Cerebrospinal fluid parameters of B cell-related activity in patients with active disease during natalizumab therapy

Mult Scler. 2013 Aug;19(9):1209-12. doi: 10.1177/1352458512463483. Epub 2012 Oct 23.


Recently, the disappearance of oligoclonal bands (OCBs) from the cerebrospinal fluid (CSF) of a few natalizumab-treated patients with multiple sclerosis (MS) has been reported. This is interesting since CSF-restricted OCB are believed to persist in MS. We pooled CSF data from 14 MS centers to obtain an adequate sample size for investigating the suspected changes in central nervous system (CNS)-restricted humoral immune activities in the context of natalizumab therapy. In a retrospective chart analysis, CSF parameters of blood-CSF barrier integrity and intrathecal IgG production from 73 natalizumab-treated MS patients requiring a diagnostic puncture for exclusion of progressive multifocal leukoencephalopathy were compared with CSF data obtained earlier in the course of disease before natalizumab therapy. At the time of repeat lumbar puncture, local IgG production (according to Reibergram) was significantly reduced (p < 0.0001) and OCB had disappeared in 16% of the patients. We therefore conclude that natalizumab therapy interferes with intrathecal antibody production at least in a significant number of patients.

Keywords: Natalizumab; cerebrospinal fluid; intrathecal IgG; multiple sclerosis; oligoclonal bands.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antibody Formation / drug effects*
  • B-Lymphocytes / drug effects
  • B-Lymphocytes / immunology*
  • Female
  • Humans
  • Immunoglobulin G / cerebrospinal fluid*
  • Immunoglobulin G / immunology
  • Male
  • Middle Aged
  • Multiple Sclerosis / cerebrospinal fluid*
  • Multiple Sclerosis / drug therapy
  • Multiple Sclerosis / immunology
  • Natalizumab
  • Oligoclonal Bands / cerebrospinal fluid*
  • Oligoclonal Bands / drug effects
  • Oligoclonal Bands / immunology
  • Retrospective Studies
  • Young Adult


  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin G
  • Natalizumab
  • Oligoclonal Bands