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Intrathecal synthesis of antiviral IgG antibodies in multiple sclerosis

Karin Licha1,2,3, Pavlina Kusnierova1,2,3,4, Kamila Zondra Revendova4,5

  • 1Institute of Laboratory Medicine, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic.

Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
|June 30, 2026
PubMed

Insights

The Measles-Rubella-Zoster (MRZ) reaction, a test for intrathecal antibody synthesis, shows high specificity for multiple sclerosis (MS) diagnosis. However, its sensitivity varies, prompting research into broader antibody panels to improve diagnostic accuracy for MS.

Area of Science:

  • Neurology
  • Immunology
  • Clinical Diagnostics

Background:

  • The Measles-Rubella-Zoster (MRZ) reaction assesses intrathecal IgG antibody synthesis against measles, rubella, and varicella-zoster viruses.
  • It has been utilized since the 1990s as an adjunctive diagnostic tool for multiple sclerosis (MS), despite its debated clinical relevance and absence in current diagnostic criteria.
  • Current practice defines a positive result as a polyspecific MRZ reaction (MRZ-2), requiring at least two elevated antibody indices.

Purpose of the Study:

  • To evaluate the diagnostic utility of the MRZ reaction, specifically MRZ-2, as a laboratory marker for multiple sclerosis.
  • To investigate the variability in sensitivity of MRZ-2 across different populations, such as the Czech adult MS cohort compared to meta-analyses.
  • To explore the potential of broadening the antibody panel (MRZ+) with additional viral targets to enhance diagnostic sensitivity for MS.

Main Methods:

  • Analysis of intrathecal IgG antibody synthesis against measles, rubella, and varicella-zoster viruses.
  • Assessment of the diagnostic performance (specificity and sensitivity) of the polyspecific MRZ reaction (MRZ-2) in multiple sclerosis diagnosis.
  • Comparison of MRZ-2 sensitivity in specific populations (e.g., Czech adults) with pooled data from meta-analyses.
  • Consideration of expanding the antibody panel to include other viruses like parvovirus B19 and mumps virus.

Main Results:

  • The polyspecific MRZ reaction (MRZ-2) demonstrates high specificity (>90%) for multiple sclerosis.
  • Sensitivity of MRZ-2 varies significantly, reported as low as 32% in the Czech adult MS population, contrasting with higher pooled estimates.
  • The diagnostic specificity of MRZ-2 is well-established, but its sensitivity remains a limitation.

Conclusions:

  • The MRZ-2 reaction is a highly specific but variably sensitive laboratory marker for multiple sclerosis.
  • Lower sensitivity in certain populations highlights the need for improved diagnostic approaches for MS.
  • Expanding the antibody panel (MRZ+) with additional viral targets is a potential strategy to increase sensitivity while maintaining high specificity for MS diagnosis, requiring further investigation.
Keywords:
MRZ reactioncerebrospinal fluidmultiple sclerosismumps virusparvovirus B19

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