[Evaluation of serum neurofilament light chains levels for diagnosis, treatment monitoring and prognosis in multiple sclerosis]

[Neurofilament light chain: a diagnostic potential for multiple sclerosis]

OBJECTIVE

To evaluate the influence of disease activity, the degree of patient disability and pathogenetic therapy on the concentration of neurofilament light chain (NFL) in the blood serum of patients with multiple sclerosis (MS).

MATERIAL AND METHODS

One hundred and fourteen patients (84 women and 30 men) with definite MS were examined. The concentration of NFL in the blood serum of patients with MS was determined by enzyme immunoassay. The level of NFL was analyzed depending on the characteristics of the course and activity of the demyelinating process, the severity of neurological disorders as well as disease modifying drugs (DMDs).

RESULTS

An NFL level equal to or greater than 4201 pg/ml was found to be associated with a higher risk of developing a clinical exacerbation in the next 4 months. In patients with progression of disability over the next 2 years, the initial concentration of NFL was significantly higher than in the group with a stable EDSS score. The NFL level (4943 pg/ml and higher), which may be a predictor of increased disability in the next two years, was established.

CONCLUSION

The study demonstrates the possibility of using serum NFL levels as a diagnostic marker of possible exacerbation, as well as predicting disability in patients with MS.

[The use of monoclonal antibodies in the treatment of patients with high-active multiple sclerosis in real clinical practice]

OBJECTIVE

To study the efficacy of ocrelizumab (OCR) and natalizumab (NAT) using indicators of activity and progression in patients with highly active multiple sclerosis (HAMS) during the first year of therapy in real clinical practice.

MATERIAL AND METHODS

The study included 110 patients with HAMS and 13 patients with rapidly progressive MS (RPMS), aged 19 to 60 years, who received monoclonal antibody (MAT) therapy for 12 months. Group 1 consisted of 77 patients receiving NAT therapy, group 2 of 46 patients receiving OCR therapy. To assess the efficacy of therapy, we used indicators of the average frequency of exacerbations per year, EDSS estimates, and MRI data.

RESULTS

EDSS score at the time of initiation of MAT therapy was 2.4±1.0 in group 1 and 2.8±1.2 in group 2 (p=0.047); 12 months after the start of MAT therapy, EDSS score in group 1 decreased slightly (p=0.001), in group 2 it has not changed. The frequency of exacerbations per year after the start of MAT therapy was 0.04±0.2 in group 1 and 0.07±0.2 in group 2 (p<0.0001 in both groups). The number of foci accumulating gadolinium detected during the year was 3 in group 1, one in group 2 (p=0.629 between groups). Subgroups of patients who received line 1 DMT (n=22) or NAT (n=21) before the start of OCR therapy were considered separately. In both subgroups, a stable assessment of EDSS was noted, the average annual number of exacerbations did not differ (p=0.117). In patients with RPMS after a year of MAT therapy, EDSS scores were stable, the average annual frequency of exacerbations was 0.08±0.3 per year.

CONCLUSION

The administration of MAT therapy led to a statistically significant decrease in the number of exacerbations and stabilization of neurological deficits during the first year of follow-up. After 12 months of therapy, both groups experienced a dramatic decrease in the average annual number of exacerbations, no increase in disability, and positive dynamics according to MRI results. A similar level of OCR efficacy was found in patients who switched from DMT 1 line therapy and NAT.

Low-Dose Ozone Therapy Improves Sleep Quality in Patients with Insomnia and Coronary Heart Disease by Elevating Serum BDNF and GABA

We studied the effects of low-dose ozone therapy on the sleep quality of patients with coronary heart disease (CHD) and insomnia by measuring the levels of brain-derived neurotrophic factor (BDNF) and GABA in blood serum. The 3-month course of low-dose ozone therapy significantly elevated serum BDNF and GABA in CHD patients with insomnia and improved parameters of anxiety, depression, and sleep quality according to Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and Self-Rating Scale of Sleep (SRSS). Ozone therapy also significantly (p<0.05) improved the total antioxidant status of the body by elevating catalase activity and reducing malondialdehyde and 8-OHdeoxyguanosine in the saliva. The serum levels of BDNF and GABA negatively and closely correlated with PSQI and HADS scores. Low-dose ozone therapy improved sleep quality and reduced PSQI and HADS scores due to up-regulation of BDNF and GABA.