ArticleFrontiers in immunology2026
CSF/serum IL-6 ratio and its correlation with mri severity in mog antibody-associated cerebral cortical encephalitis: an exploratory pilot study.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: We aimed to quantify the relationship between CSF IL-6 compartmentalization and MRI lesion extent in patients with MOG-CCE, and to evaluate the CSF/serum IL-6 ratio as a biomarker of CNS-compartmentalized inflammation. Methods: Eight MOG-CCE patients (≥14 years old) were retrospectively enrolled. CSF and serum cytokines (IL-6, IL-17, IFN-γ) and MRI scans were collected. A semi-quantitative MRI scoring system (0-9) was developed; inter-rater reliability was assessed by two independent radiologists. Associations were evaluated using Spearman correlation and simple linear regression. Results: All patients presented with seizures at onset. Median CSF IL-6 (284.53 pg/mL) markedly exceeded paired serum levels (2.25 pg/mL; Z = 2.521, p = 0.012; Cohen's d = 1.084). The median CSF/serum IL-6 ratio was 220.33 (IQR: 64.26-690.89), exceeding 1 in all patients. The MRI scoring system showed good inter-rater reliability (87.5% concordance; P = 0.893). The total MRI score correlated significantly with CSF IL-6 (r = 0.819, p = 0.013) and the CSF/serum IL-6 ratio (r = 0.807, p = 0.015). Simple linear regression confirmed that the Ln-transformed ratio predicted MRI score (R² = 0.573, p = 0.030, B = 0.659, β = 0.757). Crucially, the ratio showed no significant correlation with conventional systemic inflammatory markers. Conclusion: CSF IL-6 levels correlated significantly with MRI severity in MOG-CCE. The Ln-transformed CSF/serum IL-6 ratio explained approximately 57.3% of MRI variance and was uncorrelated with systemic inflammatory indices, supporting its specificity for CNS-compartmentalized immune activation. These findings position the CSF/serum IL-6 ratio as a candidate quantitative biomarker of local CNS inflammatory intensity and lesion burden in MOG-CCE. As an exploratory, hypothesis-generating pilot study (n = 8), these results require prospective validation in larger cohorts with Reiber graph analysis before the ratio can be adopted as a clinical biomarker.
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