Axonal damage in relapsing multiple sclerosis is markedly reduced by natalizumab

✍ Scribed by Martin Gunnarsson; Clas Malmeström; Markus Axelsson; Peter Sundström; Charlotte Dahle; Magnus Vrethem; Tomas Olsson; Fredrik Piehl; Niklas Norgren; Lars Rosengren; Anders Svenningsson; Jan Lycke

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 185 KB
• Volume: 69
• Category: Article
• ISSN: 0364-5134
• DOI: 10.1002/ana.22247

✦ Synopsis

The impact of present disease-modifying treatments (DMTs) in multiple sclerosis (MS) on nerve injury and reactive astrogliosis is still unclear. Therefore, we studied the effect of natalizumab treatment on the release of 2 brain-specific tissue damage markers into cerebrospinal fluid (CSF) in MS patients. Methods: CSF samples from 92 patients with relapsing forms of MS were collected in a prospective manner prior to natalizumab treatment and after 6 or 12 months. In 86 cases, natalizumab was used as second-line DMT due to breakthrough of disease activity. The levels of neurofilament light (NFL) and glial fibrillary acidic protein (GFAP) were determined using highly sensitive in-house developed enzyme-linked immunosorbent assays. Results: Natalizumab treatment led to a 3-fold reduction of NFL levels, from a mean value of 1,300 (standard deviation [SD], 2,200) to 400 (SD, 270) ng/l (p < 0.001). The later value was not significantly different from that found in healthy control subjects (350ng/l; SD, 170; n ¼ 28). Subgroup analysis revealed a consistent effect on NFL release, regardless of previous DMT or whether patients had relapses or were in remission within 3 months prior to natalizumab treatment. No differences between pre-and post-treatment levels of GFAP were detected. Interpretation: Our data demonstrate that natalizumab treatment reduces the accumulation of nerve injury in relapsing forms of MS. It is anticipated that highly effective anti-inflammatory treatment can reduce axonal loss, thereby preventing development of permanent neurological disability.