6 February 2023

Biomarkers for the personalised and early detection of a possible progression of multiple sclerosis are setting new standards for the treatment of affected patients. Jens Kuhle's research group is providing further groundbreaking insights in this field.

In their latest study, published in the journal JAMA Neurology, the researchers show that blood levels of glial fibrillary acidic protein (GFAP) have great potential as a prognostic biomarker for the progression of multiple sclerosis (MS). GFAP is a cytoskeletal protein that is primarily specific for astrocytes. This cell type makes up the majority of glial cells in the central nervous system. It plays a major role in neurodegenerative processes and thus in the progressive disability faced by the majority of MS sufferers. Blood levels of GFAP increase as a result of astrocyte activation or when their breakdown is increased. The results of this new study suggest, that elevated GFAP blood levels indicate existing disease progression and are also associated with future disease progression. In return, GFAP blood levels are little affected by the extent of acute inflammatory processes.

The use of biomarkers is changing clinical practice

With the establishment of the biomarker "neurofilament light chain (NfL)" as a standardised and easily measurable marker for neuronal damage in blood, better conditions for more precise and personalised therapy decisions have been set only recently. Work from Jens Kuhle's research group, published last March in the journal The Lancet Neurology, showed that a proportion of MS sufferers with an apparently stable disease course had high NfL blood levels. These individuals were significantly more likely to also develop increased clinical and imaging disease activity in the following year. Thus, because NfL early and sensitively predicts disease activity, these patients can now be treated in a more targeted and predictive manner.

Increasing understanding of disease mechanisms

GFAP as a blood marker in MS is of great interest to the researchers because, compared to NfL, it allows us to look into a different aspect of the complex pathophysiology of MS: While elevated NfL blood levels indicate neuronal damage, the new biomarker GFAP specifically indicates chronic disease processes in which astrocytes play the main role and which lead to progressive disability. GFAP and NfL thus complement each other in their potential to make patient management in MS more individualised and predictive. Such results of biomarker research bring both the possibilities in therapy monitoring and prognosis as well as the research in this field a big step forward.

The data basis

The Swiss MS Cohort, which has been initiated and managed from Basel since 2012, provides unique conditions for such biomarker research, also in an international cross-comparison. SMSC is the basis for one of the internationally most complete databases for clinical research on MS and includes data from over 1'600 patients from 8 Swiss centers. It documents information from over 13'000 visits and nearly 1'000 relapses and includes about 8'000 standardised and evaluated MRI examinations.