Sept 28, 2015
Biomarkers are needed in multiple sclerosis (MS) to help with early diagnosis, estimate prognosis, and monitor treatment response, and a few candidates look promising, researchers reported.
In a review of the literature, new B-cell-associated blood biomarkers may be useful for predicting conversion to MS, and new markers of axonal damage may help with prognosis, according to Charlotte Teunissen, PhD, of VU University Medical Center in Amsterdam, and colleagues. They reported their findings in Nature Reviews Neurology..
There's still a tremendous need for biomarkers of treatment response and predicting adverse events, especially with the rise of disease-modifying therapies, they added.
Researchers have long been investigating biomarkers for MS in blood and cerebrospinal fluid (CSF). It started with the discovery of CSF-specific IgG oligoclonal bands (OCBs), which turned out to be sensitive diagnostic markers of MS. The search for additional body fluid markers grew from there, the researchers said.
The need for those markers is growing with the increasing recognition of greater heterogeneity of the disease, as well as the rise of pharmaceuticals that would be well served by ways to monitor treatment response and predict adverse effects.
For their paper, Teunissen and colleagues focused on body fluid markers -- they did not review genetic markers -- that have been assessed in recent studies, from 2012 to 2015, and validated in at least two independent cohorts.
For early diagnosis, researchers are trying to predict who will convert from clinically isolated syndrome (CIS) to MS, and several new B-cell-associated candidate blood biomarkers have emerged.
Studies have suggested that B-cell attracting CDC motif chemokine 13 (CXCL13) mRNA has high potential as a prognostic biomarker for CIS conversion to MS -- although its lack of specificity impedes its use as a diagnostic marker for MS. Similarly, Chitinase-3-like protein 1 (CHI3L1) has been shown to be a prognostic marker of conversion, but it needs further replication as a marker for MS, the researchers said.
Since IgG OCBs are a well-established independent prognostic factor for conversion from CIS to MS, IgM OCBs have become a promising prognostic marker for conversion. Other humoral immunity markers being investigated include IgG directed against neurotropic viruses and immunoglobulin free light chains.