Serum Glial Fibrillary Acidic Protein as a Biomarker for Disease Progression in Multiple Sclerosis

There is a lack of validated biomarkers for disability progression independent of relapse activity (PIRA) in multiple sclerosis (MS). New research published in JAMA Neurology suggests that sGFAP is a prognostic biomarker for future PIRA and revealed its complementary potential next to serum neurofilament light chain (sNfL).

The pathogenesis of multiple sclerosis (MS) involves both adaptive and innate immune disease mechanisms. The former is associated with recurring episodes of acute neurologic symptoms, relapses, and formation of localised lesions in the brain and spinal cord caused by invasion of blood-derived immune cells. In contrast, the latter has been suggested to drive more diffuse inflammation and neurodegeneration, also called smouldering MS, that clinically presents as disease progression. Although high-efficacy therapies, such as B-cell–depleting treatment (BCDT), result in almost complete suppression of focal lesion formation, their effectiveness for preventing development of long-term disability is modest.

The long-term course of disability in MS is driven by 2 partly independent pathomechanisms: focal lesional activity and brain-diffuse neurodegeneration. Serum neurofilament light chain (sNfL) has been established in recent years as a biomarker of ongoing neuronal damage in the course of the former process, whereas its association with progression as the clinical manifestation of the latter is relatively weaker.