Discrepancies between qualitative and quantitative analysis of cerebrospinal fluid IgG: densitometric comparison of nephelometry-silver versus immuno-enzymes

Ann Clin Biochem 2008;45:404-408
© 2008 Association for Clinical Biochemistry


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Original Articles

Geoffrey Keir1,
Susana Barrio2 and
Edward J Thompson1

1 Department of Neuroinflammation, Institute of Neurology, Queen Square, London WC1 N 3BG, UK;
2 Speciality Labs, Valencia, CA 91355, USA

Corresponding author: Professor E Thompson. Email: e.thompson{at}ion.ucl.ac.uk

Background: Detection of local synthesis of IgG within the central nervoussystem is important for the diagnosis of brain inflammatorydiseases such as multiple sclerosis. This is typically doneby comparing the amounts of IgG in serum and parallel cerebrospinalfluid (CSF). Although there have been well-described problemswith qualitative versus quantitative measurements of abnormalIgG, such as in myeloma paraproteins, similar difficulties arealso found with CSF IgG.

Methods: Traditional quantitative analysis of IgG by rate nephelometrywas followed by separation of the IgG using isoelectric focusingand then either silver stain or immunofixation. Finally, quantitativeanalysis was performed by scanning densitometry using publicdomain software downloaded from the National Institutes of Health.

Results: We report here the major discrepancies that can occur with CSFIgG between the silver stain versus the IgG stain.

Conclusions: We concur with the earlier recommendation that qualitative separationfollowed by densitometric estimation of enzyme-linked immunofixationis also more useful than simple quantitative nephelometric analysisfollowed by silver staining in the detection of local synthesisof IgG, analogous to the earlier work on paraproteins.

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