The researchers focused on a cell component that is measurable in the blood and is characteristic of a certain type of brain cell. These cells, called astrocytes, play a key role in multiple sclerosis (MS) processes, which can lead for example to permanent paralysis and disability.
The blood level of this cellular component, called "glial fibrillary acidic protein" (GFAP), increases when astrocytes are activated or damaged. The new study by the research group led by Professor Jens Kuhle and published in the journal JAMA Neurology shows that elevated GFAP blood levels can indicate both current and future progression of MS. Their results are based on data from, inter alia, the Swiss Multiple Sclerosis Cohort (see box).
Use of biomarkers is changing clinical practiceIn a short space of time, the research group headed by Kuhle at the University of Basel and the University Hospital Basel has thus presented a second biomarker that can support therapy decisions in MS. Last year, the research team demonstrated that some persons with MS with an apparently stable disease course had high blood levels of the neurofilament light chain (NfL) biomarker. NfL specifically indicates neuronal damage.
These people had a significantly higher probability of presenting symptoms caused by MS in the following year. Since NfL sensitively predicts disease activity at an early stage, these patients can now be treated in a more targeted, proactive manner.
Understanding the disease mechanismCompared with NfL, the GFAP blood marker allows conclusions to be drawn about a different aspect of the complex pathophysiology of MS. Although increased NfL blood values indicate neuronal damage, GFAP in blood specifically indicates chronic disease processes in which astrocytes are involved and that contribute to gradual progressive disability.
"GFAP and NfL thus complement each other," says Kuhle. "They can help us in making MS therapy more individually tailored and forward-looking." These outcomes of biomarker research bring both potential therapy monitoring and prognosis, as well as research on disease origins, a big step forward.
Stephanie Meier et. al.
Serum Glial Fibrillary Acidic Protein Compared With Neurofilament Light Chain as a Biomarker for Disease Progression in Multiple Sclerosis
JAMA Neurology (2023), doi: 10.1001/jamaneurol.2022.5250
The Swiss MS Cohort (SMSC), which has been initiated and managed from Basel since 2012, offers unique conditions for such biomarker research, even in an international cross-comparison. The SMSC is the basis for one of the most comprehensive international databases for clinical research into MS, and includes data from more than 1,600 patients from eight Swiss centers. It documents data from over 13,000 visits performed and documented in a standardized way and almost 1,000 prospective MS relapses. It also includes around 8,000 standardized and evaluated MRI examinations.