Multiple sclerosis in 2024: evolving evidence and new hopes

[frodo]

Multiple sclerosis in 2024: evolving evidence and new hopes

https://www.thelancet.com/journals/lane ... 6/abstract

Abstract

In 2024, several trends in multiple sclerosis research have extended evidence from previous years. First, the idea of the disease as a continuum—from exposure and risk factors to biological onset, a prodromal phase, a first clinical episode, and eventually later disease stages—has received increasing attention.

In this context, there continues to be an intense focus on identifying biomarkers of the preclinical phase of multiple sclerosis.

Colin Zamecnik and colleagues used the US Department of Defense Serum Repository to explore whole-proteome autoantibody profiles before and after disease onset. A distinct subgroup of individuals had an autoantibody signature targeting a shared motif that has similarities with human pathogens, including two Epstein–Barr Virus proteins. Notably, these antibodies were detectable years before the appearance of clinical symptoms.

These individuals also had higher serum neurofilament light concentrations than those who did not develop multiple sclerosis, revealing ongoing neuroaxonal damage before clinical onset and providing molecular evidence of an immunologically active preclinical phase.

This autoantibody signature represents a step towards identifying antigen-specific biomarkers that could help detect high-risk individuals with early demyelinating syndromes, enabling timely intervention.