Toward Precision Phenotyping of Multiple Sclerosis
Posted: Mon Sep 05, 2022 12:02 am
In MS we are still using the Lublin classification from 1996. This paper proposes a new classification for MS phenotypes, based on the underlying processes.
https://nn.neurology.org/content/9/6/e200025.full
Toward Precision Phenotyping of Multiple Sclerosis
Excerpt
A recent study has demonstrated that MRI biomarkers assessing WM lesions, WM integrity, and atrophy can provide remarkable insights into MS heterogeneity by identifying subcategories in which clinical phenotypes have little to no organizing value. In this study, 3 MS subtypes were identified based on changes in MRI patterns over time.
41 Patients exhibited early cortical atrophy (cortical-led phenotype), early reduction in the T1/T2 ratio across various NAWM areas (NAWM-led phenotype), or early and extensive accrual of T2 lesions followed by severe deep gray matter atrophy. These 3 subgroups exhibited substantial differences regarding risk of progression, relapse rate, and treatment responses.
This example illustrates that MRI pattern–based MS subtypes, which correlate with different pathologic processes (neuronal damage, WM tissue damage, and inflammation/demyelination), predict disease activity, disability progression, and treatment response better than conventional clinical phenotypes. Similarly, the incorporation of different oligodendrocyte response patterns25 into the classification system and its quantification with biomarkers might be highly informative about potential responses to pre-remyelinating drugs.
https://nn.neurology.org/content/9/6/e200025.full
Toward Precision Phenotyping of Multiple Sclerosis
Excerpt
A recent study has demonstrated that MRI biomarkers assessing WM lesions, WM integrity, and atrophy can provide remarkable insights into MS heterogeneity by identifying subcategories in which clinical phenotypes have little to no organizing value. In this study, 3 MS subtypes were identified based on changes in MRI patterns over time.
41 Patients exhibited early cortical atrophy (cortical-led phenotype), early reduction in the T1/T2 ratio across various NAWM areas (NAWM-led phenotype), or early and extensive accrual of T2 lesions followed by severe deep gray matter atrophy. These 3 subgroups exhibited substantial differences regarding risk of progression, relapse rate, and treatment responses.
This example illustrates that MRI pattern–based MS subtypes, which correlate with different pathologic processes (neuronal damage, WM tissue damage, and inflammation/demyelination), predict disease activity, disability progression, and treatment response better than conventional clinical phenotypes. Similarly, the incorporation of different oligodendrocyte response patterns25 into the classification system and its quantification with biomarkers might be highly informative about potential responses to pre-remyelinating drugs.