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Clinical Chemistry 50: 1809-1813, 2004. First published July 22, 2004; 10.1373/clinchem.2004.033977
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(Clinical Chemistry. 2004;50:1809-1813.)
© 2004 American Association for Clinical Chemistry, Inc.

Clinical Immunology

Kappa Free Light Chains in Cerebrospinal Fluid as Markers of Intrathecal Immunoglobulin Synthesis

Christian Fischer1, Borros Arneth1, Jürgen Koehler2, Johannes Lotz1 and Karl J. Lackner1,a

1 Institute of Clinical Chemistry and Laboratory Medicine, and2 Department of Neurology, Johannes Gutenberg University, Mainz, Germany.

aAddress correspondence to this author at: Institute of Clinical Chemistry and Laboratory Medicine, Medical Centre of the Johannes Gutenberg University, D-55101 Mainz, Germany. Fax 49-6131-176627; e-mail lackner{at}zentrallabor.klinik.uni-mainz.de.

Background: Intrathecal immunoglobulin synthesis is observed in several inflammatory disorders of the central nervous system, but its detection by current laboratory tests is either tedious or relatively insensitive. We assessed the diagnostic accuracy of an assay for {kappa} free light chains ({kappa}FLC) in cerebrospinal fluid (CSF) and serum, and compared it with traditional tests for intrathecal immunoglobulin synthesis.

Methods: {kappa}FLCs were measured by nephelometry in CSF/serum pairs from 112 patients. Samples were excluded if blood contamination of CSF as a result of traumatic lumbar puncture (n = 12) or monoclonal bands in both CSF and serum (n = 5) were present. The remaining sample pairs were grouped according to the presence (n = 71) or absence (n = 24) of oligoclonal bands. Data were analyzed as {kappa}FLC concentrations in CSF, as {kappa}FLC CSF/serum ratios, and by use of the quotient diagram described previously for immunoglobulins.

Results: Both {kappa}FLC concentrations in CSF and the {kappa}FLC CSF/serum ratio identified patients with oligoclonal bands with high specificity and sensitivity. The areas under the ROC curves were 0.991 (95% confidence interval, 0.944–0.998) and 0.978 (0.924–0.996), respectively. Exclusion of patients with impaired blood–CSF barrier function further improved diagnostic accuracy. To account for patients with impaired blood–CSF barrier function, data were also analyzed in a quotient diagram. Only two patients without detectable oligoclonal bands would have been misclassified by this approach.

Conclusions: Our data indicate that the nephelometric assay for {kappa}FLCs in CSF reliably detects intrathecal immunoglobulin synthesis. This automated and quantitative method could simplify the diagnostic procedure for CSF analysis in the routine laboratory.




The following articles in journals at HighWire Press have cited this article:


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A. R. Bradwell
Serum Free Light Chain Measurements Move to Center Stage
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E. J. Thompson
Quality versus Quantity: Which Is Better for Cerebrospinal Fluid IgG?
Clin. Chem., October 1, 2004; 50(10): 1721 - 1722.
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