A consensus protocol for the standardization of cerebrospinal fluid collection and biobanking.

There is a long history of research into body fluid biomarkers in neurodegenerative and neuroinflammatory diseases. However, only a few biomarkers in CSF are being used in clinical practice. One of the most critical factors in CSF biomarker research is the inadequate powering of studies because of the lack of sufficient samples that can be obtained in single-center studies. Therefore, collaboration between investigators is needed to establish large biobanks of well-defined samples. Standardized protocols for biobanking are a prerequisite to ensure that the statistical power gained by increasing the numbers of CSF samples is not compromised by preanalytical factors. Here, a consensus report on recommendations for CSF collection and biobanking is presented, formed by the BioMS-eu network for CSF biomarker research in multiple sclerosis. We focus on CSF collection procedures, preanalytical factors, and high-quality clinical and paraclinical information. The biobanking protocols are applicable for CSF biobanks for research targeting any neurologic disease.

[Future possibilities of the multiple sclerosis treatment]. / Kudy se bude ubírat lécba roztrousené sklerózy v budoucnosti?

Multiple sclerosis is an autoimmune disease of the central nervous system. Pathogenetic mechanisms involve inflammation and neurodegeneration leading to myelin sheaths destruction and irreversible nerve fibre loss. At present mainly the inflammatory part can be influenced and undoubtedly only the earliest beginning of the treatment can effectively postpone irreversible disability. High-dose corticosteroids remain the "gold standard" in MS attack treatment. Interferon beta and glatiramer acetate represent disease modifying drugs. Both of these medicaments decrease the number of attacks for about 30 %, however each patient responds differently. In many cases new attacks appear and it is necessary to intensify the treatment--to add immunosuppresives, to use combinations of steroid and cytostatic treatment. Intravenous immunoglobulins represent second line treatment. In the case of rapid disease progression immunoablation and stem cells transplantation is available. From recently tested drugs the most successful was the monoclonal antibody natalizumab. Unfortunately because of serious adverse effects in patients treated by combination of interferon beta + natalizumab, the application has been stopped. Monoclonal antibody against inteleukin 12 and chemokine receptor CCR2, cytostatics fumarate, laquinimod and cladribine are also tested in the clinical studies. DNA vaccination represents revolutionary opportunity of inducing tolerance against myelin autoantigens.