23) Now let's look at laboratory #biomarkers in the diagnosis and follow-up of #MultipleSclerosis. Much interest has recently been garnered regarding the use of CSF and serum biomarkers to monitor disease progression as well as help predict disease course in patients with MS.

24) Neurofilament Light may serve as a nonspecific but quantitative marker of axonal and neuronal injury in patients with multiple sclerosis (doi.org/10.1038/s41598…).

25) Neurofilaments form the cytoskeleton of myelinated axons and may increase surface area of axons, provide stability, as well as assist with electrical transmission within neurons. J. Cell Sci. 125, 3257–3263

26) Recent advances in ELISA assays using Single Molecule Array Assays (SIMOA) have led to the potential utility of measuring Neurofilaments in biofluid with high correlation to CSF . . .

27) . . . making this a promising prospect to monitor disease activity as well as treatment response during routine clinical care. J Neurol Neurosurg Psych 2016;87:126. Serum NfL levels are particularly high in pwMS with gadolinium enhancing MRI lesions. Ann Neurol 2017;81:857

28) Elevated neurofilament light levels most likely represent which of the following? a. Clinical relapse or disease activity b. MS subtype c. Cognitive decline d. DMT optimal response

29) The answer is (a), clinical relapse or disease activity.

30) GFAP is another important potential marker for disease monitoring/prognostication. It is an astrocytic cytoskeletal protein that is highly expressed in astrogliosis in MS lesions.

31) Elevated GFAP levels have been shown to be associated with disability severity and ambulatory loss in patients with MS. Brain 2002; 125(Pt. 7): 1462–1473.

32) Chitinase 3-Like 1 or CHI3L1 is a glycoprotein expressed in activated glia, activated macrophages, and vascular smooth muscle. It is overexpressed in patients with CIS who convert to cdMS and is also correlated with GAD enhancing lesions on MRI.

33) CHIL31 levels at baseline also have been found to correlate with disability progression in patients with MS. Multiple Sclerosis 2015;21(14): 1761-1770. Brain 2010;133:1092-1093

34) Summary: MS prognosis remains difficult to predict on an individual basis! Emerging individual serum biomarkers or a collection of bioprofiles may help in earlier detection of disease progression,

35) suboptimal treatment response, and hopefully serve as predictive models where early intervention can change the natural history of disease on an individual level.

36) That's it! You made it! Free CE/#CME! Now go to academiccme.com/MSdiagnosis and claim your credit! I am Dr. Rany Aburashed. Follow @MS_CME for more tweetorials, and visit us at academiccme.com/MSswitching and . . .

Join here tomorrow for the launch of a new accredited #tweetorial on "Insights into #MultipleSclerosis disease course through the Topographical Model of #MS"! Earn 0.5 CE/CME credits: #physicians, #nurses, #pharmacists! Expert faculty is stephen krieger.

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