RT Journal Article
SR Electronic
T1 Intrathecal B-cell accumulation and axonal damage distinguish MRI-based benign from aggressive onset in MS
JF Neurology - Neuroimmunology Neuroinflammation
JO Neurol Neuroimmunol Neuroinflamm
FD Lippincott Williams & Wilkins
SP e595
DO 10.1212/NXI.0000000000000595
VO 6
IS 5
A1 Sinah Engel
A1 Michaela Friedrich
A1 Muthuraman Muthuraman
A1 Falk Steffen
A1 Alicia Poplawski
A1 Sergiu Groppa
A1 Stefan Bittner
A1 Frauke Zipp
A1 Felix Luessi
YR 2019
UL http://nn.neurology.org/content/6/5/e595.abstract
AB Objective We explored the incremental value of adding multiple disease activity biomarkers in CSF and serum for distinguishing MRI-based benign from aggressive MS in early disease course.Methods Ninety-three patients diagnosed with clinically isolated syndrome (CIS) or early MS were divided into 3 nonoverlapping severity groups defined by objective MRI criteria. Ninety-seven patients with noninflammatory neurologic disorders and 48 patients with other inflammatory neurologic diseases served as controls. Leukocyte subsets in the CSF were analyzed by flow cytometry. CSF neurofilament light chain (NfL) and chitinase-3-like protein 1 (CHI3L1) levels were measured by ELISA. Serum NfL levels were examined using single molecule array technology.Results CSF CD20+/CD14+ ratios and NfL levels in CSF and serum were significantly different between high and low MRI severity groups, whereas no difference was found for CSF CHI3L1 levels. NfL levels in CSF and serum highly correlated. Receiver operating characteristic analysis demonstrated that the cumulative sums combining CSF CD20+/CD14+ ratios and NfL levels in serum or CSF considerably improved diagnostic accuracy. A composite score built from these 2 cumulative sums best distinguished MRI severity. These findings were validated by support vector machine analysis, which confirmed that the accuracy of the cumulative sums and composite score outperforms single biomarkers.Conclusion Patients with extreme manifestations of CIS or early MS defined by strict MRI parameters can be best distinguished by combining markers of intrathecal B-cell accumulation and axonal damage. This could stratify individual treatment decisions toward a more personalized immunotherapy.AUC=area under the curve; CCR6=C-C chemokine receptor type 6; CHI3L1=chitinase-3-like protein 1; CIS=clinically isolated syndrome; FACS=fluorescence-activated cell sorting; NfL=neurofilament light chain; NIND=noninflammatory neurologic disorder; OCB=oligoclonal band; OIND=other inflammatory neurologic diseases; RIS=radiologically isolated syndrome; ROC=receiver operating characteristic; RRMS=relapsing-remitting MS; SiMoA=single molecule array; SVM=support vector machine