1
|
Michetti L, Maffina F, Ravasio R, Barcella V, Radaelli M, Chiudinelli L, Sessa M, Alessio MG. Free light chains as a reliable biomarker of intrathecal synthesis in the diagnosis of CNS inflammatory diseases. J Neuroimmunol 2023; 379:578091. [PMID: 37210840 DOI: 10.1016/j.jneuroim.2023.578091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/20/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To address the diagnostic performances of cerebrospinal fluid (CSF) free light chains (FLC) measurements compared to oligoclonal bands (OCB) to support multiple sclerosis (MS) diagnosis. RESULTS kFLC index showed the highest diagnostic accuracy to detect MS patients with the highest AUC compared to OCB, IgG index, IF kFLC R, kFLC H, λFLC index and IF λFLC. CONCLUSIONS FLC indices are biomarkers of intrathecal Immunoglobulin synthesis and central nervous system (CNS) inflammation. kFLC index can discriminate between MS and other CNS inflammatory disorders, while λFLC index is less informative for MS but can play a role to support the diagnosis of other inflammatory CNS disorders.
Collapse
Affiliation(s)
- Laura Michetti
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy.
| | - Francesca Maffina
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Rudi Ravasio
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Valeria Barcella
- Department of Neurology and Multiple Sclerosis Center, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | | | - Maria Sessa
- Department of Neurology and Multiple Sclerosis Center, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Maria Grazia Alessio
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| |
Collapse
|
2
|
Kolčava J, Pelíšek O, Vlčková E. Predictive factors of multiple sclerosis relapse after the first demyelinating event: A 5-year follow-up. Mult Scler Relat Disord 2023; 71:104566. [PMID: 36805172 DOI: 10.1016/j.msard.2023.104566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023]
Abstract
There is a growing need to discover the characteristics that predict prognostic factors after the first demyelinating event. In this study of 141 patients that met the 2017 McDonald criteria, a higher number of oligoclonal bands, cervical spinal cord demyelinating lesions, and sensory involvement were identified as independent predictors of the second demyelinating event during the 5-year follow-up period in patients who experienced the first demyelinating event. The identification of the aforementioned risk variables will make it possible to identify patients who are more likely to exhibit early second demyelinating event, implying more frequent monitoring and consideration of early application of highly effective disease-modifying treatment.
Collapse
Affiliation(s)
- Jan Kolčava
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, University Hospital Brno, Czech Republic
| | - Ondřej Pelíšek
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eva Vlčková
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, University Hospital Brno, Czech Republic.
| |
Collapse
|
3
|
Hegen H, Arrambide G, Gnanapavan S, Kaplan B, Khalil M, Saadeh R, Teunissen C, Tumani H, Villar LM, Willrich MAV, Zetterberg H, Deisenhammer F. Cerebrospinal fluid kappa free light chains for the diagnosis of multiple sclerosis: A consensus statement. Mult Scler 2023; 29:182-195. [PMID: 36527368 PMCID: PMC9925908 DOI: 10.1177/13524585221134217] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cerebrospinal fluid (CSF) analysis is of utmost importance for diagnosis and differential diagnosis of patients with suspected multiple sclerosis (MS). Evidence of intrathecal immunoglobulin G (IgG) synthesis proves the inflammatory nature of the disease, increases diagnostic certainty and substitutes for dissemination in time according to current diagnostic criteria. The gold standard to determine intrathecal IgG synthesis is the detection of CSF-restricted oligoclonal bands (OCBs). However, advances in laboratory methods brought up κ-free light chains (FLCs) as a new biomarker, which are produced in excess over intact immunoglobulins and accumulate in CSF in the case of central nervous system-derived inflammation. Overwhelming evidence showed a high diagnostic accuracy of intrathecal κ-FLC synthesis in MS with sensitivity and specificity of approximately 90% similar to OCB. κ-FLCs have advantages as its detection is fast, easy, cost-effective, reliable, rater-independent and returning quantitative results which might also improve the value of predicting MS disease activity. An international panel of experts in MS and CSF diagnostics developed a consensus of all participants. Six recommendations are given for establishing standard CSF evaluation in patients suspected of having MS. The panel recommended to include intrathecal κ-FLC synthesis in the next revision of MS diagnostic criteria as an additional tool to measure intrathecal immunoglobulin synthesis.
Collapse
Affiliation(s)
- Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sharmilee Gnanapavan
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Batia Kaplan
- Laboratory of Hematology, Sheba Medical Center, Ramat Gan, Israel
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Ruba Saadeh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA/Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Charlotte Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Program Neuroinflammation, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Hayrettin Tumani
- CSF Laboratory, Department of Neurology, University of Ulm, Ulm, Germany
| | - Luisa Maria Villar
- Biostatistics Unit, Department of Immunology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden/Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden/Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK/UK Dementia Research Institute at UCL, London, UK/Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | | |
Collapse
|
4
|
Petržalka M, Meluzínová E, Libertínová J, Mojžišová H, Hanzalová J, Ročková P, Elišák M, Kmetonyová S, Šanda J, Sobek O, Marusič P. IL-2, IL-6 and chitinase 3-like 2 might predict early relapse activity in multiple sclerosis. PLoS One 2022; 17:e0270607. [PMID: 35759479 PMCID: PMC9236235 DOI: 10.1371/journal.pone.0270607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Abstract
Background The possibility to better predict the severity of the disease in a patient newly diagnosed with multiple sclerosis would allow the treatment strategy to be personalized and lead to better clinical outcomes. Prognostic biomarkers are highly needed. Objective To assess the prognostic value of intrathecal IgM synthesis, cerebrospinal fluid and serum IL-2, IL-6, IL-10, chitinase 3-like 2 and neurofilament heavy chains obtained early after the onset of the disease. Methods 58 patients after the first manifestation of multiple sclerosis were included. After the initial diagnostic assessment including serum and cerebrospinal fluid biomarkers, all patients initiated therapy with either glatiramer acetate, teriflunomide, or interferon beta. To assess the evolution of the disease, we followed the patients clinically and with MRI for two years. Results The IL-2:IL-6 ratio (both in cerebrospinal fluid) <0.48 (p = 0.0028), IL-2 in cerebrospinal fluid ≥1.23pg/ml (p = 0.026), and chitinase 3-like 2 in cerebrospinal fluid ≥7900pg/ml (p = 0.033), as well as baseline EDSS ≥1.5 (p = 0.0481) and age <22 (p = 0.0312), proved to be independent markers associated with shorter relapse free intervals. Conclusion The IL-2:IL-6 ratio, IL-2, and chitinase 3-like 2 (all in cerebrospinal fluid) might be of value as prognostic biomarkers in early phases of multiple sclerosis.
Collapse
Affiliation(s)
- Marko Petržalka
- Second Faculty of Medicine, Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
- * E-mail:
| | - Eva Meluzínová
- Second Faculty of Medicine, Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jana Libertínová
- Second Faculty of Medicine, Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Hana Mojžišová
- Second Faculty of Medicine, Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jitka Hanzalová
- Second Faculty of Medicine, Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
- Second Faculty of Medicine, Department of Immunology, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petra Ročková
- Second Faculty of Medicine, Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Elišák
- Second Faculty of Medicine, Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Silvia Kmetonyová
- Second Faculty of Medicine, Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jan Šanda
- Second Faculty of Medicine, Department of Radiology, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Ondřej Sobek
- Topelex sro, Laboratory for CSF, Neuroimmunology, Pathology and Special Diagnostics, Prague, Czech Republic
| | - Petr Marusič
- Second Faculty of Medicine, Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
| |
Collapse
|
5
|
Holmes RD, Vavasour IM, Greenfield J, Zhao G, Lee JS, Moore GRW, Tam R, Metz LM, Trablousee A, Li DKB, Laule C. Nonlesional diffusely abnormal appearing white matter in clinically isolated syndrome: Prevalence, association with clinical and MRI features, and risk for conversion to multiple sclerosis. J Neuroimaging 2021; 31:981-994. [PMID: 34128576 DOI: 10.1111/jon.12900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE While diffusely abnormal white matter (DAWM) is a nonlesional MRI abnormality identified in ∼25% of patients with multiple sclerosis (MS), it has yet to be investigated in patients at an earlier disease stage, namely clinically isolated syndrome (CIS). The goals of this study were to (1) determine the prevalence of DAWM in patients with a CIS suggestive of MS, (2) evaluate the association between DAWM and demographic, clinical, and MRI features, and (3) evaluate the prognostic significance of DAWM on conversion from CIS to MS. METHODS One hundred and forty-two CIS participants were categorized into DAWM and non-DAWM groups at baseline and followed for up to 24 months or until MS diagnosis. The primary outcome was conversion to MS (2005 McDonald criteria) within 6 months. RESULTS DAWM was present in 27.5% of participants, and was positively associated with brainstem symptom onset, receiving corticosteroids, dissemination in space, and T2 lesion volume. DAWM was associated with an increased risk of conversion to MS over 6 months after adjustment for age and disability (hazard ratio [HR] = 2.24, p = 0.004). This association remained at a trend-level after adjustment for high-risk imaging features (HR = 1.68, p = 0.10). CONCLUSIONS DAWM is present in a similar proportion of patients with CIS and clinically definite MS, and it is associated with increased risk of conversion to MS over 6 months.
Collapse
Affiliation(s)
- R Davis Holmes
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Irene M Vavasour
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamie Greenfield
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guojun Zhao
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jimmy S Lee
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G R Wayne Moore
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luanne M Metz
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anthony Trablousee
- UBC MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelia Laule
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
6
|
Berek K, Bsteh G, Auer M, Di Pauli F, Grams A, Milosavljevic D, Poskaite P, Schnabl C, Wurth S, Zinganell A, Berger T, Walde J, Deisenhammer F, Hegen H. Kappa-Free Light Chains in CSF Predict Early Multiple Sclerosis Disease Activity. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/4/e1005. [PMID: 34049994 PMCID: PMC8168046 DOI: 10.1212/nxi.0000000000001005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
Objective To investigate whether κ-free light chain (κ-FLC) index predicts multiple sclerosis (MS) disease activity independent of demographics, clinical characteristics, and MRI findings. Methods Patients with early MS who had CSF and serum sampling at disease onset were followed for 4 years. At baseline, age, sex, type of symptoms, corticosteroid treatment, and number of T2 hyperintense (T2L) and contrast-enhancing T1 lesions (CELs) on MRI were determined. During follow-up, the occurrence of a second clinical attack and start of disease-modifying therapy (DMT) were registered. κ-FLCs were measured by nephelometry, and κ-FLC index calculated as [CSF κ-FLC/serum κ-FLC]/albumin quotient. Results A total of 88 patients at a mean age of 33 ± 10 years and female predominance of 68% were included; 38 (43%) patients experienced a second clinical attack during follow-up. In multivariate Cox regression analysis adjusting for age, sex, T2L, CEL, disease and follow-up duration, administration of corticosteroids at baseline and DMT during follow-up revealed that κ-FLC index predicts time to second clinical attack. Patients with κ-FLC index >100 (median value 147) at baseline had a twice as high probability for a second clinical attack within 12 months than patients with low κ-FLC index (median 28); within 24 months, the chance in patients with high κ-FLC index was 4 times as high as in patients with low κ-FLC index. The median time to second attack was 11 months in patients with high κ-FLC index whereas 36 months in those with low κ-FLC index. Conclusion High κ-FLC index predicts early MS disease activity. Classification of Evidence This study provides Class II evidence that in patients with early MS, high κ-FLC index is an independent risk factor for early second clinical attack.
Collapse
Affiliation(s)
- Klaus Berek
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Gabriel Bsteh
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Michael Auer
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Franziska Di Pauli
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Astrid Grams
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Dejan Milosavljevic
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Paulina Poskaite
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Christine Schnabl
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Sebastian Wurth
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Anne Zinganell
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Thomas Berger
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Janette Walde
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Florian Deisenhammer
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria
| | - Harald Hegen
- From the Department of Neurology (K.B., M.A., F.D.P., A.Z., F.D., H.H.), Medical University of Innsbruck; Department of Neurology (G.B., T.B.), Medical University of Vienna; Department of Neuroradiology (A.G., P.P.), Medical University of Innsbruck; FH Campus Wien (D.M., C.S.), University of Applied Sciences, Vienna; Department of Neurology (S.W.), Medical University of Graz; and Department of Statistics (J.W.), Faculty of Economics and Statistics, University of Innsbruck, Austria.
| |
Collapse
|
7
|
Oldoni E, Smets I, Mallants K, Vandebergh M, Van Horebeek L, Poesen K, Dupont P, Dubois B, Goris A. CHIT1 at Diagnosis Reflects Long-Term Multiple Sclerosis Disease Activity. Ann Neurol 2020; 87:633-645. [PMID: 31997416 PMCID: PMC7187166 DOI: 10.1002/ana.25691] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Evidence for a role of microglia in the pathogenesis of multiple sclerosis (MS) is growing. We investigated association of microglial markers at time of diagnostic lumbar puncture (LP) with different aspects of disease activity (relapses, disability, magnetic resonance imaging parameters) up to 6 years later in a cohort of 143 patients. METHODS In cerebrospinal fluid (CSF), we measured 3 macrophage and microglia-related proteins, chitotriosidase (CHIT1), chitinase-3-like protein 1 (CHI3L1 or YKL-40), and soluble triggering receptor expressed on myeloid cells 2 (sTREM2), as well as a marker of neuronal damage, neurofilament light chain (NfL), using enzyme-linked immunosorbent assay and electrochemiluminescence. We investigated the same microglia-related markers in publicly available RNA expression data from postmortem brain tissue. RESULTS CHIT1 levels at diagnostic LP correlated with 2 aspects of long-term disease activity after correction for multiple testing. First, CHIT1 increased with reduced tissue integrity in lesions at a median 3 years later (p = 9.6E-04). Second, CHIT1 reflected disease severity at a median 5 years later (p = 1.2E-04). Together with known clinical covariates, CHIT1 levels explained 12% and 27% of variance in these 2 measures, respectively, and were able to distinguish slow and fast disability progression (area under the curve = 85%). CHIT1 was the best discriminator of chronic active versus chronic inactive lesions and the only marker correlated with NfL (r = 0.3, p = 0.0019). Associations with disease activity were, however, independent of NfL. INTERPRETATION CHIT1 CSF levels measured during the diagnostic LP reflect microglial activation early on in MS and can be considered a valuable prognostic biomarker for future disease activity. ANN NEUROL 2020;87:633-645.
Collapse
Affiliation(s)
- Emanuela Oldoni
- KU Leuven ‐ Department of Neurosciences, Laboratory for NeuroimmunologyLeuvenBelgium
- Leuven Brain Institute, KU LeuvenLeuvenBelgium
| | - Ide Smets
- KU Leuven ‐ Department of Neurosciences, Laboratory for NeuroimmunologyLeuvenBelgium
- Leuven Brain Institute, KU LeuvenLeuvenBelgium
- Department of Neurology, University Hospitals LeuvenLeuvenBelgium
| | - Klara Mallants
- KU Leuven ‐ Department of Neurosciences, Laboratory for NeuroimmunologyLeuvenBelgium
- Leuven Brain Institute, KU LeuvenLeuvenBelgium
| | - Marijne Vandebergh
- KU Leuven ‐ Department of Neurosciences, Laboratory for NeuroimmunologyLeuvenBelgium
- Leuven Brain Institute, KU LeuvenLeuvenBelgium
| | - Lies Van Horebeek
- KU Leuven ‐ Department of Neurosciences, Laboratory for NeuroimmunologyLeuvenBelgium
- Leuven Brain Institute, KU LeuvenLeuvenBelgium
| | - Koen Poesen
- Leuven Brain Institute, KU LeuvenLeuvenBelgium
- KU Leuven ‐ Department of Neurosciences, Laboratory for Molecular Neurobiomarker ResearchLeuvenBelgium
| | - Patrick Dupont
- Leuven Brain Institute, KU LeuvenLeuvenBelgium
- KU Leuven ‐ Department of Neurosciences, Laboratory for Cognitive NeurologyLeuvenBelgium
| | - Bénédicte Dubois
- KU Leuven ‐ Department of Neurosciences, Laboratory for NeuroimmunologyLeuvenBelgium
- Leuven Brain Institute, KU LeuvenLeuvenBelgium
- Department of Neurology, University Hospitals LeuvenLeuvenBelgium
| | - An Goris
- KU Leuven ‐ Department of Neurosciences, Laboratory for NeuroimmunologyLeuvenBelgium
- Leuven Brain Institute, KU LeuvenLeuvenBelgium
| |
Collapse
|
8
|
Rotstein D, Montalban X. Reaching an evidence-based prognosis for personalized treatment of multiple sclerosis. Nat Rev Neurol 2020; 15:287-300. [PMID: 30940920 DOI: 10.1038/s41582-019-0170-8] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Personalized treatment is ideal for multiple sclerosis (MS) owing to the heterogeneity of clinical features, but current knowledge gaps, including validation of biomarkers and treatment algorithms, limit practical implementation. The contemporary approach to personalized MS therapy depends on evidence-based prognostication, an initial treatment choice and evaluation of early treatment responses to identify the need to switch therapy. Prognostication is directed by baseline clinical, environmental and demographic factors, MRI measures and biomarkers that correlate with long-term disability measures. The initial treatment choice should be a shared decision between the patient and physician. In addition to prognosis, this choice must account for patient-related factors, including comorbidities, pregnancy planning, preferences of the patients and their comfort with risk, and drug-related factors, including safety, cost and implications for treatment sequencing. Treatment response has traditionally been assessed on the basis of relapse rate, MRI lesions and disability progression. Larger longitudinal data sets have enabled development of composite outcome measures and more stringent standards for disease control. Biomarkers, including neurofilament light chain, have potential as early surrogate markers of prognosis and treatment response but require further validation. Overall, attainment of personalized treatment for MS is complex but will be refined as new data become available.
Collapse
Affiliation(s)
- Dalia Rotstein
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Xavier Montalban
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. .,Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| |
Collapse
|
9
|
Abstract
Multiple sclerosis (MS) is a heterogeneous disease. With several disease modifying treatments of different mechanisms of action in use now and in development, it is important to identify reliable biomarkers to identify those higher risk MS patients in whom stronger but riskier treatments might be used, as well as to identify those for whom safer treatments of lower efficacy would be sufficient. Here we review cerebrospinal fluid (CSF) and blood biomarkers that show promise for differentiating people with MS who are at risk for severe disease and disability from those with more benign disease. We reviewed published literature for studies reporting biomarkers with predictive value in MS. Most studies of MS CSF found the presence of oligoclonal bands (both IgG and IgM), high IgG index and high levels of kappa light chains to each be associated with worse prognosis. Neurofilament light chain (NfL) and two markers of glial activation, glial fibrillary acidic protein (GFAP) and YKL-40, were higher in CSF of people with subsequent clinical progression or imaging evidence for neurodegeneration. Few reports have been made yet on the prognostic significance of blood NfL, but in one early report baseline, serum NfL (sNfL) predicted subsequent brain volume loss.
Collapse
Affiliation(s)
- Roberta Magliozzi
- Department of Neurosciences, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Anne H Cross
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| |
Collapse
|
10
|
Comini-Frota ER, Marques BCC, Torres C, Cohen KMS, Miranda EC. Nine-year follow up after hematopoietic stem cell transplantation in five multiple sclerosis patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:531-535. [PMID: 31508677 DOI: 10.1590/0004-282x20190097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 05/14/2019] [Indexed: 11/22/2022]
Abstract
Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system. Its treatment has focused on inflammation control as early as possible to avoid disability. Autologous hematopoietic stem cell transplantation (AHSCT) has been used for treating MS since 1996, with recent decisive results regarding benefits in long-term efficacy. Five patients followed up at an MS center in Belo Horizonte, Brazil, who had relapsing-remitting MS with high disease activity, underwent AHSCT between 2009 and 2011. They were evaluated clinically, with magnetic resonance imaging, and by the EDSS every six months after transplantation, up to July 2018. The patients were four women and one man, with ages ranging from 25-50 years, and time since disease onset ranging from 4-17 years at the time of the procedure. Four patients improved, one patient was stabilized, and all patients were free of disease activity after 5-9 years. Through improving patient selection and decreasing the time from disease onset, AHSCT could stop epitope spreading and disease progression. Despite multiple other therapeutic choices being approved for relapsing-remitting MS, AHSCT continues to be a treatment to consider for aggressive MS disease.
Collapse
Affiliation(s)
| | | | - Caio Torres
- Universidade José do Rosário Vellano, Belo Horizonte, MG, Brasil
| | | | | |
Collapse
|
11
|
Dalla Costa G, Martinelli V, Sangalli F, Moiola L, Colombo B, Radaelli M, Leocani L, Furlan R, Comi G. Prognostic value of serum neurofilaments in patients with clinically isolated syndromes. Neurology 2019; 92:e733-e741. [PMID: 30635483 PMCID: PMC6382362 DOI: 10.1212/wnl.0000000000006902] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 12/14/2018] [Indexed: 01/21/2023] Open
Abstract
Objective To assess the prognostic role of serum neurofilament light chains (NfL) for clinically defined multiple sclerosis (CDMS) and McDonald 2017 multiple sclerosis (MS) in patients with clinically isolated syndromes (CIS). Methods We retrospectively analyzed data of patients admitted to our neurologic department between 2000 and 2015 for a first demyelinating event. We evaluated baseline serum NfL in addition to CSF, MRI, and clinical data. Results Among 222 patients who were enrolled (mean follow-up 100.6 months), 45 patients (20%) developed CDMS and 141 patients (63.5%) developed 2017 MS at 2 years. Serum NfL (median 22.0, interquartile range 11.6–40.4 pg/mL) was noticeably increased in patients with a recent relapse, with a high number of T2 and gadolinium-enhancing lesions at baseline MRI. Serum NfL was prognostic for both CDMS and McDonald 2017 MS, with a threefold and a twofold respective reduction in CDMS and 2017 MS risk in those patients with low and extremely low levels of NfL. The results remained unchanged subsequent to adjustment for such established MS prognostic factors as oligoclonal bands, Gd-enhancing lesions, and a high T2 lesion load at baseline MRI. NfL was associated with disability at baseline but not at follow-up. Conclusions Serum NfL have a prognostic value for CIS patient conversion to MS. NfL might play a twin role as biomarker in MS as peak level measurements can act as a quantitative marker of serious inflammatory activity, while steady-state levels can be a reflection of neurodegenerative and chronic inflammatory processes.
Collapse
Affiliation(s)
- Gloria Dalla Costa
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Vittorio Martinelli
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Francesca Sangalli
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Lucia Moiola
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Bruno Colombo
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Marta Radaelli
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Letizia Leocani
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Roberto Furlan
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy
| | - Giancarlo Comi
- From the Department of Neurology (G.D.C., V.M., F.S., L.M., B.C., M.R., G.C.), Experimental Neurophysiology Research Unit (L.L.), and Neuroimmunology Research Unit (R.F.), San Raffaele Hospital, Milan, Italy.
| |
Collapse
|
12
|
Martinelli V, Dalla Costa G, Messina MJ, Di Maggio G, Sangalli F, Moiola L, Rodegher M, Colombo B, Furlan R, Leocani L, Falini A, Comi G. Multiple biomarkers improve the prediction of multiple sclerosis in clinically isolated syndromes. Acta Neurol Scand 2017; 136:454-461. [PMID: 28393349 DOI: 10.1111/ane.12761] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Since its introduction, MRI had a major impact on the early and more precise diagnosis of multiple sclerosis (MS), and the 2010 diagnostic criteria even allow a diagnosis to be made just after a single attack if stringent MRI criteria are met. Several other clinical and paraclinical markers have been reported to be associated with an increased risk of MS independently of MRI in patients with clinically isolated syndromes (CIS), but the incremental usefulness of adding them to the current criteria has not been evaluated. In this study, we determined whether multiple biomarkers improved the prediction of MS in patients with CIS in a real-world clinical practice. MATERIALS AND METHODS This was a retrospective study involving patients with CIS admitted to our department between 2000 and 2013. We evaluated baseline clinical, MRI, neurophysiological, and cerebrospinal fluid (CSF) data. RESULTS During follow-up (median, 7.2 years), 127 of 243 participants (mean age, 31.6 years) developed MS. Cox proportional-hazards models adjusted for established MRI criteria, age at onset, number of T1 lesions, and presence of CSF oligoclonal bands significantly predicted the risk of developing MS at 2 and 5 years. The use of multiple biomarkers led to 29% net reclassification improvement at 2 years (P<.001) and 30% at 5 years (P<.001). CONCLUSIONS The simultaneous addition of several biomarkers significantly improved the risk stratification for MS in patients with CIS beyond that of a model based only on established MRI criteria.
Collapse
Affiliation(s)
- V. Martinelli
- Department of Neurology; San Raffaele Hospital; Milan Italy
| | - G. Dalla Costa
- Department of Neurology; San Raffaele Hospital; Milan Italy
| | - M. J. Messina
- Department of Neurology; San Donato Hospital; Milan Italy
| | - G. Di Maggio
- Department of Neurology; San Raffaele Hospital; Milan Italy
| | - F. Sangalli
- Department of Neurology; San Raffaele Hospital; Milan Italy
| | - L. Moiola
- Department of Neurology; San Raffaele Hospital; Milan Italy
| | - M. Rodegher
- Department of Neurology; San Donato Hospital; Milan Italy
| | - B. Colombo
- Department of Neurology; San Raffaele Hospital; Milan Italy
| | - R. Furlan
- Institute of Experimental Neurology; San Raffaele Hospital; Milan Italy
| | - L. Leocani
- Institute of Experimental Neurophysiology; San Raffaele Hospital; Milan Italy
| | - A. Falini
- Department of Neuroradiology; San Raffaele Hospital; Milan Italy
| | - G. Comi
- Department of Neurology; San Raffaele Hospital; Milan Italy
| |
Collapse
|
13
|
Free Light Chains and Intrathecal B Cells Activity in Multiple Sclerosis: A Prospective Study and Meta-Analysis. Mult Scler Int 2017; 2016:2303857. [PMID: 28116160 PMCID: PMC5225376 DOI: 10.1155/2016/2303857] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/17/2016] [Accepted: 11/30/2016] [Indexed: 11/20/2022] Open
Abstract
Background. The presence of CSF oligoclonal bands (OBs) is an independent prognostic factor for multiple sclerosis (MS), but the difficulties in the standardization of the test and the interlaboratory variation in reporting have contributed to its limited use in the diagnosis of the disease. Standard nephelometric assays to measure free light chains (FLC) levels have been recently developed and the test may improve the detection of intrathecal B cells activity. Methods. The presence of OBs, kappa and lambda FLC levels, and standard indices of intrathecal inflammation were assessed in 100 consecutive patients, including patients with MS, clinically isolated syndromes (CIS), other inflammatory diseases of the CNS, and other noninflammatory diseases. Results. Both KFLC and LFLC correlated strongly with the presence of OCBs and with all common tests for intrathecal inflammation (p < 0.001 for all comparisons). KFLC and LFLC were significantly different in patients with MS and CIS compared to the other groups (p < 0.001 and p < 0.001, resp.) and had a better diagnostic accuracy than all the other tests (area under the curve 82.3 % for KFLC index and 79.3 % for LFLC index). Conclusion. Nephelometric assays for KFLC in CSF reliably detect intrathecal immunoglobulin synthesis and discriminate MS patients.
Collapse
|
14
|
Gastaldi M, Zardini E, Franciotta D. An update on the use of cerebrospinal fluid analysis as a diagnostic tool in multiple sclerosis. Expert Rev Mol Diagn 2016; 17:31-46. [DOI: 10.1080/14737159.2017.1262260] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Matteo Gastaldi
- Laboratory of Neuroimmunology, and Dept. of General Neurology, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Elisabetta Zardini
- Laboratory of Neuroimmunology, and Dept. of General Neurology, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Diego Franciotta
- Laboratory of Neuroimmunology, and Dept. of General Neurology, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| |
Collapse
|
15
|
Puthenparampil M, Miante S, Federle L, Zanetta C, Toffanin E, Ruggero S, Rinaldi F, Gallo P. BAFF is decreased in the cerebrospinal fluid of multiple sclerosis at clinical onset. J Neuroimmunol 2016; 297:63-7. [DOI: 10.1016/j.jneuroim.2016.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/06/2016] [Accepted: 05/11/2016] [Indexed: 12/24/2022]
|