At the ECTRIMS annual congress in October 2018, there was a lot of talk on serum neurofilament light (sNfL) becoming the first blood biomarker predicting neuronal damage caused by neurological disorders. In particular, clinical research in multiple sclerosis (MS) demonstrated that sNfL levels are associated with disease activity and treatment response.1 So, does the promise of sNfL as a blood biomarker for MS hold true in 2019? At the 2019 AAN annual meeting, five of the nine presentations given during the scientific session on MS Biomarkers detailed the advancement in clinical research of sNfL as a highly informative marker for neuronal damage.
Dr Jakimovski (University of Buffalo, USA), presented results on the association of sNfL levels with cognitive impairment in MS.2 Baseline sNfL levels in MS patients were found to predict for poorer processing speed performance and verbal memory. In both MS patients and healthy controls, sNfL levels measured after five years were associated with processing speed and visuospatial memory. Cognitively impaired (CI) MS patients had a higher increase in sNfL levels compared with non-CI MS patients.
The use of sNfL – along with other biomarkers such as cerebrospinal fluid (CSF) NfL, immunoglobulin G oligoclonal bands (OCB) and the 2005 dissemination in space (DIS) criteria – was presented by Dr Thouvenot (University Hospital Carémeau, France) in patients with radiologically isolated syndrome (RIS).3 The presence of sNfL >6.5 pg/mL, CSF NfL >400 pg/mL, presence of OCB and 4/4 2005 DIS criteria were predictive of disease activity. However, only CSF NfL levels were found to be predictive of clinical conversion.
Dr Thebault (University of Ottawa, Canada) showed how sNfL correlates with disease activity and treatment response before and after autologous haematopoietic stem cell transplant (AHSCT) better than other markers (glial fibrillary acids protein and Tau).4 All three biomarkers reached their highest level three months post-AHSCT, which was correlated with MRI-detected brain atrophy and might be indicative of cyclophosphamide and busulfan neurotoxicity.
Low sNfL levels were found to identify MS patients with very low risk of recent radiological disease activity.5 According to Dr Uher (Charles University, Czech Republic), sNfL assessment could replace or supplement the need for annual brain MRI in clinically stable MS patients.
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- D Jakimovski. “Serum neurofilament light chain levels and cognitive performance in multiple sclerosis: a longitudinal retrospective 5-year study”. S37.002 presented at AAN Annual Meeting, May 4–10, 2019.
- E Thoucenot. “Neurofilament-light chain levels are predictive of on-going disease activity in radiologically isolated syndrome”. S37.003 presented at AAN Annual Meeting, May 4–10, 2019.
- S Thebault. “Serum neurofilament, GFAP and Tau in patients with aggressive multiple sclerosis before and after haematopoietic stem cell transplant”. S37.004 presented at AAN Annual Meeting, May 4–10, 2019.
- T Uher. “Monitoring of subclinical disease activity by serum neurofilament light chain levels in multiple sclerosis”. S37.005 presented at AAN Annual Meeting, May 4–10, 2019.