Application of κ free light chains in cerebrospinal fluid as a biomarker in multiple sclerosis diagnosis: development of a diagnosis algorithm.

BACKGROUND: The determination of κ free light chains (KFLC) in cerebrospinal fluid (CSF) by nephelometry is a feasible alternative to immunoglobulin G oligoclonal bands (OCB) in the evaluation of intrathecal synthesis of immunoglobulin in multiple sclerosis (MS) and other demyelinating diseases. The aim of this study was to assess the diagnostic value of KFLC and its inclusion in a procedure algorithm along with OCB interpretation. METHODS: A cross-sectional study, which included 123 patients with a CSF OCB request, was carried out. Isoelectric focusing followed by immunofixation was used to detect OCB, and nephelometry was used to analyze KFLC. The KFLC index was calculated using CSF/serum quotient of KFLC and albumin. The KFLC index was compared with MS diagnosis to find the optimal cutoff. It was obtained from the receiver operating characteristic (ROC) curves and the Youden method. RESULTS: The CSF KFLC median was 1.66 mg/L in the MS group, whereas in other central nervous system diseases, KFLC showed generally no or only moderate increase in CSF (median 0.10 mg/L). KFLC index showed a significant difference between groups. ROC analysis for CSF KFLC concentration, and KFLC indexes were 91.88% and 93.94%, respectively. The best cutoff for the KFLC index was 2.91 for MS diagnosis (sensitivity: 83.78%; specificity: 85.88%). The proposed algorithm showed high sensitivity (89.19%) and specificity (84.71%). CONCLUSIONS: KFLC determination is rapid and automatized, but it has no higher sensitivity and specificity than OCB in MS diagnosis. Nevertheless, when used in screening, it could reduce the number of manual OCB tests.

Evaluación de un método inmunonefelométrico competitivo para la cuantificación de la homocisteína / Evaluation of a competitive immunonephelometric method for the measurement of homocysteine

Introducción y objetivos. La homocisteína se relaciona con enfermedad vascular, alteraciones del estado nutricional y detección de homocistinuria en neonatos, entre otras enfermedades. Debido a la importancia de su determinación, han aparecido diferentes métodos de cuantificación; el objeto de este trabajo es evaluar el método inmunonefelométrico del aparato BN II (Dade Behring). Material y método. Se realizó una comparación entre 2 métodos de cuantificación: el inmunoanálisis competitivo (IMMULITE 2000, DPC) y el análisis nefelométrico (BN II, Dade Behring), para lo cual se compararon los resultados de 74 muestras, además de determinar la imprecisión intraserial, imprecisión interdiaria, el límite de detección, el límite de cuantificación y el valor crítico del método inmunonefelométrico del BN II de Dade Behring. Resultados. La comparación entre ambos métodos mostró una buena correlación entre el inmunoanálisis competitivo, IMMULITE 2000 de DPC y el análisis nefelométrico, BN II de Dade Behring (Y = 1,4825 + 0,8342X). El valor crítico obtenido fue de 5,46 mmol/l y el límite de detección, de 5,77 mmol/l. La imprecisión intraserial fue inferior al 5% (3,65-4,66%). Conclusiones. El análisis nefelométrico (BN II, Dade Behring) ha demostrado cumplir todos los requisitos técnicos necesarios para su validación como método para la determinación de la homocisteína(AU)

Introduction. The homocysteine is associated with vascular diseases, alterations in the nutritional states, homocystinuria detection in neonates, as well as other diseases. Due to the importance of its determination, different measurement methods have been developed. The aim of this work is to evaluate the imunonephelometric method used in the Dade Behring BN II Nephelometer system. Material and method. We present a comparison between 2 methods: a competitive inmunoassay (IMMULITE 2000, DPC) and the nephelometric test (BN II, Dade Behring). For the determination of within batch and between-day imprecision, 74 samples were analysed and compared. Results. The detection and quantification limits, and the critical value of the inmunonephelometric method, were also determined. Both methods showed good correlations (Y = 1.4825 + 0.8342X). We also obtained a critical value of 5.46 mmol/L and the detection limit was 5.77 mmol/L. Within batch imprecision was below 5 % (3.65-4.66%). Conclusions. The nephelometric test (Dade Behring BN II System) has demonstrated to fulfill all the technical requirements needed for its validation as a method for the determination of homocysteine(AU)