Journal
EXPERT REVIEW OF MOLECULAR DIAGNOSTICS
Volume 17, Issue 1, Pages 31-46Publisher
TAYLOR & FRANCIS AS
DOI: 10.1080/14737159.2017.1262260
Keywords
Biomarkers; blood-cerebrospinal fluid barrier; cerebrospinal fluid; diagnostic criteria; free light chains; IgM; isoelectric focusing; multiple sclerosis; neuroinflammation; oligoclonal IgG bands
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Introduction: Intrathecal B-lymphocyte activation is a hallmark of multiple sclerosis (MS), a multi-factorial inflammatory-demyelinating disease of the central nervous system. Such activation has a counterpart in the cerebrospinal fluid (CSF) oligoclonal IgG bands (OCB), whose diagnostic role in MS has been downgraded within the current McDonald's criteria. With a theoretico-practical approach, the authors review the physiopathological basis of the CSF dynamics, and the state-of-the-art of routine CSF analysis and CSF biomarkers in MS.Areas covered: The authors discuss pros and cons of CSF analysis, including critical evaluations of both well-established, and promising diagnostic and prognostic laboratory tools. New acquisitions on the CSF and cerebral interstitial fluid dynamics are also presented. The authors searched the PubMed database for English-language articles reported between January 2010 and June 2016, using the key words multiple sclerosis', cerebrospinal fluid', oligoclonal bands'. Reference lists of relevant articles were scanned for additional studies.Expert commentary: The availability of performing high-quality, routine CSF tests in specialized laboratories, the emerging potential of novel CSF biomarkers, and the trend for early treatments should induce a reappraisal of CSF analysis for diagnostic and prognostic purposes in MS. Further procedural and methodological improvements seem to be necessary in both research and translational diagnostic CSF settings.
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