Toward Precision Phenotyping of Multiple Sclerosis

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frodo
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Toward Precision Phenotyping of Multiple Sclerosis

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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

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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.
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frodo
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Re: Toward Precision Phenotyping of Multiple Sclerosis

Post by frodo »

And lets remember this:

"There has been a reduction in the proportion of people with PPMS. This is probably related to the fact that there are no licensed treatments for PPMS; patients may be labelled as having relapsing MS in order to receive treatment, raising ethical questions about the division of MS into distinct subtypes. This artificial division of MS into different diseases was driven by the pharmaceutical industry to get interferon beta licensed under the Orphan Drug Act in the USA."

Multiple sclerosis – a review
https://onlinelibrary.wiley.com/doi/ful ... /ene.13819
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