Slowing the Progression of Smoldering Myeloma - NCI

Blood Test Might Someday Diagnose Early MS

An early marker of multiple sclerosis could help doctors figure out who will eventually fall prey to the degenerative nerve disease, a new study says.

In one in 10 cases of MS, the body begins producing a distinctive set of antibodies in the blood years before symptoms start appearing, researchers reported April 19 in the journal Nature Medicine.

This antibody pattern was 100% predictive of an MS diagnosis, researchers found. Every patient who carried this set of antibodies went on to develop MS.

Researchers hope these antibodies will someday form the basis of a simple blood test to screen for MS.

"Over the last few decades, there's been a move in the field to treat MS earlier and more aggressively with newer, more potent therapies," said senior researcher Dr. Michael Wilson, a neurologist with the University of California, San Francisco (UCSF).

"A diagnostic result like this makes such early intervention more likely, giving patients hope for a better life," Wilson added in a news release.

MS occurs when the body's own immune system attacks the central nervous system, damaging the protective sheath around nerve fibers called myelin. This disrupts signals to and from the brain, causing a variety of symptoms that impede the senses and impact the ability to move.

An autoimmune disease like MS is believed to result in part from rare immune reactions to common infections, researchers said.

For this study, researchers screened blood samples taken from 250 MS patients collected before and after their diagnosis, and compared them to the blood samples of healthy people.

All of the samples came from U.S. Armed service members, who provide blood samples when they apply to join the military.

It was "a phenomenal cohort of individuals to look at to see how this kind of autoimmunity develops over the course of clinical onset of this disease," said lead researcher Colin Zamecnik, a postdoctoral researcher at UCSF.

The researchers thought they would see a jump in antibodies as the MS patients suffered their first symptoms of the disease.

Instead, they found that 10% of the MS patients had strikingly high levels of autoantibodies—antibodies that can attack the body itself—years before their diagnosis.

The dozen or so autoantibodies flagged by the researchers all stuck to a chemical pattern resembling one found in common viruses. These include Epstein-Barr virus, which infects more than 85% of all people and has been flagged in earlier studies as a potential contributing cause for MS.

Essentially, this 10% of MS patients showed signs of an immune war raging in the brain years before diagnosis, researchers said. These patients also had elevated levels of a protein that gets released as neurons break down.

To confirm their findings, researchers analyzed blood samples from patients in another study involving neurological symptoms. Once again, 10% of the patients diagnosed with MS had the same autoantibody pattern.

"Diagnosis is not always straightforward for MS, because we haven't had disease specific biomarkers," Wilson explained. "We're excited to have anything that can give more diagnostic certainty earlier on, to have a concrete discussion about whether to start treatment for each patient."

It's still not clear what causes MS in the other 90% of patients, but researchers believe they now have a definitive early warning sign that the disease is brewing.

"Imagine if we could diagnose MS before some patients reach the clinic," said senior researcher Dr. Stephen Hauser, director of the UCSF Weill Institute for Neurosciences. "It enhances our chances of moving from suppression to cure."

More information: Colin R. Zamecnik et al, An autoantibody signature predictive for multiple sclerosis, Nature Medicine (2024). DOI: 10.1038/s41591-024-02938-3

The National MS Society has more on multiple sclerosis.

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'I Tried New Test That Can Find Tiny Speck Of Cancer With Astonishing Accuracy'

I don't even feel the needle prick, and the three syringes fill up in seconds. But this blood sample - taken by a phlebotomist in my kitchen - could just save my life by catching cancer before it's even big enough to be seen on a hospital scan.

It will take less than two weeks to tell me what millions of Brits would like to know - whether there is a tumour, however small, somewhere in my body… and if there is, exactly where.

Since Kate Middleton bravely told the world she is fighting cancer last month searches about the early detection of cancer have soared as more people worry about whether they too could be unknowingly harbouring the deadly disease. Visits to the NHS's cancer page rose by nearly five-fold following Kate's announcement, while visits to cancer charities Cancer Research UK and Macmillan also soared.

The King's own cancer diagnosis in January had a similar effect, leading to a 51% increase in searches for NHS advice on how even outwardly healthy people can discover if their bodies are hiding an undiagnosed cancer.

In fact a groundbreaking trial is currently taking place in the NHS which might do just that - and which might mean we could receive treatment before noticing any symptoms, or even before tumours are big enough to be picked up on CT scans.

The new blood test detects circulating tumour cells (CTCs), which are now known to be present in the blood of almost all patients who have cancer. (

Image:

Getty Images)

Around 140,000 people aged 50 to 70 are taking part in the NHS Galleri study, which began in 2021 and uses a new blood test which can detect signs of even the minutest tumour - and pinpoint exactly where it is. The NHS is due to analyse preliminary results in the coming weeks to decide whether to go ahead with the next stage, which could mean millions of Brits could soon be able to benefit from the blood test for free - revolutionising the detection and treatment of cancer.

The test - which evaluates the presence of circulating tumour cells, or CTCs, in the blood, with an accuracy rate of over 80% - is at the cutting edge of cancer research and has only been available, privately, for a year.

To find out how the process works, I took a blood test by one of only two private companies that have a license to offer it in the UK, Goodbody Clinic. The TruCheck Cancer Test - which normally costs around £1200 - can detect up to 70 types of cancer tumours, and accurately pinpoint which organ the cancerous cells originated.

Like most people, hearing the Princess of Wales is battling cancer aged just 42 made me think about my own health and the consequences of discovering a hidden cancer too late. I've just turned 50 - an age after which, depressingly, the risk factors for most illnesses, and especially cancer, suddenly shoot up.

Kate Middleton's video message revealing her cancer diagnosis caused a surge in searches about the disease

The idea of discovering if there was any kind of cancer, even at its earliest stage, curled up inside me was both reassuring and terrifying.

The test itself, however, wasn't at all traumatic. First, I was called by one of Goodbody's doctors, Dr John Pettit, who also works as an NHS GP, who asked me about my family history and reasons for doing the test, while explaining the background and science. The blood tests, he explained, go to a lab in Guildford where they take two to three weeks to process. "There are three or four complex stages of scientific laboratory work they have do," he says.

The test is the result of a decade of groundbreaking research into circulating tumour cells, or CTCs, which are now known to be present in the blood of almost all patients who have cancer. "Even at the earliest stage, maybe when the tumour is just a millimetre across and not doing very much, it's releasing these little marker cells into the blood."

Filled vacutainer blood collection tubes ready to be sent off to the lab for analysis

The test, Dr Pettit explains, is incredibly accurate, and is able to precisely pinpoint the organ the CTCs are coming from. Specificity, or the percentage of people who correctly get a negative result, is 96-96% with the TruCheck test - compared with 90% for mammograms, 80% for PSA prostate testing and 86% for bowel cancer screening.

The other marker for screening tests, sensitivity - or those correctly diagnosed with cancer - is 88%. He says: "That means if you do have cancer lurking in your body, and you have a TruCheck test, there's an 88% chance of getting a positive result and finding it."

"So you've got a 9 out of 10 chance of picking up a cancer in there. That's not ideal, but again comparatively mammogram sensitivity is about 80% and prostate blood test is about 60%. If you're someone with no symptoms or signs of cancer, by having the test you're giving yourself a 9 out of 10 chance of detecting something that's hiding there. It's a 0% rate if you don't have the test."

The blood test, he explains, can detect 70 different types of cancer with the same degree of accuracy. "It includes what we call the big four, breast, bowel, lung and prostate, but 66 others as well, pretty much any cancer you can think of.

"The only ones it won't pick up are leukaemia, lymphomas and myeloma, because of the nature of the science. Those cancers sit in the blood cells, which are taken out of the samples before it is processed."

A few days after my phone consultation I received a kit with three vacutainer blood collection tubes in the post before a friendly phlebotomist came to my home to draw blood from my arm.

The process took less than ten minutes, after which she put the samples back in the prepaid envelope and popped them in the post box on the other side of my road.

Phlebotomist draws blood to test for cancer

The following days were certainly nerve-wracking, but unnecessarily so - if I did have cancer in my body surely it would be best to know about it, so I could get treatment as soon as possible. We know that early detection of cancer can mean the difference between survival and a death sentence - 9 out of ten diagnosed with bowel cancer at the earliest stage survive, compared with one in 10 at the latest stage.

I was told that if the laboratory found CTCs in my blood then a doctor would call me, so was relieved when 13 days later an email with my result pinged into my inbox.

"No circulating turnout cells were detected in your blood, which means that there is a much lower risk that you are harbouring a malignancy," it read.

The knowledge I was - with around 99% certainly - free of any type of cancer immediately took away any worry or uncertainty I had as I entered my 50th year.

Dr Pettit says: "A negative result means it is highly unlikely that I will develop a cancer in the next year, so it gives you that level of peace of mind."

He adds that of patients who have a positive result, seven out of ten have the cancer picked up on their first hospital scan, and for three out of ten there's a delay in finding the tumour because "the test is so sensitive sometimes the tumour's too small to show up on an MRI scan. So those people get retested and it might appear six weeks later, or months later, when it gets to the 3mm threshold that can be seen on an MRI. But it's been caught early and is usually curable."

He says if the test is rolled out on the NHS it would be game-changing. "You could be picking up nine out of ten cancers early, so the potential is huge.

"They're just trying to work out where it might fit into our healthcare system, for instance, whether it becomes a screening tool that's used for everyone over a certain age.

"As a GP it would be great to have these tests just to screen people who have symptoms, we're probably a few years short of that, but there is a lot of interest and a lot of work going on.

"There's lots of high-level excitement about this. It is a new science, the answers aren't all there, but there's enough data to show that the test is accurate and can save lives."

TruCheck is one of two blood based cancer screening programmes that have EU medical approval. The other, Galleri, which is currently being trialled on the NHS, also detects a broad range of cancers, by looking for DNA found in the blood that is shed by cancer cells.

NHS chief executive Amanda Pritchard said: "This quick and simple blood test could mark the beginning of a revolution in cancer detection and treatment here and around the world. By finding cancer before signs and symptoms even appear, we have the best chance of treating it and we can give people the best possible chance of survival".

Yellow Nail Syndrome: What To Know

Medically reviewed by Brendan Camp, MD

Yellow nail syndrome is a rare disease that affects the fingernails and toenails. It typically affects people over 50.

Yellow nail syndrome gets its name from the buildup of lymph under the nails, making them appear yellow. People with this condition may develop pulmonary (lung) and lymphatic system (infection-fighting) problems.

This article covers everything you need to know about yellow toenails and fingernails, including causes, symptoms, treatment, and prevention. 

Pawel Kacperek / Getty Images

What Causes Yellow Nail Syndrome?

Many people with yellow nail syndrome wonder why their nails are yellow. Unfortunately, usually the cause is unknown. However, some causes may include:

Genetic factors: If yellow nails run in your family, you may also be more likely to develop them.

Certain forms of cancer: Rarely, it has been associated with multiple myeloma (bone marrow cancer), lung cancer, breast cancer, non-Hodgkin lymphoma, gallbladder cancer, larynx cancer, renal cell carcinoma, endometrial cancer, and melanoma.

Immunodeficiency syndromes: Yellow nail syndrome is rarely associated with immunoglobulin G (IgG) deficiency (a type of antibody deficiency, in which your body does not make enough IgG) and common variable immunodeficiency (a condition marked by recurrent infections).

Nephrotic syndrome: Rarely, nephrotic syndrome (when the kidneys don't function properly) can also present alongside yellow nail syndrome.

Thyroid disease: Yellow nail syndrome is occasionally associated with Hashimoto's thyroiditis (damaged and enlarged thyroid), severe hypothyroidism (underactive thyroid), and hyperthyroidism (overactive thyroid).

Rheumatoid arthritis (RA): Yellow nail syndrome can sometimes occur after beginning treatment for RA.

Lymphatic disorders: Yellow nail syndrome is often associated with lymphedema (a buildup of fluid in tissues causing swelling) and breathing abnormalities.

Vitamin E can help treat yellow nail syndrome, so a vitamin E deficiency may also cause yellow nails and toenails.

What Are the Symptoms of Yellow Nail Syndrome?

While yellow nails are the primary symptom of yellow nail syndrome, there are other signs to watch out for. These signs and symptoms may include:

How Is Yellow Nail Syndrome Diagnosed?

Since there are so many things that can contribute to yellow nail syndrome, a diagnosis is important. Healthcare providers use the following criteria to diagnose yellow nail syndrome:

A healthcare provider will evaluate your symptoms and do a physical exam. They may also use a pulmonary function test and computed tomography (CT) scan to confirm a diagnosis.

Conditions with similar symptoms include the following:

Related: Causes of Thick Toenails and How to Treat Them

What Are the Complications of Yellow Nail Syndrome?

Complications of yellow nail syndrome may involve the respiratory and lymph systems. For example, if your lymphatic system doesn't drain properly, you may experience the following problems:

You may be at greater risk of developing serious respiratory infections like pneumonia and bronchiectasis with respiratory system complications.

How Is Yellow Nail Syndrome Treated?

Yellow nail syndrome treatment is usually symptom-based, meaning healthcare providers cater therapies to whatever is causing problems for a person. Treatments may include:

Can You Prevent Yellow Nail Syndrome?

Genetics and chronic health conditions often cause yellow nail syndrome, so there isn't anything you can do to actively prevent it. However, if you develop yellow nail syndrome, the symptoms are manageable with various therapies targeting your situation.

Summary

Yellow nail syndrome is more than just yellow nails and toenails. The condition also involves the respiratory and lymphatic systems. If you have symptoms of yellow nail syndrome, a healthcare provider will carefully listen to your symptoms, perform a physical exam, and order diagnostic tests to rule out other conditions. While you can't prevent yellow nail syndrome, the good news is that its symptoms are manageable with different therapies.

Read the original article on Verywell Health.

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