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Toward Precision Phenotyping of Multiple Sclerosis.
David Pitt1, Chih Hung Lo2, Susan A Gauthier2
1From the Yale University (David Pitt, C.H.L., E.L., M.M., M.R.L.), New Haven; Nanyang Technological University (C.H.L.), Singapore; Weill Cornell Medicine (S.A.G.), New York; Memorial Sloan Kettering Cancer Center (R.A.H.), New York; University of Turku (L.M.A.), Finland; University of Michigan Medical School (Y.M.-D.), Ann Arbor; Columbia University Medical Center (C.R., P.L.D.J., S.W.), New York; The Boster Center for Multiple Sclerosis (A.B.), Columbus, OH; Cerneris Inc (I.T.), Wilmington, DE; Vanderbilt University Medical Center (F.B.), Nashville, TN; University of Texas Southwestern Medical Center (O.S.), Dallas; NYU Langone Medical Center (I.K.), New York; University of Southern California (Daniel Pelletier), Los Angeles; National and Kapodistrian University of Athens Medical School (P.S.), Greece; Cleveland Clinic Lerner College of Medicine (R.D.), Case Western Reserve University, OH; and University of Toronto and St. Michael's Hospital (M.L.), ON, Canada. david.pitt@yale.edu.
This study proposes an expanded classification for multiple sclerosis (MS) by incorporating key pathological processes. This aims to improve prognostication and personalize care for MS patients.
Area of Science:
- Neurology
- Immunology
Background:
- The current classification of multiple sclerosis (MS) was revised in 2013, including activity qualifiers.
- Distinguishing between active and non-active MS progression is clinically important.
Purpose of the Study:
- To propose an extended framework for conceptualizing MS phenotypes.
- To enhance the precision of MS classification by including underlying pathological processes.
- To guide the development of biomarkers for monitoring MS activity.
Main Methods:
- Review and extension of the existing Lublin classification for MS.
- Conceptual integration of pathological processes like inflammation, degeneration, and remyelination.
Main Results:
- The proposed classification distinguishes MS phenotypes based on distinct pathological drivers.
- Identifies clinically identical MS presentations driven by different pathological combinations.
Conclusions:
- An expanded MS classification incorporating chronic perilesional inflammation, neuroaxonal degeneration, and remyelination is proposed.
- This framework will improve MS prognostication, personalized care, and clinical trial design.
- Facilitates biomarker development for monitoring key pathological axes in MS.
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