Cited by 32Multiple Sclerosis Research StudiesPeripheral Neuropathies and DisordersClinical Laboratory Practices and Quality Control

Oligoclonal bands and kappa free light chains: Competing parameters or complementary biomarkers?

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Konen, Franz F., Wurster, Ulrich, Schwenkenbecher, Philipp, Gerritzen, Andreas, Groß, Catharina C., Eichhorn, Peter, Harrer, Andrea, Isenmann, Stefan +19 more·2025·Autoimmunity Reviews

Abstract

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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  1. [13][13] [Wurster U. Demonstration of Oligoclonal IgG in the unconcentrated CSF by silver stain. In: Stathakos D, editor. Electrophoresis 082. De Gruyter; 1983. p. 250 -9.](http://refhub.elsevier.com/S1568-9972(25)00025-4/rf0065) -
  2. [17][17] [Wurster U. Nachweis oligoklonaler Banden: Grundlage der Liquoranalytik. In: Regeniter A, editor. Praktische Liquordiagnostik. UNI-MED Verlag; 2021. p. 132 -55.](http://refhub.elsevier.com/S1568-9972(25)00025-4/rf0085) -
  3. [109][109] Petzold A. Intrathecal oligoclonal IgG synthesis in multiple sclerosis. J Neuroimmunol 2013;262(1 -2):1 -10. https://doi.org/10.1016/j. jneuroim.2013.06.014. - · DOI

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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
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
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

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