Blood levels of GFAP protein may predict disease progression in PPMS

 Risk of disability worsening nearly 3 times greater with high GFAP: Study

The ongoing worsening of disability among people with primary progressive multiple sclerosis (PPMS) may be predicted by elevated blood levels of the GFAP protein, a marker of damage to star-shaped support cells in the brain and spinal cord called astrocytes, a study suggests.

The risk of disability progression was nearly three times higher in PPMS patients with high GFAP levels, the data showed. Moreover, it increased to four times higher among patients who also had low levels of neurofilament light chain (NfL), a marker for nerve cell damage.

These findings suggest that testing both GFAP and NfL may help identify PPMS patients with less active disease and a particularly high progression risk, according to the researchers.

The team noted that “insufficient tools to evaluate the disease course are some of the critical limitations” of caring for those with progressive MS at this time.

The study, “Serum glial fibrillary acidic protein and disability progression in progressive multiple sclerosis,” was published in the Annals of Clinical and Translational Neurology.

Predicting progression a ‘significant unmet need’ in PPMS

MS is a chronic neurological disorder that affects the brain and spinal cord, marked by specific areas of damage, known as lesions, that can be seen on imaging scans. Such lesions disrupt the normal function of nerve impulses, resulting in a wide range of MS symptoms.

The majority of patients are initially diagnosed with relapsing-remitting MS (RRMS), in which periods of acute symptom worsening, called relapses, are interspersed with periods when symptoms ease or go away, or remission. These patients can then transition into a progressive form of the disease called secondary progressive MS (SPMS), in which the disease steadily worsens even in the absence of relapses.

In the alternate, about 1 in 10 patients will first be diagnosed with PPMS, characterized by a constant worsening of symptoms from disease onset, with or without relapses.

According to the researchers, based at the University Hospital of Ulm, in Germany, “progression prediction is a significant unmet need in people with progressive multiple sclerosis.”

EmBioProMS is an ongoing multicenter observational study in Germany that aims to define the association between novel blood biomarkers and disease progression in a well-characterized group of SPMS or PPMS patients.

As part of it, GFAP and NfL levels in blood samples were measured at least once for 243 participants, of whom 108 were diagnosed with SPMS and 135 with PPMS.

GFAP provides structure to astrocytes, cells that support nerve cell function, while NfL supports the structure of nerve fibers. With damage, these proteins are released from cells and can be detected at higher than normal levels in the blood and other body fluids.

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