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Desu HL, Sawicka KM, Wuerch E, Kitchin V, Quandt JA. A rapid review of differences in cerebrospinal neurofilament light levels in clinical subtypes of progressive multiple sclerosis. Front Neurol 2024; 15:1382468. [PMID: 38654736 PMCID: PMC11035744 DOI: 10.3389/fneur.2024.1382468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Background Multiple sclerosis (MS) is divided into three clinical phenotypes: relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS). It is unknown to what extent SPMS and PPMS pathophysiology share inflammatory or neurodegenerative pathological processes. Cerebrospinal (CSF) neurofilament light (NfL) has been broadly studied in different MS phenotypes and is a candidate biomarker for comparing MS subtypes. Research question Are CSF NfL levels different among clinical subtypes of progressive MS? Methods A search strategy identifying original research investigating fluid neurodegenerative biomarkers in progressive forms of MS between 2010 and 2022 was applied to Medline. Identified articles underwent title and abstract screen and full text review against pre-specified criteria. Data abstraction was limited to studies that measured NfL levels in the CSF. Reported statistical comparisons of NfL levels between clinical phenotypes were abstracted qualitatively. Results 18 studies that focused on investigating direct comparisons of CSF NfL from people with MS were included in the final report. We found NfL levels were typically reported to be higher in relapsing and progressive MS compared to healthy controls. Notably, higher NfL levels were not clearly associated with progressive MS subtypes when compared to relapsing MS, and there was no observed difference in NfL levels between PPMS and SPMS in articles that separately assessed these phenotypes. Conclusion CSF NfL levels distinguish individuals with MS from healthy controls but do not differentiate MS subtypes. Broad biological phenotyping is needed to overcome limitations of current clinical phenotyping and improve biomarker translatability to decision-making in the clinic.
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Affiliation(s)
- Haritha L. Desu
- Neuroimmunology Unit, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada
| | - Katherine M. Sawicka
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Emily Wuerch
- Hotchkiss Brain Institute and the Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
| | - Vanessa Kitchin
- University of British Columbia Library, Vancouver, BC, Canada
| | - Jacqueline A. Quandt
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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Giuffrè GM, Quaranta D, Costantini EM, Citro S, Martellacci N, De Ninno G, Vita MG, Guglielmi V, Rossini PM, Calabresi P, Marra C. Cerebrospinal fluid neurofilament light chain and total-tau as biomarkers of neurodegeneration in Alzheimer's disease and frontotemporal dementia. Neurobiol Dis 2023; 186:106267. [PMID: 37652185 DOI: 10.1016/j.nbd.2023.106267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION CSF Neurofilament light chain(NfL) is a promising biomarker of neurodegeneration, but its utility in discriminating between Alzheimer's disease(AD) and frontotemporal dementia(FTD) is limited. METHODS 105 patients with clinical-biological diagnosis of mild cognitive impairment(MCI) due to AD (N = 72) or clinical diagnosis of FTD (N = 33) underwent neuropsychological assessment and CSF Aβ42/40, p-tau181, total-tau and NfL quantification. Group comparisons, correlations between continuous variables and ROC curve analysis were carried out to assess NfL role in discriminating between MCI due to AD and FTD, exploring the associations between NfL, ATN biomarkers and neuropsychological measures. RESULTS NfL levels were significantly lower in the AD group, while levels of total-tau were higher. In the FTD group, significant correlations were found between NfL, p-tau181 and total-tau, and between NfL and cognitive performances. In the AD group, NfL levels were directly correlated with total-tau and p-tau181; Aβ42/40 ratio was inversely correlated with total-tau and p-tau181, but not with NfL. Moreover, p-tau181 and t-tau levels were found to be associated with episodic memory and lexical-semantic impairment. Total-tau/NfL ratio differentiated prodromal-AD from FTD with an AUC of 0.951, higher than the individual measures. DISCUSSION & CONCLUSIONS The results support that NfL and total-tau levels reflect distinct pathophysiological neurodegeneration mechanisms, independent and dependent of Aβ pathology, respectively, Combining them may enhance both markers reliability, their ratio showing high accuracy in distinguishing MCI due to AD from FTD. Moreover, our results revealed associations between NfL and disease severity in FTD and between tauopathy and episodic memory and lexical-semantic impairment in prodromal-AD.
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Affiliation(s)
- Guido Maria Giuffrè
- Neurology Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Memory Clinic Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
| | - Davide Quaranta
- Neurology Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Memory Clinic Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy.
| | | | - Salvatore Citro
- Neurology Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Memory Clinic Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
| | - Noemi Martellacci
- Memory Clinic Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Grazia De Ninno
- UOC of Chemistry, Biochemistry and Clinical Molecular Biology - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Gabriella Vita
- Neurology Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valeria Guglielmi
- Neurology Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma, Rome, Italy
| | - Paolo Calabresi
- Neurology Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Memory Clinic Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
| | - Camillo Marra
- Memory Clinic Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
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Kim JS. Protein biomarkers in multiple sclerosis. ENCEPHALITIS 2023; 3:54-63. [PMID: 37469674 PMCID: PMC10295828 DOI: 10.47936/encephalitis.2022.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/18/2023] [Indexed: 07/21/2023] Open
Abstract
This review aimed to elucidate protein biomarkers in body fluids, such as blood and cerebrospinal fluid (CSF), to identify those that may be used for early diagnosis of multiple sclerosis (MS), prediction of disease activity, and monitoring of treatment response among MS patients. The potential biomarkers elucidated in this review include neurofilament proteins (NFs), glial fibrillary acidic protein (GFAP), leptin, brain-derived neurotrophic factor (BDNF), chitinase-3-like protein 1 (CHI3L1), C-X-C motif chemokine 13 (CXCL13), and osteopontin (OPN), with each biomarker playing a different role in MS. GFAP, leptin, and CHI3L1 levels were increased in MS patient groups compared to the control group. NFs are the most studied proteins in the MS field, and significant correlations with disease activity, future progression, and treatment outcomes are evident. GFAP CSF level shows a different pattern by MS subtype. Increased concentration of CHI3L1 in the blood/CSF of clinically isolated syndrome (CIS) is an independent predictive factor of conversion to definite MS. BDNF may be affected by chronic progression of MS. CHI3L1 has potential as a biomarker for early diagnosis of MS and prediction of disability progression, while CXCL13 has potential as a biomarker of prognosis of CIS and reflects MS disease activity. OPN was an indicator of disease severity. A periodic detailed patient evaluation should be performed for MS patients, and broadly and easily accessible biomarkers with higher sensitivity and specificity in clinical settings should be identified.
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Affiliation(s)
- Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
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4
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Adams A, Tilden W, Bestwick J, Holden D, Bianchi L, Smets I, Giovannoni G, Gnanapavan S. The relationship of CSF neurofilament levels with MRI lesion location and disease activity in Multiple Sclerosis. Eur J Neurol 2022; 29:2754-2760. [PMID: 35615966 PMCID: PMC9544913 DOI: 10.1111/ene.15419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 04/24/2022] [Accepted: 05/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurofilament light chain (NfL) is an accepted biomarker of disease activity in MS, but its relationship with MRI activity, particularly in reference to lesion location and recurrent activity is not well understood. METHODS In 139 MS patients who underwent lumbar punctures with follow up in 25, we evaluated the relationship between CSF NFL and cranial MRI based on lesion location and lesion number. Spearman rank correlation was used to assess the association between CSF NFL and MRI lesion location and lesion counts at baseline and follow up at 1 year. Multiple linear regression analysis was performed to assess which lesion location was most strongly associated with CSF NFL values. RESULTS The associations between baseline CSF NFL and lesion location and follow-up lesions were modest, whilst those between baseline MRI and follow-up CSF NFL were greater: periventricular (r=0.31, p=0.141), juxtacortical (r=0.47, p=0.022), infratentorial (r=0.71, p≤0.001), and cord lesions (r=0.60, p=0.002). All associations, however improved following adjustment for disease duration and type of MS. Modelling revealed 53% of (log) CSF NfL could be explained by variance in baseline MRI lesion location. CONCLUSIONS Baseline CSF NFL did not correlate with current or future MRI activity and lesion location. However, baseline MRI activity explained around 53% variation in the follow up CSF NfL, suggesting that the relationship between MRI and CSF NfL is mainly precedent rather than an association, one occurring before another.
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Affiliation(s)
- Ashok Adams
- Department of Neuroradiology, Barts Health NHS Trust, London, UK
| | - William Tilden
- Department of Neuroradiology, Barts Health NHS Trust, London, UK
| | - Jonathan Bestwick
- Wolfson Institute of Preventative Medicine, Queen Mary University of London, UK
| | - David Holden
- Department of Neurocience & Trauma, Blizard Institute, Queen Mary University of London, UK
| | - Lucia Bianchi
- Department of Neurocience & Trauma, Blizard Institute, Queen Mary University of London, UK
| | - Ide Smets
- Department of Neurocience & Trauma, Blizard Institute, Queen Mary University of London, UK
| | - Gavin Giovannoni
- Department of Neurocience & Trauma, Blizard Institute, Queen Mary University of London, UK.,Department of Neurology, Barts Health NHS Trust, London, UK
| | - Sharmilee Gnanapavan
- Department of Neurocience & Trauma, Blizard Institute, Queen Mary University of London, UK.,Department of Neurology, Barts Health NHS Trust, London, UK
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Biernacki T, Kokas Z, Sandi D, Füvesi J, Fricska-Nagy Z, Faragó P, Kincses TZ, Klivényi P, Bencsik K, Vécsei L. Emerging Biomarkers of Multiple Sclerosis in the Blood and the CSF: A Focus on Neurofilaments and Therapeutic Considerations. Int J Mol Sci 2022; 23:ijms23063383. [PMID: 35328802 PMCID: PMC8951485 DOI: 10.3390/ijms23063383] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Multiple Sclerosis (MS) is the most common immune-mediated chronic neurodegenerative disease of the central nervous system (CNS) affecting young people. This is due to the permanent disability, cognitive impairment, and the enormous detrimental impact MS can exert on a patient's health-related quality of life. It is of great importance to recognise it in time and commence adequate treatment at an early stage. The currently used disease-modifying therapies (DMT) aim to reduce disease activity and thus halt disability development, which in current clinical practice are monitored by clinical and imaging parameters but not by biomarkers found in blood and/or the cerebrospinal fluid (CSF). Both clinical and radiological measures routinely used to monitor disease activity lack information on the fundamental pathophysiological features and mechanisms of MS. Furthermore, they lag behind the disease process itself. By the time a clinical relapse becomes evident or a new lesion appears on the MRI scan, potentially irreversible damage has already occurred in the CNS. In recent years, several biomarkers that previously have been linked to other neurological and immunological diseases have received increased attention in MS. Additionally, other novel, potential biomarkers with prognostic and diagnostic properties have been detected in the CSF and blood of MS patients. AREAS COVERED In this review, we summarise the most up-to-date knowledge and research conducted on the already known and most promising new biomarker candidates found in the CSF and blood of MS patients. DISCUSSION the current diagnostic criteria of MS relies on three pillars: MRI imaging, clinical events, and the presence of oligoclonal bands in the CSF (which was reinstated into the diagnostic criteria by the most recent revision). Even though the most recent McDonald criteria made the diagnosis of MS faster than the prior iteration, it is still not an infallible diagnostic toolset, especially at the very early stage of the clinically isolated syndrome. Together with the gold standard MRI and clinical measures, ancillary blood and CSF biomarkers may not just improve diagnostic accuracy and speed but very well may become agents to monitor therapeutic efficacy and make even more personalised treatment in MS a reality in the near future. The major disadvantage of these biomarkers in the past has been the need to obtain CSF to measure them. However, the recent advances in extremely sensitive immunoassays made their measurement possible from peripheral blood even when present only in minuscule concentrations. This should mark the beginning of a new biomarker research and utilisation era in MS.
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Affiliation(s)
- Tamás Biernacki
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Zsófia Kokas
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Dániel Sandi
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Judit Füvesi
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Zsanett Fricska-Nagy
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Péter Faragó
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Tamás Zsigmond Kincses
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
- Albert Szent-Györgyi Clinical Centre, Department of Radiology, Albert Szent-Györgyi Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Péter Klivényi
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - Krisztina Bencsik
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
| | - László Vécsei
- Albert Szent-Györgyi Clinical Centre, Department of Neurology, Faculty of General Medicine, University of Szeged, 6725 Szeged, Hungary; (T.B.); (Z.K.); (D.S.); (J.F.); (Z.F.-N.); (P.F.); (T.Z.K.); (P.K.); (K.B.)
- MTA-SZTE Neuroscience Research Group, University of Szeged, 6725 Szeged, Hungary
- Correspondence: ; Tel.: +36-62-545-356; Fax: +36-62-545-597
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Kouchaki E, Dashti F, Mirazimi SMA, Alirezaei Z, Jafari SH, Hamblin MR, Mirzaei H. Neurofilament light chain as a biomarker for diagnosis of multiple sclerosis. EXCLI JOURNAL 2021; 20:1308-1325. [PMID: 34602928 PMCID: PMC8481790 DOI: 10.17179/excli2021-3973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/22/2021] [Indexed: 12/16/2022]
Abstract
The treatments for multiple sclerosis (MS) have improved over the past 25 years, but now the main question for physicians is deciding who should receive treatment, for how long, and when to switch to other options. These decisions are typically based on treatment tolerance and a reasonable expectation of long-term efficacy. A significant unmet need is the lack of accurate laboratory measurements for diagnosis, and monitoring of treatment response, including deterioration and disease progression. There are few validated biomarkers for MS, and in practice, physicians employ two biomarkers discovered fifty years ago for MS diagnosis, often in combination with MRI scans. These biomarkers are intrathecal IgG and oligoclonal bands in the CSF (cerebrospinal fluid). Neurofilament light chain (NfL) is a relatively new biomarker for MS diagnosis and follow up. Neurofilaments are neuron-specific cytoskeleton proteins that can be measured in various body compartments. NfL is a new biomarker for MS that can be measured in serum samples, but this still needs further study to specify the laboratory cut-off values in clinical practice. In the present review we discuss the evidence for NfL as a reliable biomarker for the early detection and management of MS. Moreover, we highlight the correlation between MRI and NfL, and ask whether they can be combined.
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Affiliation(s)
- Ebrahim Kouchaki
- MS Fellowship, Department of Neurology, School of Medicine, Physiology Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatemeh Dashti
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.,Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Mohammad Ali Mirazimi
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.,Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Alirezaei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Paramedical School, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Seyed Hamed Jafari
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, IR, Iran
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Yuan A, Nixon RA. Neurofilament Proteins as Biomarkers to Monitor Neurological Diseases and the Efficacy of Therapies. Front Neurosci 2021; 15:689938. [PMID: 34646114 PMCID: PMC8503617 DOI: 10.3389/fnins.2021.689938] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
Biomarkers of neurodegeneration and neuronal injury have the potential to improve diagnostic accuracy, disease monitoring, prognosis, and measure treatment efficacy. Neurofilament proteins (NfPs) are well suited as biomarkers in these contexts because they are major neuron-specific components that maintain structural integrity and are sensitive to neurodegeneration and neuronal injury across a wide range of neurologic diseases. Low levels of NfPs are constantly released from neurons into the extracellular space and ultimately reach the cerebrospinal fluid (CSF) and blood under physiological conditions throughout normal brain development, maturation, and aging. NfP levels in CSF and blood rise above normal in response to neuronal injury and neurodegeneration independently of cause. NfPs in CSF measured by lumbar puncture are about 40-fold more concentrated than in blood in healthy individuals. New ultra-sensitive methods now allow minimally invasive measurement of these low levels of NfPs in serum or plasma to track disease onset and progression in neurological disorders or nervous system injury and assess responses to therapeutic interventions. Any of the five Nf subunits - neurofilament light chain (NfL), neurofilament medium chain (NfM), neurofilament heavy chain (NfH), alpha-internexin (INA) and peripherin (PRPH) may be altered in a given neuropathological condition. In familial and sporadic Alzheimer's disease (AD), plasma NfL levels may rise as early as 22 years before clinical onset in familial AD and 10 years before sporadic AD. The major determinants of elevated levels of NfPs and degradation fragments in CSF and blood are the magnitude of damaged or degenerating axons of fiber tracks, the affected axon caliber sizes and the rate of release of NfP and fragments at different stages of a given neurological disease or condition directly or indirectly affecting central nervous system (CNS) and/or peripheral nervous system (PNS). NfPs are rapidly emerging as transformative blood biomarkers in neurology providing novel insights into a wide range of neurological diseases and advancing clinical trials. Here we summarize the current understanding of intracellular NfP physiology, pathophysiology and extracellular kinetics of NfPs in biofluids and review the value and limitations of NfPs and degradation fragments as biomarkers of neurodegeneration and neuronal injury.
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Affiliation(s)
- Aidong Yuan
- Center for Dementia Research, Nathan Kline Institute, Orangeburg, NY, United States
- Department of Psychiatry, NYU Neuroscience Institute, New York, NY, United States
| | - Ralph A. Nixon
- Center for Dementia Research, Nathan Kline Institute, Orangeburg, NY, United States
- Department of Psychiatry, NYU Neuroscience Institute, New York, NY, United States
- Department of Cell Biology, New York University Grossman School of Medicine, (NYU), Neuroscience Institute, New York, NY, United States
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Measuring Treatment Response in Progressive Multiple Sclerosis-Considerations for Adapting to an Era of Multiple Treatment Options. Biomolecules 2021; 11:biom11091342. [PMID: 34572555 PMCID: PMC8470215 DOI: 10.3390/biom11091342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
Disability in multiple sclerosis accrues predominantly in the progressive forms of the disease. While disease-modifying treatment of relapsing MS has drastically evolved over the last quarter-century, the development of efficient drugs for preventing or at least delaying disability in progressive MS has proven more challenging. In that way, many drugs (especially disease-modifying treatments) have been researched in the aspect of delaying disability progression in patients with a progressive course of the disease. While there are some disease-modifying treatments approved for progressive multiple sclerosis, their effect is moderate and limited mostly to patients with clinical and/or radiological signs of disease activity. Several phase III trials have used different primary outcomes with different time frames to define disease progression and to evaluate the efficacy of a disease-modifying treatment. The lack of sufficiently sensitive outcome measures could be a possible explanation for the negative clinical trials in progressive multiple sclerosis. On the other hand, even with a potential outcome measure that would be sensitive enough to determine disease progression and, thus, the efficacy or failure of a disease-modifying treatment, the question of clinical relevance remains unanswered. In this systematic review, we analyzed outcome measures and definitions of disease progression in phase III clinical trials in primary and secondary progressive multiple sclerosis. We discuss advantages and disadvantages of clinical and paraclinical outcome measures aiming for practical ways of combining them to detect disability progression more sensitively both in future clinical trials and current clinical routine.
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Williams T, Zetterberg H, Chataway J. Neurofilaments in progressive multiple sclerosis: a systematic review. J Neurol 2021; 268:3212-3222. [PMID: 32447549 PMCID: PMC8357650 DOI: 10.1007/s00415-020-09917-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neurofilament proteins have been extensively studied in relapsing-remitting multiple sclerosis, where they are promising biomarkers of disease activity and treatment response. Their role in progressive multiple sclerosis, where there is a particularly urgent need for improved biomarkers, is less clear. The objectives of this systematic review are to summarise the literature on neurofilament light and heavy in progressive multiple sclerosis, addressing key questions. METHODS A systematic search of PubMed, Embase, Web of Science and Scopus identified 355 potential sources. 76 relevant sources were qualitatively reviewed using QUADAS-2 criteria, and 17 were identified as at low risk of bias. We summarise the findings from all relevant sources, and separately from the 17 high-quality studies. RESULTS Differences in neurofilament light between relapsing-remitting and progressive multiple sclerosis appear to be explained by differences in covariates. Neurofilament light is consistently associated with current inflammatory activity and future brain atrophy in progressive multiple sclerosis, and is consistently shown to be a marker of treatment response with immunosuppressive disease-modifying therapies. Associations with current or future disability are inconsistent, and there is no evidence of NFL being a responsive marker of purportedly neuroprotective treatments. Evidence on neurofilament heavy is more limited and inconsistent. CONCLUSIONS Neurofilament light has shown consistent utility as a biomarker of neuroinflammation, future brain atrophy and immunosuppressive treatment response at a group level. Neither neurofilament light or heavy has shown a consistent treatment response to neuroprotective disease-modifying therapies, which will require further data from successful randomised controlled trials.
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Affiliation(s)
- Thomas Williams
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK.
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK
- UK Dementia Research Institute, University College London, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy At the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jeremy Chataway
- Department of Neuroinflammation, Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
- Biomedical Research Centre, National Institute for Health Research, University College London Hospitals, London, UK
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10
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Moraes AS, Boldrini VO, Dionete AC, Andrade MD, Longhini ALF, Santos I, Lima ADR, Silva VAPG, Dias Carneiro RPC, Quintiliano RPS, Ferrari BB, Damasceno A, Pradella F, Farias AS, Tilbery CP, Domingues RB, Senne C, Fernandes GBP, von Glehn F, Brandão CO, Stella CRAV, Santos LMB. Decreased Neurofilament L Chain Levels in Cerebrospinal Fluid and Tolerogenic Plasmacytoid Dendritic Cells in Natalizumab-Treated Multiple Sclerosis Patients - Brief Research Report. Front Cell Neurosci 2021; 15:705618. [PMID: 34381335 PMCID: PMC8350727 DOI: 10.3389/fncel.2021.705618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background Neurofilament Light (NfL) chain levels in both cerebrospinal fluid (CSF) and serum have been correlated with the reduction of axonal damage in multiple sclerosis (MS) patients treated with Natalizumab (NTZ). However, little is known about the function of plasmacytoid cells in NTZ-treated MS patients. Objective To evaluate CSF NfL, serum levels of soluble-HLA-G (sHLA-G), and eventual tolerogenic behavior of plasmacytoid dendritic cells (pDCs) in MS patients during NTZ treatment. Methods CSF NfL and serum sHLA-G levels were measured using an ELISA assay, while pDCs (BDCA-2+) were accessed through flow cytometry analyses. Results CSF levels of NfL were significantly reduced during NTZ treatment, while the serum levels of sHLA-G were increased. Moreover, NTZ treatment enhanced tolerogenic (HLA-G+, CD274+, and HLA-DR+) molecules and migratory (CCR7+) functions of pDCs in the peripheral blood. Conclusion These findings suggest that NTZ stimulates the production of molecules with immunoregulatory function such as HLA-G and CD274 programmed death-ligand 1 (PD-L1) which may contribute to the reduction of axonal damage represented by the decrease of NfL levels in patients with MS.
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Affiliation(s)
- Adriel S Moraes
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Vinicius O Boldrini
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Alliny C Dionete
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marilia D Andrade
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ana Leda F Longhini
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil.,Department of Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Irene Santos
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Amanda D R Lima
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Veronica A P G Silva
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Rafael P C Dias Carneiro
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil.,Department of Neurology, University of Campinas, Campinas, Brazil.,MS Clinic of Santa Casa de São Paulo (CATEM), São Paulo, Brazil
| | - Raphael P S Quintiliano
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Breno B Ferrari
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Fernando Pradella
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Alessandro S Farias
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Renan B Domingues
- MS Clinic of Santa Casa de São Paulo (CATEM), São Paulo, Brazil.,Senne Liquor Diagnóstico, São Paulo, Brazil
| | - Carlos Senne
- Senne Liquor Diagnóstico, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Gustavo B P Fernandes
- Senne Liquor Diagnóstico, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Felipe von Glehn
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Carlos Otavio Brandão
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil.,Department of Neurology, University of Campinas, Campinas, Brazil
| | | | - Leonilda M B Santos
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology, and Immunology, University of Campinas (UNICAMP), Campinas, Brazil.,National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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11
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Ferreira-Atuesta C, Reyes S, Giovanonni G, Gnanapavan S. The Evolution of Neurofilament Light Chain in Multiple Sclerosis. Front Neurosci 2021; 15:642384. [PMID: 33889068 PMCID: PMC8055958 DOI: 10.3389/fnins.2021.642384] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune, inflammatory neurodegenerative disease of the central nervous system characterized by demyelination and axonal damage. Diagnosis and prognosis are mainly assessed through clinical examination and neuroimaging. However, more sensitive biomarkers are needed to measure disease activity and guide treatment decisions in MS. Prompt and individualized management can reduce inflammatory activity and delay disease progression. Neurofilament Light chain (NfL), a neuron-specific cytoskeletal protein that is released into the extracellular fluid following axonal injury, has been identified as a biomarker of disease activity in MS. Measurement of NfL levels can capture the extent of neuroaxonal damage, especially in early stages of the disease. A growing body of evidence has shown that NfL in cerebrospinal fluid (CSF) and serum can be used as reliable indicators of prognosis and treatment response. More recently, NfL has been shown to facilitate individualized treatment decisions for individuals with MS. In this review, we discuss the characteristics that make NfL a highly informative biomarker and depict the available technologies used for its measurement. We further discuss the growing role of serum and CSF NfL in MS research and clinical settings. Finally, we address some of the current topics of debate regarding the use of NfL in clinical practice and examine the possible directions that this biomarker may take in the future.
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Affiliation(s)
- Carolina Ferreira-Atuesta
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Neurology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Saúl Reyes
- Department of Neurology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.,The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Gavin Giovanonni
- The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Neurology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sharmilee Gnanapavan
- The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,Department of Neurology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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12
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Verberk IMW, Koel-Simmelink M, Twaalfhoven H, Vrenken H, Korth C, Killestein J, Teunissen CE, Bridel C. Ultrasensitive immunoassay allows measurement of serum neurofilament heavy in multiple sclerosis. Mult Scler Relat Disord 2021; 50:102840. [PMID: 33626430 DOI: 10.1016/j.msard.2021.102840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Neurofilament heavy (NfH) is a promising biomarker for neuro-axonal damage in Multiple Sclerosis (MS). We compared the performance of high-sensitivity serum-NfH immunoassays, with as aim to investigate the value of serum-NfH as biomarker for MS. METHODS We measured serum-NfH in 76 MS patients with Simoa (one commercial, one in-house) or Luminex assays. Serum-NfH measured by the immunoassay with greatest sensitivity was related to clinical and radiological outcomes with age and sex-adjusted linear regression analysis, and to biological outcomes cerebrospinal fluid (CSF)-NfH, serum neurofilament light (NfL) and CSF-NfL with Spearman's correlation analysis. RESULTS With the commercial Simoa assay, we obtained 100% serum-NfH detectability (in-house Simoa: 70%, Luminex: 61%), with lowest coefficient of variation (CV) between duplicates of 11%CV (in-house Simoa: 22%CV, Luminex: 30%CV). Serum-NfH quantified with the commercial Simoa assay was associated with disease duration (standardized beta (sβ) = 0.28, p = 0.034), T2 lesion volume (sβ = 0.23, p = 0.041), and tended to associate with black hole count (sβ = 0.21, p = 0.084) but not with Expanded Disease Disability Score (EDSS) or normalized brain volume (all: p>0.10). Furthermore, serum-NfH showed correlations with CSF-NfH (rho = 0.27, p = 0.018) and serum-NfL (rho=0.44, p < 0.001), but not with CSF-NfL. CONCLUSIONS Serum-NfH can be quantified with high-sensitivity technology. Cross-sectionally, we observed some weak correlations of serum-NfH with MS disease burden parameters, suggesting there might be some utility for serum-NfH as biomarker for MS disease burden.
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Affiliation(s)
- Inge M W Verberk
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Marleen Koel-Simmelink
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Harry Twaalfhoven
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Hugo Vrenken
- Department of Radiology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Carsten Korth
- Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Joep Killestein
- Multiple Sclerosis center Amsterdam, Department of neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Claire Bridel
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands; Department of Clinical Neurosciences, Neurology Unit, Geneva University Hospital, Geneva, Switzerland
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13
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Gois LCDP, Pimentel-Silva LR, Damasceno BP, Damasceno A. Associations between cognitive and clinical disability across MS subtypes: The role of the underlying brain damage. Mult Scler Relat Disord 2020; 48:102701. [PMID: 33477004 DOI: 10.1016/j.msard.2020.102701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/18/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cognitive impairment (CI) is present in all stages and subtypes of multiple sclerosis (MS). However, the majority of studies examined relapsing-remitting (RRMS) patients, and did not address cognitive phenotyping. Is still not clear whether patients with progressive MS (PMS) have a distinct pattern of CI compared to RRMS. In addition, there is conflicting data regarding the correlation between clinical and cognitive disability. OBJECTIVE To investigate the differences of CI between PMS and RRMS patients, evaluating cognitive phenotypes. We also aimed to analyze the association between physical and cognitive disability with MRI measures of grey-matter atrophy and lesion burden. METHODS Thirty patients with PMS and twenty-four with RRMS underwent neurological, neuropsychological (BRB-N, Boston Naming, and Tower of London), and MRI assessments (3T). Brain volume evaluations were performed using FreeSurfer. Principal Components Analysis on neuropsychological yielded six principal cognitive domains. Cognitive deficits were classified according to three categories: no CI, impairment in isolated cognitive domain, or impairment in combined domains. RESULTS In the overall sample, the most frequently impaired cognitive domains were information processing speed (IPS) and visual memory. PMS patients had a higher prevalence of verbal memory and verbal fluency deficits, and more frequent impairment in combined cognitive domains compared to RRMS individuals. After multivariable regression analysis with clinical variables, EDSS was associated with most cognitive domains. Nevertheless, after including T1-lesion volume in the model, it was the most consistent predictor of cognitive performance. To further analyze the interaction between EDSS and T1-lesions, we performed GLM analysis with EDSS and T1-hypointense lesion volume as covariates, and T1-lesion volume adjusted better the model for verbal memory (p = 0.013), IPS (p = 0.021) and total number of impaired cognitive domains (p = 0.021). CONCLUSIONS RRMS and PMS patients tend to have a similar neuropsychological profile in general, but the extent of CI was greater in PMS patients. Worse cognitive performance was associated with increased physical disability, but this correlation was no longer significant after controlling for T1-lesion volume, suggesting that the underlying MS pathology might be involved in this relationship. Thalamic and T1-lesion volumes were the most consistent MRI predictors associated with cognitive disability.
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14
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Reyes S, Smets I, Holden D, Carrillo-Loza K, Christmas T, Bianchi L, Ammoscato F, Turner B, Marta M, Schmierer K, Giovannoni G, Gnanapavan S. CSF neurofilament light chain testing as an aid to determine treatment strategies in MS. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:e880. [PMID: 32826298 PMCID: PMC7455313 DOI: 10.1212/nxi.0000000000000880] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the use of CSF neurofilament light chain (NfL) measurements in clinical practice as well as their effect on treatment strategies and outcomes in patients with MS. METHODS This was an observational cohort study of patients with MS who had a CSF NfL measurement between December 2015 and July 2018 as part of their routine clinical care. Treatment strategies were classified as "No Treatment/No Escalation" (no treatment or no escalation of treatment) or "Treatment/Escalation" (first-line injectable/oral disease-modifying therapies (DMTs), highly active DMTs, or treatment escalation). Change in Expanded Disability Status Scale (EDSS) scores was evaluated after 1-year follow-up. RESULTS Of 203 patients with MS, 117 (58%) had relapsing-remitting MS. Disease activity was most frequently indicated by elevated CSF NfL (n = 85), followed by clinical (n = 81) and MRI activity (n = 65). CSF NfL measurements were independently associated with clinical (p = 0.02) and MRI activity (p < 0.001). Of those with elevated CSF NfL as the only evidence of disease activity (n = 22), 77% had progressive MS (PMS). In patients with PMS, 17 (20%) had elevated CSF NfL as the sole indicator of disease activity. Elevated CSF NfL resulted more frequently in Treatment/Escalation than normal CSF NfL (p < 0.001). Median EDSS change at follow-up was similar between patients receiving No Treatment/No Escalation and Treatment/Escalation decisions (p = 0.81). CONCLUSIONS CSF NfL measurements informed treatment strategies, alongside clinical and MRI measures. CSF NfL levels were the only indicator of disease activity in a subset of patients, which was more pronounced in patients with PMS. Elevated CSF NfL was associated with more Treatment/Escalation strategies, which had an impact on EDSS outcomes at 1 year.
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Affiliation(s)
- Saúl Reyes
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Ide Smets
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - David Holden
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Karina Carrillo-Loza
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Tatiana Christmas
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Lucia Bianchi
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Francesca Ammoscato
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Benjamin Turner
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Monica Marta
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Klaus Schmierer
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Gavin Giovannoni
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Sharmilee Gnanapavan
- From the The Blizard Institute (S.R., I.S., D.H., K.C.-L., T.C., L.B., F.A., M.M., K.S., G.G., S.G.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; and Clinical Board Medicine (Neuroscience) (S.R., I.S., B.T., M.M., K.S., G.G., S.G.), The Royal London Hospital, Barts Health NHS Trust, London, UK.
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15
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Serum neurofilament light chain studies in neurological disorders, hints for interpretation. J Neurol Sci 2020; 416:116986. [DOI: 10.1016/j.jns.2020.116986] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/23/2022]
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16
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Lambertsen KL, Soares CB, Gaist D, Nielsen HH. Neurofilaments: The C-Reactive Protein of Neurology. Brain Sci 2020; 10:brainsci10010056. [PMID: 31963750 PMCID: PMC7016784 DOI: 10.3390/brainsci10010056] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/12/2022] Open
Abstract
Neurofilaments (NFs) are quickly becoming the biomarkers of choice in the field of neurology, suggesting their use as an unspecific screening marker, much like the use of elevated plasma C-reactive protein (CRP) in other fields. With sensitive techniques being readily available, evidence is growing regarding the diagnostic and prognostic value of NFs in many neurological disorders. Here, we review the latest literature on the structure and function of NFs and report the strengths and pitfalls of NFs as markers of neurodegeneration in the context of neurological diseases of the central and peripheral nervous systems.
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Affiliation(s)
- Kate L. Lambertsen
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense C, Denmark; (K.L.L.); (C.B.S.); (D.G.)
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, st, 5000 Odense C, Denmark
- BRIDGE—Brain Research—Inter Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 19, 3. sal, 5000 Odense C, Denmark
| | - Catarina B. Soares
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense C, Denmark; (K.L.L.); (C.B.S.); (D.G.)
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, st, 5000 Odense C, Denmark
| | - David Gaist
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense C, Denmark; (K.L.L.); (C.B.S.); (D.G.)
- BRIDGE—Brain Research—Inter Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 19, 3. sal, 5000 Odense C, Denmark
- Department of Clinical Research, Neurology Research Unit, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Helle H. Nielsen
- Department of Neurology, Odense University Hospital, J.B. Winsloewsvej 4, 5000 Odense C, Denmark; (K.L.L.); (C.B.S.); (D.G.)
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsloewsvej 21, st, 5000 Odense C, Denmark
- BRIDGE—Brain Research—Inter Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, J.B. Winsloewsvej 19, 3. sal, 5000 Odense C, Denmark
- Department of Clinical Research, Neurology Research Unit, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
- Correspondence:
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17
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Baldassari LE, Planchon SM, Bermel RA, Nakamura K, Fisher E, Feng J, Sakaie KE, Ontaneda D, Cohen JA. Serum neurofilament light chain concentration in a phase 1/2 trial of autologous mesenchymal stem cell transplantation. Mult Scler J Exp Transl Clin 2019; 5:2055217319887198. [PMID: 31723439 PMCID: PMC6831979 DOI: 10.1177/2055217319887198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/26/2019] [Accepted: 10/13/2019] [Indexed: 11/15/2022] Open
Abstract
Background Serum neurofilament light chain concentration is a proposed biomarker of axonal injury in multiple sclerosis. Mesenchymal stem cells have anti-inflammatory and repair-promoting activities, making them of interest for potential multiple sclerosis treatment. Objectives The purpose of this study was to assess correlation of serum neurofilament light chain concentration and measures of multiple sclerosis disease activity/severity, longitudinal stability of serum neurofilament light chain concentration, and treatment effect of mesenchymal stem cell transplantation on serum neurofilament light chain concentration. Methods Twenty-four multiple sclerosis patients underwent intravenous infusion of autologous mesenchymal stem cells. Clinical assessments, serum collection, and brain magnetic resonance imaging were performed at months -1, 0 (transplant), 1, 3, and 6. Matched control serum was collected once (n = 10). Serum neurofilament light chain concentration was measured by single-molecule array. Serum neurofilament light chain concentration correlations with disease measures were analyzed by Spearman correlations and linear mixed effect models. Pre-post transplant serum neurofilament light chain concentration was compared by Wilcoxon signed rank testing. Results There were significant (p<0.01) correlations between serum neurofilament light chain concentration and gadolinium-enhancing lesion number (rho = 0.55) and volume (rho = 0.65), and new/enlarging T2 lesions (rho = 0.65). Patients without disease activity had lower fluctuation in serum neurofilament light chain concentration (p = 0.01). Mean pre- versus post-treatment serum neurofilament light chain concentration values were not significantly different. Conclusions Serum neurofilament light chain concentration correlated with magnetic resonance imaging measures of disease activity cross sectionally and longitudinally, and was stable in patients without disease activity. There was no clear treatment effect of mesenchymal stem cell transplantation on serum neurofilament light chain concentration.
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Affiliation(s)
- Laura E Baldassari
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
| | - Sarah M Planchon
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
| | | | | | - Jenny Feng
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
| | | | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, USA
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Macaron G, Ontaneda D. Diagnosis and Management of Progressive Multiple Sclerosis. Biomedicines 2019; 7:E56. [PMID: 31362384 PMCID: PMC6784028 DOI: 10.3390/biomedicines7030056] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022] Open
Abstract
Multiple sclerosis is a chronic autoimmune disease of the central nervous system that results in varying degrees of disability. Progressive multiple sclerosis, characterized by a steady increase in neurological disability independently of relapses, can occur from onset (primary progressive) or after a relapsing-remitting course (secondary progressive). As opposed to active inflammation seen in the relapsing-remitting phases of the disease, the gradual worsening of disability in progressive multiple sclerosis results from complex immune mechanisms and neurodegeneration. A few anti-inflammatory disease-modifying therapies with a modest but significant effect on measures of disease progression have been approved for the treatment of progressive multiple sclerosis. The treatment effect of anti-inflammatory agents is particularly observed in the subgroup of patients with younger age and evidence of disease activity. For this reason, a significant effort is underway to develop molecules with the potential to induce myelin repair or halt the degenerative process. Appropriate trial methodology and the development of clinically meaningful disability outcome measures along with imaging and biological biomarkers of progression have a significant impact on the ability to measure the efficacy of potential medications that may reverse disease progression. In this issue, we will review current evidence on the physiopathology, diagnosis, measurement of disability, and treatment of progressive multiple sclerosis.
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Affiliation(s)
- Gabrielle Macaron
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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