Multiple sclerosis progression in a natural history study: Predictive value of cerebrospinal fluid free kappa light chains

Abstract

In this study, CSF free kappa light chains predicted subsequent physical deterioration in prospectively evaluated MS patients. If this is confirmed by larger studies, then CSF free kappa light chains could serve as a target for intervention in therapeutic trials.

Oligoclonal free light chains in cerebrospinal fluid as markers of intrathecal inflammation. Comparison with oligoclonal IgG

“…4). These two types may correspond to patients with the elevation of free κ monomers and free λ dimers in CSF in the study of Kaplan et al 41 On the other hand, free λ predominance was rare in our study. It would be interesting to demonstrate whether κ light chain predominance is associated with more or less aggressive course of the disease compared to balanced κ and λ light chain intrathecal production.…”

“…It has been demonstrated that the presence of OCB considerably increases the risk of suffering a second attack even in MRI-negative patients 37 and, in contrast, that as many as 50% of MRI-positive but OCB-negative CIS patients were finally diagnosed as having diseases other than MS during the follow-up 38 . Different properties of fLC monomers and dimers have been reported, as well as a more specific CSF fLC profile for MS using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) separation 40,41 . Interestingly, we also found two types of CSF-restricted oligoclonal patterns in MS patients: one with a predominance of κ light chains and the other with both CSF-restricted κ as well as λ light chains (Fig.…”

“…It would be interesting to demonstrate whether κ light chain predominance is associated with more or less aggressive course of the disease compared to balanced κ and λ light chain intrathecal production. The value of elevated CSF free κ concentrations for predicting disability progression has already been reported 41,42 , but no ratio of CSF free κ to CSF free λ concentrations has been sought for. Further studies on similar relationships are warranted.…”

Kappa Free Light Chains in Cerebrospinal Fluid as Markers of Intrathecal Immunoglobulin Synthesis

“…These investigators found a positive correlation between FLC, quantified by ELISA (17 ), and cerebral lesion volume after 2 years. A previous report from the same group pointed to the predictive value of FLC concentrations in CSF for the progression of MS, and they even proposed FLCs as a target for intervention in therapeutic trials (18 ). The automated quantification of FLCs in CSF that we describe here could facilitate the use of this marker in the routine laboratory.…”

Quality versus Quantity: Which Is Better for Cerebrospinal Fluid IgG?

“…As Fischer et al rightly state, this is to "follow changes" (1 ), e.g., in response to therapy and possibly prognosis (7 ). To reiterate, however: for diagnosis, qualitative analysis is much preferred.…”