Gema Maldonado Cantero
At the beginning of 2020, the Dr. Alfredo Rodríguez-Antigüedadhead of the Neurology Service at the Cruces University Hospital (Bizkaia), announced in a specific forum on multiple sclerosis the research in which he was immersed together with other colleagues on the value that light chain neurofilaments as a biomarker of disease progression.
Less than five years later, the determination of these neurofilaments through a simple blood test has already spread in Spain to more than 80 hospitals, is in the service portfolio of several autonomous communities and is a clear indicator of neuronal damage and brain destruction who already use a large group of neurologists with their patients to optimize the available treatments and prevent the progression of this neurodegenerative pathology.
The determination of these neurofilaments through a simple blood test as a biomarker in multiple sclerosis has already been extended in Spain to more than 80 hospitals.
This same Wednesday, Dr. Rodríguez-Antigüedad, together with experts in other specialties, presented a well-established roadmap to make known among all neurologists the potential of this biomarker and the simplicity and economical nature of its determination to be able to predict the evolution of the disease, the response to treatments and improve the quality of life of patients living with this disease, whose approach has changed a lot in recent decades.
He knows it Dr. Jesus Porta-Etessampresident of the Spanish Society of Neurology, who remembers the number of patients with multiple sclerosis in wheelchairs that he saw in the waiting room at the beginning of his career compared to today. “We see fewer and fewer wheelchairs in multiple sclerosis clinics and we don’t want to see any. We hope that the neurofilament biomarker contributes to this.”third the Dr. Luisa María Villarimmunologist at the Ramón y Cajal University Hospital in Madrid.
Dr. Luisa María Villar: “We see fewer and fewer wheelchairs in multiple sclerosis clinics and we don’t want to see any. We hope that the neurofilament biomarker contributes to this.”
Why should neurofilaments be measured and why is it a cost-effective measure?
The authors of the NeuroPath-EM Projectthis is the name of the roadmap to promote the use of neurofilaments in the approach to this disease, for which they have had the support of the Roche company, they seek to inform neurologists, patients and health authorities, develop initiatives such as its inclusion in clinical guidelines (one of them, which includes this biomarker, is about to be released) and working to ensure that it is included in the portfolio of services of the National Health System.
In the research carried out in recent years they have seen that the biomarker reliability“it is 100%”stated Dr. Rodríguez-Antigüedad since “Neurofilaments reflect the irreversible damage that occurs in the brain. Currently, we are satisfied when the patient does not have an outbreak, because we are not able to see more lesions than those that are visible through MRI. “So it is a great advance to be able to know which patients who apparently are well controlled are not, since this will allow us to improve the future of these people.”.
Dr. Rodríguez-Antigüedad: “Neurofilaments reflect the irreversible damage that occurs in the brain. It is a great advance to be able to know which patients with multiple sclerosis who, apparently, are well controlled, are not”
The MRI, an expensive test that should not be done very often, and the interview with the patient to find out how they feel, if they notice worsening or outbreaks, are not enough to make the best possible therapeutic decisions. “We have to be very clear when a therapeutic change is going to be made, and measuring neurofilaments will allow us to optimize resources and treat patients in the best way”noted Dr. Porta-Etessam.
Neurofilaments are the “skeleton” of neurons and axons. When the neuron is damaged, these neurofilaments come out and can be found in the cerebrospinal fluid and to a much lesser extent in the blood. “Therefore, Finding neurofilaments in the blood is irrefutable evidence that damage has occurred to neurons and axons and, with this, we evaluate the damage that has occurred in the brain”explained Dr. Rodríguez-Antigüedad.
The decrease in neurofilaments in the blood indicates to doctors that the patient has an optimal response to treatment against multiple sclerosis
Until very recently, technology did not allow extremely small amounts of a substance to be detected and measured in the blood. It is now possible and is done by Simoa technology platform. Two other platforms are already being validated. It can be done as many times as necessary because it requires a non-invasive test such as a blood test and its determination is not complex. The decrease in neurofilaments in the blood indicates to doctors that the patient has an optimal response to the current treatment against multiple sclerosis.
But this biomarker is not only useful for this disease and its use in other pathologies is already being investigated, to the point that some authors speak of neurofilaments as the future PCR of neurologists. “It is a useful biomarker in vasculitis, it can help us make a differential diagnosis; In migraine we can use them to see if, during the inflammation phase, the neurons are affected or not. When a biomarker is discovered that tells us about neuronal damage, we can expand it to other neurological diseases; it will have to be validated. “Once it is included in the portfolio of services, new studies can be carried out to see its usefulness in other pathologies.”explained the president of the SEN.
Dr. Porta-Etessam: “When a biomarker is discovered that tells us about neuronal damage, we can expand it to other neurological diseases, it will have to be validated”
Many of the determinations of this biomarker are made from the Simoa technological platform at the Ramón y Cajal Hospital in Madrid, which is then sent to neurologists at other hospitals. In other European countries, in the United States and Canada, this biomarker is being implemented, in which identification and investigation have been Spanish researchers pioneers. If it has not yet spread further it is “due to lack of knowledge rather than difficulty or cost in introducing it” because its potential does not generate doubt among neurologists. “It is the first time that we have a biomarker to measure damage in the brain,” stated Dr. Rodríguez-Antigüedad.
The next step is to ensure equity: that all patients who need it have access to this determination. “It has already begun to be consolidated into protocols and is being used in hospitals, but we cannot depend on atomization in the system, going management by management convincing it to be incorporated in each center, but rather It is necessary to take the leap to incorporate it into the portfolio of common services of the SNS so that it is implemented with equity”reflected during the presentation of the NeuroPath-EM Project, the director of Corporate Affairs of Roche Farma Spain, Federico Plaza.
