title: Flow cytometric analysis of T cell/monocyte ratio in clinically isolated syndrome identifies patients at risk of rapid disease progression.
abstract: BACKGROUND
  Multiple sclerosis is a chronic inflammatory central nervous system disease diagnosed by clinical presentation and characteristic magnetic resonance imaging findings. The role of cerebrospinal fluid (CSF) analysis has been emphasized in particular in the context of differential diagnosis in patients with a first episode suggestive of multiple sclerosis.
  
  
  OBJECTIVE
  We investigated here the potential additional value of analysis of CSF cellularity by fluorescence activated cell sorting (FACS) in the setting of a routine diagnostic work-up in our inpatient clinic.
  
  
  METHODS
  CSF cells from back-up samples from patients with suspected chronic inflammatory central nervous system disorder were analyzed by FACS and correlated with clinical data, magnetic resonance imaging findings and oligoclonal band status.
  
  
  RESULTS
  We found distinct changes of T cell/monocyte (CD4/CD14) and B cell/monocyte (CD20/CD14) ratios between clinically isolated syndrome (CIS)/multiple sclerosis and other neurologic diseases or other inflammatory neurologic diseases. In particular, patients with a rapid transition from CIS to multiple sclerosis had an elevated CD4/CD14 ratio. A subgroup analysis showed diagnostic value of CD4/CD8 ratio in the differential diagnosis of CIS/multiple sclerosis to neurosarcoidosis.
  
  
  CONCLUSIONS
  The diagnostic and prognostic accuracy of autoimmune neuroinflammatory diseases can be improved by FACS analysis of CSF cells.
authors.affiliation: Neurology Department, Johannes Gutenberg University Mainz, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Nemecek
authors.affiliation: Neurology Department, Johannes Gutenberg University Mainz, Germany.
authors.forename: Hilga
authors.initials: H
authors.lastname: Zimmermann
authors.affiliation: Neurology Department, Johannes Gutenberg University Mainz, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Rübenthaler
authors.affiliation: Neurology Department, Johannes Gutenberg University Mainz, Germany.
authors.forename: Vinzenz
authors.initials: V
authors.lastname: Fleischer
authors.affiliation: Neurology Department, Johannes Gutenberg University Mainz, Germany.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Paterka
authors.affiliation: Neurology Department, Johannes Gutenberg University Mainz, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Luessi
authors.affiliation: Institute of Neuroradiology, Johannes Gutenberg University Mainz, Germany.
authors.forename: Wibke
authors.initials: W
authors.lastname: Müller-Forell
authors.affiliation: Neurology Department, Johannes Gutenberg University Mainz, Germany.
authors.forename: Frauke
authors.initials: F
authors.lastname: Zipp
authors.affiliation: Neurology Department, Johannes Gutenberg University Mainz, Germany/Charité - Universitätsmedizin Berlin, Germany siffrinv@gmx.de.
authors.forename: Volker
authors.initials: V
authors.lastname: Siffrin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018951:Antigens, CD20 / Q000134:cerebrospinal fluid; D015415:Biomarkers / Q000134:cerebrospinal fluid; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D002469:Cell Separation / Q000379:methods*; D002555:Cerebrospinal Fluid / Q000166:cytology / Q000276:immunology; D003711:Demyelinating Diseases / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology; D018450:Disease Progression; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D016130:Immunophenotyping / Q000379:methods*; D018950:Lipopolysaccharide Receptors / Q000134:cerebrospinal fluid; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D009103:Multiple Sclerosis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology; D043025:Oligoclonal Bands / Q000134:cerebrospinal fluid; D010641:Phenotype; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors; D055815:Young Adult
chemical_list: D018951:Antigens, CD20; D015415:Biomarkers; D018950:Lipopolysaccharide Receptors; D043025:Oligoclonal Bands
keywords: B cell; Cerebrospinal fluid; FACS; T cell; flow cytometry; monocyte; multiple sclerosis; prognostic factor