Kappa free light chains in cerebrospinal fluid to identify patients with oligoclonal bands

Abstract

The KFLC index with a cut-off value of 3.61 had high diagnostic accuracy to predict immunoglobulin G synthesis via OCB analysis. Determination of the KFLC index provided a quantitative parameter that could be used as an initial diagnostic step in inflammatory central nervous system disorders before measuring OCB.

Reiber’s Diagram for Kappa Free Light Chains: The New Standard for Assessing Intrathecal Synthesis?

“…We compared four different methods to assess an intrathecal synthesis of KFLC in order to help standardize this promising biomarker for the diagnosis of MS. Although measurement of KFLC is easy to perform, it has not yet found its way into clinical routine [9,17]. One of the reasons might be the disagreement about the "correct" cut-off for the KFLC index, which is used to determine the intrathecal produced KFLC fraction [9,17].…”

“…Although measurement of KFLC is easy to perform, it has not yet found its way into clinical routine [9,17]. One of the reasons might be the disagreement about the "correct" cut-off for the KFLC index, which is used to determine the intrathecal produced KFLC fraction [9,17]. In addition to the inconsistent use of KFLC index cut-off values, a CSF/serum index reflects the non-linear relationship between blood-derived molecules of different size only inaccurate [1].…”

“…The CSF/serum KFLC quotient with reference to the albumin CSF/serum concentration quotient (Q Kappa /Q Alb ), the so-called the KFLC index, is the most frequently used approach to determine an intrathecal synthesis of KFLC [4,5]. However, empirically defined threshold KLFC indices vary considerably and the following values were suggested: 3.6, 5.9, 6.07, and 12 [6][7][8][9]. In opposition to the non-physiological linear index, Reiber developed a theoretically and empirically founded hyperbolic function in analogy to his well-established hyperbolic evaluation schemes for immunoglobulins G, A, M aiming to improve the diagnostic sensitivity and specificity for determination of an intrathecal synthesis of KLFC [1].…”

The Impact of Immunomodulatory Treatment on Kappa Free Light Chains as Biomarker in Neuroinflammation

“…The two isotypes kappa and lambda light chains are components of immunoglobulin molecules and are also secreted by plasma cells as free light chains alongside the production of intact immunoglobulins [10][11][12]. However, although being a promising biomarker for MS and other neuroinflammatory diseases, kappa free light chains (KFLC) are currently not established for clinical routine due to missing methodological standards [13]. Since immunomodulatory treatment with intravenous corticosteroids, immunoadsorption, plasma exchange, and intravenous immunoglobulins is often started before taking CSF samples in patients with severe neurological disability, the knowledge of the effects of such treatments on the concentration of KFLC is of great importance but scarcely examined.…”

Diagnostik bei Multipler Sklerose

“…B. des MRT) sowie vereinfachten Diagnosekriterien ist es somit möglich, zeitnah nach Erstereignis die Diagnose zu stellen, um effektiv und frühzeitig die Basistherapie zu beginnen. Zukünftig werden neue Methoden wie die im Serum be stimmbaren Neurofilament-Leichtketten[2], die Liquor marker der freien Leichtketten[16] oder das OCT[14] in der Darstellung retinaler Veränderungen zu einer weiteren Verbesserung beitragen.…”