Distinct mechanism underlying patients who might benefit from edaravone or those may not - a combined quantitative susceptibility mapping and DTI study

The coexistence of multiple complicated pathological mechanisms, and lack of valid biomarker for treatment effects, remains to be main challenges that retarded ALS clinical trials. The approve of edaravone in treating ALS confirmed the importance of oxidative stress in ALS pathology. However, only a subgroup of patients would benefit with edaravone. We used QSM and DTI to explore the different mechanism that underlying those two cohorts. Our study revealed that neuroinflammation-prominent pathology and age-dependent oxidative stress might a feature for patients benefit with eradavone. While for patients not fulfill edaravone therapy, iron-mediated injury, like ferroptosis might accelerate disease progression.