Evaluation of the clinical utility of cerebrospinal fluid (CSF) indices ofinflammatory markers in multiple sclerosis

(C) Munksgaard 2000. Objectives - Accumulating evidence indicates significa nt heterogeneity in MS and soluble (s) adhesion molecules are postulated as markers of disease activity. We sought to evaluate intrathecal production of these and other molecules across the clinical spectrum of MS. Methods - CSF indices of IgG, sICAM-1, sVCAM-1, sE-selectin and sCD30 were calculated in 17 primary progressive (PPMS) patients, 15 secondary progressive patien ts (SPMS), 28 relapsing-remitting patients in relapse (RRMSR) and 14 RRMS p atients in remission (RRMSNR) using commercially available ELISA kits. Pati ents had not received any immunomodulating therapy within the previous 6 mo nths. MS patients were compared with 44 patients with non-inflammatory neur ological diseases (NINDs). Results - The most sensitive CSF index at a 90% level of specificity was for IgG which had 93% sensitivity in RRMSR and 92% sensitivity in RRMSNR. Corresponding sensitivity in PPMS and SPMS was 71% and 73% respectively. None of the other indices had sensitivity >50% apart from sVCAM-1 (64% in RRMSR and 52% RRMSNR) and sCD30 (53% in PPMS). Conclus ions - Unsurprisingly the strongest association in MS was with the intrathe cal production of IgG. Similar results in PPMS and SPMS may reflect compara ble rates of progression in these 2 groups. Of the other molecules only int rathecal sVCAM-1 production is significantly associated with MS and only in relapsing-remitting disease.