Abstract Details

Title Glymphatic Impairment and Disease Severity in Multiple Sclerosis

Topic Multiple Sclerosis

Presentation(s) P3 - Poster Session 3 (11:45 AM-12:45 PM)

Poster/Presentation
Number 1-010

Objective

To asses glymphatic system function in multiple sclerosis (MS) among other neuroinflammatory and neurodegenerative imaging correlates, and evaluate glymphatic measures compared to established MS imaging markers as a classifier of people with MS (PwMS) with lower and higher disability.

Background The role of the glymphatic system in MS-related disability is under-explored. Diffusion-tensor image analysis along the perivascular space (DTI-ALPS) offers a non-invasive method to assess the glymphatic system function.

Design/Methods This retrospective study included 118 PwMS who underwent clinical evaluation including assessment of Expanded Disability Status Scale (EDSS) scores, as well as structural and diffusion-weighted magnetic resonance imaging. The participants were divided into lower (MS-L) and higher disability (MS-H) groups using an EDSS milestone of 3. The structural images underwent lesion segmentation and spatial normalization estimating white matter hyperintense lesion load (LL) and brain parenchymal fraction (BPF). DTI-ALPS indices were calculated using the diffusion-weighted images. Correlations between DTI-ALPS index, clinical and imaging measures were calculated. Multivariate logistic regression was performed to evaluate LL, BPF, and DTI-ALPS index in classifying lower and higher disability PwMS.

Results MS-L (EDSS < 3) included 57 PwMS (mean age: 43.2 ± 12.1; 50.9% female), and MS-H (EDSS ≥ 3) included 61 PwMS (mean age 46.7 ± 11.4; 78.7% female). DTI-ALPS index correlated significantly with disease duration (r_p = -0.29, false-discovery rate adjusted p-value (p-FDR) = 0.002) and EDSS (r_sp = -0.35, p-FDR = 0.0002). It also showed significant correlations with LL and BPF. DTI-ALPS index and LL were significant classifiers of PwMS into lower and higher disability (DTI-ALPS: odds ratio (OR) = 1.77, p = 0.04, LL: OR = 0.94, p = 0.02).

Conclusions Our findings highlight DTI-ALPS index as a possible imaging biomarker in MS, suggesting a role for glymphatic impairment in MS pathology, although further research is needed to elucidate its role in contributing to MS-related disability.

Authors/Disclosures
Ahmed A. Bayoumi, MD (McGovern Medical School) PRESENTER	Dr. Bayoumi has nothing to disclose.
Khader M. Hasan, PhD	Prof. Hasan has nothing to disclose.
John A. Lincoln, MD, PhD (McGovern Medical School, UTHealth)	The institution of Dr. Lincoln has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi-Genzyme. Dr. Lincoln has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Lincoln has received research support from Deaprtment of Defense. The institution of Dr. Lincoln has received research support from National Institutes of Health. The institution of Dr. Lincoln has received research support from EMD-Serono. Dr. Lincoln has received intellectual property interests from a discovery or technology relating to health care.

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