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Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis
M Thangarajh1, J Gomez-Rial, A K Hedström
1Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Background And Objective:
The presence of lipid-specific immunoglobulin M bands in the cerebrospinal fluid (CSF) predicts an aggressive course in patients with relapsing-remitting multiple sclerosis (MS) during early stages of the disease. This study examined whether it is also a predictor of long-term prognosis in MS.
Methods:
Eighty-one patients with MS and 22 headache controls were analyzed for anti-lipid IgM reactivity in CSF samples. The correlation between the presence of lipid-specific immunoglobulin M bands in CSF and disease progression was assessed in patients with MS who had been followed longitudinally for, on average, more than 11 years.
Results:
Lipid-specific immunoglobulin M bands were detected in the CSF of 24 of 81 patients with MS and were absent in the CSF of all headache controls. Median time to conversion to a secondary progressive course was 11 years in patients with bands and 22 years in patients without bands. Median time to an Expanded Disability Status Scale score of 4 was 14 years in patients with bands and 24 years in patients without bands.
Conclusion:
The presence of lipid-specific immunoglobulin M bands in CSF predicts a more adverse long-term outcome in patients with MS; it may thus define a subset of patients who might benefit from aggressive treatment during the early phase of the disease.
Insights
The presence of lipid-specific immunoglobulin M bands in cerebrospinal fluid (CSF) indicates a worse long-term prognosis for multiple sclerosis (MS) patients. This finding may help identify individuals who would benefit from early, aggressive treatment strategies.
Area of Science:
- Neuroimmunology
- Clinical Neurology
Background:
- Relapsing-remitting multiple sclerosis (MS) is characterized by unpredictable disease courses.
- Early identification of aggressive disease phenotypes is crucial for effective management.
Purpose of the Study:
- To determine if lipid-specific immunoglobulin M (IgM) bands in cerebrospinal fluid (CSF) predict long-term disease progression in MS.
- To evaluate the prognostic value of these bands beyond the initial stages of MS.
Main Methods:
- Analysis of anti-lipid IgM reactivity in CSF samples from 81 MS patients and 22 controls.
- Longitudinal follow-up of MS patients for over 11 years to assess disease progression.
- Correlation of lipid-specific IgM band presence with time to secondary progressive MS and disability milestones.
Main Results:
- Lipid-specific IgM bands were found in the CSF of 24 out of 81 MS patients, but not in controls.
- Patients with CSF bands converted to secondary progressive MS a median of 11 years earlier than those without bands.
- Disability progression (Expanded Disability Status Scale score of 4) occurred a median of 10 years earlier in patients with bands.
Conclusions:
- Lipid-specific IgM bands in CSF are a significant predictor of adverse long-term outcomes in MS.
- This biomarker may identify a subset of MS patients requiring intensified early therapeutic interventions.
- The findings support the utility of CSF lipid-specific IgM analysis for personalized MS treatment strategies.
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