Signs of neuroinflammation outweigh neurodegeneration as predictors for early conversion to MS

Nervana Mohamed El Fayomy,Aya Hamid Alsayyad,Reham Mohamed Shamloul,Manal Mohamed Kamal,Hanan Helmy Mohamed,Enas Hamid Alsayyad

doi:10.1186/s41983-021-00356-7

Nervana Mohamed El Fayomy, Aya Hamid Alsayyad + Show 4 more

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https://doi.org/10.1186/s41983-021-00356-7

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Abstract

BackgroundThe pathophysiological mechanisms underlying multiple sclerosis include both inflammatory and degenerative processes. We aimed to study and compare markers of neuroinflammation and neurodegeneration in patients with first presentation of demyelinating disorder and to prospectively identify which of the studied markers serve as predictors for early conversion to multiple sclerosis. Thus, 42 patients with first clinical manifestations suggestive of demyelinating disease were included in a prospective study. Subjects underwent thorough history taking and clinical evaluation. Laboratory studies involved analysis of cerebrospinal fluid (CSF) and serum chitinase 3-like 1 levels. Brain imaging included MRI and ultrasonographic assessment.ResultsT1 black holes, elevated oligoclonal bands (OCB), high baseline T2 lesion load, and enhanced MRI lesions were significantly higher in patients with 1st attack multiple sclerosis. Significantly higher CSF-OCB and serum chitinase 3-like 1 protein was detected in patients with multiple sclerosis (MS) compared to clinically isolated syndrome, and higher levels in MS convertors than non-convertors. Cognitive dysfunction evaluated by MoCA test and brain atrophy assessed using transcranial sonography did not show significant difference among the studied groups. Logistic regression analysis showed that heavy T2 lesion load served as the only predictor of conversion to MS.ConclusionEarly conversion to MS after first attack of demyelination is related to detection of signs of neuroinflammation rather than neurodegeneration.

Highlights

The pathophysiological mechanisms underlying multiple sclerosis include both inflammatory and degenerative processes
Muller and colleagues [5] found that third ventricular enlargement is associated with increased risk for future multiple sclerosis (MS) relapses while Walter and colleagues [6] reported that hyperechogenicity of basal ganglia (BG) and substantia nigra (SN) due to trace metal accumulation in MS patients is associated with disease progression
We identified forty-two patients presented with first clinical manifestations suggestive of demyelinating disease, twenty-two patients (52.4%) with clinically isolated syndrome (CIS) and twenty patients (47.6%) with first attack of multiple sclerosis (MS)

Summary

Introduction

The pathophysiological mechanisms underlying multiple sclerosis include both inflammatory and degenerative processes. We aimed to study and compare markers of neuroinflammation and neurodegeneration in patients with first presentation of demyelinating disorder and to prospectively identify which of the studied markers serve as predictors for early conversion to multiple sclerosis. Multiple variables including clinical picture, imaging protocols, and other para-clinical tests as CSF studies have been evaluated as prognostic factors [1] all of which addressing either signs of neurodegeneration or inflammation of the disease. Several studies reported that early axonal degeneration and brain atrophy may predict short time for conversion to CDMS [3]. Several markers of inflammation have been studied as predictors for conversion to CDMS; of those, the most significant were the presence of CSF oligoclonal bands [7] and a new biomarker chitinase 3-like 1 (CHI3L1) [8]. Several studies reported that it may act as a marker for conversion from CIS to MS [10] and as marker for disease progression at time of diagnosis [11]

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