Reibergram and Oligoclonal Bands in Diagnosis of Multiple Sclerosis
Jasenko Karamehic, Marina Delic-Sarac, Djemo Subasic, Tomica Jukic, Jozo Coric, Mirsad Panjeta, Zahida Drace, Lamija Zecevic, Selma Mutevelic, Nejra Dzananovic, Nerima Grcic, Amila Kešmer
Med Arh. 2012; 66(4): 222-225
Introduction: In this study authors have analyzed the correlation between the IgG immunoglobulins in cerebrospinal fluid and the findings of oligoclonal bands on gel. Immunoglobulin IgG in cerebrospinal fluid (CSF) can be detected in neurological diseasses (infections and inflammatory neurological diseases and in demyelinating diseases, like multiple sclerosis (MS)). Quantitative IgG in CSF can be expressed by different formulae Reiber (Reiber and Felgenhauer 1987), Tourtel-lotte (Tourtellotte 1970), Schuller (Schuller and Sagar 1983) and IgG Index (Link and Tibbling 1977). In this study we used Reibergram. Qualitative CSF IgG can be measured by electrophoresis and isoelectric focusing (IEF). We used IEF for analysig CSF and seum because of its higher sensitivity. Aims of the study: To determine the correlation of immunoglobulins IgG positivity in CSF with the finding of oligoclonal bands on the gel. Material and methods:: The retrospective study based on data processed in OJ Clinical Immunology KCUS. Patients were suspicious of multiple sclerosis according to clinical findings and magnetic resonance imaging. All CSF and serum samples were processed by nephelometry, isoelectric focusing on the gel. Statistical analysis of intrathecal synthesis was also performed according to Reibergram. Results: Analyses were performed on 76 samples of cerebrospinal fluid and serum of patients from neurological clinic, suspected of multiple sclerosis. We received following results: 42 samples tested had type 1. 25 samples tested showed type 2. 3 samples had type 3. 5 samples had type 4. 1 sample had a fifth type. When we compare these results with values obtained by intrathecal synthesis of which is determined by Reibergram we obtained the following values: 16 samples had intra-thecal synthesis of 20%–60%, 9 samples had a negative value of intrathecal synthesis of 10% or less. Discussion and Conclusion: For most patients with established MS we found intrathecal humoral response, type two, and the number and arrangement of IgG bands generally does not change during the disease, because they reflect long-term non-specific immune stimulation rather than a specific immune response that during infectious disease changes (quantitatively and qualitatively).
1. Karamehic J, Dizdarevic Z i sar. Klinicka imunologija, Svjetlost, 2007; (23) 519-527.
2. Dean G. How many people in the world have multiple sclerosis? Neuroepidemiology 1994; 13: 1-7. [DOI via Crossref] [Pubmed]
3. Detection of IgG oligoclonal bands in unconcentrated CSF by isoelectric focusing in ultrathin polyacrylamide gel, direct antiserum immunofixation and silver nitrate staining.Trbojevic-Cepe M, Poljakovic Z, Vrkic N, Bielen I.J Clin Chem Clin Biochem. 1989; 27(4):211-6. [Pubmed]
4. Polman C, Reingold S, Edan G et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “ McDonald Criteria“. Ann Neurol 2005; 58: 840-846. [DOI via Crossref] [Pubmed]
5. Andersson M, Alvarez-Cermeno J, Bernardi G, et al. Cerebrospinal fluid in the diagnosis of multiple sclerosis: a consensus report, J Neurol Neurosurg Psychiatry, 1994; 57(8):897-902. [DOI via Crossref] [Pubmed]
6. Freedman MS, Thompson EJ, Deisenhammer F et al. Recommended standard of cerebrospinal fluid analysis in the diagnosis of multiple sclerosis. Arch neurol 2005;62:865-870 [DOI via Crossref] [Pubmed]
7. Lynch, Marina A, Mills, Kingston HG. Immunology meets neuroscience – Opportunities for immune intervention in neurodegenerative diseases. Brain, Behavior & Immunity, 2012;26 (1), p1-10, [DOI via Crossref] [Pubmed]
8. Saxena A, Martin-Blondel G, Mars LT, Liblau RS, Role of CD8 T cell subsets in the pathogenesis of multiple sclerosis. Febs Letters, 2011; 585 (23), p3758-3763 [DOI via Crossref] [Pubmed]
9. Larochelle, Alvarez C, Jorge I, Prat A. How do immune cells overcome the blood–brain barrier in multiple sclerosis? Febs Letters, 2011; 585 (23), p3770-3780, [DOI via Crossref] [Pubmed]
10. Graber, Jerome J, Dhib-Jalbut, Suhayl. Biomarkers of disease activity in multiple sclerosis. Journal of the Neurological Sciences, 2011; 305(1/2), p1-10, 10p;
11. Trbojevic-Cepe M, Schiller S, Dupelj M, Arko K. Nadopuna elektroforetskim istrazivanjima proteina cerebrospinalnog likvora na celuloznom likvora na celuloznom acetatu „Multifrakcionirana i imunofiksacijska elektroforeza“ Farm Glas 1980;36:11-18.
12. Trbojevic-Cepe M, Poljakovic Z, Vrkic N, Bielen I. Detection of IgG oligoclonal bands in unconcentrated CSF by isoelectric focusing in ultrathin polyacrylamide gel, direct immunofixation and silver nitrate staining. J Clin Chem Clin Biochem 1989;27:211-6 [Pubmed]
13. Trbojevic-Cepe M, Vogrinc Z. Inflammation and humoral immune responce within the CNS compartment: characteristic features and cerebrospinal fluid analysis. Review. Biochemia medica 2004;1-2:1-36
14. Kurtovic-Alajbegovic A. I saradnici. Multipla skleroza. Sarajevo: Magistrat, 2005: 49-74
15. Steinman L. Multiple sclerosis: a two stage disease. Nature Immunol 2001; 2: 762-764 [DOI via Crossref] [Pubmed]
16. Kornek B, LassmannH, Neuropathology of multiple sclerosis- new concepts. Brain Res Bull 2003; 61: 321-326 [DOI via Crossref]
17. Waxman SG. Sodium channel as molecular targets in multiple sclerosis. J rehab Res Dev 2002; 39:323-242.
18. Fox EJ. Immunopathology of multiple sclerosis, Neurology 2004; 63: (6): S3-S7 [DOI via Crossref] [Pubmed]
19. Compston A, Coles A. Multiple sclerosis. Lancet 2002; 359: 1221-1231 [DOI via Crossref]
20. Lucchinetti CF, Bruck W, Lassmann H. Evidence for pathogenic heterogenecity in multiple sclerosis. Ann Neurol 2004; 56(2) 308. [DOI via Crossref] [Pubmed]
21. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an internatinal survey. Neurology 1996; 46: 907-911. [DOI via Crossref] [Pubmed]
22. Keiseir BC, Hartung HP. Current disease-modifiying therapies in multiple sclerosis. Semin Neurol 2003; 23: 133-146. [DOI via Crossref] [Pubmed]
23. Barišic N. Imunološki aspekti bolesti središnjeg i perifernog zivcanog sustava. Pediatr Croat 2005; 49 (1): 94-101.