Blood Test Predicts Multiple Sclerosis Worsening up to Two Years in Advance

A recent research investigation has unveiled a compelling discovery in the field of multiple sclerosis (MS). The study reveals that elevated levels of a biomarker known as NfL (Neurofilament Light Chain) in the blood of MS patients can serve as an early predictor of worsening disability, with a lead time of one to two years. This groundbreaking finding, derived from a meticulous analysis of extensive data, underscores the potential of NfL as a valuable indicator for assessing the progression of MS and highlights the critical importance of timely intervention.

The study, conducted by a team of researchers at UC San Francisco, is noteworthy for its ability to quantify the period preceding the deterioration of disability in MS patients, during which damage to the central nervous system occurs. Dr. Ahmed Abdelhak, a co-first author affiliated with the UCSF Department of Neurology and the Weill Institute for Neurosciences, emphasized the novelty of this approach.

Multiple sclerosis affects nearly one million Americans, often leading to limited mobility and a range of distressing symptoms, including spasticity, weakness, poor coordination, and incontinence in advanced cases. However, recent advances have suggested the possibility of delaying or even preventing more severe symptoms.

The rise in NfL levels up to two years before the onset of disability worsening represents a critical window for potential interventions, as elucidated by Dr. Abdelhak. In this comprehensive study, published in the journal JAMA Neurology and co-led by researchers from the University Hospital and University of Basel in Switzerland, the investigators examined disability worsening, categorized into two forms: disability worsening with relapse, characterized by residual or recurring symptoms following a relapse, and gradual progression of symptoms without relapse.

To gather data, the researchers tracked information spanning a decade, comprising approximately 4,000 patient visits to UCSF (EPIC study) and around 9,000 patient visits to various sites in Switzerland (SMSC study). These two studies collectively included almost 1,900 patients, among whom 570 individuals exhibited worsening disability, with the majority experiencing a decline independent of relapses.

The research findings demonstrated a compelling association between elevated NfL levels and a significantly higher risk of disability worsening. Specifically, patients with increased NfL levels faced up to a 91% greater risk of worsening disability with relapse approximately one year later and up to a 49% higher risk of worsening disability without relapse nearly two years later.

Dr. Ari Green, the co-senior author and medical director of the UCSF Multiple Sclerosis and Neuroinflammation Center, noted that the distinct pattern of NfL elevation in disability worsening without relapse suggests a more extended process that gradually decreases in intensity before culminating in increased impairment. This aligns with the understanding that nerve cell degeneration is a gradual process leading to permanent disability, indicating that interventions aimed at protecting nerve cells might have the potential to halt disability progression.

Furthermore, Dr. Jens Kuhle, another co-senior author who led the Swiss cohort and heads the Multiple Sclerosis Center at University Hospital and University of Basel, Switzerland, highlighted the role of NfL as an early marker of nerve damage. Monitoring NfL levels may offer a higher sensitivity in detecting disease activity compared to clinical examinations or conventional imaging techniques.

Future investigations will delve into therapeutic approaches aimed at halting disease progression during the period of elevated NfL levels. This research was supported by funding from various foundations and organizations, including Westridge Foundation Grants from F. Hoffmann-La Roche, the Fishman Family, the Swiss National Research Foundation, the NIH/NINDS, and the Valhalla Foundation. Additionally, the UCSF MS biorepository received support from the National MS Society.

Frequently Asked Questions (FAQs) about MS Disability Prediction

More about MS Disability Prediction

• JAMA Neurology Study
• UCSF Department of Neurology
• Weill Institute for Neurosciences
• University Hospital and University of Basel, Switzerland
• National MS Society
• F. Hoffmann-La Roche
• Swiss National Research Foundation
• NIH/NINDS
• Valhalla Foundation