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The demarcation of transition of multiple sclerosis (MS) from the relapsing remitting (RR) to the secondary progressive (SP) phase is still illusive with no defined clinical, radiological or biological biomarkers. The need for detection of the transition phase has become an urgent need to avoid the insidious transformation to the SP stage especially in the context of new emerging approved therapies. The clinical signs are usually under looked. We aimed at detecting clinical biomarkers that can define the potential transition from RRMS to SPMS.

Recently, evidence of the association between the kynurenine pathway (KP) and multiple sclerosis (MS) has rapidly grown. The role of KP (major metabolic pathway of tryptophan) was investigated in the pathogenesis of several neurodegenerative, inflammatory, psychiatric, vascular and autoimmune diseases. Stimulation of KP by inflammatory molecules leads to a complex cascade production of neuroactive metabolites. This neuroactive metabolites are known to have different effects on neurons, some being neuroprotective such as kynurenic acid and picolinic acid, while others are neurotoxic like quinolinic acid and 3-hydroxykynurenine. Neurotoxic KP metabolites were associated with the excitotoxicity of oligodendrocytes and neurons that could contribute to the pathogenesis and disease progression of MS by promoting brain cell dysfunction and death.

•Neutrophil-lymphocyte ratio was significantly higher in multiple sclerosis (MS) patients compared to controls.•NLR was a significant factor associated with MS disability and activity.•The results suggest that NLR could be utilized as a simple, rapid, and inexpensive inflammatory marker of MS disability and activity.

•There is high frequency of MetS and its component in Egyptian MS patients.•Metabolic syndrome was not a significant factor affecting disability in MS patients.•Disease duration, current medication, BMI and dyslipidemia were the independent factors significantly associated with disability in MS patients.