Overview

• Participants in the highest UPF quartile had roughly 30% more relapses during five years of follow-up.
• By two years, higher UPF scores correlated with more new active lesions and larger increases in T2 lesion volume.
• At baseline, higher scores were associated with greater T1 hypointense lesion volume and lower neurological function.
• UPF scores did not predict conversion to clinically definite MS, suggesting a role in amplifying inflammatory activity rather than triggering disease onset.
• Findings are observational despite adjustment for key confounders, with researchers advising UPF reduction as a complementary step and planning replication, microbiome work, and intervention trials.