A Blood Test Shows MS Worsening 1 To 2 Years Before It Happens

According to a new study ,MS patients with elevated NfL, a biomarker of nerve damage could see worsening disability one to two years later
This rising of NfL up to two years before signs of disability worsening in MS(Reprsentational image:Unsplash)
This rising of NfL up to two years before signs of disability worsening in MS(Reprsentational image:Unsplash)

Multiple sclerosis patients whose blood tests reveal elevated NfL, a biomarker of nerve damage, could see worsening disability one to two years later, according to a new study spearheaded by researchers at UC San Francisco.  
 
The study is the first to quantify the timeframe preceding disability worsening in which injury to the central nervous system takes place, said co-first author Ahmed Abdelhak, MD, of the UCSF Department of Neurology and the Weill Institute for Neurosciences. 
 
Almost 1 million Americans suffer from MS. In advanced cases, patients may have limited mobility and experience spasticity, weakness, poor coordination and incontinence. However, recent advances suggest that more severe symptoms can be substantially delayed or even averted. 

This rising of NfL up to two years before signs of disability worsening in MS(Reprsentational image:Unsplash)
Different Pain Types In Multiple Sclerosis Can Cause Difficulty Staying Active


 
“This rising of NfL up to two years before signs of disability worsening, represents the window when interventions may prevent worsening,” said Abdelhak.  
 
In the study, publishing in JAMA Neurology on Nov. 6, 2023, and co-led by University Hospital and University of Basel, in Switzerland, the researchers looked at the incidence of disability worsening, defined as six months or more of increased impairment reflected in a higher score on the Expanded Disability Status Scale. They distinguished between disability worsening with relapse, which involves residual symptoms or the return of old ones following relapse, and gradual progression of symptoms without relapse.  
 
91% at elevated risk of developing disability worsening 

This rising of NfL up to two years before signs of disability worsening in MS(Reprsentational image:Unsplash)
Oral Medication Is the Leading Choice for Multiple Sclerosis Treatment


 
The researchers tracked data spanning a 10-year period from approximately 4,000 patient visits to UCSF, comprising the EPIC study, and from approximately 9,000 patient visits to multiple sites in Switzerland, comprising the SMSC study. Together, the two studies included almost 1,900 patients. Among those, 570 patients were identified with disability that continued to worsen, of which the majority were independent of relapses. 
 
Elevated NfL levels were associated with up to a 91% higher risk of worsening disability with relapse approximately a year later, and up to a 49% higher risk of worsening disability without relapse nearly two years later, the researchers found.  

This rising of NfL up to two years before signs of disability worsening in MS(Reprsentational image:Unsplash)
Poor Gut Health May Drive Multiple Sclerosis


 
“We think that NfL elevation occurs earlier in disability worsening without relapse,” said Abdelhak.

A more prolonged process that decreases in intensity in advance of increased impairment.This aligns with recognition that death of nerve cells is a slow process that builds toward permanent disability and means that interventions to protect nerve cells might have time to also stop disability.
Ari Green, MD, Medical director, UCSF Multiple Sclerosis and Neuroinflammation Center
Death of nerve cells is a slow process that builds toward permanent disability and means that interventions to protect nerve cells might have time to also stop disability (Reprsentational image: Unsplash)
Death of nerve cells is a slow process that builds toward permanent disability and means that interventions to protect nerve cells might have time to also stop disability (Reprsentational image: Unsplash)
In addition to the groundbreaking findings on the temporal relationship between NfL increases and gradual disease progression in MS, the study supports the important role of NfL as an early marker of nerve damage.
Jens Kuhle, MD, PhD, Head of the Multiple Sclerosis Center, University Hospital and University of Basel, Switzerland

“Monitoring NfL levels might be able to detect disease activity with higher sensitivity than clinical exam or conventional imaging,” he said.  
 
Future investigation will look into therapies that can stop progression during this period of elevated NfL.  

This rising of NfL up to two years before signs of disability worsening in MS(Reprsentational image:Unsplash)
National registry of multiple sclerosis launched - ICMR

Authors: Co-first author is Pascal Benkert, PhD, of University Hospital and University of Basel, Switzerland. Co-senior author is Jens Kuhle, MD, PhD, also of University Hospital and University of Basel, Switzerland. For other authors, please see the study. 

Funding: Westridge Foundation Grants from F. Hoffmann-La Roche, Fishman Family, grant 320030-160221 from the Swiss National Research Foundation, grant R35NS111644 from the NIH/NINDS, the Valhalla Foundation. The UCSF MS biorepository is supported by grant Si-2001- 375 35701 from the National MS Society. 

Disclosures: Please see the study.

 About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at https://ucsf.edu, or see our Fact Sheet. (VP/Newswise)

This rising of NfL up to two years before signs of disability worsening in MS(Reprsentational image:Unsplash)
How Are Epstein-Barr Virus and Multiple Sclerosis (MS) Connected?
logo
Medbound
www.medboundtimes.com