The clinical significance of mirror patterns of cerebrospinal fluid oligoclonal immunoglobulin G bands (IgG-OCBs) in peripheral neuropathy disorders

IF 3.2 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Clinica Chimica Acta Pub Date : 2025-01-19 DOI:10.1016/j.cca.2025.120145

Jingluan Tian , Xiaoni Liu , Yarong Li , Yuehua Gu , Bo Deng , Wenbo Yang , Hai Yu , Xiang Zhang , Xiangjun Chen

{"title":"The clinical significance of mirror patterns of cerebrospinal fluid oligoclonal immunoglobulin G bands (IgG-OCBs) in peripheral neuropathy disorders","authors":"Jingluan Tian , Xiaoni Liu , Yarong Li , Yuehua Gu , Bo Deng , Wenbo Yang , Hai Yu , Xiang Zhang , Xiangjun Chen","doi":"10.1016/j.cca.2025.120145","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>CSF (cerebrospinal fluid) oligoclonal immunoglobulin G bands (IgG-OCBs) analysis plays a crucial role in diagnosis of various neurological disorders. However, the clinical significance of mirror pattern bands remains unclear, and their precise application is not well understood.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed a total of 7597 IgG-OCB records detected using isoelectric focusing from May 2020 and August 2023 at Huashan Hospital. Among these, 121 mirror pattern bands (62 type IV and 59 type V) were identified in patients with neurological disorders. Basic clinical data, including discharge diagnosis, gender, and age, were collected. Additionally, CSF and serum immunological parameters, as well as monoclonal protein (M protein) detection, were reviewed.</div></div><div><h3>Results</h3><div>Although mirror pattern bands are rarely observed in neurological diseases, approximately half of these patterns were found in patients with peripheral neuropathy (PN). In the type IV group, 40.74 % of cases were associated with immune-mediated PN, while type V pattern was predominantly observed in cancer-related/lymphoproliferative PN, comprising 63.33 % of the cases. Patients with cancer-related or lymphoproliferative PN showed significantly higher IgG-CSF concentrations (<em>p</em> = 0.017) and 24-h intrathecal IgG synthesis rate (<em>p</em> = 0.022), indicating a stronger humoral immune response. Additionally, both patients with immune-mediated PN and cancer-related/lymphoproliferative PN exhibited abnormal intrathecal synthesis rate and moderate to severe blood–brain barrier impairment. Furthermore, the type V group also exhibited a high prevalence of M protein positivity.</div></div><div><h3>Conclusions</h3><div>The differential immunological responses and distinct patterns of OCBs observed in our study underscore the critical role of OCB analysis in the diagnostic workup of PN.</div></div>","PeriodicalId":10205,"journal":{"name":"Clinica Chimica Acta","volume":"569 ","pages":"Article 120145"},"PeriodicalIF":3.2000,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinica Chimica Acta","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0009898125000245","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICAL LABORATORY TECHNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

CSF (cerebrospinal fluid) oligoclonal immunoglobulin G bands (IgG-OCBs) analysis plays a crucial role in diagnosis of various neurological disorders. However, the clinical significance of mirror pattern bands remains unclear, and their precise application is not well understood.

Methods

We retrospectively reviewed a total of 7597 IgG-OCB records detected using isoelectric focusing from May 2020 and August 2023 at Huashan Hospital. Among these, 121 mirror pattern bands (62 type IV and 59 type V) were identified in patients with neurological disorders. Basic clinical data, including discharge diagnosis, gender, and age, were collected. Additionally, CSF and serum immunological parameters, as well as monoclonal protein (M protein) detection, were reviewed.

Results

Although mirror pattern bands are rarely observed in neurological diseases, approximately half of these patterns were found in patients with peripheral neuropathy (PN). In the type IV group, 40.74 % of cases were associated with immune-mediated PN, while type V pattern was predominantly observed in cancer-related/lymphoproliferative PN, comprising 63.33 % of the cases. Patients with cancer-related or lymphoproliferative PN showed significantly higher IgG-CSF concentrations (p = 0.017) and 24-h intrathecal IgG synthesis rate (p = 0.022), indicating a stronger humoral immune response. Additionally, both patients with immune-mediated PN and cancer-related/lymphoproliferative PN exhibited abnormal intrathecal synthesis rate and moderate to severe blood–brain barrier impairment. Furthermore, the type V group also exhibited a high prevalence of M protein positivity.

Conclusions

The differential immunological responses and distinct patterns of OCBs observed in our study underscore the critical role of OCB analysis in the diagnostic workup of PN.

查看原文本刊更多论文

脑脊液寡克隆免疫球蛋白G带镜像模式在周围神经病变中的临床意义

背景：CSF（脑脊液）寡克隆免疫球蛋白G带（IgG-OCBs）分析在各种神经系统疾病的诊断中起着至关重要的作用。然而，镜像带的临床意义尚不清楚，其精确应用也不清楚。方法：回顾性分析华山医院2020年5月至2023年8月共7597例IgG-OCB等电聚焦检测记录。其中，121个镜像带（62个IV型和59个V型）在神经系统疾病患者中被发现。收集出院诊断、性别、年龄等基本临床资料。此外，还对脑脊液和血清免疫学参数以及单克隆蛋白（M蛋白）检测进行了综述。结果：虽然镜像带在神经系统疾病中很少观察到，但在周围神经病变（PN）患者中发现了大约一半的镜像带。在IV型组中，40.74 %的病例与免疫介导的PN相关，而V型模式主要观察到癌症相关/淋巴增生性PN，占63.33 %的病例。肿瘤相关或淋巴增生性PN患者IgG- csf浓度（p = 0.017）和24小时鞘内IgG合成率（p = 0.022）均显著升高，提示体液免疫反应更强。此外，免疫介导的PN和癌症相关/淋巴增生性PN患者均表现出鞘内合成率异常和中度至重度血脑屏障损伤。此外，V型组也表现出较高的M蛋白阳性患病率。结论：本研究中观察到的OCB的不同免疫反应和不同模式强调了OCB分析在PN诊断工作中的关键作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinica Chimica Acta 医学-医学实验技术

CiteScore

10.10

自引率

2.00%

发文量

1268

审稿时长

23 days

期刊介绍： The Official Journal of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Clinica Chimica Acta is a high-quality journal which publishes original Research Communications in the field of clinical chemistry and laboratory medicine, defined as the diagnostic application of chemistry, biochemistry, immunochemistry, biochemical aspects of hematology, toxicology, and molecular biology to the study of human disease in body fluids and cells. The objective of the journal is to publish novel information leading to a better understanding of biological mechanisms of human diseases, their prevention, diagnosis, and patient management. Reports of an applied clinical character are also welcome. Papers concerned with normal metabolic processes or with constituents of normal cells or body fluids, such as reports of experimental or clinical studies in animals, are only considered when they are clearly and directly relevant to human disease. Evaluation of commercial products have a low priority for publication, unless they are novel or represent a technological breakthrough. Studies dealing with effects of drugs and natural products and studies dealing with the redox status in various diseases are not within the journal''s scope. Development and evaluation of novel analytical methodologies where applicable to diagnostic clinical chemistry and laboratory medicine, including point-of-care testing, and topics on laboratory management and informatics will also be considered. Studies focused on emerging diagnostic technologies and (big) data analysis procedures including digitalization, mobile Health, and artificial Intelligence applied to Laboratory Medicine are also of interest.