Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. There is a need for new circulating biomarkers for multiple sclerosis, in particular markers that differentiate MS subtypes (relapsing-remitting, secondary progressive and primary progressive MS), as this can help in making treatment decisions. In this study, we explore two classes of potential MS biomarkers – proteins and microRNAs – circulating in CSF and serum.
Targeted medium-throughput proteomics (92 proteins) and microRNA sequencing were performed on serum samples collected in a cross-sectional case–control cohort (cohort I, controls n=30, MS n=75) and a prospective MS cohort (cohort II, n=93). For cohort I, we also made these measurements in paired CSF samples.
In the cohort I CSF, we observed differences between MS and controls for 13 proteins, including some previously described to be markers for MS (e.g. CD27, C-X-C motif chemokine 13 (CXCL13), interleukin-7 (IL7). No microRNAs were significantly differentially expressed between MS and controls in CSF. In serum, 10 proteins (including angiopoietin-1 receptor (TIE2)) and 16 microRNAs were significantly different between relapsing-remitting MS and secondary progressive MS after performing a meta-analysis combining both cohorts. In the prospective part of the study, participants with relapsing-remitting MS were followed for around 3 years, during which time 12 participants converted to secondary progressive MS. In these longitudinally collected serum samples, we observed a peak in granzyme B, A and H proteins around the time of conversion. Single-sample enrichment analysis of serum microRNA profiles revealed that the peak in granzyme B levels around conversion coincides with enrichment for microRNAs that are enriched in CD4+, CD8+ and natural killer cells (e.g. miRNA-150).
We identified several proteins and microRNAs in serum that represent potential biomarkers for relapsing-remitting and secondary progressive MS. Conversion to secondary progressive disease is marked by a peak in granzyme B levels and enrichment for immune-related microRNAs. This indicates that specific immune cell–driven processes may contribute to the conversion of relapsing-remitting MS to secondary progressive MS.