Editing Multiple sclerosis (section)

=== Biomarkers ===
{{Main|Biomarkers of multiple sclerosis}}
[[File:Journal.pone.0057573.g005 cropped.png|thumb|upright|[[Magnetic resonance imaging|MRI]] brain scan produced using a ''Gradient-echo phase sequence'' showing an iron deposit in a white matter lesion (inside green box in the middle of the image; enhanced and marked by red arrow top-left corner)<ref name="pmid23516409">{{cite journal | vauthors = Mehta V, Pei W, Yang G, Li S, Swamy E, Boster A, Schmalbrock P, Pitt D | title = Iron is a sensitive biomarker for inflammation in multiple sclerosis lesions | journal = PLOS ONE | volume = 8 | issue = 3 | pages = e57573 | year = 2013 | pmid = 23516409 | pmc = 3597727 | doi = 10.1371/journal.pone.0057573 | bibcode = 2013PLoSO...857573M | doi-access = free }}</ref>]]

Since disease progression is the result of degeneration of neurons, the roles of proteins showing loss of nerve tissue such as [[neurofilament]]s, [[Tau protein|tau]], and [[N-acetylaspartate]] are under investigation.<ref>{{cite journal | vauthors = Khalil M, Teunissen CE, Otto M, Piehl F, Sormani MP, Gattringer T, Barro C, Kappos L, Comabella M, Fazekas F, Petzold A, Blennow K, Zetterberg H, Kuhle J | title = Neurofilaments as biomarkers in neurological disorders | journal = Nature Reviews. Neurology | volume = 14 | issue = 10 | pages = 577–589 | date = October 2018 | pmid = 30171200 | doi = 10.1038/s41582-018-0058-z | url = https://discovery.ucl.ac.uk/id/eprint/10057189/ }}</ref><ref>{{cite journal | vauthors = Petzold A | title = Neurofilament phosphoforms: surrogate markers for axonal injury, degeneration and loss | journal = Journal of the Neurological Sciences | volume = 233 | issue = 1–2 | pages = 183–98 | date = June 2005 | pmid = 15896809 | doi = 10.1016/j.jns.2005.03.015 | url = https://discovery.ucl.ac.uk/id/eprint/18928/ }}</ref>

Improvement in neuroimaging techniques such as [[positron emission tomography]] (PET) or MRI carry a promise for better diagnosis and prognosis predictions. Regarding MRI, there are several techniques that have already shown some usefulness in research settings and could be introduced into clinical practice, such as double-inversion recovery sequences, [[magnetization transfer]], [[Diffusion MRI#Diffusion tensor imaging|diffusion tensor]], and [[functional magnetic resonance imaging]].<ref name="pmid22159052">{{cite journal | vauthors = Filippi M, Rocca MA, De Stefano N, Enzinger C, Fisher E, Horsfield MA, Inglese M, Pelletier D, Comi G | title = Magnetic resonance techniques in multiple sclerosis: the present and the future | journal = Archives of Neurology | volume = 68 | issue = 12 | pages = 1514–20 | date = December 2011 | pmid = 22159052 | doi = 10.1001/archneurol.2011.914 | doi-access = free }}</ref> These techniques are more specific for the disease than existing ones, but still lack some standardization of acquisition protocols and the creation of normative values.<ref name="pmid22159052" /> This is particularly the case for [[proton magnetic resonance spectroscopy]], for which a number of methodological variations observed in the literature may underlie continued inconsistencies in central nervous system metabolic abnormalities, particularly in [[N-acetyl aspartate]], [[myoinositol]], [[choline]], [[Glutamate (neurotransmitter)|glutamate]], [[GABA]], and [[Glutathione|GSH]], observed for multiple sclerosis and its subtypes.<ref>{{cite journal | vauthors = Swanberg KM, Landheer K, Pitt D, Juchem C | title = Quantifying the Metabolic Signature of Multiple Sclerosis by ''in vivo'' Proton Magnetic Resonance Spectroscopy: Current Challenges and Future Outlook in the Translation From Proton Signal to Diagnostic Biomarker | language = English | journal = Frontiers in Neurology | volume = 10 | pages = 1173 |year = 2019 | pmid = 31803127 | pmc = 6876616 | doi = 10.3389/fneur.2019.01173 | doi-access = free }}</ref> There are other techniques under development that include contrast agents capable of measuring levels of peripheral [[macrophage]]s, inflammation, or neuronal dysfunction,<ref name="pmid22159052" /> and techniques that measure iron deposition that could serve to determine the role of this feature in MS, or that of cerebral perfusion.<ref name="pmid22159052" />