of Immunoglobulins Determination in Serum. J Med Biochem 2007. [DOI: 10.2478/v10011-007-0032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Importance of Free Light Chains of Immunoglobulins Determination in SerumFor many years, Bence Jones proteinuria has been an important diagnostic marker for multiple myeloma. Relatively new serum tests for free kappa and free lambda light chains of immunoglobulins reflect the production of free light chains more accurately than urine tests. In this study, we examined the value of serum free light chains measurement in the diagnosis of some neoplastic diseases and the discrepance between the findings of serum protein electrophoresis and serum free light chains. Thirty one patients (f=19, m=12) were included in the study, most of them with blood malignant diseases. The results show that in six patients with normal gamma and beta electrophoresis fractions there are abnormal levels of free light chains and/or an abnormal κ/LD ratio. In 20 patients we found an abnormal κ/LD ratio, and in 21 patients we found an abnormal κ or LD level, or both. The obtained results show the important role of serum free light chains determination in identifying patients with monoclonal gammopathies.
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Hildebrandt B, Müller C, Pezzutto A, Daniel PT, Dörken B, Scholz C. Assessment of free light chains in the cerebrospinal fluid of patients with lymphomatous meningitis - a pilot study. BMC Cancer 2007; 7:185. [PMID: 17915026 PMCID: PMC2194780 DOI: 10.1186/1471-2407-7-185] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 10/03/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphomatous meningitis (LM) represents a severe complication of malignant lymphomas. While clinical suspicion is raised by symptoms ranging from mild disturbances of sensation to severe pain or impaired consciousness, the definite diagnosis of LM is often difficult to obtain. Since B-cell lymphomas are clonally restricted to express either kappa or lambda immunoglobulin light chain, we hypothesised that analysis of free light chain (FLC) ratios might facilitate the diagnosis of LM. METHODS Kappa and lambda FLC were measured using a novel nephelometric assay in cerebrospinal fluid (CSF) and serum from 17 patients. 5/17 suffered from LM as demonstrated by cytology, immunocytology, and/or imaging procedures. RESULTS Measurement of FLC concentrations in CSF was achieved for all 17 patients. FLC levels in CSF were lower than serum FLC levels in samples for the same patient obtained at the same time (p < 0.01). CSF and serum FLC concentrations correlated weakly in all patients irrespective of LM status. Significantly more patients with cytopathologically and immunohistochemically proven LM displayed abnormal kappa/lambda FLC ratios in CSF compared to individuals with no LM (p < 0.01). CONCLUSION This is the first report demonstrating that a significant proportion of LM patients display an abnormal kappa/lambda FLC ratio in the CSF.
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Affiliation(s)
- B Hildebrandt
- Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - C Müller
- Zentrum für Diagnostische und Präventive Labormedizin, Zentralinstitut für Laboratoriumsmedizin und Pathobiochemie, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - A Pezzutto
- Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - PT Daniel
- Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - B Dörken
- Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
| | - C Scholz
- Charité-Centrum für Tumormedizin, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13344 Berlin, Germany
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van der Heijden M, Kraneveld A, Redegeld F. Free immunoglobulin light chains as target in the treatment of chronic inflammatory diseases. Eur J Pharmacol 2006; 533:319-26. [PMID: 16455071 DOI: 10.1016/j.ejphar.2005.12.065] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2005] [Indexed: 11/21/2022]
Abstract
Immunoglobulin free light chains were long considered irrelevant bystander products of immunoglobulin synthesis by B lymphocytes. To date, different studies suggest that free light chains may have important functional activities. For instance, it has been shown that immunoglobulin free light chains can elicit mast cell-driven hypersensitivity responses leading to asthma and contact sensitivity. Free light chains also show other biologic actions such as anti-angiogenic and proteolytic activities or can be used as specific targeting vehicles. Levels of free light chain levels in body fluids increase markedly in diseases such as multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus. In this review, we will focus on the unexpected biological activities of immunoglobulin free light chains with special attention to its possible role in the induction of chronic inflammatory diseases.
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Affiliation(s)
- Maurice van der Heijden
- Department of Pharmacology and Pathophysiology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB Utrecht, The Netherlands
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Desplat-Jégo S, Feuillet L, Pelletier J, Bernard D, Chérif AA, Boucraut J. Quantification of Immunoglobulin Free Light Chains in CerebroSpinal Fluid by Nephelometry. J Clin Immunol 2005; 25:338-45. [PMID: 16133990 DOI: 10.1007/s10875-005-5371-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2005] [Indexed: 10/25/2022]
Abstract
Oligoclonal free light chains (FLC) banding has been described in multiple sclerosis (MS) and should be correlated with disease activity. However, discrepancies between studies have been reported because of differences in methods. A new quantitative, rapid, and automated method using nephelometry is now available. Our objective was to investigate the interest of this method for the diagnosis and prognosis of MS. For this purpose, FLC index was determined in paired samples of CSF and serum from consecutive and unselected patients from the same department of neurology. We enrolled 89 patients (33 MS, 15 "possible MS", and 41 controls) and correlated with IgG index, IgG oligoclonal banding, and clinical MS progression criteria. The main results were (1) FLC kappa index was more sensitive but less specific than IgG index for the diagnosis of MS, (2) two MS patients were negative for oligoclonal banding but exhibited a positive kappa index, (3) no relation between FLC kappa indices, MS clinical criteria, and disease progression was found. In conclusion, FLC kappa index should be considered as a useful complementary test for MS diagnosis. Its pronostic interest remains to be determined on a larger cohort of possible MS patients.
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Affiliation(s)
- Sophie Desplat-Jégo
- Laboratoire d'Immunologie, Hôpital de la Conception, 147, Bd Baille, 13005 Marseille/UMR 6184, Faculté de Médecine Timone, 27, Bd Jean Moulin, 13005 Marseille, France
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