Are anti-myelin antibodies a predictor of MS?

Findling O, Durot I, Weck A, Jung S, Kamm CP, Greeve I, Mattle HP, Sellner J. Anti-myelin antibodies as predictors of disability after clinically isolated syndrome. Int J Neurosci. 2013 Nov  [Epub ahead of print]

There is controversy whether determination of antibodies against myelin, myelin oligodendrocyte glycoprotein, and myelin basic protein in serum from patients with a first episode suggestive of multiple sclerosis is of prognostic value. We evaluated whether detection of anti-myelin antibodies in serum indicate a worse course with earlier time to a second relapse and increased progression of disability. We conducted a prospective study at the Department of Neurology, Inselspital Bern, Switzerland from 2004-2008 in patients presenting with a clinically isolated syndrome (CIS) and a follow-up of at least four months. Anti-myelin antibodies were assessed by Western blot. Results were correlated with clinical course and sex. Among 93 consecutive patients with a CIS, 74 (80%) were positive for either one or both anti-myelin antibodies. A relapse occurred in 49 (53%) and the median EDSS was 2 (range 1-3.5) after a mean observation period of 20 months. Presence of anti-myelin antibodies at CIS neither increased the risk for a second relapse nor for progression of disability. Stratification for gender did not reveal differences for any of the clinical surrogates. The sole determination of anti-myelin antibodies in serum is of limited prognostic value for the identification of patients with different short-term course.

Interesting 80% of CISers had anti-myelin antiboides but this did not indicate if it they would subsequently have a second attack and be diagnosed with MS. This may suggest that anti-myelin antibodies may be the chicken rather than the egg. If you have myelin breakdown that is released into the blood this could stimulate an anti-myelin response Maybe some would ask why not look at alpha B crystallin which may be a better candidate autoantigen than myelin antigens, maybe they will? 

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