2023-05-23 07:50:35
Combination of two new biomarkers optimizes prognosis and therapy of MS
The course of the chronic inflammatory nerve disease multiple sclerosis can be very different. Individualized therapies for MS sufferers require an early and precise prediction of future disease activity. This is made possible by combining different biomarkers, as a study by the neuroimmunologist Harald Hegen at the University Clinic for Neurology shows.
Multiple sclerosis (MS) is a common neurological disease in young adults. Inflammatory changes in the central nervous system (brain and spinal cord) can lead to individually variable symptoms such as paralysis, sensitivity deficits, visual disturbances, balance problems, walking disabilities and cognitive impairments. Typically, these symptoms appear in the form of so-called flare-ups. Ultimately, there is a risk of suffering a permanent disability at a young age.
Early prognosis enables personalized therapy
“When the next flare-up occurs varies greatly between the affected patients and ranges from several flare-ups per year to phases that have been stable for years,” says neuroimmunologist Harald Hegen from the University Clinic for Neurology (Director: Stefan Kiechl). Advances in the development of disease-modifying therapies in recent years now enable disease flares to be effectively prevented. “These therapies differ not only in their effectiveness, but also in possible side effects and risks. An accurate prediction of future disease activity is of great importance in order to be able to carry out a reasonable benefit/risk assessment before initiating a therapy tailored to the individual patient,” says Hegen.
Harald Hegen, who has been active in research and clinical care with a focus on MS for many years, recently, together with colleagues, was able to detect a protein in the cerebrospinal fluid (Liquor cerebrospinalis) – the so-called κ -free light chains (κ-FLC, kappa free light chains) – identify as biomarkers for predicting early MS activity. The benefit of κ-FLC as a biomarker in MS was confirmed in an international consensus meeting organized by the neuroimmunological working group (leader: Florian Deisenhammer) with the support of ECTRIMS (European Committee for Treatment and Research in MS) in Vienna.
Biomarker combination accurately predicts MS activity
“In addition to the inflammatory marker κ-FLC that we have established, there is another very promising biomarker in MS research, namely serum neurofilament light (sNfL), which is released from nerve cells after neuroxonal damage. For the first time, we have addressed the question of whether the combination of these two biomarkers further improves the predictive power of MS disease activity,” explains Hegen.
In the funded by a grant from the Austrian Multiple Sclerosis Society, carried out in cooperation with the Leopold Franzens University (Department for Statistics: J. Walde) and in the specialist journal eBioMedicine In the published Innsbruck study, 86 patients with early-stage MS were included and followed up for four years. “Our results show that the combination of these two biomarkers allows an even more differentiated risk assessment for future disease activity. In the case of high values for the κ-FLC index as well as the sNfL Z score, there is a 98 percent probability that the next flare-up can be expected within a year; while normal levels of both biomarkers make a relapse unlikely in the next 12 months,” reports Hegen.
With such an accurate prediction of future disease activity, it should be possible to select the individually appropriate therapy from the now wide range of different disease-modifying therapies. “With the prognostic potential of combining both biomarkers, the benefit-risk assessment of the various immunotherapies is made much easier,” emphasizes Hegen. The results of a prospective, multi-centre study led by Innsbruck to confirm these results are eagerly awaited.
(23.05.2023, Text: D. Heidegger, Bild: D. Bullock)
Links:
Kappa free light chain and neurofilament light independently predict early multiple sclerosis disease activity—a cohort study. Harald Hegen et al., eBioMedicine, Published: April 19, 2023, VOLUME 91, 104573, MAY 2023
Cerebrospinal fluid kappa free light chains for the diagnosis of multiple sclerosis: A consensus statement. Harald Hegen et al. Mult Scler. 2023 Feb;29(2):182-195
University Clinic for Neurology
Department of Statistics, Leopold Franzens University
Archive: New biomarker in multiple sclerosis enables early risk assessment and targeted therapy selection
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