title: Free Light Chains and Intrathecal B Cells Activity in Multiple Sclerosis: A Prospective Study and Meta-Analysis.
abstract: Background. The presence of CSF oligoclonal bands (OBs) is an independent prognostic factor for multiple sclerosis (MS), but the difficulties in the standardization of the test and the interlaboratory variation in reporting have contributed to its limited use in the diagnosis of the disease. Standard nephelometric assays to measure free light chains (FLC) levels have been recently developed and the test may improve the detection of intrathecal B cells activity.Methods. The presence of OBs, kappa and lambda FLC levels, and standard indices of intrathecal inflammation were assessed in 100 consecutive patients, including patients with MS, clinically isolated syndromes (CIS), other inflammatory diseases of the CNS, and other noninflammatory diseases.Results. Both KFLC and LFLC correlated strongly with the presence of OCBs and with all common tests for intrathecal inflammation (p< 0.001 for all comparisons). KFLC and LFLC were significantly different in patients with MS and CIS compared to the other groups (p< 0.001 andp< 0.001, resp.) and had a better diagnostic accuracy than all the other tests (area under the curve 82.3 % for KFLC index and 79.3 % for LFLC index).Conclusion. Nephelometric assays for KFLC in CSF reliably detect intrathecal immunoglobulin synthesis and discriminate MS patients.
authors.affiliation: Department of Laboratory Medicine, San Raffaele Hospital, Milan, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Passerini
authors.affiliation: Department of Neurology, San Raffaele Hospital, Milan, Italy.
authors.forename: Gloria
authors.identifier: 0000-0002-8761-9337
authors.initials: G
authors.lastname: Dalla Costa
authors.affiliation: Department of Neurology, San Raffaele Hospital, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sangalli
authors.affiliation: Department of Neurology, San Raffaele Hospital, Milan, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Moiola
authors.affiliation: Department of Neurology, San Raffaele Hospital, Milan, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Colombo
authors.affiliation: Department of Laboratory Medicine, San Raffaele Hospital, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Locatelli
authors.affiliation: Department of Neurology, San Raffaele Hospital, Milan, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Comi
authors.affiliation: Institute of Experimental Neurology, San Raffaele Hospital, Milan, Italy.
authors.forename: Roberto
authors.identifier: 0000-0001-7376-9425
authors.initials: R
authors.lastname: Furlan
authors.affiliation: Department of Neurology, San Raffaele Hospital, Milan, Italy.
authors.forename: Vittorio
authors.identifier: 0000-0002-5987-5739
authors.initials: V
authors.lastname: Martinelli