Multiple sclerosis diagnosis: free light chain testing as a possible valuable marker in cerebrospinal fluid


https://doi.org/10.4081/wpph.2025.9947
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Authors

  • Cristina Montarolo
    cristina.montarolo@tiscali.it
    Department of Science and Technological Innovation (DISIT), University of Piemonte Orientale "Amedeo Avogadro", Alessandria, Italy. https://orcid.org/0009-0000-8727-7878
  • Lara Calcagno Analysis Laboratory, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
  • Simona Martinotti Department of Science and Technological Innovation (DISIT), University of Piemonte Orientale "Amedeo Avogadro", Alessandria, Italy.
  • Filippo Erli Scientific Department, The Binding Site Italy (part of Thermo Fisher Scientific), Bergamo, Italy.
  • Antonio Covelli Neurology and Stroke Unit, ASST Sette Laghi, Varese, Italy.
  • Fabiana Vercellino Child Neuropsychiatry Unit, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
  • Elia Ranzato Department of Science and Technological Innovation (DISIT), University of Piemonte Orientale "Amedeo Avogadro", Alessandria, Italy.
  • Iacopo Megna Research, Training, Innovation Infrastructure, Research and Innovation Department, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.

Background: the aim of the study was to assess the importance of free light-chain analysis in the Cerebrospinal Fluid (CSF) for the diagnosis of Multiple Sclerosis (MS) in patients visited at the General Hospital of Alessandria.

Materials and Methods: detecting κFLC and λFLC levels in CSF and serum using Freelite tests on Optilite analyser (The Binding Site) and Isoelectric Focusing (IEF) on Hydrasis 2 analyser (Sebia). Statistical analysis was conducted by GraphPad statistical software and Excel statistical tools. Calculation of p-value by Kruskal-Wallis test and χ2 test. Evaluation of the Free Light Chain (FLC)  indices’ performance through the construction of a Receiver Operating Characteristics (ROC) curve.

Results: 132 CSF and serum samples were collected, and 25% of the patients were diagnosed with MS. Through the ROC analysis, the optimal cut-off value was found to be 6,56 for the K index, 10,12 for the λ index, and 0,65 for the IgG index. FLC indices were higher in MS patients than in others.

Conclusions: the study shows that the K index has an equivalent reliability and a higher predictive value, but with lower costs and times than Oligoclonal Bands (OCB). The λ index could have the potential to become a further test used for differential diagnosis of MS, but more in-depth studies via more sensitive techniques are needed to evaluate real performance.