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CSF parameters associated with early MRI activity in patients with MS
Ana Klein1, Rebecca C Selter1, Alexander Hapfelmeier1
1Department of Neurology (A.K., R.C.S., A.B., V.P., C.G., M.M., B.H.), Klinikum rechts der Isar, Medical Faculty, Technical University of Munich; Institute of Medical Informatics (A.H.), Statistics and Epidemiology, Medical Faculty, Technical University of Munich; Max Planck Institute of Psychiatry (B.M.-M.), Munich; Department of Neuroradiology (C.Z.), Klinikum rechts der Isar, Medical Faculty, Technical University of Munich; TUM Neuroimaging Center (M.M.), Klinikum rechts der Isar, Medical Faculty, Technical University of Munich; and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany.
Objective:
To identify CSF parameters at diagnosis of clinically isolated syndrome (CIS) and MS that are associated with early inflammatory disease activity as measured by standardized cerebral MRI (cMRI).
Methods:
One hundred forty-nine patients with newly diagnosed CIS and MS were included in the retrospective study. cMRI at onset and after 12 months was analyzed for T2 and gadolinium-enhancing lesions. CSF was tested for oligoclonal bands and intrathecal synthesis of immunoglobulin G (IgG), A (IgA), and M (IgM) before initiation of disease-modifying therapy (DMT). In a subgroup of patients, CSF and serum samples were analyzed for sCD27, neurofilament light chain, and IgG subclasses 1 and 3. Association between CSF parameters and cMRI activity was investigated by univariable and multivariable regression analysis in all patients, DMT-treated patients, and untreated patients.
Results:
IgG index, sCD27 levels in CSF, and to a lesser extent IgM index were associated with the occurrence of new cMRI lesions. IgG index and sCD27 levels in CSF were highly correlated. In a multivariable analysis, IgG index and to a lesser extent IgM index together with DMT treatment status and gender were strongest predictors of future cMRI activity.
Conclusions:
CSF parameters such as IgG and IgM index are independently associated with future MRI activity and thus might be helpful to support early treatment decisions in patients newly diagnosed with CIS and MS.
Insights
Cerebrospinal fluid (CSF) IgG and IgM indices predict future MRI activity in early multiple sclerosis (MS) and clinically isolated syndrome (CIS). These biomarkers can aid early treatment decisions for MS and CIS patients.
Area of Science:
- Neurology
- Immunology
- Radiology
Background:
- Early inflammatory activity in clinically isolated syndrome (CIS) and multiple sclerosis (MS) impacts long-term prognosis.
- Predicting disease progression is crucial for timely therapeutic intervention.
Purpose of the Study:
- To identify cerebrospinal fluid (CSF) parameters associated with early inflammatory disease activity in CIS and MS.
- To correlate CSF biomarkers with cerebral MRI (cMRI) findings at diagnosis and follow-up.
Main Methods:
- Retrospective analysis of 149 newly diagnosed CIS and MS patients.
- cMRI assessment for T2 and gadolinium-enhancing lesions.
- CSF analysis for oligoclonal bands, immunoglobulin G (IgG), A (IgA), and M (IgM) indices, sCD27, neurofilament light chain, and IgG subclasses.
Main Results:
- CSF IgG index, sCD27 levels, and IgM index were associated with new cMRI lesions.
- IgG index and sCD27 showed a high correlation.
- Multivariable analysis identified IgG index, IgM index, DMT status, and gender as predictors of future cMRI activity.
Conclusions:
- CSF IgG and IgM indices are independent predictors of future MRI activity in early MS and CIS.
- These CSF parameters can assist in early treatment decisions for CIS and MS patients.
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