Increased Disability, Grey Matter Loss in MS Linked to Anti-Müllerian Hormone Levels
The investigators suggest that progressive MS may be driven by biological aging processes.
Low levels of anti-Müllerian hormone (AMH) represent an important marker of ovarian aging and indicate risk for increased disability and gray matter loss among women with multiple sclerosis (MS), according to an analysis published in Neurology.
Investigators included women with MS who participated in a 10-year follow-up longitudinal study that evaluated the phenotype and genotype of MS (n=415). In addition to this cohort, a total of 180 age-similar control patients who were free of MS were included to compare AMH levels in disease-free patients and patients with MS.
At baseline, there was no significant difference between patients with MS (mean age, 42.6 years) and healthy control patients (mean age, 44 years) in regard to AMH levels (0.98-fold difference, 95% CI, 0.69-1.37; P =.87). Adjusting for age, disease duration, and body mass index in the multivariable analysis, the investigators observed a 0.43-higher Expanded Disability Status Scale score among women with MS with a 10-fold lower AMH level (95% CI, 0.15-0.70; P =.0028).
In addition, women with MS exhibited lower cortical gray matter volume by 7.44 mm3 (95% CI, −14.6 to −0.30 mm3; P =.041), as well as a 0.25-unit worse MS Functional Composite z score (95% CI, −0.40 to −0.10; P =.0015). The investigators also found a 5.48 mm3 (95% CI, −11.3 to 0.33 mm3; P =.065) decrease in total gray matter, a 0.27 increase in Expanded Disability Status Scale score, and a 4.55 mm3 (95% CI, −9.33 to 0.23; P =.062) reduction in cortical gray matter among women who had a 10-fold AMH decrease over time (95% CI, 0.11-0.43; P =.006).
There were no available MRI data for the healthy control patients to evaluate the association between gray matter volume and AMH, which limited the investigators' ability to determine whether this association was specific to MS.
Rethinking progressive MS "as an aging-related disease driven by biological aging processes may help to explain the phenomena of this phase of the disease and identify new targets for therapy."
Graves JS, Henry RG, Cree BAC, et al. Ovarian aging is associated with gray matter volume and disability in women with MS. Neurology. 2018;90(3):e254-e260.