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Lower Levels of N-Acetylaspartate in Multiple Sclerosis Patients With the Apolipoprotein E 4 Allele

Christian Enzinger, MD; Stefan Ropele, PhD; Siegrid Strasser-Fuchs, MD; Peter Kapeller, MD; Helena Schmidt, MD; Birgit Poltrum, MD; Reinhold Schmidt, MD; Hans-Peter Hartung, MD; Franz Fazekas, MD

Arch Neurol. 2003;60:65-70.

Background  In multiple sclerosis (MS), the 4 allele of apolipoprotein E (APOE 4) has been associated with more rapid clinical worsening and more severe tissue damage on magnetic resonance imaging.

Objective  To use proton magnetic resonance spectroscopy (¹H-MRS) to further explore the biochemical changes in the brains of patients with MS associated with APOE 4.

Design  A 2-year clinical and ¹H-MRS follow-up cohort study.

Setting  The MS outpatient clinic, Department of Neurology, and Magnetic Resonance Center of Karl-Franzens University.

Patients  We performed ¹H-MRS of the central portion of both hemispheres and APOE genotyping in 72 patients (52 women and 20 men; mean ± SD age, 34.8 ± 8.8 years) with clinically definite relapsing-remitting MS. Repeated studies were performed in 44 patients after a mean ± SD interval of 34 ± 9 months.

Main Outcome Measure  Levels of N-acetylaspartate as measured by ¹H-MRS.

Results  Patients with MS and an 4 allele (n = 19) had a significantly lower mean ± SD N-acetylaspartate–creatine ratio than those without an 4 allele (n = 53) (1.73 ± 0.26 vs 1.89 ± 0.24; P = .04) despite the absence of significant differences in age at onset, disease duration, Expanded Disability Status Scale score, and number of previous relapses between subgroups. During follow-up, the drop in the N-acetylaspartate–creatine ratio of 4 carriers was also significantly larger (-0.31 vs -0.10; P = .01). This was paralleled by a higher number of relapses (mean ± SD, 4.1 ± 2.7 vs 1.7 ± 1.6; P = .02) and a faster although nonsignificant progression of disability (mean ± SD Expanded Disability Status Scale score, 0.9 ± 1.8 vs 0.3 ± 1.1; P = .19).

Conclusions  The APOE 4 allele has a negative effect on the course of MS, and increasing axonal damage may be an important mechanism.

From the Department of Neurology (Drs Enzinger, Ropele, Strasser-Fuchs, Kapeller, Poltrum, R. Schmidt, and Fazekas), the Magnetic Resonance Center (Drs Ropele, Kapeller, and Fazekas), and the Institute of Medical Biochemistry (Dr H. Schmidt), Karl-Franzens University, Graz, Austria; and the Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany (Dr Hartung).

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