Identifying Biomarkers to Predict Disease Severity, Progression, and Cognitive Impairment in MS

Laura Joszt

Because the cause of multiple sclerosis (MS) is multifactorial, a result of genetic, environmental, and inflammatory factors, researchers are exploring an array of biomarkers to determine the severity and state of the disease. Two abstracts presented at the 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers analyzed biomarkers in MS.

The first, examined [Met5]-enkephalin, β-endorphin, and interleukin (IL)-17 as potential markers of disease severity and progression in MS.1 The researchers recruited patients from the Penn State Hershey Neurology Clinic and extracted and analyzed serum for expression of the 3 markers. Patients were separated into cohorts based on their treatment (dimethyl fumarate group, glatiramer acetate group, low-dose naltrexone [LDN] group, and no-drug treatment group) and compared with a control group of patients who did not have MS.

They found that for all patients with MS, [Met5]-enkephalin was significantly reduced, but it was restored by 80% in the LDN group of patients. In comparison, [Met5]-enkephalin was only restored by 48% and 57% in patients treated with dimethyl fumarate and glatiramer acetate, respectively. Compared with patients without MS, IL-17 concentration was 1.3 times and 7 times greater in patients treated with glatiramer acetate and dimethyl fumarate, respectively. There were no significant differences among the MS groups regarding β-endorphin, but it was slightly elevated in all patients with MS compared with the cohort of patients without MS.

According to the authors, the findings support the idea that [Met5]-enkephalin may be a useful noninvasive marker, while the significance of β-endorphin and IL-17 levels has yet to be determined.

In a second abstract, researchers studied blood, cerebrospinal fluid, and imaging biomarkers for cognitive impairment in MS.2 The researchers analyzed 22 patients with relapsing-remitting MS enrolled at the Atlanta VA and The Emory Clinic. The patients underwent brain magnetic resonance imaging and neuropsychological testing.

Of the enrolled patients, 55% had cognitive impairment and only 8 completed all the required study procedures. However, the researchers did identify a strong positive correlation between thalamus volume and the Symbol Digit Modalities Test. There was a strong negative correlation between caudate volume and the Brief Visuospatial Memory Test.

The study is ongoing, and the researchers expect to understand these correlations better as the sample size grows.

1. Zomorodi N, Patel C, Thomas G, Meadowcroft MD, Zagon IS, McLaughlin PJ. Novel biomarkers as predictors of disease severity and progression in multiple sclerosis. Presented at: 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers; May 28-June 1, 2019; Seattle, Washington. Abstract NIB02.

2. Rosenthal JF, Hu R, Penna S, Tyor W. Neurodegenerative biomarkers in cognitively impaired multiple sclerosis patients. Presented at: 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers; May 28-June 1, 2019; Seattle, Washington. Abstract QOL14.
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