Correlation of Serum Glial Fibrillary Acidic Protein (Gfap) and Soluble Triggering Receptor Expressed on Myeloid Cells-2 (Strem-2) Levels With Disability and Clinical Characteristics in Multiple Sclerosis Publisher



Khodadadi S ; Rezaeimanesh N ; Varzandi T ; Rezaei A ; Hamidi M ; Montazeri Shatouri R ; Mohammadi Lapevandani M ; Sahraian M A ; Naser Moghadasi A
Source: Acta Neurologica Belgica Published:2026

Abstract

Introduction: Serum biomarkers such as soluble triggering receptor expressed on myeloid cells-2 (sTREM-2) and glial fibrillary acidic protein (GFAP) can indicate astrocyte and microglial activity in Multiple sclerosis (MS) patients. GFAP has been linked to disability progression, but the role of serum sTREM-2 in MS disability remains unclear. Objectives/Aims: To assess the relationship between serum levels of GFAP and sTREM-2, the Expanded Disability Status Scale (EDSS), and clinical characteristics in MS patients. Methods: This cross-sectional study involved 120 MS patients who were diagnosed using the updated 2017 McDonald criteria at Sina Hospital in Tehran, Iran. Following the collection of demographic data and EDSS scores, patient blood samples were obtained, and serum levels of GFAP and sTREM-2 were measured using the enzyme-linked immunosorbent assay (ELISA) method. After determining normality, the connection between serum GFAP and sTREM-2 levels and clinical variables was examined using appropriate tests. The squared correlation coefficient was calculated for significant biomarker–EDSS correlations to estimate the percentage of explained/shared variance. The significance level was set at p < 0.05. Results: The mean ± standard deviation (SD) age of participants was 38.72 ± 8.86 years. The majority were female, comprising 79.2% of the sample (95 out of 120). Most patients had relapsing-remitting MS (RRMS, 79.2%). The median EDSS score was 2.50 (IQR 1.0–4.0). The median serum levels of GFAP and sTREM-2 were 1.13 (0.85–1.38) ng/mL and 0.60 (0.39–0.86) ng/mL, respectively. Both GFAP and sTREM-2 showed statistically significant but modest-to-weak positive correlations with EDSS. GFAP was correlated with EDSS (r = 0.279, p = 0.002), corresponding to approximately 7.8% explained/shared variance, while sTREM-2 was correlated with EDSS (r = 0.199, p = 0.030), corresponding to approximately 4.0% explained/shared variance. In multivariable linear regression models adjusting for age, sex, disease duration, MS subtype, DMT efficacy, and relapse rate, both GFAP (p = 0.020) and sTREM-2 (p = 0.035) remained independently associated with EDSS. There was no significant correlation found between age, disease duration, annual relapse rate, MS subtypes, treatment groups, and the biomarkers studied. Conclusion: Our results show statistically significant but modest-to-weak positive correlations between EDSS and serum levels of sTREM-2 and GFAP, suggesting these biomarkers could help evaluate current disability and further our knowledge of MS pathophysiology. © The Author(s) under exclusive licence to Belgian Neurological Society 2026.