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CSF free light chain identification of demyelinating disease: comparison with oligoclonal banding and other CSF

Kari M Gurtner1, Eslam Shosha2, Sandra C Bryant3

  • 1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.

Clinical Chemistry and Laboratory Medicine
|February 19, 2018
PubMed

Insights

Cerebrospinal fluid free light chains (cFLC) offer a simpler, more sensitive alternative to oligoclonal bands (OCBs) for diagnosing multiple sclerosis. This method reduces costs and complexity while maintaining diagnostic accuracy.

Area of Science:

  • Neurology
  • Clinical Chemistry
  • Immunology

Background:

  • Cerebrospinal fluid (CSF) immunoglobulin gamma (IgG) index and oligoclonal bands (OCBs) are standard for multiple sclerosis (MS) diagnosis.
  • Measurement of CSF free light chains (FLC) presents a potential alternative to labor-intensive isoelectric focusing (IEF) for OCBs.

Purpose of the Study:

  • To evaluate CSF kappa free light chains (cKFLC) as a diagnostic marker for demyelinating diseases.
  • To compare the performance of cKFLC with traditional OCB testing.

Main Methods:

  • Analyzed 325 paired CSF and serum specimens using cKFLC, CSF lambda FLC (cLFLC), albumin, and IgG measurements.
  • Calculated various indices including kappa-index, kappa intrathecal fraction, and IgG-index.
  • Assessed cKFLC performance alone and in comparison to OCBs.

Main Results:

  • cKFLC alone demonstrated over 90% agreement with OCBs, outperforming other calculated markers.
  • In demyelinating disease cases, cKFLC showed 86% sensitivity and 77% specificity.
  • cKFLC measurement reduced the number of required analytes and complex calculations.

Conclusions:

  • cKFLC offers comparable performance to OCBs with enhanced sensitivity for demyelinating diseases.
  • Replacing OCBs with cKFLC simplifies the diagnostic process, reducing costs and maintaining accuracy for MS diagnosis.
Abstract

Keywords:
cerebrospinal fluidfree light chainsmultiple sclerosisnephelometryoligoclonal banding

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