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In a new study of 43 sets of identical (monozygotic) twins, it was reported that twins typically show similar patterns of immune cells, even when one twin had MS and the other does not. Some of the twins with no MS symptoms showed some signs of MS-like brain lesions on MRI, and their immune profiles mimicked those of people in early stages of MS. These findings add to mounting evidence that the onset of MS is preceded by “silent” disease activity. Understanding these early signals can yield new strategies for treating and preventing disease.

• There is mounting evidence that MS begins below the surface, often long before any signs or symptoms emerge. Defining the constellation of hidden signals and biological markers of this MS “prodrome” will eventually enable earlier detection and treatment to prevent full-blown MS, and can also provide clues to the underlying causes of MS.
• This team studied a unique population of 43 sets of identical (monozygotic) twins, in which one twin had MS and the other did not. Using advanced technology allowing researchers to analyze numerous immune cells at high resolution simultaneously, they found that the so-called “immune signatures” – the pattern of immune cells – was remarkably similar between twins affected by MS and those unaffected.
• The team also studied twins who did not have symptoms of MS for the presence of disease activity on MRI scans, indicating increased risk of developing MS. In the subgroup of people with this activity, the researchers identified a subtle, but distinct pattern of immune cells (CD4+ T cells) known for launching immune attacks, which matched immune profiles of an unrelated group of people in early stages of MS.
• This study yields important clues to what might be the earliest signals of MS. Understanding these signals is the first step toward addressing them with treatment and prevention strategies. Read more about what causes MS 

“Immune signatures of prodromal multiple sclerosis in monozygotic twins” was published by Lisa Ann Gordes (Ludwig-Maximilians Universität München) and Luisa Klotz (University Hospital Münster) and colleagues in Proceedings of the National Academy of Science (published online August 17, 2020).