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Sample Preparation for Endopeptidomic Analysis in Human Cerebrospinal Fluid
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Kappa free light chains in cerebrospinal fluid to identify patients with oligoclonal bands

M Süße1, M Hannich2, A Petersmann2

  • 1Department of Neurology, University Medicine Greifswald, Greifswald.

European Journal of Neurology
|April 24, 2018
PubMed

Insights

The kappa free light chains (KFLC) index can accurately predict oligoclonal bands (OCB), a marker for intrathecal immunoglobulin synthesis. This quantitative measure offers a potential initial diagnostic step for central nervous system disorders.

Area of Science:

  • Neurology
  • Immunology
  • Clinical Diagnostics

Background:

  • Oligoclonal bands (OCB) are the gold standard for detecting intrathecal immunoglobulin synthesis.
  • The kappa free light chains (KFLC) index demonstrates comparable sensitivity and specificity to OCB in multiple sclerosis diagnosis.

Purpose of the Study:

  • To investigate the predictive value of the KFLC index for the presence of OCB.
  • To evaluate the KFLC index as a potential initial diagnostic tool for central nervous system inflammatory disorders.

Main Methods:

  • Prospective determination of the KFLC index in 295 paired serum and cerebrospinal fluid samples (cohort I).
  • Nephelometry was used for KFLC determination, with a cut-off value established via ROC analysis.
  • Validation in 96 samples (cohort II) and retrospective analysis of 46 OCB-positive patients (cohort III).
  • Comparison of two commercial KFLC nephelometric assays.

Main Results:

  • A KFLC index cut-off of 3.61 achieved 100% sensitivity and 88% specificity in cohort I.
  • Prospective validation showed 92% sensitivity and 96% specificity.
  • Retrospective analysis (cohort III) yielded 93% sensitivity.
  • Good agreement (r² = 0.86) was observed between two KFLC assays.

Conclusions:

  • The KFLC index, with a cut-off of 3.61, accurately predicts immunoglobulin G synthesis detected by OCB analysis.
  • KFLC index determination offers a quantitative parameter suitable as an initial diagnostic step for inflammatory CNS disorders prior to OCB measurement.
Abstract

Keywords:
cerebrospinal fluid analysisintrathecal immunoglobulin synthesiskappa free light chainsoligoclonal bands

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