Study finds biomarkers to predict disability progression in multiple sclerosis

NEW DELHI: A team of researchers has identified critical biomarkers that can predict disability worsening in people with multiple sclerosis (MS) -- a chronic autoimmune disease that affects the central nervous system (CNS).

The findings can potentially transform treatment strategies for millions of people suffering from MS worldwide, and will also pave the way for more personalised and effective treatment plans.

The team from Hospital Universitario Ramon y Cajal in Spain conducted an observational study on 725 MS patients, across 13 hospitals in Spain and Italy.

They found that high levels of serum neurofilament light chain (sNfL) -- a protein indicating nerve cell damage -- at the onset of MS could predict both relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA).

In addition, levels of serum glial fibrillary acidic protein (sGFAP) -- a protein derived from astrocytes that enter the bloodstream when the central nervous system (CNS) is injured or inflamed -- correlate with PIRA in patients with low levels of sNfL. High sGFAP levels indicated more localised inflammation driven by microglia in the CNS and are also known to be associated with progression.

Dr. Enric Monreal and his team at the Hospital analysed blood samples from the 725 MS patients collected within 12 months of disease onset.

Their findings reveal that higher sNfL levels are indicative of acute inflammation within the CNS in MS. These were associated with a 45 per cent increased risk of RAW and a 43 per cent increased risk of PIRA.

While people with high sNfL levels often did not respond well to standard disease-modifying treatments (DMTs), they showed significant benefits from high-efficacy DMTs such as Natalizumab, Alemtuzumab, Ocrelizumab, Rituximab, and Ofatumumab.

Monreal, a researcher in MS, suggested measuring both sNfL and sGFAP levels at disease onset, which will help tailor treatment strategies for MS patients more effectively.

The researcher explained that this will mean people with low levels of both biomarkers, who show good prognosis, can be treated via injectable or oral DMTs.

Current DMTs primarily target the peripheral adaptive immune system without affecting CNS immunity. Thus, finding people “with higher levels of peripheral inflammation is crucial for preventing disability and improving patient outcomes," Monreal said

The results were presented at the 40th European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS 2024) Congress in Copenhagen, Denmark.