Cerebrospinal Fluid Testing for Multiple Sclerosis

Hematological markers as prognostic indicators in multiple sclerosis progression

AIMS

To evaluate routine blood count parameters as diagnostic and prognostic markers in Multiple Sclerosis (MS) progression.

PATIENTS/METHODS

182 patients with Relapsing-Remitting MS (RRMS) and 60 with Secondary Progressive MS (SPMS) were analyzed for blood parameters.

RESULTS

In RRMS, the Expanded Disability Status Scale (EDSS) score correlated positively with Red Cell Distribution Width (RDW). In SPMS, the EDSS score correlated positively with White Blood Cell count (WBC) and Mean Platelet Volume (MPV). RDW predicted higher EDSS scores in RRMS, while MPV was a predictor in SPMS. Elevated MPV levels characterized the increased risk of transitioning from RRMS to SPMS.

CONCLUSIONS

Elevated MPV may serve as a significant indicator of disease progression from RRMS to SPMS, emphasizing its potential clinical relevance.

Integrative diagnostics: the time is now-a report from the International Society for Strategic Studies in Radiology

Enormous recent progress in diagnostic testing can enable more accurate diagnosis and improved clinical outcomes. Yet these tests are increasingly challenging and frustrating; the volume and diversity of results may overwhelm the diagnostic acumen of even the most dedicated and experienced clinician. Because they are gathered and processed within the "silo" of each diagnostic discipline, diagnostic data are fragmented, and the electronic health record does little to synthesize new and existing data into usable information. Therefore, despite great promise, diagnoses may still be incorrect, delayed, or never made. Integrative diagnostics represents a vision for the future, wherein diagnostic data, together with clinical data from the electronic health record, are aggregated and contextualized by informatics tools to direct clinical action. Integrative diagnostics has the potential to identify correct therapies more quickly, modify treatment when appropriate, and terminate treatment when not effective, ultimately decreasing morbidity, improving outcomes, and avoiding unnecessary costs. Radiology, laboratory medicine, and pathology already play major roles in medical diagnostics. Our specialties can increase the value of our examinations by taking a holistic approach to their selection, interpretation, and application to the patient's care pathway. We have the means and rationale to incorporate integrative diagnostics into our specialties and guide its implementation in clinical practice.

Integrative Diagnostics: The Time Is Now-A Report From the International Society for Strategic Studies in Radiology

Enormous recent progress in diagnostic testing can enable more accurate diagnosis and improved clinical outcomes. Yet these tests are increasingly challenging and frustrating; the volume and diversity of results may overwhelm the diagnostic acumen of even the most dedicated and experienced clinician. Because they are gathered and processed within the "silo" of each diagnostic discipline, diagnostic data are fragmented, and the electronic health record does little to synthesize new and existing data into usable information. Therefore, despite great promise, diagnoses may still be incorrect, delayed, or never made. Integrative diagnostics represents a vision for the future, wherein diagnostic data, together with clinical data from the electronic health record, are aggregated and contextualized by informatics tools to direct clinical action. Integrative diagnostics has the potential to identify correct therapies more quickly, modify treatment when appropriate, and terminate treatment when not effective, ultimately decreasing morbidity, improving outcomes, and avoiding unnecessary costs. Radiology, laboratory medicine, and pathology already play major roles in medical diagnostics. Our specialties can increase the value of our examinations by taking a holistic approach to their selection, interpretation, and application to the patient's care pathway. We have the means and rationale to incorporate integrative diagnostics into our specialties and guide its implementation in clinical practice.

Fluid phase biomarkers in multiple sclerosis

PURPOSE OF REVIEW

Multiple sclerosis (MS) is highly heterogenic disorder with respect to clinical course, diagnosis, and treatment response. There is an urgent need to search for simply and reliable fluid body biomarker which would assist the diagnosis and prediction of clinical and treatment prognosis.

RECENT FINDINGS

'Traditional' MS biomarkers, with exception of cerebrospinal fluid oligoclonal bands, still are having limited clinical value. Therefore, there is growing interest in novel molecules and ingredients. The most robust results have been generated with regard to cerebrospinal fluid and serum levels of neurofilament light chains (NfL). However, there are still some limitations related to specificity of NfL which delays its use in everyday practice. We present a new approach to search for biomarkers involving extracellular RNA, particularly microRNA (miRNA), and small extracellular vesicles. MiRNA represents an important molecular mechanism influencing gene expression, including those involved in MS pathogenesis and extracellular vesicles transfer multiple cargo, including myelin molecules from parental cells of central nervous system to the long-distance targets.

SUMMARY

MiRNAs which control gene expression in cells involved in autoimmune processes in MS as well as extracellular vesicles transferring myelin content might generate a new promising categories of biomarkers of MS.

Adiponectin in Cerebrospinal Fluid from Patients Affected by Multiple Sclerosis Is Correlated with the Progression and Severity of Disease

Adiponectin exerts relevant actions in immunity and is modulated in several disorders, such as multiple sclerosis (MS). In this study, we characterized adiponectin expression and profiles in cerebrospinal fluid (CSF) from MS patients to investigate its potential relationship with the severity and progression of the disease. Total adiponectin in CSF was measured by ELISA in 66 unrelated CSF MS patients and compared with 24 age- and sex-matched controls. Adiponectin oligomer profiles were analysed by Western blotting and FPLC chromatography. Total CSF adiponectin was significantly increased in MS patients compared with controls (9.91 ng/mL vs 6.02 ng/mL) (p < 0.001). Interestingly, CSF adiponectin positively correlated with CSF IgG, and CSF/serum albumin directly correlated with CSF/serum adiponectin. Our data demonstrated that CSF adiponectin predicts a worse prognosis: patients with the progressive form of MS had higher levels compared with the relapsing remitting form; patients with higher EDSS at baseline and a higher MS severity score at 4.5-year follow-up had significantly elevated adiponectin levels with respect to patients with a less severe phenotype. Finally, the adiponectin oligomerization profile was altered in CSF from MS patients, with a significant increase in HMW and MMW. The correlation of CSF adiponectin with the severity and prognosis of MS disease confirmed the role of this adipokine in the inflammatory/immune processes of MS and suggested its use as a complementary tool to assess the severity, progression and prognosis of the disease. Further studies on larger MS cohorts are needed to clarify the contribution of adiponectin to the etiopathogenesis of MS.