April 9, 2024 — A blood test could sooner or later determine the likely course of a multiple sclerosis patient's disease and suggest individual courses of treatment, a brand new study suggests.
The study found that based on immune markers within the patient's blood, multiple sclerosis has three distinct subtypes, each with barely different disease progression and responses to therapy.
With further studies, determining the “immune signature” or endophenotype in a patient's blood before starting immunomodulatory therapy could help predict the course of the clinical disease and result in more personalized treatment decisions, the researchers said.
“Knowing the specific immune signature of a patient’s disease at the time of diagnosis will ultimately help suggest the best course of therapy,” said Dr. Heinz Wiendl, Professor and Chairman of the Department of Neurology on the University of Münster in Germany. “This is a rational path for precision medicine for the future.”
The study was published online March 27 within the magazine Scientific translational medicine.
Degenerative and inflammatory subtypes
MS is an especially diverse disease with different symptoms and disease progression, which makes managing it a challenge. It is unclear whether this diversity is reflected in several immune signatures within the blood.
To investigate this, Wiendl and a team analyzed the characteristics of blood samples taken from 309 patients with early MS and a control group of 232 patients with early MS.
In each groups, they found that the cellular immune signatures split into three differing kinds, called E1, E2 and E3.
The different subtypes were related to different, distinct disease courses. E3 patients were more prone to higher inflammatory disease activity, as evidenced by the next relapse rate throughout the first yr.
E3 patients also had the next variety of a certain style of brain lesion, the next relapse rate, and rapidly increasing disability inside 2 years.
E1 patients had previous structural brain damage and better disease severity, including disability and impairment.
Towards personalized care
With further studies and refinements, the hope is to make this test a “clinical reality,” Wiendl said.
Kimberly O'Neill, MD, clinical associate professor within the department of neurology at NYU Grossman School of Medicine in New York City, said that individuals with MS “can have a wide variety of disease progression and outcomes, ranging from mild to very severe range and can be lifelong.” -Change in the course of the disease. At this point, we cannot predict well who will take which route and which medications will be appropriate for each patient.
“Research like this provides us hope for more personalized precision medicine in MS,” said O'Neill, who was not involved in the study. “The ideal world would be a blood test that could provide information about the progression of the disease and the appropriate treatments for each individual patient, but we are certainly not there yet.”
Mary Rensel, MD, director of wellness and pediatric MS at the Cleveland Clinic Mellen Center for MS, also provided an outside perspective, saying, “Precision medicine is our goal and dream in MS treatment.” — to give you the option to do a blood test and know what medications a patient may or will not be responding to, and to avoid wasting them years of persistent symptoms or risk of disability. This study is an ideal start.”