A 3-year prospective observational study investigating ATP changes in MS via T7 MRSI, comparing patients with and without vascular disease risk factors (VDRF), demonstrated that VDRF-positive patients had lower brain ATP rates and total brain parenchymal volumes than VDRF-negative patients at baseline. Dr Vijayshree Yadav (Oregon Health & Science University, USA) presented the preliminary results of the study and explained the link between ATP depletion, VDRF, and accelerated disease progression in MS [1].

  VDRF are common in MS, affecting over 50% of the patients, with hyperlipidaemia, hypertension, and obesity being the most prevalent [2]. Disease progression in MS is increased by presence of VDRF, but the mechanisms behind this association are not well known. It has been hypothesised that VDRF leads to a reduced substrate delivery, which causes impaired mitochondrial function. Subsequently, this could lead to increased high-energy phosphate metabolite deficiencies, increased neurodegeneration, and disease progression. In the presented study, baseline VDRF-positive (n=29, mean age 56.3) and VDRF-negative (n=23, mean age 52.4) MS patients were subjected to 7T MRSI to assess differences in high-energy phosphate metabolites, brain volumes, and associated disease progression. Preliminary results of the MRSI analysis showed that VDRF-positive patients had approximately 5% lower brain ATP rates than VDRF-negative patients. The MRI signal changes were consistent over white and grey matter. Moreover, the VDRF-positive group had lower total brain parenchymal volumes (1,017) than the VDRF-negative group (1,099), representing an 8% difference. Patients in the VDRF-positive group had higher neurological disability, indicated by EDSS scores. Dr Yadav argued that ATP reductions in VDRF-positive MS patients are possibly caused by lower cranial blood flow and are related to mitochondrial dysfunction, which contributes to an accelerated disease progression.

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  1. Yadav V, et al. Vascular Disease Risk Factors in Multiple Sclerosis (MS) is Associated with Brain Adenosine Triphosphate Abnormalities: Dysmetabolism May Drive MS Disease Progression. S2.004, AAN 2021 Virtual Congress, 17-22 April.