Does T and B lymphocyte subset differentiation indicate disease activity in Multiple Sclerosis (MS)?

From the Guidelines

T and B lymphocyte subset differentiation can indicate disease activity in Multiple Sclerosis (MS), but its use is limited to research settings or monitoring specific disease-modifying therapies due to the complexity and cost of flow cytometry. The current evidence suggests that changes in T cell subsets, such as increased Th1 and Th17 cells and decreased regulatory T cells (Tregs), correlate with active disease phases in MS 1. Similarly, alterations in B cell populations, including elevated memory B cells and plasmablasts, have been associated with MS relapses. However, in clinical practice, MRI findings, clinical symptoms, and other biomarkers like neurofilament light chain are more commonly used to monitor disease activity. Some key points to consider:

• Changes in lymphocyte subsets reflect the underlying autoimmune pathology of MS, where dysregulated lymphocytes attack myelin in the central nervous system.
• Lymphocyte subset analysis is primarily used in research settings or when monitoring responses to disease-modifying therapies that target specific lymphocyte populations, such as ocrelizumab (anti-CD20) or natalizumab (anti-α4-integrin) 1.
• The complexity and cost of flow cytometry for detailed lymphocyte subset analysis limit its routine clinical application for disease activity monitoring in MS.
• MRI findings and clinical symptoms remain the primary methods for monitoring disease activity in MS, with guidelines established for using MRI to monitor treatment trials in MS 1.

From the Research

T and B Lymphocyte Subset Differentiation in MS

• T and B lymphocyte subset differentiation plays a crucial role in the pathogenesis of Multiple Sclerosis (MS) 2, 3.
• B cells have been shown to have both inflammatory and anti-inflammatory functions in MS, with different subsets varying in their effects on T cell differentiation 2, 4.
• The interaction between B cells and T cells is complex, with B cells influencing T cell polarizing properties and T cells influencing B cell development and function 2, 3.
• Studies have found alterations in blood B-cell homeostasis in MS patients, including an increase in CD19+ cell number and a loss of correlation between CD19+ B cells and total lymphocyte count 5.
• Treatment with glatiramer acetate and interferon beta-1a has been shown to modulate the B cell system in MS patients, with increases in IL-10 and BAFF protein concentrations observed 6.

Disease Activity Indication

• T and B lymphocyte subset differentiation may indicate disease activity in MS, with changes in B cell subsets and regulatory T cells potentially reflecting disease progression or response to treatment 3, 5.
• The use of anti-CD20 treatment has been effective in reducing disease activity in MS patients, suggesting that B cells play a key role in the disease process 3, 4.
• Further research is needed to fully understand the relationship between T and B lymphocyte subset differentiation and disease activity in MS, including the potential use of biomarkers such as IL-10 and BAFF to monitor disease progression 6.