Changes in serum levels of ICAM and TNF-R correlate with disease activity in multiple sclerosis

Objective: To study the change in serum levels of soluble intercellular adh esion molecule 1 (sICAM-1) and soluble tumor necrosis factor receptors (sTN F-Rs) in MS patients in relation to clinical disease activity and changes o n brain MRI. Background: Circulating forms of adhesion molecules or soluble receptors may be released from cells as a consequence of activation and ma y be useful markers for inflammation. Methods: During a prospective longitu dinal study over 1 year, 40 patients with MS underwent frequent imaging of the brain (22 MR images per patient) at the time of blood sampling as well as monthly neurologic examinations, and scoring on Kurtzke's Expanded Disab ility Status Scale (EDSS) and ambulation index (Al). Results: Patients with relapsing-progressive disease had the highest levels of sICAM-1 whereas pa tients with progressive disease had the highest levels of sTNF-Rs. Fluctuat ions in sICAM-1 correlated with the occurrence of attacks in patients with relapsing and relapsing-progressive disease. In patients with relapsing-pro gressive MS, an increase in sICAM-1 level preceded the appearance of new ga dolinium (Gd) enhancing lesions an MRI. In patients with progressive diseas e, an increase in sTNF-R p55 level preceded the appearance of new Gd enhanc ing lesions on MRI, whereas a decrease in sICAM-1 levels correlated with th e appearance of new Gd enhancing lesions. Conclusions: These results demons trate a linkage between sICAM-1 and sTNF-R levels and disease activity in M S. Furthermore, patients with progressive disease appear to have a differen t immunologic stage of disease in which immune changes are tightly linked w ith changes on MRI. The demonstration of a correlation in individual patien ts between immunologic events and changes in disease activity has implicati ons for monitoring patients undergoing treatment and for monitoring disease progression.