Identifying Blood-based Markers Associated with Disease Progression in MS

Summary: Researchers investigated a blood-based marker called glial fibrillary acidic protein (GFAP), to understand whether it is associated with disease progression in multiple sclerosis (MS). GFAP was found to be associated with progression and future risk of disease progression in MS and serves as a potential biomarker. Identifying and validating biomarkers of disease progression will be important for developing new therapies and improving care for people living with MS.

Background: There are a lack of biomarkers for disease progression in MS. Biomarkers are biological factors found in the body that can help in the detection and management of diseases. Neurofilament light chain (NfL) has been found to be a marker associated with active disease and nerve cell damage in MS, however, its association with disease progression or in predicting progression is not known. Glial fibrillary acidic protein (GFAP) is another emerging marker in MS. Early studies showed a correlation between levels of GFAP in the cerebrospinal fluid (CSF), the area surrounding the brain and spinal cord, and disability and disease progression.

Details: In this study, researchers examined whether GFAP and NfL levels measured in the blood are associated with disease progression and can be used to predict future risk of progression in MS. The researchers measured the levels of GFAP and NfL from blood samples obtained from 355 people with MS (i.e., with stable MS, relapsing MS, and worsening progressive MS) and 259 people without MS. This data was acquired from the Swiss MS Cohort, a multicentre study across eight centres in Switzerland, and collected between January 1, 2012, to October 20, 2022.

Results: The study found that GFAP levels were strongly increased in people with MS compared to people without MS. People with worsening progressive MS had the highest levels of GFAP. High levels of GFAP were also found to be associated with faster loss of grey matter in the brain, a sign of disease progression. When assessing NfL levels in the blood, they were highest in those with active relapsing-remitting MS, consistent with previous studies, and were not highly associated with disease progression when compared to GFAP. Overall, higher levels of GFAP in the blood were found to be associated with progression in the absence of relapses and were better at predicting risk of future disease progression compared to NfL.

Impact: This study identified GFAP as a potential blood-based biomarker for disease progression in MS. Biomarkers of disease progression measured through a single blood test have the potential to improve clinical care and accelerate the development of novel therapeutics. More research is needed to validate GFAP as a biomarker for use in routine clinical practice.


Article published in JAMA Neurology on February 6, 2023 - Serum Glial Fibrillary Acidic Protein Compared With Neurofilament Light Chain as a Biomarker for Disease Progression in Multiple Sclerosis. Link to article – here.