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Maria Stella Graziani

Deputy Director
Martina Zaninotto

Associate Editors
Ferruccio Ceriotti
Davide Giavarina
Bruna Lo Sasso
Giampaolo Merlini
Martina Montagnana
Andrea Mosca
Paola Pezzati
Rossella Tomaiuolo
Matteo Vidali

International Advisory Board Khosrow Adeli Canada
Sergio Bernardini Italy
Marcello Ciaccio Italy
Eleftherios Diamandis Canada
Philippe Gillery France
Kjell Grankvist Sweden
Hans Jacobs The Netherlands
Eric Kilpatrick UK
Magdalena Krintus Poland
Giuseppe Lippi Italy
Mario Plebani Italy
Sverre Sandberg Norway
Ana-Maria Simundic Croatia
Tommaso Trenti Italy
Cas Weykamp The Netherlands
Maria Willrich USA
Paul Yip Canada

Biomedia srl
Via L. Temolo 4, 20126 Milano

Responsible Editor
Giuseppe Agosta

Editorial Secretary
Andrea di Bello
Biomedia srl
Via L. Temolo 4, 20126 Milano
Tel. 0245498282


ISSN print: 0393 – 0564
ISSN digital: 0392- 7091

Articoli con TAG: bande oligoclonali

Il calcolo del kappa index come valida alternativa alla determinazione delle bande oligoclonali nell’iter diagnostico dei pazienti con sclerosi multipla
The Kappa Index as a valid alternative to oligoclonal bands determination in the diagnostic process of patients with multiple sclerosis
<p>Introduction: the role of the kappa free light chains (KFLC) index in the diagnostic workup of multiple sclerosis (MS) is still a matter of debate.<br />Methods: 667 subjects from three reference laboratories have been enrolled, including 181 MS patients and 486 controls with other immune-mediated or non-inflammatory disorders. Serum and cerebrospinal fluid KFLC index, serum and cerebrospinal fluid albumin and IgG concentrations were measured on BNII nephelometer (Siemens Healthineers. Marburg. Germany), while oligoclonal bands (OCB) were detected by isoelettrofocusing on Hydrasys system (Sebia. Bagno a Ripoli. Italia).<br />Results: KFLC index was higher in MS than in controls [median (interquartile range - IQR) 76.56 (35.05) versus 17.99 (2,34), p &lt;0.001]. A cut-off of 5.0 resulted in 93.9% (min-max 82.6-96.0) sensitivity and 77.4% (70.3-80.3) specificity, with positive and negative predictive values of 60.7% (41.4-69.3) and 97.2% (93.6-98.0), respectively. OCB assessment yielded 94.6% (87.9-96.5) sensitivity and 91.4% (86.6-94.8) specificity, with positive and negative predictive values of 87.5% (78.6-92.0) and 96.4 (93.6-98.0), respectively. The three laboratories showed similar results, making it possible to adopt common thresholds. The relatively low specificity of KFLC may be related to the characteristics of the control population, in particular to the percentage of subjects with inflammatory conditions associated with intratechal immunoreactivity.<br />Conclusions: an algorithm for the diagnostic management of MS could be suggested based on the KFLC index as screening test, followed by the detection of OCB, in case of a positive result. Future studies are needed to evaluate possible relationships between KFLC index, as a quantitative variable, and other clinical features of MS, such as severity of the disease and prognostic scores.</p>
Biochimica Clinica ; 45(1) 044-051
Contributi Scientifici - Scientific Papers
Catene leggere libere nella diagnostica liquorale della sclerosi multipla: possibile alternativa alla ricerca delle bande oligoclonali?
Free light chains in diagnosis of multiple sclerosis: an alternative to oligoclonal bands?
<p>Multiple sclerosis (MS) is one of the most common causes of neurological disability in young adults. MS presents heterogeneous clinical manifestations and both genetic and environmental factors are considered involved in the risk of developing the disease. The clinical diagnosis is rather complex reflecting the heterogeneity of the pathology. The diagnostic criteria, frequently modified over the years, require clinical symptoms, presence of typical lesions detected by magnetic resonance imaging and laboratory findings. The laboratory examination of the cerebrospinal fluid (CSF) allows an evaluation of inflammatory processes confined to the central nervous system reflecting the changes in the immunological pattern due to the progression of the pathology, playing thus an important role in the diagnosis and monitoring of MS. The detection of the oligoclonal bands (OCBs) is recognized as a &ldquo;gold standard&rdquo; for laboratory diagnosis of MS, although it suffers from methodological limitations. Indeed, OCBs assay is a manual multistep procedure, time-consuming that requires a subjective interpretation. In the last years, the measurement of the free light chains (FLC) in CSF appeared to assist in the diagnosis of MS. This procedure has been presented as a simpler and cheaper tool than the qualitative detection of OCBs. This article examines the current knowledge about the laboratory diagnostic of CSF, investigating both the validated method (OCBs) and the alternative biomarkers of immunoglobulins intrathecal synthesis, as the quantification of FLC in CSF.</p>
Biochimica Clinica ; 44(2) 157-167
Opinioni - Opinions
La misura delle catene leggere libere nel liquor nella diagnosi della sclerosi multipla
Cerebrospinal fluid kappa and lambda free light chains for the diagnosis of multiple sclerosis
<p>Presently, oligoclonal band (OCB) detection is considered the gold standard for Multiple Sclerosis (MS) diagnosis. The technique is however cumbersome and requires interpretative expertise for the evaluation of dubious OCB patterns. Recently, the kappa and lambda free light chains (FLCs) measurement in cerebrospinal fluid (CSF) has been suggested as potential diagnostic tool. We describe here two case reports where the FLCs determination contributed importantly to the diagnosis. A 43 years old female with left homonym hemianopia and frontal headache showed a negative OCBs pattern showing only a single monoclonal band. CSF and serum FLCs were within the reference range while kFLC index was positive. Visual evoked potentials and magnetic resonance investigation (MRI) were suggestive of clinically isolated syndrome. A 55 year old female with visual left homonym hemianopia and mild retroorbital pain showed very similar findings with a negative pattern for OCBs, and a single monoclonal band. CSF FLCs were slightly above the upper value of the reference range and kFLC index was positive. Evoked potentials and MRI were suggestive for MS diagnosis. In conclusion, the FLCs quantification in CSF could be a valid tool to support MS diagnosis especially in the presence of unclear OCB results.</p>
Biochimica Clinica ; 42(2) e22-e25
Casi clinici - Case report