Cerebrospinal fluid kappa free light chains as biomarker in multiple sclerosis-from diagnosis to prediction of disease activity

Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system that shows a high interindividual heterogeneity, which frequently poses challenges regarding diagnosis and prediction of disease activity. In this context, evidence of intrathecal inflammation provides an important information and might be captured by kappa free light chains (kappa-FLC) in the cerebrospinal fluid (CSF). In this review, we provide an overview on what is currently known about kappa-FLC, its historical development, the available assays and current evidence on its diagnostic and prognostic value in MS. Briefly, intrathecal kappa-FLC synthesis reaches similar diagnostic accuracy compared to the well-established CSF-restricted oligoclonal bands (OCB) to identify patients with MS, and recent studies even depict its value for prediction of early MS disease activity. Furthermore, detection of kappa-FLC has significant methodological advantages in comparison to OCB detection.