Tissue Markers and Personalized Medicine and Treatment Response in Multiple Sclerosis

Multiple Sclerosis (MS) is complex immune-mediated disease, affecting millions worldwide. For decades, doctors have relied on generalized treatment protocols—especially corticosteroids and apheresis—to manage acute MS relapses. But what if we could tailor treatment to the biology of each patient’s disease? That’s the vision behind personalized medicine, and a 2018 editorial by Dr. Robert J. Fox in JAMA Neurology explores one of the most significant steps toward making that vision a reality: using tissue markers to predict treatment response.

Cracking the Code of MS Lesions
MS is an autoimmune disease that damages the central nervous system by attacking the myelin sheath that insulates nerve fibers. However, this damage doesn’t occur the same way in every patient. In fact, back in 2000, Lucchinetti and colleagues identified four distinct patterns of lesion development in MS:

Pattern 1: T-cell–mediated inflammation without antibodies.

Pattern 2: T-cell–mediated inflammation with antibody and complement activation.

Pattern 3: Primary oligodendrocyte dystrophy.

Pattern 4: Less commonly studied, also involving oligodendrocyte issues.

Interestingly, a patient tends to have just one pattern across multiple lesions, and that pattern remains consistent over time. Yet, this invaluable insight remained confined to academic discussions—until now.

Apheresis and the Promise of Personalization
In the study reviewed by Dr. Fox, researchers applied these lesion patterns to assess short-term treatment responses to apheresis (a procedure where harmful substances are removed from the blood, either through plasma exchange or immunoadsorption).

The findings were compelling:

Patterns 1 and 2, both involving T-cell activity, showed response rates to apheresis ranging from 31% to 55%.

Pattern 2 (with antibodies and complement) had the strongest positive response.

Pattern 3 patients showed no improvement, suggesting that apheresis may not benefit individuals with this lesion type.

This marks the first direct evidence linking the pathology of MS lesions to treatment effectiveness. In simple terms: the kind of MS lesion a person has could predict whether they will benefit from certain acute treatments.

Why This Matters
For patients, this could be life-changing. Imagine no longer having to endure ineffective treatments during an already traumatic relapse. Instead, doctors could choose therapies based on biological data, increasing the chance of quick recovery and reducing unnecessary side effects.

From a scientific standpoint, this also deepens our understanding of MS’s heterogeneity—why it looks and behaves differently in different people—and opens up the path to more targeted and rational drug development.

The Caveats: Promising, But Not Yet Mainstream
Despite its importance, this approach isn’t ready for wide adoption. All patients in the study had brain biopsies, a highly invasive procedure not typically performed unless diagnosis is uncertain. Moreover, there are currently no non-invasive biomarkers (like blood or imaging tests) that can reliably determine a patient’s lesion pattern.

This limits the immediate clinical applicability of these findings—but also lights the way forward. The next crucial step is to discover accessible biomarkers that reflect lesion patterns, allowing all MS patients—not just the few who undergo biopsy—to benefit from personalized care.

Looking Ahead
The study’s findings also raise fascinating questions about how apheresis works. It’s especially intriguing that even patients without antibody involvement (pattern 1) saw benefits, suggesting that apheresis may act on broader immune mechanisms than previously thought.

In the future, personalized medicine in MS could extend well beyond apheresis. Biomarkers that predict long-term responses to disease-modifying therapies or track progression to more severe forms of MS are urgently needed. And if the science keeps progressing, we may one day match every patient with the therapy most likely to help them—right from the start.

Conclusion
This research isn't just a technical advancement; it’s a beacon of hope. For the first time, scientists have shown that the biological underpinnings of MS lesions can help predict which patients will benefit from specific treatments. It’s a vital step toward bringing precision medicine to MS care—a future where treatment isn’t just standard, but smart, strategic, and deeply personal.

Disclaimer: This blog post is based on the provided research article and is intended for informational purposes only. It is not intended to provide medical advice. Please consult with a healthcare professional for any health concerns.

References:
Fox, R. J. (2018). Tissue Markers for Acute Multiple Sclerosis Treatment Response—A Step Toward Personalized Medicine. JAMA Neurology.