Blood Test Could Predict RRMS Disease Activity

New research finds that levels of a specific nerve protein spike in the weeks before new lesions appear in patients with RRMS.

Christian A. Vedeler, MD, PhD

A blood test might someday be able to detect pending disease activity in patients with relapsing-remitting multiple sclerosis (RRMS), according to a new study.

Researchers from the University of Bergen, in Norway, found that levels of the nerve protein neurofilament light chain appear to increase in the blood of patients who are developing new T1 and T2 lesions.

The findings suggest there might be a simpler and less expensive method of monitoring disease activity in RRMS patients versus standard MRI scans.

“We think blood tests measuring neurofilaments in sera from stable MS patients can replace routine MRI controls,” sstudy co-author Christian A. Vedeler, MD, PhD, said. “Our results,

however, need to be confirmed in larger and prospective studies.”

Vedeler, a professor in the university’s Department of Neurology, told MD Magazine neurofilament light chain was a logical biomarker because it represents neurodegeneration and it can be measured in serum.

The study was conducted over 2 years and involved 85 patients who had had RRMS for an average of 2 years at the start of the study. For the first 6 months, the patients abstained from disease-modifying therapies, but for the last 18 months they received interferon-beta 1a.

Participants were given MRI scans each of the first 9 months, at the 1-year mark, and at the 2-year mark. Meanwhile, blood samples were taken at months 3, 6, 12, and 24.

They found higher nerve protein levels were present up to 2 months before new lesions formed, and for 1 month after. Patients who had an increase of 10 picograms per milliliter of neurofilament light chain had a 48% higher chance of developing T1 lesions, and a 62% greater chance of developing T2 lesions, compared to patients who didn’t develop new lesions at the same time.

Notably, nerve protein levels were lower when the interferon-beta 1a treatment was started. The therapy targets flare-ups and slows the formation of lesions in the brain.

Mark Allegretta, PhD, associate vice president of commercial research at the National MS Society, told MD Magazine that if the results are confirmed, a blood test could create the potential to more quickly learn whether a therapy is working in a particular patient.

“Time is critical when you are talking about protecting the nervous system from damage,” Allegretta said.

He said this area of research is an active one within the neurology community, and for good reason.

“Identifying objective indicators of disease activity that mark the transition to progression, measure treatment impact, and predict an individual’s course and response to therapy is needed to improve clinical management of MS,” he said.

Indeed, Vedeler said he and his colleagues are also looking for other biomarkers, including promising biomarkers found in the spinal fluid. But he hopes these biomarkers can also be measured in the blood.

“In the future, probably several biomarkers reflecting both inflammation and neurodegeneration can be used to follow MS disease activity and response to therapy,” Vedeler said. “We plan prospective studies to confirm and expand our research on biomarkers in MS.”

The study, “Neurofilament light chain predicts disease activity in relapsing-remitting MS,” was published online in Neurology Neuroinflammation last month.

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