Multiple sclerosis RRMS Role of antibodies and MRIs for monitoring

Monitoring the response to Disease Modifying Therapies in Relapsing Remitting MS involves periodic MRIs to assess lesion progression and brain atrophy, and testing for specific autoantibodies like AQP4 and MOG-IgG. MRI is crucial for tracking new lesions and atrophy, while autoantibodies indicate specific disease aspects. Oligoclonal bands and CHI3L1 levels in CSF also provide prognostic information.

2024-01-06 05:55:09 - Editor

Monitoring Disease Modifying Therapy in RRMS

The response to disease modifying therapy (DMT) can be monitored by periodic magnetic resonance imaging (MRI), and autoantibodies. (1, 2, 3).

Role of MRI in Monitoring RRMS:

MRI and Disease Activity

MRI plays the main role to monitor disease activity in RRMS. MRI monitor for T2-hyperintense lesions, T1- hypointesnse lesions and brain atrophy. A higher T2-hyperintense lesion volume is associated with increased short term disability and increased Expanded Disability Status Scale (EDSS) at the long term as per clinical trial results. (4, 5) Also, T1-hypointense lesions (black holes) are hypointensities persistent for 6 months after the initial enhancement. Chronic T1-hypointense lesions are closely linked to neurodegeneration and are known to correlate with disability in patients with RRMS. (6)

Brain Atrophy and Disease Progression

Also, MRI is very effective to show brain atrophy which has the strongest correlation with clinical disease progression and increased atrophy over time could predict worsening cognitive and ambulatory function. Also, regional brain atrophy especially thalamic volume loss is linked to disease progression. (7, 8)

RI Scheduling

Periodic MRI studies during the course of therapy are important to monitor the development of new asymptomatic lesions and development of side effects. It is suggested to repeat MRI at 6months from starting DMT, then annually thereafter. If a patient presents with new clinical symptoms, MRI should be obtained to determine the extent of disease activity. The presence of new activities on MRI is an important marker and can be interpreted as a suboptimal response to DMT which requires a change of treatment. (9)

Role of Antibodies in Monitoring RRMS

The following autoantibodies are effective to monitor RRMS. They include aquaporin-4 (AQP4) IgG serum autoantibody and the myelin oligodendrocyte glycoprotein IgG autoantibody (MOG-IgG). The AQP4 antibody is a specific biomarker for neuromyelitis optica spectrum disorder (NMOSD). It is high in patients with bilateral optic neuritis, involving the optic chiasm or patients with a complete spinal cord syndrome with paroxysmal tonic spasms. They should be tested for AQP4 antibody. The MOG-IgG antibody is a marker of MOG-associated encephalomyelitis (MOG-EM). Patients who present with relapsing and bilateral optic neuritis, transverse myelitis, brainstem encephalitis, and acute disseminated encephalomyelitis (ADEM) have high MOG-IgG. (10, 11) Oligoclonal bands: The detection of oligoclonal IgG bands in CSF is associated with a conversion from clinically isolated syndrome (CIS) to MS and can therefore determine MS prognosis. Also, a high level of oligoclonal bands increased the risk of disability in the course of the disease. (12) Chitinase-3-like-1: The protein chitinase-3-like-1 (CHI3L1) is a glycosidase secreted by monocytes, microglia and activated astrocytes. High CHI3L1 levels are associated with disability progression. (13) Neutralizing antibodies against natalizumab: Neutralizing antibodies can be formed during therapy with natalizumab. The neutralizing antibodies lower the serum level of natalizumab and, their continuous presence is associated with a reduced efficacy of the therapy. (14) Neutralizing antibodies against interferon beta: They include neutralizing antibodies (NAbs) and myxovirus resistance protein A (MxA). The presence of such antibodies in patients treated with interferon beta can limit their effectiveness. (15)

References

More Posts