Relationship of urinary myelin basic protein-like material with cranial magnetic resonance imaging in advanced multiple sclerosis

Background; A significant correlation exists between disability and the vol ume of black-holes (BHL VOL), defined as hypointense lesions on T1-weightee d cranial magnetic resonance imaging. A consistent correlation has also bee n reported between urinary myelin basic protein-like material(MBPLM) and th e transition toward secondary progression (SP) and the transition toward se condary progression (SP) from relapsing-remitting (RR) multiple sclerosis ( MS). Objectives: To improve the management of MS through a noninvasive and cost- effective test for monitoring disease activity or disease status. Design and Methods: From 662 patients with MS (86 with RR MS, 259 with SP M S without continued attacks, and 317 with continued attacks),24-hour urine samples were obtained at enrollment in the phase 3 Linomide(roquinmex) drug study. The urine specimens were analysed for MBPLM and correlated with cli nical features and findings on cranial magnetic resonance imaging. Results: Significant but weak correlations existed between urinary MPBLM an d BHL VOL in all patients with MS(r=0.144, P-.003; n=662), patients with SP MS without attacks(r=0.185, P=.003; n=576). No significant correlations we re detected in the RR MS group or any of the disease groups or subgroups wh ose Expanded Disability Status Scale score was 5.0 or lower. In subgroup an alysis, the most significant correlation was detected between urinary MBPLM after adjustment for creantinine and BHL VOL in patients with SP MS with a n Expanded Disability Status Scale score of 5.5 or higher but without conti nued relapses (r=0.417, P<.001; n=138). Conclusions: In patients with advanced SP MS , urinary MPBLM may possibly s erve as an indicator of failed remission and axonal damage. Urinary MBPLM c orrelates with disease status in MS, especially the transition of RR MS to SP MS with advancing disability.