Myelin Basic Protein (MBP), Cerebrospinal Fluid

Cerebrospinal fluid (CSF)

1 mL

0.8 mL; when oligoclonal banding is ordered along with myelin basic protein, the minimum volume of CSF is 0.9 mL.

Plastic transport tube

Lumbar puncture should be performed within five days of onset of neurologic symptoms suggestive of multiple sclerosis.

Assist in diagnosing multiple sclerosis; determine whether an MS patient is having an active demyelinating episode; determine whether active demyelination is occurring in patients being treated by intrathecal chemotherapy or radiation therapy for neoplastic diseases involving the central nervous system; diagnose acute brain tissue destruction in children, including newborns; assess the efficacy of potential treatments for MS

Multiple sclerosis is often episodic. The MBP level may be low to undetectable between attacks. Patients in remission usually have no detectable MBP in their spinal fluid. Results for this test are for research purposes only by the assay's manufacturer. The performance characteristics of this product have not been established. Results should not be used as a diagnostic procedure without confirmation of the diagnosis by another medically established diagnostic product or procedure.

Enzyme-linked immunosorbent assay (ELISA)

See table.

This test provides a measure of myelin fragments released into the spinal fluid as a result of the breakdown of myelin during acute phases in the course of demyelinating disease of the CNS (most common example of which is multiple sclerosis). MBP is a 169 amino acid peptide that comprises 30% of the protein of the myelin sheath. While MBP is a useful test in the diagnosis of active MS, some patients with this disorder will have normal limits, especially during remissions, and elevations may be seen in other disorders as well. Therefore, tests such as CSF oligoclonal bands and IgG index, which are positive in 90% of MS patients during active disease or remission, are preferred for the initial diagnosis. However, MBP is useful for providing objective evidence of disease activity.

CSF MBP levels were found to decrease to the level of controls in a group of 11 cases of chronic progressive multiple sclerosis patients receiving immunosuppressive therapy (cyclophosphamide and prednisone). These findings suggest that MBP might be used to monitor the hoped for beneficial effect of such therapy in some cases of MS.

It has been suggested that MBP levels in the CSF might be used in the assessment of radiation-induced myelopathy. MS patients in relapse have been shown to have increased interleukin 1 and interleukin 2 production as the result of MBP stimulated peripheral blood mononuclear cells.