Axial Spondyloarthritis (axSpA)

Biomarkers for evaluating axial spondyloarthritis (axSpA)

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that mainly affects the axial skeleton including the spine and the sacroiliac joints. The hallmarks of axSpA are inflammation and new bone formation at the axial skeleton and entheseal sites (where tendons insert into the bone).

Inflammation takes place, accompanied by bone and cartilage loss with subsequent remodeling with new bone formation. Despite the advancements in drug development for axSpA in recent years, there is still unmet needs for a timely diagnosis and higher rates of response to treatment (with 40% of patients currently not responding to available therapies).

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Nordic ProteinFingerPrint Technology™ biomarkers in axSpA

Tissue remodeling and immune cell activity play pivotal roles in axSpA. Assessing disease activity and remodeling in axSpA can provide a unique insight into structural and functional changes in the disease pathogenesis. In addition, one of the key features of the biomarkers is the ability to monitor the disease activity, pharmacodynamic effects, and identification of disease endotypes.

Our rheumatology biomarker panels offer extracellular matrix-based-based biomarkers, which are fundamentally more different and more specific compared to what’s offered by omics providers. Our technology provides valuable insights into tissue formation, degradation, and resolution, that offer a deeper understanding of pathological processes related to joint diseases. At the same time, proteomics providers’ wide-range arrays may not offer the same level of mechanistic specificity.

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Biomarkers associated with disease activity and treatment response in axSpA

The delicate equilibrium between repair and response within the ECM becomes disrupted by the infiltration of immune cells into the inflamed tissue. This disruption results in excessive production and activation of proteases such as matrix metalloproteinases (MMPs).

Type I collagen is found in cartilage and bone. The biomarker C1M, which measures type I collagen degradation by MMPs, can differentiate between patients with axSpA and other subjects with the same back conditions or healthy controls (Figure 1).

This same biomarker also serves as a pharmacodynamic biomarker, being suppressed after 6 or 12 weeks of treatment with Adalimumab (a TNF-α inhibitor) compared to placebo in two clinical trials, DANISH and ASIM (Figure 2, below).

Figure 2. The C1M biomarker is suppressed after 6 or 12 weeks by axSpA patients benefiting from Adalimumab (TNF-α inhibitor) compared to patients receiving placebo in two clinical trials (DANISH and ASIM).

Biomarkers associated with disease activity and treatment response in axSpA

Like other chronic inflammatory diseases, the natural course of axSpA is highly heterogeneous. There exists a spectrum of inflammation, concomitant extra-articular manifestations, and varying degrees of structural damage within patients with axSpA.

Improved patient stratification or the identification of disease endotypes, rather than disease phenotypes, may thus enhance drug response rates and lead to a more precise disease taxonomy.

By using ECM biomarkers, three endotypes were identified: high levels of tissue inflammation markers, low levels of tissue inflammation markers, and high levels of cartilage turnover markers (Figure 3).

Figure 3. Principal component analysis biplot of individuals and principal component dimensions. Ellipses represent 80% of the patients within the cluster, which are differentiated by colour. Cluster 1, 2 and 3 correspond to Endotype1, 2 and 3, respectively.
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The Nordic ProteinFingerPrint Technology™ in rheumatic disorders

Unsure about how our technology can benefit your clinical trial in rheumatic disorder? Watch this short video and get an understanding of the benefit you gain from our biomarkers .

About axial spondyloarthritis (axSpA)

  • Axial spondyloarthritis (axSpA) is a chronic inflammatory condition primarily affecting the spine and sacroiliac joints. Diagnosis is based on clinical symptoms, imaging (like MRI), and laboratory tests, but early detection remains challenging, which is why biomarker research is gaining importance.

  • Biomarkers help assess disease activity, track structural damage, and monitor treatment response in axSpA. They can also support patient stratification by identifying underlying biological endotypes, improving precision medicine approaches.

  • Yes, biomarkers such as C1M can help predict who is likely to benefit from therapies like TNF inhibitors. This enables more targeted treatment decisions and may reduce unnecessary exposure to ineffective drugs.

  • Identifying biological endotypes—distinct molecular profiles within axSpA—can improve understanding of disease heterogeneity and enhance drug development. Endotyping using ECM biomarkers supports more personalized and effective treatment strategies.

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