A New Marker to Predict MS Progression

When people are diagnosed with MS, it is very difficult to predict how their condition will progress as each individual will often have different outcomes. This leads to a large level of uncertainty for the person involved. Recently however, it has become apparent that the level of damage to axons does correspond to disability progression. Therefore, there is a lot of current work that is focused on developing an easy clinical technique for assessing this axonal injury, which could be used to more accurately predict or monitor an individual’s MS.

It is known that a major part of the axon is made up of three parts, known as neurofilament subunits, of which there are the heavy, medium and light subunits. Previous work has shown that after axonal injury or death, these subunits can be detected in both the serum and cerebrospinal fluid (CSF). In addition, high levels of both the light and heavy neurofilaments in the CSF are associated with poorer clinical outcomes. Due to the dangers and invasiveness of lumbar punctures, a marker present in serum would be better than having to analyse CSF.

In this study by Gresle et al, the use of a modified (phosphorylated) form of the heavy subunit was assessed as a potential marker of disease progression. The levels of this protein were studied in people with relapsing-remitting MS (RRMS – 81), secondary progressive MS (SPMS – 13), primary progressive MS (PPMS – 6), as well as those with a first demyelinating event (FDE – 82) and unaffected individuals (135). The protein was found in the serum of 9% of people with RRMS and FDE, as well as 38.5% with SPMS. Furthermore, they showed that high levels of this protein in the serum matched to worse disease progression. Therefore, the use of a blood test to assess the levels of the phosphorylated heavy neurofilament subunit may be useful to accurately predict and monitor MS progression.

The full text of this article can be found in the J Neurol Neurosurg Psychiatry, March 2014.