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IgM The BOC consolidate

the prognosis of MS

Oligoclonal bands (BOC) of immunoglobulin G (IgG) and of immunoglobulin M (IgM) in cerebrospinal fluid (CSF) are useful markers in multiple sclerosis (MS). A team from the Ramón y Cajal Hospital is leading the research on these biomarkers.

Sonia Moreno - Medical Journal April 2011 -19

Luisa María Villar The immunologist and neurologist Jose Carlos Alvarez-Cermak, coordinator of the MS, both from the Hospital Universitario Ramón y Cajal (Madrid), periodically organize a course on the study of biomarkers in MS. Villar also is responsible within the English Society of Immunology, seeing that these techniques are performed with the required quality. "We succeeded in establishing a very high quality in the determination of oligoclonal bands (BOC) of IgG, and now the goal is to achieve the same level of IgM bands," he says. 97 percent of patients with presence of bands of IgG in the first outbreak will end up developing multiple sclerosis IgM bands are associated with poor prognosis of MS, to the extent that patients have more buds and greater disability.

addition to transfer its experience to other laboratories, Ramón y Cajal team continues to investigate the role of the BOC in the disease. Álvarez-Cermak explained that "once we determine IgM bands are associated with poor prognosis in a group of patients, we are now studying whether treatment can modify this evolution."

are two key issues in these studies: if the treatment is able to decrease the biomarker IgM and whether this decline is associated with an improvement. "We do not have definitive results in this regard. It is a complex task, because the sampling is not always possible: it must be done when strictly necessary from a clinical point of view." Hence the importance of adding cohorts of patients from other groups.

Other cohorts

Amit Bar-Or, a specialist in Neurology and Immunology, Montreal Neurological Institute at McGill University (Canada), collaborating on several projects with multiple sclerosis group Villar Álvarez-Cermak. One such project is the BOMARC implementation of the pediatric MS.
According reveals the Canadian cohort, "one in twenty patients had an outbreak during his childhood, which indicates that a significant proportion of disease onset in childhood." By type, there has been a primary progressive MS in childhood, the vast majority of affected children have relapsing-remitting MS and continue with this type of disease until adulthood, when many of them derive a secondary progressive MS. The latter is very rare in childhood but can occur.
"pediatric MS has certain peculiarities; can be said to be similar to adult, but not identical, and that prevents a total extrapolation of the McDonald criteria. We have to adapt and for this we must use them, follow the children diagnosed using the criteria and then check to what extent they worked. However, we know that children differ in multiple sclerosis imaging tests with respect to adult. Perhaps one of the biggest challenges is to distinguish it from other conditions that look like MS, but are another neurological disease. "

Based on experience

Regarding treatment, there has been no clinical trials with children, well that the conclusions are based on the experience of specialists. "We apply the same treatments as in adults, and my impression is that they operate to the same extent," said Bar-Or.

Another aspect to be resolved is whether the function biomarkers in the same way as they do in adults. "Measurements in children, to be closer to the onset of the disease, can provide valuable information beyond the pediatric population."

also works to find biomarkers of disease that can be obtained from blood samples. However, remember that the great advantage of the CSF study is that, while in the central nervous system, provides much information about the pathogenesis. "Maybe in future find blood markers of these biomarkers, but we have to work in parallel, as the LCR provides essential data on the mechanisms of multiple sclerosis."

Irycis: present and future projects

Luisa María Villar directs the Multiple Sclerosis Group Irycis (Ramon y Cajal Institute of Health Research), which, like José Carlos Álvarez- Cermak, is principal investigator. The line of work is the study group immunological profiles presented by different forms of MS. Ongoing projects are specified in the identification of predictive markers, the study of CSF immunological profiles in different forms of the disease, and clinical value analysis, forecast and pathophysiological heterogeneity of blood-borne B lymphocytes. In addition, the group plans to start research in the microRNA in MS and the involvement of Epstein-Barr virus and other herpesvirus family in the onset of the disease.