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Relationship of Urinary Myelin Basic Protein–Like Material With Cranial Magnetic Resonance Imaging in Advanced Multiple Sclerosis
John N. Whitaker, MD;
Jerry S. Wolinsky, MD;
Ponnada A. Narayana, PhD;
Alfred A. Bartolucci, PhD;
John H. Noseworthy, MD;
Fred D. Lublin, MD;
Anders Linde, MB;
Per Gjörstrup, MD, PhD;
Herman C. Sullivan, MD;
for the North American Linomide Investigators
Arch Neurol. 2001;58:49-54.
Background A significant correlation exists between disability and the volume of
black holes (BHL VOL), defined as hypointense lesions on T1-weighted cranial
magnetic resonance imaging. A consistent correlation has also been reported
between urinary myelin basic protein–like material (MBPLM) and the transition
toward secondary progression (SP) from relapsing-remitting (RR) multiple sclerosis
(MS).
Objective To improve the management of MS through a noninvasive and cost-effective
test for monitoring disease activity or disease status.
Design and Methods From 662 patients with MS (86 with RR MS, 259 with SP MS without continued
attacks, and 317 with SP MS with continued attacks), 24-hour urine samples
were obtained at enrollment in the phase 3 Linomide (roquinimex) drug study.
The urine specimens were analyzed for MBPLM and correlated with clinical features
and findings on cranial magnetic resonance imaging.
Results Significant but weak correlations existed between urinary MBPLM and
BHL VOL in all patients with MS (r = 0.114, P = .003; n = 662), patients with SP MS without attacks
(r = 0.185, P = .003; n
= 259), and all patients with SP MS (r = 0.122, P = .003; n = 576). No significant correlations were detected
in the RR MS group or any of the disease groups or subgroups whose Expanded
Disability Status Scale score was 5.0 or lower. In subgroup analysis, the
most significant correlation was detected between urinary MBPLM after adjustment
for creatinine and BHL VOL in patients with SP MS with an Expanded Disability
Status Scale score of 5.5 or higher but without continued relapses (r = 0.417, P<.001; n = 138).
Conclusions In patients with advanced SP MS, urinary MBPLM may possibly serve as
an indicator of failed remission and axonal damage. Urinary MBPLM correlates
with disease status in MS, especially the transition of RR MS to SP MS with
advancing disability.
From the Departments of Neurology (Dr Whitaker) and Biostatistics (Dr
Bartolucci), University of Alabama at Birmingham; Neurology and Research Services,
Birmingham Veterans Administration Medical Center (Dr Whitaker); Departments
of Neurology (Dr Wolinsky) and Radiology (Dr Narayana), University of Texas
at Houston Health Science Center; Department of Neurology, Mayo Clinic, Rochester,
Minn (Dr Noseworthy); Department of Neurology, Allegheny University of the
Health Sciences, Philadelphia, Pa (Dr Lublin); and Pharmacia and Upjohn, Kalamazoo,
Mich (Drs Gjörstrup and Sullivan and Mr Linde).
Reprints: John N. Whitaker, MD, Department of Neurology, University
of Alabama at Birmingham, 625 19th St S, Birmingham, AL 35233-7340 (e-mail: jnwhit{at}uab.edu).
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