Abstract Details

Title Reduced Intrathecal IgG Synthesis in the Cerebrospinal Fluid from Natalizumab-Treated Patients with Active Multiple Sclerosis

Topic MS and Related Diseases

Presentation(s) P05 - (-)

Poster/Presentation
Number 191

Objective

Background BACKGROUND: Evidence of oligoclonal bands (OCB) disappearing from the cerebrospinal fluid (CSF) in natalizumab (NZB)-treated patients with multiple sclerosis (MS) is accumulating. OCB are only qualitative but not quantitative evidence of an intrathecal IgG production and considered to persist in MS.

Design/Methods DESIGN/METHODS: We included 31 MS patients, 17 were untreated and in 14 CSF was investigated to rule out progressive multifocal leukoencephalopathy (PML) during NZB treatment. From 6 patients of the NZB-treated group IgGIF results of the lumbar punctures at first diagnosis were available. IgG and albumin concentrations of CSF and serum samples were measured by immunonephelometry and used to calculate the CSF/serum quotients and IgGIF (in %) according to Reiber (1998).

Results RESULTS: Quantification of CNS-restricted IgG showed a reduced IgGIF in NZB-treated patients compared to untreated MS patients (p=0.0026). Likewise, intraindividual comparisons of baseline and follow-up data in the natalizumab-treated group of 6 showed disappearance of local IgG production in 2 and an overall significant reduction of the IgGIF (p=0.018).

Conclusions CONCLUSIONS: Quantifying intrathecal IgG synthesis revealed a pronouncedly reduced IgGIF in natalizumab-treated MS patients of both, inter- and intraindividual group comparisons. This corroborates previous reports about disappearing OCB and strongly suggests effectiveness of NZB therapy on intrathecal IgG production. Since lumbar punctures were performed to rule out PML this observation is limited to natalizumab-treated patients with active disease. Clarification of the underlying mechanisms will provide important knowledge about the clinical relevance of this finding and the potential pathogenesis of opportunistic CNS infections during NZB therapy.

Authors/Disclosures
Joerg R. Kraus, MD (Ordination Dr. Kraus) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Peter Wipfler	Peter Wipfler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Peter Wipfler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Peter Wipfler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Peter Wipfler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Peter Wipfler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Peter Wipfler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS/Celgene. Peter Wipfler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen. Peter Wipfler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Peter Wipfler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Peter Wipfler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. Peter Wipfler has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.
	No disclosure on file
Barbara J. Holl, MD	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Eugen Trinka	Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bial. Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GW Pharmaceuticals. The institution of Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rapport. The institution of Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. The institution of Eugen Trinka has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Eugen Trinka has received research support from European Union. Eugen Trinka has received publishing royalties from a publication relating to health care.
	No disclosure on file

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