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Intrathecal immunoglobulin g and MRZ reaction in demyelinating diseases of central nervous system

BACKGROUND: We aimed to assess the MRZ reactivity (MRZR) in comparison with oligoclonal IgG bands (OIgG) and positive intrathecal IgG fraction (IgG IF) in demyelinating diseases of central nervous system (DD) because of its higher specificity for chronic autoimmune inflammation. METHODS: 48 inpatient subjects with multiple sclerosis (MS) and 43 with other demyelinating diseases (ODD) were enrolled in the study. Paired samples of serum and cerebrospinal fluid (CSF) were analyzed. OIgG bands were detected by semi- automated method of isoelectric focusing with immunofixation (SEBIA, France). IgG and albumin were determined by immunonephelometry (Siemens, Germany) and IgG IF were calculated from CSF/serum quotients using Reiber's formula. Measles (M), rubella (R), varicella zoster (Z) and herpes simplex (H) virus-specific IgG antibodies were detected both in serum and CSF by enzyme immunoassay (Euroimmun, Germany). The specific antibody index (AI) was calculated, values ≥1.5 were considered indicative for intrathecal IgG synthesis against the respective pathogen. MRZR was considered positive if two or more AI values were ≥1.5. RESULTS: OIgG were positive more frequently than IgG IF both in MS (85% vs 52%, P=0.049) and in ODD cohorts (40% vs 12%, P=0.0105). Comparing MS and ODD, both IgGIF and OIgG was found more frequently in MS (85% vs. 40%, p=0.0062 and 52% vs. 12%, p=0.0008, respectively). OIgG was found in 74% of MS and in 32% of ODD subjects who were IgG IF negative (p=0.0201). Positive MRZR was found in 31% MS and 5% ODD subjects (p=0.0034). Along with OIgG in 39% MS and 12% ODD patients (p=0.0898) ; along with IgG IF in 57% MS and 40% ODD (p=0.6473). Positive MRZR was found in 9% MS and 3% ODD without IgG IF (p=0.3006), but in none of OIgG negative MS or ODD patients. CONCLUSIONS: OIgG reveals more subjects with positive intrathecal synthesis than IgG IF in patient with DD. Although MRZR was significantly more prevalent in MS than ODD our results couldn’t confirm its additional value in differential diagnosis. However, this conclusion should be tested in a larger cohort.

Multiple sclerosis; Isoelectric focusing; Immunofixation; MRZ reaction

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