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De Napoli G, Gastaldi M, Natali P, Bedin R, Simone AM, Santangelo M, Mariotto S, Vitetta F, Smolik K, Cardi M, Meletti S, Ferraro D. Kappa index in the diagnostic work-up of autoimmune encephalitis. J Neurol Sci 2024; 463:123146. [PMID: 39033735 DOI: 10.1016/j.jns.2024.123146] [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: 05/06/2024] [Revised: 07/03/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The presence of inflammatory changes in the cerebrospinal fluid (CSF), including immunoglobulin intrathecal synthesis (IS), can support the diagnosis of autoimmune encephalitis (AE) and allow prompt treatment. The main aim of our study was to calculate the Kappa index as a marker of IS, in patients with AE. METHODS Charts of patients undergoing a diagnostic work-up for suspected AE between 2009 and 2023 were reviewed and the Graus criteria applied. CSF and serum kappa free light chains were determined using the Freelite assay (The Binding Site Group) and the turbidimetric Optilite analyzer. RESULTS We identified 34 patients with "definite" AE (9 anti-NMDAR AE and 25 limbic AE) and nine patients with "possible" AE. Five patients (15%) with definite AE had pleocytosis and twelve (34%) showed CSF-restricted oligoclonal bands (OCB) at isoelectric focusing. The Kappa index was >6 in 29.4% and > 3 in 50% of the definite AE patients. It was elevated (>3) in 36.4% of patients with definite AE who resulted negative to OCB testing and was the only altered parameter suggestive of an ongoing inflammatory process in the CNS in three definite AE patients with otherwise normal CSF findings (i.e. normal cell count and protein levels, no OCBs). In the possible AE group, one patient had a Kappa index >3 in the absence of OCB. CONCLUSIONS The Kappa index could be useful, as a more sensitive marker of IS and as a supportive marker of neuroinflammation, in the diagnostic work-up of suspected AE.
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Affiliation(s)
- Giulia De Napoli
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Neurosciences, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Patrizia Natali
- Department of Laboratory Medicine, Azienda Ospedaliero-Universitaria and Azienda Unità Sanitaria Locale, Ospedale Civile di Baggiovara, Modena, Italy
| | - Roberta Bedin
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Vitetta
- Department of Neurosciences, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Krzysztof Smolik
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Neurosciences, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Martina Cardi
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Neurosciences, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Neurosciences, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
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Candeloro R, Ferri C, Bellini T, Pugliatti M, Castellazzi M. Breaking Barriers: Unveiling Sex-Related Differences in Cerebrospinal Fluid Analysis-A Narrative Review. BIOLOGY 2024; 13:420. [PMID: 38927300 PMCID: PMC11200519 DOI: 10.3390/biology13060420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
(1) Background: The recent emphasis on sexual and gender diversity's impact on human health underscores the need for tailored diagnostic and therapeutic approaches in neurology. The aim of this article is to conduct a narrative review of the available scientific literature on sex differences in cerebrospinal fluid analysis. (2) Methods: The literature search encompassed PubMed databases, focusing on cerebrospinal fluid analysis and sex differences, considering parameters like cerebrospinal fluid protein content, cell count, albumin quotient (QAlb) and intrathecal IgG synthesis. (3) Results: Nine articles from the past two decades were identified, revealing limited research in this area. Males consistently exhibited higher cerebrospinal fluid protein content and albumin quotient values across various pathologies and age groups. Consequently, males more frequently manifested blood-cerebrospinal fluid barrier dysfunction than females. No significant sex differences were observed in cerebrospinal fluid leukocyte count or intrathecal IgG synthesis. (4) Conclusions: This review highlights the dearth of research on sex differences in cerebrospinal fluid analysis, despite consistent findings of higher protein content and albumin quotient values in males. Revisiting current diagnostic thresholds based on sex is crucial for accurate prognosis and personalised treatment strategies in neurological disorders. Moving towards sex-specific approaches in clinical practice is imperative for advancing personalised medicine.
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Affiliation(s)
- Raffaella Candeloro
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (T.B.); (M.P.)
| | - Caterina Ferri
- Department of Neuroscience, “S. Anna” University Hospital, 44124 Ferrara, Italy;
| | - Tiziana Bellini
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (T.B.); (M.P.)
- University Strategic Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Maura Pugliatti
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (T.B.); (M.P.)
| | - Massimiliano Castellazzi
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (T.B.); (M.P.)
- University Strategic Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
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Maglio G, D’Agostino M, Caronte FP, Pezone L, Casamassimi A, Rienzo M, Di Zazzo E, Nappo C, Medici N, Molinari AM, Abbondanza C. Multiple Sclerosis: From the Application of Oligoclonal Bands to Novel Potential Biomarkers. Int J Mol Sci 2024; 25:5412. [PMID: 38791450 PMCID: PMC11121866 DOI: 10.3390/ijms25105412] [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: 04/10/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Multiple sclerosis is a chronic immune-mediated disorder of the central nervous system with a high heterogeneity among patients. In the clinical setting, one of the main challenges is a proper and early diagnosis for the prediction of disease activity. Current diagnosis is based on the integration of clinical, imaging, and laboratory results, with the latter based on the presence of intrathecal IgG oligoclonal bands in the cerebrospinal fluid whose detection via isoelectric focusing followed by immunoblotting represents the gold standard. Intrathecal synthesis can also be evidenced by the measurement of kappa free light chains in the cerebrospinal fluid, which has reached similar diagnostic accuracy compared to that of oligoclonal bands in the identification of patients with multiple sclerosis; moreover, recent studies have also highlighted its value for early disease activity prediction. This strategy has significant advantages as compared to using oligoclonal band detection, even though some issues remain open. Here, we discuss the current methods applied for cerebrospinal fluid analysis to achieve the most accurate diagnosis and for follow-up and prognosis evaluation. In addition, we describe new promising biomarkers, currently under investigation, that could contribute both to a better diagnosis of multiple sclerosis and to its monitoring of the therapeutic treatment response.
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Affiliation(s)
- Grazia Maglio
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
| | - Marina D’Agostino
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
| | - Francesco Pio Caronte
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
| | - Luciano Pezone
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
| | - Amelia Casamassimi
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Monica Rienzo
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | - Erika Di Zazzo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Carmela Nappo
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
| | - Nicola Medici
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Anna Maria Molinari
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Ciro Abbondanza
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Castellazzi M, Candeloro R, Pugliatti M, Govoni M, Silvagni E, Bortoluzzi A. Cerebrospinal Fluid Analysis in Rheumatological Diseases with Neuropsychiatric Complications and Manifestations: A Narrative Review. Diagnostics (Basel) 2024; 14:242. [PMID: 38337758 PMCID: PMC10854855 DOI: 10.3390/diagnostics14030242] [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: 12/27/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
The analysis of cerebrospinal fluid (CSF) remains a valuable diagnostic tool in the evaluation of inflammatory and infectious conditions involving the brain, spinal cord, and meninges. Since many rheumatic inflammatory diseases can involve the central and peripheral nervous system, the aims of this narrative review were to summarize the latest evidence on the use of CSF analysis in the field of neuropsychiatric manifestations of rheumatic diseases. Routine CSF parameters were taken into consideration for this review: appearance; total protein and cellular content (pleocytosis); lactate and/or glucose; CSF/serum albumin quotient; intrathecal synthesis of IgG. Data regarding the role of CSF analysis in the clinical management of neuropsychiatric systemic lupus erythematosus, primary Sjogren's syndrome, rheumatoid arthritis, and Behçet's syndrome are presented. Although no disease-specific picture has been identified, CSF analysis remains a useful diagnostic tool to confirm the presence of a neuro-inflammatory state or, conversely, to exclude the concomitant presence of other inflammatory/infectious diseases affecting the CNS in the context of systemic rheumatologic conditions.
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Affiliation(s)
- Massimiliano Castellazzi
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Raffaella Candeloro
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Maura Pugliatti
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (R.C.); (M.P.)
| | - Marcello Govoni
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
| | - Ettore Silvagni
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
| | - Alessandra Bortoluzzi
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.G.); (E.S.); (A.B.)
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Zondra Revendova K, Svub K, Bunganic R, Pelisek O, Volny O, Ganesh A, Bar M, Zeman D, Kusnierova P. A comparison of measles-rubella-zoster reaction, oligoclonal IgG bands, oligoclonal kappa free light chains and kappa index in multiple sclerosis. Mult Scler Relat Disord 2024; 81:105125. [PMID: 37980789 DOI: 10.1016/j.msard.2023.105125] [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: 09/24/2023] [Revised: 10/26/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the diagnostic performance of the measles-rubella-zoster reaction (MRZR) in a large real-world multiple sclerosis (MS) cohort. Second, to compare MRZR with the determination of oligoclonal IgG bands (OCB), oligoclonal kappa free light chain bands (oKFLC), and the KFLC index. METHODS A single-center retrospective study was conducted at the University Hospital Ostrava (Czech Republic). Patients were eligible if aged ≥18 years with a determined clinical diagnosis. IgG antibodies against measles (M), rubella (R), and varicella zoster (Z) viruses were determined in paired CSF and serum using ELISA and MRZR indicated as positive if at least two components had an antibody index >1.4. OCB and oKFLC were detected by means of isoelectric focusing, and KFLC CSF and serum concentrations for calculation of the KFLC index were determined immunochemically. RESULTS A total of 1,751 patients were included in the analyzed data set, which comprised 379 MS patients and 1,372 non-MS controls. The frequency of positive MRZR was higher in MS than in non-MS cases (MS 32.2 % vs non-MS 2.8 %; p < 0.001). This corresponded to a specificity of 97.2 % (95 % CI 96.1-98.0) and sensitivity of 32.2 % (95 % CI 27.5-37.2) and overall accuracy of 83.1 % (95 % CI 81.3-84.8). In comparison, the highest sensitivity of 95.6% (95 % CI 93.0-97.5) was for OCB with specificity of 86.9 % (95 % CI 84.9-88.7), followed by oKFLC with sensitivity and specificity of 94.7 % (95 % CI 91.5-96.9) and 78.4% (95 % CI 75.7-80.8), respectively, and the KFLC index with sensitivity of 92.5 % (95 % CI 86.6-96.3) and specificity of 93.5 % (95 % CI 90.5-95.9). DISCUSSION MRZR remains a very specific test for the diagnosis of MS but has low sensitivity, which disallows its independent use. In contrast, OCB showed the highest sensitivity and thus remains the gold standard for the diagnosis of MS.
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Affiliation(s)
- Kamila Zondra Revendova
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
| | - Krystof Svub
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Radovan Bunganic
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ondrej Pelisek
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Ondrej Volny
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Aravind Ganesh
- Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Michal Bar
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - David Zeman
- Institute of Laboratory Medicine, University Hospital Brno, Brno, Czech Republic
| | - Pavlina Kusnierova
- Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic; Institute of Laboratory Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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6
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Zhang X, Hao H, Jin T, Qiu W, Yang H, Xue Q, Yin J, Shi Z, Yu H, Ji X, Sun X, Zeng Q, Liu X, Wang J, Li H, He X, Yang J, Li Y, Liu S, Lau AY, Gao F, Hu S, Chu S, Ding D, Zhou H, Li H, Chen X. Cerebrospinal fluid oligoclonal bands in Chinese patients with multiple sclerosis: the prevalence and its association with clinical features. Front Immunol 2023; 14:1280020. [PMID: 38035077 PMCID: PMC10687400 DOI: 10.3389/fimmu.2023.1280020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Background Cerebrospinal fluid oligoclonal band (CSF-OCB) is an established biomarker in diagnosing multiple sclerosis (MS), however, there are no nationwide data on CSF-OCB prevalence and its diagnostic performance in Chinese MS patients, especially in the virtue of common standard operation procedure (SOP). Methods With a consensus SOP and the same isoelectric focusing system, we conducted a nationwide multi-center study on OCB status in consecutively, and recruited 483 MS patients and 880 non-MS patients, including neuro-inflammatory diseases (NID, n = 595) and non-inflammatory neurological diseases (NIND, n=285). Using a standardized case report form (CRF) to collect the clinical, radiological, immunological, and CSF data, we explored the association of CSF-OCB positivity with patient characters and the diagnostic performance of CSF-OCB in Chinese MS patients. Prospective source data collection, and retrospective data acquisition and statistical data analysis were used. Findings 369 (76.4%) MS patients were OCB-positive, while 109 NID patients (18.3%) and 6 NIND patients (2.1%) were OCB-positive, respectively. Time from symptom onset to diagnosis was significantly shorter in OCB-positive than that in OCB-negative MS patients (13.2 vs 23.7 months, P=0.020). The prevalence of CSF-OCB in Chinese MS patients was significantly higher in high-latitude regions (41°-50°N)(P=0.016), and at high altitudes (>1000m)(P=0.025). The diagnostic performance of CSF-OCB differentiating MS from non-MS patients yielded a sensitivity of 76%, a specificity of 87%. Interpretation The nationwide prevalence of CSF-OCB was 76.4% in Chinese MS patients, and demonstrated a good diagnostic performance in differentiating MS from other CNS diseases. The CSF-OCB prevalence showed a correlation with high latitude and altitude in Chinese MS patients.
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Affiliation(s)
- Xiang Zhang
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Hongjun Hao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Tao Jin
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qun Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian Yin
- Department of Neurology, Beijing Hospital, Beijing, China
| | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Yu
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Xiaopei Ji
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiuming Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoni Liu
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Jingguo Wang
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Huining Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoyan He
- Department of Neurology, The Xinjiang Uygur Autonomous Region People’s Hospital, Urumqi, China
| | - Jing Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yarong Li
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Shuangshuang Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Alexander Y. Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Feng Gao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Shimin Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Clinical Epidemiology and Evidence-Based Medicine, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Shuguang Chu
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ding Ding
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Haifeng Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiangjun Chen
- Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, National Center for Neurological Disorders, Shanghai, China
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7
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Forcadela M, Birch K, Rocchi C, Campagna G, Jackson E, Chadwick C, Hamid S, Jacob A, Huda S. Do we still need OCBs in MS diagnosis and how many? Mult Scler Relat Disord 2023; 79:105035. [PMID: 37864992 DOI: 10.1016/j.msard.2023.105035] [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: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND CSF-specific oligoclonal bands (CSF-OCBs) can be used for dissemination in time (DIT) in the 2017 multiple sclerosis (MS) diagnostic criteria. A cut-off of ≥2 CSF-OCBs was recommended but studies have suggested ≥3 CSF-OCBs may be superior. OBJECTIVES To assess utility of ≥2 and ≥3 CSF-OCBs as a cut-off for MS diagnosis. METHODS Paired serum and CSF-OCBs sent to the Walton Centre, UK between July 2018 and June 2020 were included. CSF-OCBs were assessed using isoelectric focussing and reviewed by two blinded raters. Case records were reviewed. RESULTS Of 1334 paired serum and CSF-OCB requests, 945 cases had sufficient clinical information. More than 1 CSF-OCB was detected in 268/945(28%) cases. Of these, 252 had ≥2 and 230 had ≥3 CSF-OCBs. The sensitivity and specificity for MS with ≥2 and ≥3 CSF-OCBs were 91.7%, 91.2%, 90.2% and 93.8% respectively. Only 3/22 patients with 2 CSF-OCBs had MS. In 25% of patients, CSF-OCBs reduced time to MS diagnosis (median 437.5 days (28-1332)). CONCLUSION Although cut-offs of ≥2 or ≥3 CSF-OCBs performed similarly well, 2 CSF-OCBs were frequently seen with non-inflammatory pathology. Use of ≥3 CSF-OCBs for MS diagnosis should be considered. CSF analysis reduced time to MS diagnosis by approximately 14 months.
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Affiliation(s)
| | - Katherine Birch
- The Neuroscience laboratories, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | | | - Edward Jackson
- The Neuroscience laboratories, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Carrie Chadwick
- The Neuroscience laboratories, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Shahd Hamid
- The Walton Centre Foundation Trust, Liverpool, UK
| | - Anu Jacob
- The Walton Centre Foundation Trust, Liverpool, UK; Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Saif Huda
- The Walton Centre Foundation Trust, Liverpool, UK
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8
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Belimezi M, Kalliaropoulos A, Mentis AFA, Chrousos GP. Diagnostic significance of IgG and albumin indices versus oligoclonal band types in demyelinating disorders. J Clin Pathol 2023; 76:166-171. [PMID: 34526372 DOI: 10.1136/jclinpath-2021-207766] [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: 06/14/2021] [Accepted: 08/29/2021] [Indexed: 11/04/2022]
Abstract
AIMS The laboratory diagnosis of demyelinating inflammatory disorders (DIDs) relies on both intrathecal oligoclonal band (OCB) positivity and IgG index. Although OCB typing remains the gold-standard test for DIDs, it can be laborious and ambiguous, complicating diagnostics, and unduly increasing diagnostic time. We examined whether serum or cerebrospinal fluid (CSF) parameters can classify OCB types and, thus, be used as a replacement test to standard OCB typing. METHODS We retrospectively analysed >1000 prospectively collected samples of patients with DIDs and quantified albumin and IgG levels in the CSF and serum. We determined OCB types by isoelectric focusing combined with immunofixation and evaluated the diagnostic accuracies of IgG and albumin indices in discriminating OCB types by receiver operating characteristic curves and multinomial regression. RESULTS An IgG index cut-off of 0.589 differentiated types 2/3 from types 1/4 (area under the curve 0.780, 95% CI 0.761 to 0.812, p<0.001; specificity: 71.10%, sensitivity: 73.45%). Albumin quotient cut-off values of 6.625 and of 6.707 discriminated type 1 from type 4 and type 2 from type 3, respectively (specificity: <55%, sensitivity: <75%). Female sex, age, IgG index, CSF IgG and serum albumin were associated with different OCB types. CONCLUSIONS Our study reveals that IgG and albumin index can differentiate OCB types with adequate accuracy, especially if refined by age and gender.
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Affiliation(s)
- Maria Belimezi
- Diagnostic Services Laboratory, Hellenic Pasteur Institute, Athens, Greece
| | | | - Alexios-Fotios A Mentis
- Diagnostic Services Laboratory, Hellenic Pasteur Institute, Athens, Greece .,University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
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9
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Hvaring C, Alawad N, Salvesen Ø, Hovdal H, White LR, Boullerne AI. Cut-off evaluation of intrathecal oligoclonal bands of IgM in relapsing-remitting multiple sclerosis; a retrospective study. Mult Scler Relat Disord 2022; 68:104188. [PMID: 36179461 DOI: 10.1016/j.msard.2022.104188] [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: 09/12/2022] [Accepted: 09/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common demyelinating disease and characterized by immunological changes. Oligoclonal bands of IgG in CSF not seen in corresponding serum have been used for many years as part of the diagnostic criteria. However, considerably less is known about the role of IgM, despite several studies showing marked changes to IgM metabolism in MS. Bands of oligoclonal IgM (o-IgM) are more difficult to determine than oligoclonal IgG, thus limiting their study, and there is no agreement as to whether o-IgM in CSF should be part of the clinical work-up of MS. Nevertheless, there is a possibility that such bands might provide a prognostic marker if a cut-off could be established. MATERIALS AND METHODS In this pilot study, paired samples of CSF and serum from 37 patients with relapsing-remitting MS (RRMS) and 57 controls with no subsequent signs of neurological disease were analysed for total IgM, and bands of o-IgM were visualised by isoelectric focusing and western blot. Patient records were used to compare mean changes in Expanded Disability Status Scale (EDSS) over a maximum of 17 years. RESULTS None of the controls displayed extra o-IgM in CSF compared to corresponding serum, whereas additional o-IgM band(s) were seen in CSF in most patient samples (70%). After five years of disease, there was a significant difference in the EDSS between patients with no extra o-IgM compared to patients with at least one extra o-IgM band. This difference increased over time. If a cut-off of two or more extra bands of o-IgM in CSF was applied, this difference was not found. CONCLUSION These exploratory data suggest that o-IgM support the prognostic potential for RRMS, and though tentative, the occurrence of any bands of o-IgM restricted to CSF seems to result in poorer prognosis. Despite the small size of the groups, the data infer that the absence of CSF-restricted o-IgM is good news for the patient. The results need to be reproduced in a more comprehensive study.
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Affiliation(s)
- Charlotte Hvaring
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim N-7491, Norway.
| | - Noor Alawad
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Øyvind Salvesen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim N-7491, Norway
| | - Harald Hovdal
- Department of Neurology and Clinical Neurophysiology, University Hospital of Trondheim, Trondheim N-7006, Norway
| | - Linda R White
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim N-7491, Norway
| | - Anne I Boullerne
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA
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10
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Castellazzi M, Ferri C, Tecilla G, Huss A, Crociani P, Desina G, Barbella G, Piola A, Permunian S, Senel M, Leone M, Tumani H, Pugliatti M. The Sexual Dimorphism in Cerebrospinal Fluid Protein Content Does Not Affect Intrathecal IgG Synthesis in Multiple Sclerosis. J Pers Med 2022; 12:jpm12060977. [PMID: 35743761 PMCID: PMC9224729 DOI: 10.3390/jpm12060977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS) that mainly affects young adults and females more than males. The detection of intrathecal IgG synthesis (IIS) on cerebrospinal fluid (CSF) analysis supports the diagnosis of MS. A sexual dimorphism has recently been described in CSF protein content. (2) Methods: Clinical and laboratory data from 340 MS patients (F = 231, M = 99) and 89 people with clinically isolated syndrome (CIS) (F = 57, M = 32) were retrospectively analyzed to assess the presence of variables affected by sex and age. (3) Results: In MS, the albumin quotient (QAlb), reflecting the blood–CSF barrier (BCSFB) function, was higher in males (5.6 vs. 4.34) and correlated to age with a constant difference between sexes (F = 41.71). In CIS patients, QAlb increased with age only in males (r = 0.3567). Age was positively correlated to disease duration and severity in MS (r = 0.3502, r = 0.2986, respectively). No differences emerged for quantitative and qualitative IIS determinations. (4) Discussion: Although the main difference between males and females concerns the function of BCSFB assessed by QAlb, this sexual dimorphism does not affect the determination of the IIS evaluated both by quantitative and qualitative methods.
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Affiliation(s)
- Massimiliano Castellazzi
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
- Correspondence: ; Tel.: +39-0532-236388
| | - Caterina Ferri
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
| | - Ginevra Tecilla
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
| | - André Huss
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.H.); (M.S.); (H.T.)
| | - Paola Crociani
- Neurology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (P.C.); (G.D.); (M.L.)
| | - Gaetano Desina
- Neurology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (P.C.); (G.D.); (M.L.)
| | - Gianvito Barbella
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
| | - Alice Piola
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
| | - Samantha Permunian
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
| | - Makbule Senel
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.H.); (M.S.); (H.T.)
| | - Maurizio Leone
- Neurology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (P.C.); (G.D.); (M.L.)
| | - Hayrettin Tumani
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.H.); (M.S.); (H.T.)
| | - Maura Pugliatti
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, 44121 Ferrara, Italy
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11
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Carta S, Ferraro D, Ferrari S, Briani C, Mariotto S. Oligoclonal bands: clinical utility and interpretation cues. Crit Rev Clin Lab Sci 2022; 59:391-404. [DOI: 10.1080/10408363.2022.2039591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sara Carta
- Department of Neurosciences, Biomedicine, and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Diana Ferraro
- Department of Biomedicine, Metabolic, and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sergio Ferrari
- Department of Neurosciences, Biomedicine, and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Sara Mariotto
- Department of Neurosciences, Biomedicine, and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
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12
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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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13
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Lymphocyte Counts and Multiple Sclerosis Therapeutics: Between Mechanisms of Action and Treatment-Limiting Side Effects. Cells 2021; 10:cells10113177. [PMID: 34831400 PMCID: PMC8625745 DOI: 10.3390/cells10113177] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 01/18/2023] Open
Abstract
Although the detailed pathogenesis of multiple sclerosis (MS) is not completely understood, a broad range of disease-modifying therapies (DMTs) are available. A common side effect of nearly every MS therapeutic agent is lymphopenia, which can be both beneficial and, in some cases, treatment-limiting. A sound knowledge of the underlying mechanism of action of the selected agent is required in order to understand treatment-associated changes in white blood cell counts, as well as monitoring consequences. This review is a comprehensive summary of the currently available DMTs with regard to their effects on lymphocyte count. In the first part, we describe important general information about the role of lymphocytes in the course of MS and the essentials of lymphopenic states. In the second part, we introduce the different DMTs according to their underlying mechanism of action, summarizing recommendations for lymphocyte monitoring and definitions of lymphocyte thresholds for different therapeutic regimens.
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14
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Cerebrospinal Fluid IgM and Oligoclonal IgG Bands in Multiple Sclerosis: A Meta-Analysis of Prevalence and Prognosis. Brain Sci 2021; 11:brainsci11111444. [PMID: 34827444 PMCID: PMC8615995 DOI: 10.3390/brainsci11111444] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
The presence of intrathecal IgM synthesis (ITMS) has been associated with an aggressive multiple sclerosis (MS) clinical course. In the present systematic review, we aimed at assessing the prevalence of ITMS among different MS phenotypes. Moreover, we aimed at quantifying the risk of a second relapse in ITMS positive and oligoclonal IgG bands (OCGBs)-positive patients. We selected clinical studies reporting the ITMS prevalence assessed as oligoclonal IgM Bands (OCMBs), lipid-specific OCMBs (LS-OCMBs), and/or as an intrathecal IgM production > 0% (IgMLoc, Reiber formula). The overall prevalence of ITMS was higher in relapsing-remitting (RR) than clinically isolated syndrome (CIS) patients (40.1% versus 23.8%, p < 0.00001), while was in line with that detected in primary progressive MS (PPMS, 26.7%). Almost all patients (98%) with ITMS had also OCGBs. The risk of having a second relapse was higher in OCGBs positive patients (HR = 2.18, p = 0.007) but much higher in ITMS positive patients (HR = 3.62, p = 0.0005). This study revealed that the prevalence of ITMS is higher in RRMS patients. It suggests that the risk of having a second relapse, previously ascribed to OCGBs, may, to a certain extent, be related to the presence of intrathecal IgM.
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15
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Shoeibi A, Khodatars M, Jafari M, Moridian P, Rezaei M, Alizadehsani R, Khozeimeh F, Gorriz JM, Heras J, Panahiazar M, Nahavandi S, Acharya UR. Applications of deep learning techniques for automated multiple sclerosis detection using magnetic resonance imaging: A review. Comput Biol Med 2021; 136:104697. [PMID: 34358994 DOI: 10.1016/j.compbiomed.2021.104697] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/18/2022]
Abstract
Multiple Sclerosis (MS) is a type of brain disease which causes visual, sensory, and motor problems for people with a detrimental effect on the functioning of the nervous system. In order to diagnose MS, multiple screening methods have been proposed so far; among them, magnetic resonance imaging (MRI) has received considerable attention among physicians. MRI modalities provide physicians with fundamental information about the structure and function of the brain, which is crucial for the rapid diagnosis of MS lesions. Diagnosing MS using MRI is time-consuming, tedious, and prone to manual errors. Research on the implementation of computer aided diagnosis system (CADS) based on artificial intelligence (AI) to diagnose MS involves conventional machine learning and deep learning (DL) methods. In conventional machine learning, feature extraction, feature selection, and classification steps are carried out by using trial and error; on the contrary, these steps in DL are based on deep layers whose values are automatically learn. In this paper, a complete review of automated MS diagnosis methods performed using DL techniques with MRI neuroimaging modalities is provided. Initially, the steps involved in various CADS proposed using MRI modalities and DL techniques for MS diagnosis are investigated. The important preprocessing techniques employed in various works are analyzed. Most of the published papers on MS diagnosis using MRI modalities and DL are presented. The most significant challenges facing and future direction of automated diagnosis of MS using MRI modalities and DL techniques are also provided.
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Affiliation(s)
- Afshin Shoeibi
- Faculty of Electrical Engineering, Biomedical Data Acquisition Lab (BDAL), K. N. Toosi University of Technology, Tehran, Iran.
| | - Marjane Khodatars
- Faculty of Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Mahboobeh Jafari
- Electrical and Computer Engineering Faculty, Semnan University, Semnan, Iran
| | - Parisa Moridian
- Faculty of Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mitra Rezaei
- Electrical and Computer Engineering Dept., Tarbiat Modares University, Tehran, Iran
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Geelong, Australia
| | - Fahime Khozeimeh
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Geelong, Australia
| | - Juan Manuel Gorriz
- Department of Signal Theory, Networking and Communications, Universidad de Granada, Spain; Department of Psychiatry. University of Cambridge, UK
| | - Jónathan Heras
- Department of Mathematics and Computer Science, University of La Rioja, La Rioja, Spain
| | | | - Saeid Nahavandi
- Institute for Intelligent Systems Research and Innovation (IISRI), Deakin University, Geelong, Australia
| | - U Rajendra Acharya
- Department of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Singapore; Dept. of Electronics and Computer Engineering, Ngee Ann Polytechnic, 599489, Singapore; Department of Bioinformatics and Medical Engineering, Asia University, Taiwan
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16
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Castellazzi M, Ferri C, Alfiero S, Lombardo I, Laudisi M, Tecilla G, Boni M, Pizzicotti S, Fainardi E, Bellini T, Pugliatti M. Sex-Related Differences in Cerebrospinal Fluid Plasma-Derived Proteins of Neurological Patients. Diagnostics (Basel) 2021; 11:diagnostics11050884. [PMID: 34065720 PMCID: PMC8156001 DOI: 10.3390/diagnostics11050884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background and aims: Cerebrospinal fluid (CSF) protein content presents a sexual dimorphism in humans. We investigated sex-related differences in CSF IgG levels and in the quantification of intrathecal IgG synthesis (IIS). Methods: CSF, serum albumin and IgG were measured in 1519 neurological patients and both linear and hyperbolic formulas were used for the quantification of IIS. CSF-restricted oligoclonal IgG bands (OCBs) were used as “gold standard”. Results: The linear IgG Index showed a weak agreement with OCBs in males and females (k = 0.559, k = 0.587, respectively), while the hyperbolic Reiber’s formulas had a moderate agreement with OCBs in females (k = 0.635) and a weak agreement in males (k = 0.565). Higher CSF albumin and IgG levels were found in men than in women in the whole population and in subjects without IIS after adjusting for age and for serum concentrations of albumin and IgG, respectively (Quade statistics, p < 0.000001). CSF and serum albumin and IgG levels positively correlated to age in both sexes. CSF total protein content did not correlate with CSF leukocyte numbers but was higher in patients with marked pleocytosis. Conclusions: In neurological patients, men have higher levels of CSF serum-derived proteins, such as albumin and IgG.
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Affiliation(s)
- Massimiliano Castellazzi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, 44121 Ferrara, Italy
- Correspondence: ; Tel.: +39-0532-236388
| | - Caterina Ferri
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
| | - Sarah Alfiero
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
| | - Ilenia Lombardo
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
| | - Michele Laudisi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
| | - Ginevra Tecilla
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
| | - Michela Boni
- Chemical-Clinical Analysis Laboratory, “S. Anna” University Hospital, 44124 Ferrara, Italy; (M.B.); (S.P.)
| | - Stefano Pizzicotti
- Chemical-Clinical Analysis Laboratory, “S. Anna” University Hospital, 44124 Ferrara, Italy; (M.B.); (S.P.)
| | - Enrico Fainardi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy;
| | - Tiziana Bellini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, 44121 Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, 44121 Ferrara, Italy
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17
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Di Gregorio M, Torri Clerici VLA, Fenu G, Gaetani L, Gallo A, Cavalla P, Ragonese P, Annovazzi P, Gajofatto A, Prosperini L, Landi D, Nicoletti CG, Di Carmine C, Totaro R, Nociti V, De Fino C, Ferraro D, Tomassini V, Tortorella C, Righini I, Amato MP, Manni A, Paolicelli D, Iaffaldano P, Lanzillo R, Moccia M, Buttari F, Fantozzi R, Cerqua R, Zagaglia S, Farina D, De Luca G, Buscarinu MC, Pinardi F, Cocco E, Gasperini C, Solaro CM, Di Filippo M. Defining the course of tumefactive multiple sclerosis: A large retrospective multicentre study. Eur J Neurol 2021; 28:1299-1307. [PMID: 33305459 DOI: 10.1111/ene.14672] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Tumefactive multiple sclerosis (TuMS) (i.e., MS onset presenting with tumefactive demyelinating lesions [TDLs]) is a diagnostic and therapeutic challenge. We performed a multicentre retrospective study to describe the clinical characteristics and the prognostic factors of TuMS. METHODS One hundred two TuMS patients were included in this retrospective study. Demographic, clinical, magnetic resonance imaging (MRI), laboratory data and treatment choices were collected. RESULTS TuMS was found to affect women more than men (female:male: 2.4), with a young adulthood onset (median age: 29.5 years, range: 11-68 years, interquartile range [IQR]: 38 years). At onset, 52% of TuMS patients presented with the involvement of more than one functional system and 24.5% of them with multiple TDLs. TDLs most frequently presented with an infiltrative MRI pattern (38.7%). Cerebrospinal fluid immunoglobulin G oligoclonal bands were often demonstrated (76.6%). In 25.3% of the cases, more than one acute-phase treatment was administered, and almost one-half of the patients (46.6%) were treated with high-efficacy treatments. After a median follow-up of 2.3 years (range: 0.1-10.7 years, IQR: 3.4 years), the median Expanded Disability Status Scale (EDSS) score was 1.5 (range: 0-7, IQR: 2). Independent risk factors for reaching an EDSS score ≥3 were a higher age at onset (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.03-1.14, p < 0.01), a higher number of TDLs (OR: 1.67, 95% CI: 1.02-2.74, p < 0.05) and the presence of infiltrative TDLs (OR: 3.34, 95% CI: 1.18-9.5, p < 0.001) at baseline. CONCLUSIONS The management of TuMS might be challenging because of its peculiar characteristics. Large prospective studies could help to define the clinical characteristics and the best treatment algorithms for people with TuMS.
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Affiliation(s)
- Maria Di Gregorio
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy.,Azienda Ospedaliero-Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | - Giuseppe Fenu
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy.,Centro Regionale Sclerosi Multipla, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Lorenzo Gaetani
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | - Antonio Gallo
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Cavalla
- Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paolo Ragonese
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | - Pietro Annovazzi
- U.O.C. Centro Sclerosi Multipla, ASST Valle Olona, Varese, Italy
| | - Alberto Gajofatto
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Luca Prosperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Doriana Landi
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy.,U.O.S.D Sclerosi Multipla, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Carolina Gabri Nicoletti
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy.,U.O.S.D Sclerosi Multipla, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Rocco Totaro
- Centro Malattie Demielinizzanti, Ospedale San Salvatore, L'Aquila, Italy
| | - Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara De Fino
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diana Ferraro
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Valentina Tomassini
- Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.,Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.,Division of Psychological Medicine and Clinical Neurosciences, University Hospital of Wales, Cardiff University School of Medicine, Cardiff, UK.,Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Carla Tortorella
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Isabella Righini
- UO Neurologia-Dipartimento di Specialità Mediche- Nuovo Ospedale delle Apuane, Massa, Italy
| | - Maria Pia Amato
- Dipartimento NEUROFARBA, Sezione di Neuroscienze, Università degli Studi di Firenze, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Alessia Manni
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Damiano Paolicelli
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Pietro Iaffaldano
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Roberta Lanzillo
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università degli Studi "Federico II", Naples, Italy
| | - Marcello Moccia
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università degli Studi "Federico II", Naples, Italy.,UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Fabio Buttari
- Unità di Neurologia, IRCCS Neuromed, Pozzilli, Italy
| | | | - Raffaella Cerqua
- Clinica Neurologica, Dipartimento di Medicina Sperimentale e Clinica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Sara Zagaglia
- Department of Clinical and Experimental Epilepsy, Queen Square, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, UK
| | - Deborah Farina
- Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Maria Chiara Buscarinu
- Dipartimento di Neuroscienze, Salute Mentale ed Organi di Senso, Università degli Studi di Roma "LaSapienza", Rome, Italy
| | - Federica Pinardi
- IRCCS Istituto delle scienze neurologiche di Bologna, UOSI riabilitazione SM, Bologna, Italy
| | - Eleonora Cocco
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy.,Centro Regionale Sclerosi Multipla, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Claudio Gasperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | | | - Massimiliano Di Filippo
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
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18
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Ferraro D, Bedin R, Natali P, Franciotta D, Smolik K, Santangelo M, Immovilli P, Camera V, Vitetta F, Gastaldi M, Trenti T, Meletti S, Sola P. Kappa Index Versus CSF Oligoclonal Bands in Predicting Multiple Sclerosis and Infectious/Inflammatory CNS Disorders. Diagnostics (Basel) 2020; 10:diagnostics10100856. [PMID: 33096861 PMCID: PMC7589948 DOI: 10.3390/diagnostics10100856] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Cerebrospinal fluid (CSF) kappa free light chains (KFLC) are gaining increasing interest as markers of intrathecal immunoglobulin synthesis. The main aim of this study was to assess the diagnostic accuracy (AUC) of the kappa index (CSF/serum KFLC divided by the CSF/serum albumin ratio) compared to CSF oligoclonal IgG bands (OCB) in predicting Multiple Sclerosis (MS) or a central nervous system infectious/inflammatory disorder (CNSID). Methods: We enrolled patients who underwent a diagnostic spinal tap throughout two years. KFLC levels were determined using a Freelite assay (Binding Site) and the turbidimetric Optilite analyzer. Results: Of 540 included patients, 223 had a CNSID, and 84 had MS. The kappa index was more sensitive (0.89 versus 0.85) and less specific (0.84 versus 0.89), with the same AUC (0.87) as OCB for MS diagnosis (optimal cut-off: 6.2). Adding patients with a single CSF IgG band to the OCB-positive group slightly increased the AUC (0.88). Likewise, the kappa index (cut-off: 3.9) was more sensitive (0.67 versus 0.50) and less specific (0.81 versus 0.97), with the same AUC (0.74) as OCB, for a CNSID diagnosis. Conclusion: The kappa index and CSF OCB have comparable diagnostic accuracies for a MS or CNSID diagnosis and supply the clinician with useful, complementary information.
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Affiliation(s)
- Diana Ferraro
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (V.C.); (F.V.); (S.M.); (P.S.)
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (R.B.); (K.S.)
- Correspondence: ; Tel.: +39-0593961678
| | - Roberta Bedin
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (R.B.); (K.S.)
| | - Patrizia Natali
- Department of Laboratory Medicine, Azienda Ospedaliero-Universitaria and Azienda Unità Sanitaria Locale, Ospedale Civile, 41126 Modena, Italy; (P.N.); (T.T.)
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, 27100 Pavia, Italy; (D.F.); (M.G.)
| | - Krzysztof Smolik
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (R.B.); (K.S.)
| | | | - Paolo Immovilli
- Neurology Unit, Ospedale G. da Saliceto, 29121 Piacenza, Italy;
| | - Valentina Camera
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (V.C.); (F.V.); (S.M.); (P.S.)
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (R.B.); (K.S.)
| | - Francesca Vitetta
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (V.C.); (F.V.); (S.M.); (P.S.)
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, 27100 Pavia, Italy; (D.F.); (M.G.)
| | - Tommaso Trenti
- Department of Laboratory Medicine, Azienda Ospedaliero-Universitaria and Azienda Unità Sanitaria Locale, Ospedale Civile, 41126 Modena, Italy; (P.N.); (T.T.)
| | - Stefano Meletti
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (V.C.); (F.V.); (S.M.); (P.S.)
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, 41126 Modena, Italy; (R.B.); (K.S.)
| | - Patrizia Sola
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy; (V.C.); (F.V.); (S.M.); (P.S.)
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19
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Yu X, Graner M, Kennedy PGE, Liu Y. The Role of Antibodies in the Pathogenesis of Multiple Sclerosis. Front Neurol 2020; 11:533388. [PMID: 33192968 PMCID: PMC7606501 DOI: 10.3389/fneur.2020.533388] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/08/2020] [Indexed: 01/09/2023] Open
Abstract
The presence of persistent intrathecal oligoclonal immunoglobulin G (IgG) bands (OCBs) and lesional IgG deposition are seminal features of multiple sclerosis (MS) disease pathology. Despite extensive investigations, the role of antibodies, the products of mature CD19+ B cells, in disease development is still controversial and under significant debate. Recent success of B cell depletion therapies has revealed that CD20+ B cells contribute to MS pathogenesis via both antigen-presentation and T-cell-regulation. However, the limited efficacy of CD20+ B cell depletion therapies for the treatment of progressive MS indicates that additional mechanisms are involved. In this review, we present findings suggesting a potential pathological role for increased intrathecal IgGs, the relation of circulating antibodies to intrathecal IgGs, and the selective elevation of IgG1 and IgG3 subclasses in MS. We propose a working hypothesis that circulating B cells and antibodies contribute significantly to intrathecal IgGs, thereby exerting primary and pathogenic effects in MS development. Increased levels of IgG1 and IgG3 antibodies induce potent antibody-mediated cytotoxicity to central nervous system (CNS) cells and/or reduce the threshold required for antigen-driven antibody clustering leading to optimal activation of immune responses. Direct proof of the pathogenic roles of antibodies in MS may provide opportunities for novel blood biomarker identification as well as strategies for the development of effective therapeutic interventions.
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Affiliation(s)
- Xiaoli Yu
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michael Graner
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Peter G E Kennedy
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Yiting Liu
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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20
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Zeman D, Kušnierová P, Všianský F, Reguliová K, Škutová M, Woznicová I, Zapletalová O, Hradílek P. Cerebrospinal fluid oligoclonal IgM test in routine practice: Comparison with quantitative assessment of intrathecal IgM synthesis. Clin Chim Acta 2020; 508:137-145. [PMID: 32416174 DOI: 10.1016/j.cca.2020.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intrathecal IgM synthesis demonstrated either as cerebrospinal fluid (CSF)-restricted oligoclonal (o-) IgM bands or calculated using various formulas has been linked to more aggressive multiple sclerosis (MS) course. However, the proportion of MS patients showing intrathecal IgM synthesis varies largely between studies. We aimed to explore the relation between different formulas and results of o-IgM, and to assess the frequency of o-IgM bands in an unselected series of samples. METHODS 432 samples were analyzed for o-IgM, o-IgG and quantitative measures of IgM and IgG synthesis. IgM index and formulas of Reiber, Auer and Öhman were compared to the result of the o-IgM test. RESULTS At the cut-off commonly used, the non-linear formulas for intrathecal synthesis were specific (>94%) but rather insensitive (<40% even at a cut-off of 4 CSF-restricted bands) compared to o-IgM. No significant difference was noted in the performance of different formulas. At a cut-off of 4 bands, 61% of MS patients, but none of the controls were positive for o-IgM. CONCLUSIONS Formulas for intrathecal IgM synthesis are insensitive compared to o-IgM. We propose to evaluate samples with 2 or 3 extra-CSF IgM bands as borderline and only samples with 4 or more as definitely positive.
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Affiliation(s)
- David Zeman
- Institute of Laboratory Diagnostics, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Dept. of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.
| | - Pavlína Kušnierová
- Institute of Laboratory Diagnostics, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Dept. of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - František Všianský
- Institute of Laboratory Diagnostics, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Katarína Reguliová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Monika Škutová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Ivana Woznicová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Olga Zapletalová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Dept. of Neurology and Psychiatry, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Pavel Hradílek
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
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21
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Süße M, Feistner F, Holbe C, Grothe M, Nauck M, Dressel A, Hannich MJ. Diagnostic value of kappa free light chains in patients with one isolated band in isoelectric focusing. Clin Chim Acta 2020; 507:205-209. [PMID: 32353362 DOI: 10.1016/j.cca.2020.04.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/02/2020] [Accepted: 04/26/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Oligoclonal band (OCB) determination in cerebrospinal fluid (CSF) is the gold standard to detect intrathecal inflammation. However, there is uncertainty about the significance of one isolated band in CSF. Free light chains kappa (FLC-k) are gaining interest as a complementary method to detect intrathecal inflammation. The aim of this study was to investigate the performance of an additive measurement of FLC-k in patients with one isolated band in CSF. MATERIALS & METHODS FLC-k were analyzed using the nephelometric Siemens FLC-k kit in paired samples of CSF and sera (n = 56) in patients with one isolated band in isoelectric focusing. According to medical diagnosis, samples were subdivided in inflammatory neurological disease, non-inflammatory neurological disease controls and symptomatic controls. Intrathecal fraction of FLC-k was plotted in a FLC-k quotient diagram. OCB interpretation was done blinded by three experienced raters. RESULTS Of 6695 OCB analyses, 91 (1.4%) had one isolated band in CSF. After exclusion of patient samples due to unclear OCB pattern after reevaluation and sample availability, 56 patient samples were included in the study. All patients with an inflammatory origin of disease (n = 13) had FLC-k values above the upper discrimination line (Qlim) in the FLC-k quotient diagram, resulting in a sensitivity of 100% with a positive predictive value of 52% and a negative predictive value of 100%. Fourteen patients (36%) with a non-inflammatory origin of disease (n = 39) had FLC-k values above Qlim. CONCLUSIONS In patients with one isolated band in CSF, a lack of intrathecal fraction of FLC-k strongly favors a non-inflammatory orgin of disease. Implementation of FLC-k measurement can help the clinician in the diagnostic process of neurological diseases.
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Affiliation(s)
- Marie Süße
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany.
| | - Fritz Feistner
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Christine Holbe
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Malte Johannes Hannich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
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22
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Agnello L, Lo Sasso B, Salemi G, Altavilla P, Pappalardo EM, Caldarella R, Meli F, Scazzone C, Bivona G, Ciaccio M. Clinical Use of κ Free Light Chains Index as a Screening Test for Multiple Sclerosis. Lab Med 2020; 51:402-407. [DOI: 10.1093/labmed/lmz073] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Abstract
Objective
To assess the usefulness of the κ free light chain index (κFLCi) as a screening test to identify patients with suspected MS.
Methods
The study included 56 patients with a request to test for oligoclonal bands (OCBs). OCBs were detected by isoelectric focusing, followed by immunofixation. Cerebrospinal fluid (CSF) and serum κFLC were measured by a turbidimetric assay. Also, the κFLC index (κFLCi) was calculated.
Results
CSF κFLC levels and κFLCi were significantly higher in patients with multiple sclerosis (MS) than in patients with other neurological diseases (NDs; P < .001 and P < .001, respectively). At the cutoff value of 2.9, the κFLCi detected MS with sensitivity of 97% and specificity of 65%. Overall, 92% patients with κFLCi of 2.9 or greater and who had tested positive for OCBs were diagnosed as having MS.
Conclusion
Our findings support the use of κFLCi as a screening test when MS is suspected, followed by OCB detection as a confirmatory test for the diagnosis of MS.
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Affiliation(s)
- Luisa Agnello
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, University of Palermo, Italy
| | - Bruna Lo Sasso
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, University of Palermo, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Italy
| | | | | | | | - Francesco Meli
- Department of Laboratory Medicine, University-Hospital, Palermo, Italy
| | - Concetta Scazzone
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, University of Palermo, Italy
| | - Giulia Bivona
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, University of Palermo, Italy
| | - Marcello Ciaccio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, University of Palermo, Italy
- Department of Laboratory Medicine, University-Hospital, Palermo, Italy
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23
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Gastaldi M, Zardini E, Scaranzin S, Uccelli A, Andreetta F, Baggi F, Franciotta D. Autoantibody Diagnostics in Neuroimmunology: Experience From the 2018 Italian Neuroimmunology Association External Quality Assessment Program. Front Neurol 2020; 10:1385. [PMID: 32010046 PMCID: PMC6971200 DOI: 10.3389/fneur.2019.01385] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Neuroimmunology has impressively expanded in the past decade. Novel assays, especially cell-based assays (CBAs) can detect conformational antibodies (Abs) recognizing antigens in their native conformation. Generally, the availability of in-house and of commercial tests has improved the diagnostics, but introduced demanding laboratory tasks. Hence, standardization and quality controls represent a key step to promote accuracy. We report on the results of the 2018 external quality assessment program (EQAP) organized by the Italian Neuroimmunology Association. Methods: EQAP regarded 10 schemes, including oligoclonal bands (OCBs), intracellular-neuronal (ICN)-Abs, neuronal-surface (NS)-Abs, aquaporin-4 (AQP4)-Abs, myelin oligodendrocyte glycoprotein (MOG)-Abs, myelin-associated glycoprotein (MAG)-Abs, ganglioside-Abs, acetylcholine-receptor (AChR)-Abs, and muscle-specific-kinase (MuSK)-Abs, and 34 laboratories. Assays were classified as tissue-based assays (TBAs), solid-phase assays (SPAs), liquid-phase assays (LPAs), and CBAs. Thirty-three samples were provided. Results: Three-quarter of the tests were commercial. Median accuracy for the laboratories was 75% (range 50–100). In 8/10 schemes, at least one sample provided discrepant results. Inter-laboratory “substantial agreement” was found in 6/10 schemes (AChR, MuSK, MAG, AQP4, MOG, and NS-Abs), whereas the worst agreements regarded OCBs and ganglioside-Abs. Both commercial and in-house assays performed better in experienced laboratories. Conclusions: Assays could be divided in (a) robust commercial tests with substantial inter-laboratory agreement (MAG-Abs; AChR- and MuSK-Abs); commercial/“in-house” tests with (b) partial inter-laboratory agreement (AQP4-Abs, MOG-Abs, NS-Abs, ICN-Abs), and (c) with large inter-laboratory disagreement (OCBs, ganglioside-Abs). This real-life snapshot of the neuroimmunology test performances highlights shortcomings attributable to technician-dependent performances, assay structural limitations, and errors in test interpretations.
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Affiliation(s)
- Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisabetta Zardini
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Silvia Scaranzin
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Francesca Andreetta
- UO Neurology IV, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fulvio Baggi
- UO Neurology IV, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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24
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Wildner P, Stasiołek M, Matysiak M. Differential diagnosis of multiple sclerosis and other inflammatory CNS diseases. Mult Scler Relat Disord 2020; 37:101452. [DOI: 10.1016/j.msard.2019.101452] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 12/12/2022]
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25
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Ferraro D, Trovati A, Bedin R, Natali P, Franciotta D, Santangelo M, Camera V, Vitetta F, Varani M, Trenti T, Gastaldi M, De Biasi S, Nasi M, Pinti M, Meletti S, Sola P. Cerebrospinal fluid kappa and lambda free light chains in oligoclonal band‐negative patients with suspected multiple sclerosis. Eur J Neurol 2019; 27:461-467. [DOI: 10.1111/ene.14121] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/04/2019] [Indexed: 12/20/2022]
Affiliation(s)
- D. Ferraro
- Neurology Unit Azienda Ospedaliero‐Universitaria of Modena Modena
- Department of Biomedical, Metabolic and Neurosciences University of Modena and Reggio Emilia Modena
| | - A. Trovati
- Neurology Unit Azienda Ospedaliero‐Universitaria of Modena Modena
| | - R. Bedin
- Department of Biomedical, Metabolic and Neurosciences University of Modena and Reggio Emilia Modena
| | - P. Natali
- Department of Laboratory Medicine Azienda Ospedaliero‐Universitaria and Azienda Unità Sanitaria Locale Modena
| | - D. Franciotta
- Neuroimmunology Laboratory IRCCS Mondino Foundation Pavia
| | | | - V. Camera
- Department of Biomedical, Metabolic and Neurosciences University of Modena and Reggio Emilia Modena
| | - F. Vitetta
- Neurology Unit Azienda Ospedaliero‐Universitaria of Modena Modena
| | - M. Varani
- Department of Laboratory Medicine Azienda Ospedaliero‐Universitaria and Azienda Unità Sanitaria Locale Modena
| | - T. Trenti
- Department of Laboratory Medicine Azienda Ospedaliero‐Universitaria and Azienda Unità Sanitaria Locale Modena
| | - M. Gastaldi
- Neuroimmunology Laboratory IRCCS Mondino Foundation Pavia
| | - S. De Biasi
- Department of Life Sciences University of Modena and Reggio Emilia Modena
| | - M. Nasi
- Department of Surgery, Medicine Dentistry and Morphological Sciences University of Modena and Reggio Emilia Modena Italy
| | - M. Pinti
- Department of Life Sciences University of Modena and Reggio Emilia Modena
| | - S. Meletti
- Neurology Unit Azienda Ospedaliero‐Universitaria of Modena Modena
- Department of Biomedical, Metabolic and Neurosciences University of Modena and Reggio Emilia Modena
| | - P. Sola
- Neurology Unit Azienda Ospedaliero‐Universitaria of Modena Modena
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26
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Bisulca J, De Lury A, Coyle PK, Syritsyna O, Peyster R, Bangiyev L, Duong TQ. MRI features associated with high likelihood of conversion of radiologically isolated syndrome to multiple sclerosis. Mult Scler Relat Disord 2019; 36:101381. [PMID: 31518773 DOI: 10.1016/j.msard.2019.101381] [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: 02/27/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 10/26/2022]
Abstract
Radiologically isolated syndrome (RIS) is the asymptomatic precursor to clinically isolated syndrome, relapsing-remitting multiple sclerosis (MS) or primary progressive MS. RIS is frequently diagnosed when an individual gets an MRI for an unrelated medical issue, such as headache or trauma. Treating RIS patients is controversial, but physicians may be inclined to offer prophylactic treatment for high-risk RIS patients. Identifying imaging and clinical features associated with high likelihood of early clinical conversion may prove helpful to identify a high-risk subset for potential MS therapy. The goal of this paper is to review current literatures to identify imaging and clinical features that predict early (within 5 years) conversion from RIS to MS.
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Affiliation(s)
- Joseph Bisulca
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Amy De Lury
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Patricia K Coyle
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Olga Syritsyna
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Robert Peyster
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Lev Bangiyev
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Tim Q Duong
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA.
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27
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Huss A, Mojib-Yezdani F, Bachhuber F, Fangerau T, Lewerenz J, Otto M, Tumani H, Senel M. Association of cerebrospinal fluid kappa free light chains with the intrathecal polyspecific antiviral immune response in multiple sclerosis. Clin Chim Acta 2019; 498:148-153. [PMID: 31437445 DOI: 10.1016/j.cca.2019.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 11/20/2022]
Abstract
The polyspecific B-lymphocyte response to neurotropic viruses such as measles (M), rubella (R) and varicella zoster (Z), known as MRZ reaction, is to-date the most specific neurochemical marker for multiple sclerosis (MS). The aim of this study was to investigate a possible association of immunoglobulin (Ig) kappa (κ-) and lambda (λ-) free light chains (FLC) with the presence of the MRZ reaction in multiple sclerosis. Immunoglobulin κ- and λ-FLC, MRZ reaction, oligoclonal IgG bands (OCB), and cerebrospinal fluid (CSF) routine parameters were measured in 65 MS patients. OCB were detected in 97% of MS patients, intrathecal IgG synthesis according to Reiber was detectable in 57%, an elevated IgG index (>0.7) in 66% and the MRZR was positive in 45%. All investigated κ-values (CSF κFLC, CSF-serum ratio of κFLCs (QκFLC), and κFLC index (κFLC/QAlbumin)) were significantly higher in patients with positive MRZ reaction as compared to MRZ negative MS patients. In contrast, λ-values showed no significant differences. Additionally to the putative diagnostic sensitivity and prognostic value of κFLC, the association of κFLC with a highly specific neurochemical marker for MS - the MRZ reaction, especially the determination of κFLCs is an informative tool to assess the B-cell response and determine its extent in MS patients.
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Affiliation(s)
- André Huss
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | - Tanja Fangerau
- Department of Neurology, University of Ulm, 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
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany.
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28
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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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29
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Deisenhammer F, Zetterberg H, Fitzner B, Zettl UK. The Cerebrospinal Fluid in Multiple Sclerosis. Front Immunol 2019; 10:726. [PMID: 31031747 PMCID: PMC6473053 DOI: 10.3389/fimmu.2019.00726] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/18/2019] [Indexed: 12/27/2022] Open
Abstract
Investigation of cerebrospinal fluid (CSF) in the diagnostic work-up in suspected multiple sclerosis (MS) patients has regained attention in the latest version of the diagnostic criteria due to its good diagnostic accuracy and increasing issues with misdiagnosis of MS based on over interpretation of neuroimaging results. The hallmark of MS-specific changes in CSF is the detection of oligoclonal bands (OCB) which occur in the vast majority of MS patients. Lack of OCB has a very high negative predictive value indicating a red flag during the diagnostic work-up, and alternative diagnoses should be considered in such patients. Additional molecules of CSF can help to support the diagnosis of MS, improve the differential diagnosis of MS subtypes and predict the course of the disease, thus selecting the optimal therapy for each patient.
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Affiliation(s)
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,The Fluid Biomarker Laboratory, UK Dementia Research Institute at UCL, London, United Kingdom
| | - Brit Fitzner
- Division of Neuroimmunology, Department of Neurology, University Medicine Rostock, Rostock, Germany
| | - Uwe K Zettl
- Division of Neuroimmunology, Department of Neurology, University Medicine Rostock, Rostock, Germany
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30
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Oligoclonal bands in multiple sclerosis; Functional significance and therapeutic implications. Does the specificity matter? Mult Scler Relat Disord 2018; 25:131-137. [DOI: 10.1016/j.msard.2018.07.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 01/24/2023]
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31
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Zeman D. Free light chains in the cerebrospinal fluid. Do we still need oligoclonal IgG? ACTA ACUST UNITED AC 2018; 56:1011-1014. [DOI: 10.1515/cclm-2018-0096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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32
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Gastaldi M, Zardini E, Leante R, Ruggieri M, Costa G, Cocco E, De Luca G, Cataldo I, Biagioli T, Ballerini C, Castellazzi M, Fainardi E, Pettini P, Zaffaroni M, Giunti D, Capello E, Bernardi G, Ciusani E, Giannotta C, Nobile-Orazio E, Bazzigaluppi E, Passerini G, Bedin R, Sola P, Brivio R, Cavaletti G, Sala A, Bertolotto A, Desina G, Leone MA, Mariotto S, Ferrari S, Paternoster A, Giavarina D, Lolli F, Franciotta D. Cerebrospinal fluid analysis and the determination of oligoclonal bands. Neurol Sci 2018; 38:217-224. [PMID: 29030765 DOI: 10.1007/s10072-017-3034-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This document presents the guidelines for the cerebrospinal fluid (CSF) analysis and the determination of oligoclonal bands (OCBs) as pivotal tests in neuroinflammatory pathologies of the central nervous system. The guidelines have been developed following a consensus process built on questionnaire-based surveys, internet contacts, and discussions at workshops of the sponsoring Italian Association of Neuroimmunology (AINI) congresses. Essential clinical information on the pathologies in which the CSF analysis is indicated, and, particularly, on those characterized by the presence of OCBs in the intrathecal compartment, indications and limits of CSF analysis and OCB determination, instructions for result interpretation, and agreed laboratory protocols (Appendix) are reported for the communicative community of neurologists and clinical pathologists.
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Affiliation(s)
- Matteo Gastaldi
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Elisabetta Zardini
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | | | | | | | | | | | | | | | - Clara Ballerini
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | | | - Enrico Fainardi
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Paola Pettini
- Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy
| | | | - Debora Giunti
- Ospedale Policlinico San Martino IRCCS, University of Genova, Genoa, Italy
| | - Elisabetta Capello
- Ospedale Policlinico San Martino IRCCS, University of Genova, Genoa, Italy
| | | | | | | | | | | | | | - Roberta Bedin
- Ospedale Civile Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Patrizia Sola
- Ospedale Civile Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | - Guido Cavaletti
- Expersimental Neurology Unit, University of Milano-Bicocca, Monza, Italy
| | | | | | - Gaetano Desina
- IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Maurizio A Leone
- IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | | | - Francesco Lolli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Diego Franciotta
- Laboratory of Neuroimmunology, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy.
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Akaishi T, Takahashi T, Nakashima I. Oligoclonal bands and periventricular lesions in multiple sclerosis will not increase blood-brain barrier permeability. J Neurol Sci 2018; 387:129-133. [DOI: 10.1016/j.jns.2018.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
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Dlouhy O, Kusnierova P, Kurasova I, Cisarikova M, Zeman D. Chemiluminescent detection of oligoclonal immunoglobulins after isoelectric focusing and affinity-mediated immunoblotting. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:107-115. [PMID: 29467546 DOI: 10.5507/bp.2018.003] [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: 01/11/2018] [Accepted: 02/05/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS Detection of oligoclonal IgG (o-IgG) in the cerebrospinal fluid (CSF) not found in serum is the principal laboratory test to support a diagnosis of multiple sclerosis. The aim of this study was to compare chemiluminescent and chromogenic detection of oligoclonal immunoglobulins in the cerebrospinal fluid and serum after their separation by means of isoelectric focusing followed by immunoblotting. METHODS A set of experiments was designed to detect oligoclonal immunoglobulins by means of alkaline phosphatase BCIP/NBT substrate and chemiluminescent peroxidase substrate. RESULTS Based on visual evaluation of signals, chemiluminescent detection requires about a 4 times lower amount of applied protein than very sensitive BCIP/NBT chromogenic detection. Very good correlation between methods has been shown for oligoclonal IgG. Antigen-specific oligoclonal IgG could be demonstrated by both methods although the pattern was clearer using chemiluminescence. In one patient, oligoclonal IgD bands barely visible by BCIP/NBT were convincingly demonstrated by chemiluminescence. CONCLUSION Chemiluminescent detection is a feasible option for oligoclonal immunoglobulin detection and could be used in cases when the sensitivity needs to be improved. Further studies and method optimisation are warranted.
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Affiliation(s)
- Ondrej Dlouhy
- Department of Physics, Faculty of Natural Sciences, University of Ostrava, Ostrava, Czech Republic
| | - Pavlina Kusnierova
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Institute of Laboratory Diagnostics, University Hospital Ostrava, Ostrava, Czech Republic
| | - Irena Kurasova
- Department of Physics, Faculty of Natural Sciences, University of Ostrava, Ostrava, Czech Republic
| | - Monika Cisarikova
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - David Zeman
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Institute of Laboratory Diagnostics, University Hospital Ostrava, Ostrava, Czech Republic
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35
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Franciotta D, Gastaldi M, Zardini E, Nobile-Orazio E. Cerebrospinal fluid total protein determination in acute and chronic inflammatory demyelinating polyneuropathies: a critical reappraisal. J Peripher Nerv Syst 2018; 23:70-72. [PMID: 29455455 DOI: 10.1111/jns.12253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/16/2018] [Accepted: 01/30/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Diego Franciotta
- Laboratory of Neuroimmunology, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Laboratory of Neuroimmunology, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elisabetta Zardini
- Laboratory of Neuroimmunology, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, Department of Medical Biotechnology and Translational Medicine, Humanitas Clinical and Research Institute, Milan University, Milan, Italy
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36
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37
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Matute-Blanch C, Montalban X, Comabella M. Multiple sclerosis, and other demyelinating and autoimmune inflammatory diseases of the central nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2018; 146:67-84. [DOI: 10.1016/b978-0-12-804279-3.00005-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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38
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Bernitsas E, Khan O, Razmjou S, Tselis A, Bao F, Caon C, Millis S, Seraji-Bozorgzad N. Cerebrospinal fluid humoral immunity in the differential diagnosis of multiple sclerosis. PLoS One 2017; 12:e0181431. [PMID: 28727770 PMCID: PMC5519077 DOI: 10.1371/journal.pone.0181431] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/30/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The diagnostic accuracy of cerebrospinal fluid oligoclonal bands (CSF-OCB) detected by isoelectric focusing (IEF) in patients with multiple sclerosis (MS) was evaluated in our study. METHODS Three hundred and twenty-one patients with MS and other central nervous system (CNS) immune mediated disorders were assessed (CIMD). Cerebrospinal fluid and matched serum samples were examined for the presence of OCB by IEF-IB (isoelectric focusing with immunoblotting). RESULTS Isolated oligoclonal bands (ISO-OCB) were the only predictor of MS diagnosis independent of age, gender and CSF-OCB. ISO-OCB ≥ 3.5 detected by IEF yielded a sensitivity of 98% and specificity of 87% in distinguishing MS from MS mimickers. CONCLUSIONS For the neurologist, a score of ≥ 4 ISO-OCB supports the diagnosis of MS. On the other hand, ISO-OCB ≤3 favors CIMD. Further studies with larger population samples are warranted to confirm these findings.
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Affiliation(s)
- Evanthia Bernitsas
- Department of Neurology, Wayne State School of Medicine, Detroit, MI, United States of America
- * E-mail:
| | - Omar Khan
- Department of Neurology, Wayne State School of Medicine, Detroit, MI, United States of America
| | - Sara Razmjou
- Department of Neurology, Wayne State School of Medicine, Detroit, MI, United States of America
| | - Alexandros Tselis
- Department of Neurology, Wayne State School of Medicine, Detroit, MI, United States of America
| | - Fen Bao
- Department of Neurology, Wayne State School of Medicine, Detroit, MI, United States of America
| | - Christina Caon
- Department of Neurology, Wayne State School of Medicine, Detroit, MI, United States of America
| | - Scott Millis
- Department of Physical Medicine and Rehabilitation; Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Navid Seraji-Bozorgzad
- Department of Neurology, Wayne State School of Medicine, Detroit, MI, United States of America
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39
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A multicenter study on the diagnostic significance of a single cerebrospinal fluid IgG band. J Neurol 2017; 264:973-978. [DOI: 10.1007/s00415-017-8480-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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