Predicting MS Disability: IL-1 Receptor Antagonist or Neurofilament Light?

Stephanie Blandford, MSc

Data from a recent study suggest that the interleukin-1 receptor antagonist (IL-1RA) biomarker can predict disability in people with multiple sclerosis (MS). Among researchers was Stephanie Blandford, MSc, PhD candidate, neuroimmunology laboratory, Memorial University of Newfoundland.

Blandford and colleagues found that plasma IL-1RA levels were correlated with expanded disability status scale (EDSS) score independent of variables such as age, sex, disease-modifying therapy or previous relapse activity. They also found cerebrospinal fluid (CSF) IL-1RA to be significantly correlated with CSF neurofilament light levels (NfL).

Blandford presented these findings at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2021, February 25-27, 2021. NeurologyLive spoke with Blandford to learn more about the advantages of potentially using IL-1RA to predict disability and relapse over NfL levels. She also discussed further research she would like to do with IL-1RA.

NeurologyLive: What are the benefits of predicting disability with IL-1RA levels as compared to NfL levels in CSF?

Stephanie Blandford, MSc: The biggest difference is the CSF versus the blood draw. When you're considering a CSF draw, you have to keep in mind that it's a lumbar puncture, it's pretty invasive, and can be quite painful and has long-lasting effects for the individuals who undergo the puncture. Whereas the blood draw, it's a little invasive, but not quite as invasive as a CSF draw. You can imagine that it's also quite a bit easier to do, more trained personnel are able to do a blood draw than those who are able to do a lumbar puncture. You can also measure NfL in the in the blood and it's a very good marker for ongoing disability recruitment, but the levels of it in the blood are actually so low that it does require a specialized instrument to measure it. So, that's kind of a barrier to having in widespread use in clinics.

How do you think that use of IL-1RA to predict disability in MS would improve patient care?

So right now, we only have very preliminary results. Our cohorts are quite small, the larger one being around 96 individuals. So, this data has to be looked at in a larger scheme, and in a larger population, maybe outside of the island of Newfoundland, where all this data has come from. But I think it has the potential to be extremely important in that, if we can predict when an individual might experience a relapse or an increase in disability level based on a blood test, then they can make arrangements, they can be prepared, and just have a bit more of a sense of autonomy over their disease.

Is there any further research you'd like to pursue or see conducted?

I’d like to see larger-scale investigations into this. Some of the major limitations of my study is that we only had individuals that had a very relatively mild disease, and not very active disease. The average time since the last relapse was about 5 years. So, these individuals are relatively stable. I think the first thing that really does need to be looked at is whether this holds true in a patient population that is undergoing relapse, progression, or increased disability. We had a lot of individuals at the lower end of the EDSS scale. It's really important to investigate those higher levels of disability to make sure our findings still hold true.

Transcript edited for clarity. For more coverage of ACTRIMS Forum 2021, click here.

REFERENCE

Blandford SN, Galloway D, Williams JB, et al. Il-1 receptor antagonist: A novel soluble biomarker that correlates with disability and neurofilament light in multiple sclerosis. Presented at ACTRIMS Annual Forum; February 25-27, 2021. Abstract P019.