Immunoglobulins multiple sclerosis

During inflammation, permeability increases in the blood-CSF barrier, elevating levels of sICAM in the CSF. Thus, in settings of acute meningitis, multiple sclerosis, and Guillain-Barre polyradiculoneuritis, CSF concentrations of 44 /rg L 4.5 ixg L and 16.2 /rg L respectively, were measured (R8). A precise, quantitative differentiation between the serum portion and the intrathecal fraction, comparable to the immunoglobulins, is still not possible therefore, the ICAM index represents the best approximation ... 

The most characteristic abnormality in patients with multiple sclerosis is certainly the intrathecal synthesis of IgG. It can be demonstrated—with different sensitivity— by various methods, which can be divided into qualitative and quantitative methods. The gold standard for the demonstration of intrathecal synthesis of IgG is the detection of oligoclonal bands, which are not present in CSF, in the appropriately diluted serum (i.e., to the same concentration of IgG) by isoelectric focusing. This is a qualitative method and the description of its different modifications and interpretations goes beyond the scope of this chapter. This method is by far the most sensitive, and its sensitivity is reported between 90 and 100%. Here it is suitable to repeat that the detection of plasmocytic forms in cerebrospinal fluid may also be regarded as qualitative proof of intrathecal synthesis of immunoglobulins— although in this case the proof is obviously not specific for IgG from the theoretical point of view. 

Physiological values of this formula are negative or equal to zero (software used for this purpose is able to recognize this fact) the negative values are considered to be equal to zero. Positive values indicate intrathecal synthesis of immunoglobulins and are demonstrated in 60-80% of the patients with a diagnosis of multiple sclerosis. 

In patients with multiple sclerosis, a qualitative cytological examination should always be carried out. Besides the finding of plasmocytic forms, which are considered to be one of the proofs of intrathecal synthesis of immunoglobulins, this examination also provides invaluable information concerning the reaction of the monocyte-macrophage system in the CSF compartment. It should be noted on the scope of biochemical examinations of cerebrospinal fluid in multiple sclerosis that it is most important to return to the simple and inexpensive method. 

Multiple Sclerosis (N = 55) Intrathecal Synthesis of Immunoglobulins According to Reiber s Eormula (S8)... 

Spence, A. M., Immunoglobulins in cerebrospinal fluid in multiple sclerosis. Hurru Pathol. 14, 99-103 (1983). 

Still, this has led to a short, open label fidal of human intravenous immunoglobulin, an EDA approved product that has benefit in several types of disorders, including multiple sclerosis. Dodel et al. (2004) reported that... 

Intrathecal Synthesis. Demonstration of increased intrathecal synthesis of immunoglobulins, particularly IgG, has great importance in the diagnosis of demyehnating diseases of the CNS, especially multiple sclerosis. In multiple sclerosis, patchy deterioration of myelin sheaths of axons in the CNS profoundly affects conduction of nerve impulses. 

Increased intrathecal synthesis of IgG causes an increase in the CSF/serum immunoglobulin concentration ratio and the appearance of oligoclonal immunoglobulin bands on electrophoretic separations of CSF. Investigation of these changes has now become routine when multiple sclerosis is... 

One of the earliest applications of the method was in the analysis of serum and csf gammaglobulins. Several analytical systems and sample treatments have been developed (D4, HI, K5-K8) generally, short analysis times (30-40 minutes) and small sample volumes (microliters) are possible. Using ITP analysis of serum and csf immunoglobulins, it was possible to determine central nervous system (CNS) de novo synthesis of IgG, a hallmark of multiple sclerosis. The effects of various treatments on such synthesis were investigated (T6) The conclusion was that none of the therapies studied eradicated de novo CNS IgG synthesis. 

Engel WK. (2009) Intravenous immunoglobulin in relapsing-remittin multiple sclerosis a dose-finding trial. Neurology 73, 1077-1078. 

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