American Academy of Neurology: A new biomarker to monitor disease progression and treatment response in MS

blood-1813410_960_720A major research question in multiple sclerosis (MS) is to determine if a person with MS is progressing in their disease course and how they are responding to treatments? Researchers attending the American Academy of Neurology(AAN) meeting addressed this crucial question by looking at a new emerging biomarker for MS. Biomarkers are signatures found in the body that can be objectively measured and can be an indicator of your health or reveal the presence or progress of a disease.

The biomarker that is of interest for MS right now is neurofilament, a protein that is found in nerve cells and is important for the maintenance of the cell’s structure. When damage occurs, this protein is released into the cerebrospinal fluid and blood. It can then be measured from the cerebrospinal fluid or blood as a “marker” that is indicative of brain damage in MS. In recent years, researchers have looked at the levels of this protein in people diagnosed with MS and found that neurofilament levels were associated with MS. Moreover, higher levels of serum neurofilament were present with active brain lesions, disease activity and with magnetic resonance imaging outcomes.

Researchers built on these earlier findings and presented results looking at neurofilament as a biomarker for MS. Dr. Bar-Or (University of Pensylvania), Dr. Calabresi (John Hopkins Hospital), Dr. Kuhle (University of Basel) and Dr. Sormani (University of Genoa) evaluated the levels of neurofilament in the blood and cerebrospinal fluid from people with MS treated with different disease-modifying therapies. For example, Dr. Bar-Or measured the level of neurofilament in the cerebrospinal fluid withdrawn from people treated with ocrelizumab for relapsing-remitting MS to understand what is going on in the brain. They found treatment with ocrelizumab reduced the levels of white blood cells and neurofilament suggesting that neurofilament might be a predictive biomarker of the effectiveness of a treatment. Similarly, Dr. Kuhle and Dr. Calabresi showed that individuals with MS that were treated with fingolimod or natalizumab had lower levels of neurofilament in the blood compared to the people taking a mock-drug.

Dr. Thebault, from the group of Dr. Freedman (University of Ottawa) analyzed the blood serum and cerebrospinal fluid from a small group of individuals with aggressive MS that received bone marrow transplant. Lower levels of neurofilament were found in the blood serum and cerebrospinal fluid after receiving the treatment. Again, these encouraging results, although preliminary, depicted the potential of neurofilament to monitor the response to treatment.

Together, these researchers have identified a biomarker that is easily obtained, inexpensive and can reliably correlate with disease progression. The use of biomarkers measured in a lab is still new in the clinical field and might require some more time to implement as a standard practice. This being said, the results presented during the meeting are very promising and could hold great potential to fill a critical gap in the clinic.

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