Oligoclonal bands and kappa free light chains: Competing parameters or complementary biomarkers?
Open accessAbstract
BACKGROUND: The 2024-revised McDonald criteria for multiple sclerosis (MS) proposed to incorporate cerebrospinal fluid (CSF)-specific oligoclonal bands and kappa free light chains (KFLC) as diagnostic biomarkers. While the 2017-revised criteria highlighted CSF-specific oligoclonal bands to indicate intrathecal IgG synthesis, significantly enhancing early MS diagnosis, KFLC have emerged as additional marker. Now, the question rises of whether both biomarkers serve as competing or complementary tools in MS diagnostics. METHODS: In this narrative review, we extensively searched the literature on oligoclonal bands and KFLC determination in CSF and serum across neurological disorders, with a focus on MS, using the PubMed database to demonstrate the complementarity of both biomarkers. RESULTS: Oligoclonal bands have long been a reliable marker of intrathecal IgG synthesis in MS, valued for their high diagnostic sensitivity, unique patient "fingerprints," clonality differentiation, semi-quantitative analysis, and pre-analytic robustness. However, they present challenges in standardization, labor-intensity, method variability, examiner dependency, and limited data on non-IgG immunoglobulins. Quantitative KFLC measurement provides rapid, examiner-independent, and cost-effective assessment across all immunoglobulin classes but might have lower specificity, lacked consensus on standardized interpretation in recent years, and is not yet supported by comprehensive prospective multinational studies on its prognostic role. CONCLUSION: Both oligoclonal bands and KFLC have unique strengths and limitations that complement each other, potentially serving as complementary markers for evaluating intrathecal Ig synthesis in MS diagnosis. Further evidence is needed to establish the value of KFLC in MS diagnosis, thus multicenter prospective studies are being conducted to compare the diagnostic utility of both markers.
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When applying the published diagnostic sensitivity of the select-6∗ methods of 82%-89%, hypothetically some of the missed MS diagnoses could have been made, possibly reaching a similar proportion of MS diagnosis as compared with detection of KFLC.
“When applying the published diagnostic sensitivity of the select-6∗ methods of 82%–89%, hypothetically some of the missed MS diagnoses could have been made, possibly reaching a similar proportion of MS diagnosis as compared with detection of KFLC.”
From Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany (2026) · cites this paper as [12]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn CSF, intrathecal inflammation can be demonstrated by oligoclonal bands (OCB) or by kappa free light chains (KFLC).
“in CSF, intrathecal inflammation can be demonstrated by oligoclonal bands (OCB) or by kappa free light chains (KFLC), which represent a complementary biomarker.8, 9, 10, 11, 12”
From Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany (2026) · cites this paper as [12]
CSF analysis in general and detection of CSF-restricted oligoclonal bands in special are pivotal for differential diagnosis beyond the diagnostic contribution, helping to exclude mimics and provide additional diagnostic information such as the clonality of IgG.
“CSF analysis in general and detection of CSF-restricted oligoclonal bands in special are pivotal for differential diagnosis beyond the diagnostic contribution, helping to exclude mimics and provide additional diagnostic information such as the clonality of IgG.”
From Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany (2026) · cites this paper as [12]
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Süße, M., Feistner, F., Grothe, M., Nauck, M. A., Dressel, A., & Hannich, M. J. (2020) · Neurology Neuroimmunology & Neuroinflammation · doi:10.1212/nxi.0000000000000892 · Cited by 25 · see citing works
Self-citationThe Influence of Renal Function Impairment on Kappa Free Light Chains in Cerebrospinal Fluid
Konen, F. F., Schwenkenbecher, P., Wurster, U., Jendretzky, K. F., Möhn, N., Gingele, S., Sühs, K., Hannich, M. J., Grothe, M., Witte, T., et al. (2021) · Journal of Central Nervous System Disease · doi:10.1177/11795735211042166 · Cited by 25 · see citing works
Self-citationKonen, F. F., Schwenkenbecher, P., Jendretzky, K. F., Gingele, S., Witte, T., Sühs, K., Grothe, M., Hannich, M. J., Süße, M., & Skripuletz, T. (2022) · Brain Sciences · doi:10.3390/brainsci12040475 · Cited by 24 · see citing works
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Kappa-index: Real-life evaluation of a new tool for multiple sclerosis diagnosis
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Self-citationDiagnostic Cerebrospinal Fluid Biomarker in Early and Late Onset Multiple Sclerosis
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Self-citationInter-Laboratory Concordance of Cerebrospinal Fluid and Serum Kappa Free Light Chain Measurements
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Self-citationKappa index for multiple sclerosis diagnosis: an accurate biomarker of intrathecal synthesis
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Kappa free light chains index in multiple sclerosis very long-term prognosis
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Inter-center agreement in the interpretation of oligoclonal bands
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Detection of oligoclonal IgA in cerebrospinal fluid samples by an isoelectric focusing procedure
Withold, W., Wick, M., Fateh-Moghadam, A., & Einh�upl, K. M. (1994) · Journal of Neurology · doi:10.1007/bf00868439 · Cited by 11 · see citing works
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Tortosa-Carreres, J., Cubas-Núñez, L., Quiroga‐Varela, A., Castillo-Villalba, J., Ramió‐Torrentà, L., Piqueras, M., Gasqué-Rubio, R., Quintanilla‐Bordás, C., Sanz, M. T., Lucas, C., et al. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.105734 · Cited by 10 · see citing works
Cutellé, C., Balducci, C., Cereda, D., Fusco, M. L., Iacobucci, D., Perugini, J., Pirro, F., Brivio, R., Bernasconi, D. P., Ferrarese, C., et al. (2022) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2022.577992 · Cited by 9 · see citing works
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A New Laboratory Workflow Integrating the Free Light Chains Kappa Quotient into Routine CSF Analysis
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Self-citationMiklusova, M., Fürst, T., Zimek, D., & Mareš, J. (2023) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2023.105402 · Cited by 7 · see citing works
Hannich, M. J., Konen, F. F., Gag, K., Alkhayer, A., Türker, S. N., Budde, K., Nauck, M., Wurster, U., Dressel, A., Skripuletz, T., et al. (2025) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2023-1468 · Cited by 7 · see citing works
Self-citationBiomarkers of Intrathecal Synthesis May Be Associated with Cognitive Impairment at MS Diagnosis
Virgilio, E., Ciampana, V., Puricelli, C., Naldi, P., Bianchi, A., Dianzani, U., Vecchio, D., & Comi, C. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26020826 · Cited by 6 · see citing works
Weiss, B., Pichler, A., Damulina, A., Buchmann, A., Hochmeister, S., Seifert‐Held, T., Enzinger, C., Archelos, J.-J., & Khalil, M. (2022) · Biomedicines · doi:10.3390/biomedicines10092202 · Cited by 5 · see citing works
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Saliva Free Light Chains in Patients with Neuro-Sjögren
Konen, F. F., Seeliger, T., Schwenkenbecher, P., Gingele, S., Jendretzky, K. F., Sühs, K., Ernst, D., Witte, T., & Skripuletz, T. (2022) · Biomedicines · doi:10.3390/biomedicines10102470 · Cited by 4 · see citing works
Self-citationHeim, X., Hubert, A.-M., Raouak, I., Nzepa, A. C., Mège, J., Delmont, É., Attarian, S., Koric, L., Pelletier, J., Brodovitch, A., et al. (2023) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2022-0602 · Cited by 4 · see citing works
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Flagged first, then by citations
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- Authors
- Konen, F. F., Wurster, U., Schwenkenbecher, P., Gerritzen, A., Groß, C. C., Eichhorn, P., Harrer, A., Isenmann, S., Lewczuk, P., Lewerenz, J., Leypoldt, F., Otto, M., Regeniter, A., Roskos, M., Ruprecht, K., Spreer, A., Strik, H., Uhr, M., Wick, M., Wildemann, B., Wiltfang, J., Zimmermann, T., Hannich, M., Khalil, M., Tumani, H., Süße, M., & Skripuletz, T.
- Affiliations
- Medizinische Hochschule Hannover (DE)
- University of Münster (DE)
- LMU Klinikum (DE)
- Paracelsus Medical University (AT)
- Medical University of Białystok (PL)
- Universität Ulm (DE)
- Christian-Albrechts-Universität zu Kiel (DE)
- Martin Luther University Halle-Wittenberg (DE)
- Synlab (Germany) (DE)
- Humboldt-Universität zu Berlin (DE)
- Klinikum Braunschweig (DE)
- Sozialstiftung Bamberg (DE)
- Max Planck Institute of Psychiatry (DE)
- Heidelberg University (DE)
- Universitätsmedizin Göttingen (DE)
- Universitätsmedizin Greifswald (DE)
- Medical University of Graz (AT)
- Corresponding author
- Skripuletz, Thomas
- ORCID
- Konen, Franz F.
- Schwenkenbecher, Philipp
- Groß, Catharina C.
- Harrer, Andrea
- Isenmann, Stefan
- Lewczuk, Piotr
- Lewerenz, Jan
- Leypoldt, Frank
- Otto, Markus
- Regeniter, Axel
- Ruprecht, Klemens
- Strik, Herwig
- Wildemann, Brigitte
- Wiltfang, Jens
- Zimmermann, Thomas
- Hannich, Malte
- Khalil, Michael
- Tumani, Hayrettin
- Süße, Marie
- Skripuletz, Thomas
- Venue
- Autoimmunity Reviews
- Publisher
- Elsevier BV
- Published
- 2025-04
- Volume
- 24
- Issue
- 5
- Pages
- 103765
- ISSN
- 1568-9972 (ISSN-L)
- OpenAlex
- W4407357873
- Cited by
- 31
- References
- 111
- Citations by year
- 2026: 19 · 2025: 12
- FWCI
- 5.32
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Autoimmunity Reviews (publishedVersion, cc-by)
- PubMed (publishedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion, cc-by)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
- Digitalen Hochschulbibliothek Sachsen-Anhalt (Universitäts- und Landesbibliothek Sachsen-Anhalt) (cc-by)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- multiple sclerosis, oligoclonal bands, kappa free light chains, cerebrospinal fluid biomarkers, intrathecal IgG synthesis, McDonald criteria, MS diagnosis, serum biomarkers, sensitivity and specificity
- MeSH terms
- Humans, Immunoglobulin kappa-Chains, Multiple Sclerosis, Biomarkers, Oligoclonal Bands
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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