b'world. PIRA means the person with MS isbenet. However, when combined with B-cell experiencing progression of disability in thedepletion, IFN- reversed many harmful effects absence of relapses or new lesions on MRI. lowering viral levels, reducing inammatory Unfortunately, PIRA affects many of thosecell inltration into the lungs, and improving living with MS. PIRA may be driven by severalrecovery. These effects were not due to changes factors, including smoldering inammation,in T-cell numbers, but rather reduced excessive loss of neural reserve, and deconditioning. Oneinammation, especially from neutrophils. challenge of PIRA is establishing objectiveThe ndings suggest IFN- could help protect outcomes or biomarkers. MRI metrics mayMS patients on B-cell-depleting therapies during include measuring brain volume loss, includingrespiratory virus outbreaks by counteracting whole brain volume, thalamic volume, andtreatment-relatedimmunevulnerabilities. cortical gray volume. These same MRI volumetricThe ndings were published in the Journal of programsallowforthemoresensitiveImmunology. measurement of enlarging MS lesions thatThrower can be difficult for the human eye to appreciate.- Progression independent of relapse Serumbiomarkersincludeneurolamentactivity is a topic of great interest in the MS world. light chain and glial brillary acidic protein,PIRA means the person with MS is experiencing both of which are markers of neuronal andprogression of disability in the absence of axonal integrity. These biomarkers are includedrelapses or new lesions on MRI. Unfortunately, as part of a larger test panel called Octave.PIRA affects many of those living with MS. This panel looks at multiple blood biomarkersPIRA may be driven by several factors, including and gives an MS disease activity score.smoldering inammation, loss of neural reserve, Another tool we might use as a biomarkerand deconditioning. One challenge of PIRA is forMSprogressionisopticalcoherenceestablishing objective outcomes or biomarkers. tomography.OCTisanoninvasive,quick,MRI metrics may include measuring brain painless test that uses light waves to create avolume loss, including whole brain volume, cross-sectionalimageoftheretinalnervethalamic volume, and cortical gray volume. berlayer.ResearchhasshowntheRNFLThese same MRI volumetric programs allow correlates with brain volume. This study nowforthemoresensitivemeasurementof shows OCT may be a useful biomarker forenlarging MS lesions that can be difficult for measuring PIRA.the human eye to appreciate. Serum biomarkers include neurolament light chain and glial Beta interferons may nd newbrillaryacidicprotein,bothof whichare life as antiviral agents markersofneuronalandaxonalintegrity. An Oklahoma study examined how twoThese biomarkers are included as part of a treatments for MSB-cell depletion therapylarger test panel called Octave. This panel and interferon-betaaffect respiratory virallooks at multiple blood biomarkers and gives infections. Using a mouse model of inuenza Aan MS disease activity score. infection, researchers found that B-cell depletionAnother tool we might use as a biomarker alone worsened illness, increasing viral load,for MS progression is optical coherence weight loss, lung inammation, and inammatorytomography. OCT is a noninvasive, quick, proteins in the blood. IFN- alone offered littlepainless test that uses light waves to create a 31 msfocusmagazine.org'