Glymphatic dysfunction in multiple sclerosis and its association with disease pathology and disability

Area of Science:

• Neuroimaging
• Neurology
• Biomarkers

Background:

• The glymphatic system's role in multiple sclerosis (MS)-related disability is not fully understood.
• Diffusion-tensor image analysis along the perivascular space (DTI-ALPS) is a non-invasive technique to assess glymphatic function.

Purpose of the Study:

• To investigate glymphatic function in MS patients categorized by disability level.
• To evaluate the DTI-ALPS index in relation to clinical and imaging markers of MS.

Main Methods:

• 118 MS patients were divided into lower (MS-L) and higher (MS-H) disability groups.
• Structural and diffusion-weighted imaging were performed to measure brain parenchymal fraction (BPF), lesion load (LL), and DTI-ALPS index.
• Logistic regression analyzed the predictive value of BPF, LL, and DTI-ALPS index for disability subgroups.

Main Results:

• A significantly lower DTI-ALPS index was observed in the MS-H group compared to the MS-L group.
• The DTI-ALPS index correlated negatively with disease duration and EDSS scores, and with BPF, while positively with LL.
• DTI-ALPS index and LL were significant predictors of disability subgroup.

Conclusions:

• The DTI-ALPS index serves as a potential imaging biomarker for MS disability.
• Glymphatic system impairment is implicated in MS pathology and may contribute to disease-related disability.
• Further research is warranted to fully elucidate the glymphatic system's role in MS progression.