Importance of intrathecal synthesis of IgD in multiple sclerosis. A combined clinical, immunologic, and magnetic resonance imaging study
M. K. Sharief and R. Hentges
Department of Clinical Neurochemistry, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
There is increasing evidence that soluble IgD has a certain role in the
humoral immune response within the central nervous system. We report herein
the results of a combined clinical, magnetic resonance imaging, and
immunopathologic study to determine the clinical importance of intrathecal
IgD synthesis. Intrathecal synthesis of IgD (detected through the
calculation of index values) was studied in 64 patients with multiple
sclerosis and in 50 neurologic control patients and normal subjects.
Locally secreted IgD was detected in 30% of patients with clinically active
multiple sclerosis, including two in whom magnetic resonance images of
brain and spinal cord were normal and who had no evidence of intrathecal
IgG synthesis. No intrathecal IgD production was detected in patients with
clinically stable multiple sclerosis or those suffering from chronic
progressive multiple sclerosis, while it significantly correlated with the
interval from the last relapse and with the total duration of the disease
process in patients with relapsing, remitting multiple sclerosis.
Intrathecal IgD synthesis also correlated with the degree of cerebrospinal
fluid pleocytosis and with the presence of free kappa and lambda light
chain bands in cerebrospinal fluid. Present results supplement and expand
earlier data and suggest that intrathecally secreted IgD is a putatively
important part of the immune response in clinically active relapsing,
remitting multiple sclerosis.
