From the prodromal stage of multiple sclerosis to disease prevention.

Christine Lebrun-Frenay, Helen Tremlett, Yinshan Zhao, Kathleen M Zackowski, Clare Walton, Pamela Valentine, Jon Strum, Maria Pia Sormani, Shiv Saidha, Sharon Roman, Jacqueline A Quandt, Ronald B Postuma, Daniel Ontaneda, Darin T Okuda, Kassandra L Munger, Naila Makhani, Ruth Ann Marrie, Douglas Landsman, Walter Kostich, Pamela Kanellis, Bernhard Hemmer, Anne Helme, Carla Greenbaum, Christiane Gasperi, Philip L De Jager, Benjamin Davis, Jorge Correale, Peter A Calabresi, Bruce Bebo, Lisa F Barcellos, Mark Allegretta

Journal: Nature reviews. Neurology 2022;18(9):559-572

PMID: 35840705

Full Text on Nature Publishing Group View on PubMed

Abstract

A prodrome is an early set of signs or symptoms that indicate the onset of a disease before more typical symptoms develop. Prodromal stages are well recognized in some neurological and immune-mediated diseases such as Parkinson disease, schizophrenia, type 1 diabetes mellitus and rheumatoid arthritis. Emerging evidence indicates that a prodromal stage exists in multiple sclerosis (MS), raising the possibility of intervention at this stage to delay or prevent the development of classical MS. However, much remains unclear about the prodromal stage of MS and considerable research is needed to fully characterize the prodrome and develop standardized criteria to reliably identify individuals with prodromal MS who are at high risk of progressing to a diagnosis of MS. In this Roadmap, we draw on work in other diseases to propose a disease framework for MS that incorporates the prodromal stage, and set out key steps and considerations needed in future research to fully characterize the MS prodrome, identify early disease markers and develop standardized criteria that will enable reliable identification of individuals with prodromal MS, thereby facilitating trials of interventions to slow or stop progression beyond the prodrome.

Address: Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. [email protected].; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. [email protected].; National Multiple Sclerosis Society, New York, NY, USA.; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory, School of Public Health, University of California Berkeley, Berkeley, CA, USA.; Kaiser Permanente Division of Research, Oakland, CA, USA.; Johns Hopkins University School of Medicine, Departments of Neurology, Neuroscience and Ophthalmology, Baltimore, MD, USA.; Department of Neurology, Fleni, Buenos Aires, Argentina.; Multiple Sclerosis Society of Canada, Toronto, Ontario, Canada.; Multiple Sclerosis Center, Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.; Department of Neurology, Klinikum rechts der Isar, TUM School of Medicine, Technical University of Munich, Munich, Germany.; Center for Interventional Immunology and Diabetes Program, Benaroya Research Institute, Seattle, WA, USA.; Multiple Sclerosis International Federation, London, UK.; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.; CHU de Nice Pasteur 2, CRCSEP, UR2CA-URRIS, Université Nice Cote d'Azur Nice, Nice, France.; Departments of Pediatrics and Neurology, Yale School of Medicine, New Haven, CT, USA.; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.; The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, Dallas, TX, USA.; Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.; Department of Neurology, McGill University, Montreal, Quebec, Canada.; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.; Patient representative, Vancouver, British Columbia, Canada.; Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Health Sciences, University of Genova, and IRCCS Ospedale Policlinico San Martino, Genova, Italy.; RealTalk MS, Long Beach, CA, USA.; MS Society, London, UK.; Faculty of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada.

DOI: 10.1038/s41582-022-00686-x

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MeSH Terms: Humans, Multiple Sclerosis, Prodromal Symptoms, Schizophrenia