2021 年 38 巻 4 号 p. 478-483
Selection of appropriate treatment from the early stage of the disease is important for better prognosis of patients with multiple sclerosis (MS). Although various kinds of disease modifying drugs (DMDs) have been approved for MS, there is no appropriate biomarker to predict treatment responsiveness. We have identified serum Sema4A as a biomarker predicting treatment efficacy of IFN–β therapy. One–third of patients with MS show high serum Sema4A level. These patients tend to have higher EDSS score, and possess immune characteristics of Th17–skewing condition. Interestingly, these patients do not respond effectively to IFN–β therapy. However, retrospective analysis of our MS cohort demonstrated that those with high serum Sema4A level show favorable response to fingolimod therapy. Efficacy of fingolimod was observed even in patients who later switched to fingolimod due to recurrent attacks under IFN–β therapy. Our observations suggest that fingolimod could be a better candidate for managing the disease activity of MS patients with high Sema4A level. Considering the fact that the efficacy of other DMDs still remains elusive among MS patients with varying Sema4A profile, further investigation is required to clarify the role of serum Sema4A as a biomarker in making appropriate decision of DMD choices. Regarding patients with NMOSD, we found that certain proportion of patients show high level of serum Sema4A. In the present review, we would discuss the current advances in the field of MS research focusing on the role of Sema4A, and further present the clinical features of patients of NMOSD with high Sema4A level.
