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Notes on electrophoresis.. By Dr. Ashish V. Jawarkar
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1. The diagnosis of Multiple sclerosis is ultimately a clinical one based on neurologic
history and physical examination.
2. Nevertheless, advanced laboratory results such as elevated IgG indices and presence of
oligoclonal bands of IgG or Kappa /lambda light chains on CSF electrophoresis, as well as
neuroimaging techniques have proven to be invaluable in diagnosis of MS.
Agarose gel electrophoresis
1. Concentrated CSF is used as sample
2. Shows discrete bands of IgG – the oligoclonal bands
3. Presence of two or more bands is necessary for diagnosis
4. False positive results are obtained in SSPE, CNS infections like neurosyphilis,
Crypotococcal meningitis, GBS, transverse myelitis, burkitt’s lymphoma etc.
5. Sensitivity is less than other methods of electrophoresis
Staining
Commassie brilliant blue/paragon violet/silver staining
1. silver staining is more sensitive then CBB
2. however these techniques must be simultaneously carried out on patients serum also
because polyclonal gammopathy can lead to diffusion of immunoglobulin into CSF and
lead to false positive results. This is seen in case of liver diseases, SLE, RA and chronic
granulomatous diseases.
ImmunoFixation Electrophoresis
1. Immunofixation electrophoresis (IFE) is used to demonstrate that a narrow gamma band
is due to a homogeneous immunoglobulin.
2. In the illustration below, 6 replicates of the specimen are loaded on to separate lanes of
an IFE gel.
3. Following electrophoresis, the protein in each lane is stained differently.
4. The first lane (SP) is stained for total protein.
5. The protein in each of the other lanes is "stained" with specific antisera for
immunoglobulin heavy and light chains, respectively, as illustrated in the figure.
6. The finding of the preponderance of only one light chain associated with a
predominantly staining heavy chain confirms the molecular homogeneity of the
immunoglobulin and also provides identification.
7. IFE identifies the narrow band as monoclonal IgG, lambda.
8. Sometimes malignant plasma cells synthesize excess light chains and less frequently
only light chains are synthesized. Almost never is excess heavy chain or only heavy chain
synthesized. Excess free lambda light chain is exhibited in the illustration.