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Bayoumy S, Verberk IMW, Vermunt L, Willemse E, den Dulk B, van der Ploeg AT, Pajkrt D, Nitz E, van den Hout JMP, van der Post J, Wolf NI, Beerepoot S, Groen EJN, Tüngler V, Teunissen CE. Neurofilament light protein as a biomarker for spinal muscular atrophy: a review and reference ranges. Clin Chem Lab Med 2024; 62:1252-1265. [PMID: 38215341 DOI: 10.1515/cclm-2023-1311] [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: 11/18/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
Spinal muscular atrophy (SMA) is the leading genetic cause of infant mortality, characterized by progressive neuromuscular degeneration resulting from mutations in the survival motor neuron (SMN1) gene. The availability of disease-modifying therapies for SMA therapies highlights the pressing need for easily accessible and cost-effective blood biomarkers to monitor treatment response and for better disease management. Additionally, the wide implementation of newborn genetic screening programs in Western countries enables presymptomatic diagnosis of SMA and immediate treatment administration. However, the absence of monitoring and prognostic blood biomarkers for neurodegeneration in SMA hinders effective disease management. Neurofilament light protein (NfL) is a promising biomarker of neuroaxonal damage in SMA and reflects disease progression in children with SMA undergoing treatment. Recently, the European Medicines Agency issued a letter of support endorsing the potential utilization of NfL as a biomarker of pediatric neurological diseases, including SMA. Within this review, we comprehensively assess the potential applications of NfL as a monitoring biomarker for disease severity and treatment response in pediatric-onset SMA. We provide reference ranges for normal levels of serum based NfL in neurologically healthy children aged 0-18 years. These reference ranges enable accurate interpretation of NfL levels in children and can accelerate the implementation of NfL into clinical practice.
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Affiliation(s)
- Sherif Bayoumy
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inge M W Verberk
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Lisa Vermunt
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Eline Willemse
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ben den Dulk
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ans T van der Ploeg
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dasja Pajkrt
- Organovir Labs, Department of Pediatric Infectious Diseases, Amsterdam University Medical Centers Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Elisa Nitz
- Department of Neuropediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Johanna M P van den Hout
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Julie van der Post
- Organovir Labs, Department of Pediatric Infectious Diseases, Amsterdam University Medical Centers Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole I Wolf
- Amsterdam Leukodystrophy Center, Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Center, VU University Amsterdam, and Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Amsterdam, The Netherlands
| | - Shanice Beerepoot
- Amsterdam Leukodystrophy Center, Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Center, VU University Amsterdam, and Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Amsterdam, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ewout J N Groen
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Victoria Tüngler
- Department of Neuropediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
- University Center for Rare Diseases, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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2
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Berends M, Brunger AF, Bijzet J, Kroesen BJ, Drost G, Lange F, Teunissen CE, In 't Veld S, Vrancken AF, Gans ROB, Hazenberg BPC, van der Zwaag PA, Nienhuis HLA. Longitudinal analysis of serum neurofilament light chain levels as marker for neuronal damage in hereditary transthyretin amyloidosis. Amyloid 2024; 31:132-141. [PMID: 38477065 DOI: 10.1080/13506129.2024.2327342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To evaluate serum neurofilament light chain (sNfL) as biomarker of disease onset, progression and treatment effect in hereditary transthyretin (ATTRv) amyloidosis patients and TTR variant (TTRv) carriers. METHODS sNfL levels were assessed longitudinally in persistently asymptomatic TTRv carriers (N = 12), persistently asymptomatic ATTRv amyloidosis patients (defined as asymptomatic patients but with amyloid detectable in subcutaneous abdominal fat tissue) (N = 8), in TTRv carriers who developed polyneuropathy (N = 7) and in ATTRv amyloidosis patients with polyneuropathy on treatment (TTR-stabiliser (N = 20) or TTR-silencer (N = 18)). Polyneuropathy was confirmed by nerve conduction studies or quantitative sensory testing. sNfL was analysed using a single-molecule array assay. RESULTS sNfL increased over 2 years in persistently asymptomatic ATTRv amyloidosis patients, but did not change in persistently asymptomatic TTRv carriers. In all TTRv carriers who developed polyneuropathy, sNfL increased from 8.4 to 49.8 pg/mL before the onset of symptoms and before polyneuropathy could be confirmed neurophysiologically. In symptomatic ATTRv amyloidosis patients on a TTR-stabiliser, sNfL remained stable over 2 years. In patients on a TTR-silencer, sNfL decreased after 1 year of treatment. CONCLUSION sNfL is a biomarker of early neuronal damage in ATTRv amyloidosis already before the onset of polyneuropathy. Current data support the use of sNfL in screening asymptomatic TTRv carriers and in monitoring of disease progression and treatment effect.
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Affiliation(s)
- Milou Berends
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne F Brunger
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Johan Bijzet
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart-Jan Kroesen
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea Drost
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Fiete Lange
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Charlotte E Teunissen
- Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sjors In 't Veld
- Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Reinold O B Gans
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
| | - Bouke P C Hazenberg
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul A van der Zwaag
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
- Department of Medical Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans L A Nienhuis
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Amyloidosis Center of Expertise, University Medical Center Groningen, Groningen, The Netherlands
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3
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Pappolla A, Auger C, Sao-Aviles A, Tur C, Rodriguez-Barranco M, Cobo-Calvo Á, Mongay-Ochoa N, Rodríguez-Acevedo B, Zabalza A, Midaglia L, Carbonell-Mirabent P, Carvajal R, Castilló-Justribó J, Braga N, Bollo L, Vidal-Jordana A, Arrambide G, Nos C, Salerno A, Galán I, Comabella M, Sastre-Garriga J, Tintoré M, Rovira A, Montalban X, Río J. Prediction of disease activity and treatment failure in relapsing-remitting MS patients initiating daily oral DMTs. Mult Scler 2024; 30:820-832. [PMID: 38551315 DOI: 10.1177/13524585241240653] [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] [Indexed: 05/29/2024]
Abstract
BACKGROUND Limited data exist regarding treatment response prediction to oral disease-modifying therapies (DMTs) in multiple sclerosis (MS). OBJECTIVES We assessed the capacity of available scoring systems to anticipate disease activity parameters in naïve relapsing-remitting MS (RRMS) patients initiating daily oral DMTs, hypothesizing that they exhibit different predictive potentials. METHODS We conducted a retrospective study and applied the Rio Score (RS), modified Rio Score (mRS), and MAGNIMS Score 12 months after DMT initiation. At 36 months, we examined their ability to predict evidence of disease activity (EDA) components and treatment failure by logistic regression analysis. RESULTS Notably, 218 patients (62.4% females) initiating dimethyl fumarate, teriflunomide, and fingolimod were included. At 36 months, the RS high-risk group predicted evidence of clinical activity (odds ratio (OR) 10 [2.7-36.9]) and treatment failure (OR 10.6 [3.4-32.5]) but did not predict radiological activity (OR 1.9 [0.7-5]). The mRS non-responders group did not predict EDA and treatment failure. RS, mRS, and MAGNIMS 0 categories showed significantly lower EDA and treatment failure than the remainder. CONCLUSION Scoring systems present different predictive abilities for disease activity parameters at 36 months in MS patients initiating daily oral therapies, warranting further adjustments (i.e. introduction of fluid biomarkers) to depict disease activity status fully.
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Affiliation(s)
- Agustin Pappolla
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Augusto Sao-Aviles
- Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rodriguez-Barranco
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rene Carvajal
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló-Justribó
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nathane Braga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luca Bollo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annalaura Salerno
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
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4
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Schaller-Paule MA, Maiworm M, Schäfer JH, Friedauer L, Hattingen E, Wenger KJ, Weber F, Jakob J, Steffen F, Bittner S, Yalachkov Y, Foerch C. Matching proposed clinical and MRI criteria of aggressive multiple sclerosis to serum and cerebrospinal fluid markers of neuroaxonal and glial injury. J Neurol 2024; 271:3512-3526. [PMID: 38536455 DOI: 10.1007/s00415-024-12299-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/15/2024] [Accepted: 03/04/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Definitions of aggressive MS employ clinical and MR imaging criteria to identify highly active, rapidly progressing disease courses. However, the degree of overlap between clinical and radiological parameters and biochemical markers of CNS injury is not fully understood. Aim of this cross-sectional study was to match clinical and MR imaging hallmarks of aggressive MS to serum/CSF markers of neuroaxonal and astroglial injury (neurofilament light chain (sNfL, cNfL), and glial fibrillary acidic protein (sGFAP, cGFAP)). METHODS We recruited 77 patients with relapsing-remitting MS (RRMS) and 22 patients with clinically isolated syndrome. NfL and GFAP levels in serum and CSF were assessed using a single-molecule-array HD-1-analyzer. A general linear model with each biomarker as a dependent variable was computed. Clinical and imaging criteria of aggressive MS, as recently proposed by the ECTRIMS Consensus Group, were modeled as independent variables. Other demographic, clinical or laboratory parameters, were modeled as covariates. Analyses were repeated in a homogenous subgroup, consisting only of newly diagnosed, treatment-naïve RRMS patients presenting with an acute relapse. RESULTS After adjusting for covariates and multiplicity of testing, sNfL and cNfL concentrations were strongly associated with the presence of ≥2 gadolinium-enhancing lesions (psNfL = 0.00008; pcNfL = 0.004) as well as the presence of infratentorial lesions on MRI (psNfL = 0.0003; pcNfL < 0.004). No other clinical and imaging criteria of aggressive MS correlated significantly with NfL or GFAP in serum and CSF. In the more homogeneous subgroup, sNfL still was associated with the presence of ≥2 gadolinium-enhancing lesions (psNfL = 0.001), presence of more than 20 T2-lesions (psNfL = 0.049) as well as the presence of infratentorial lesions on MRI (psNfL = 0.034), while cNfL was associated with the presence of ≥2 gadolinium-enhancing lesions (psNfL = 0.011) and presence of more than 20 T2-lesions (psNfL = 0.029). CONCLUSIONS Among proposed risk factors for an aggressive disease course, MRI findings but not clinical characteristics correlated with sNfL and cNfL as a marker of neuroaxonal injury and should be given appropriate weight considering MS prognosis and therapy. No significant correlation was detected for GFAP alone.
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Affiliation(s)
- Martin A Schaller-Paule
- Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
- Practice for Neurology and Psychiatry Eltville, 65343, Eltville, Germany.
| | - Michelle Maiworm
- Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Jan Hendrik Schäfer
- Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Lucie Friedauer
- Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Katharina Johanna Wenger
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Jasmin Jakob
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Yavor Yalachkov
- Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
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5
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Carroll AS, Razvi Y, O'Donnell L, Veleva E, Heslegrave A, Zetterberg H, Vucic S, Kiernan MC, Rossor AM, Gillmore JD, Reilly MM. Serum neurofilament light chain in hereditary transthyretin amyloidosis: validation in real-life practice. Amyloid 2024; 31:95-104. [PMID: 38348665 DOI: 10.1080/13506129.2024.2313218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/27/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND Neurofilament light chain (NfL) has emerged as a sensitive biomarker in hereditary transthyretin amyloid polyneuropathy (ATTRv-PN). We hypothesise that NfL can identify conversion of gene carriers to symptomatic disease, and guide treatment approaches. METHODS Serum NfL concentration was measured longitudinally (2015-2022) in 59 presymptomatic and symptomatic ATTR variant carriers. Correlations between NfL and demographics, biochemistry and staging scores were performed as well as longitudinal changes pre- and post-treatment, and in asymptomatic and symptomatic cohorts. Receiver-operating analyses were performed to determine cut-off values. RESULTS NfL levels correlated with examination scores (CMTNS, NIS and MRC; all p < .01) and increased with disease severity (PND and FAP; all p < .05). NfL was higher in symptomatic and sensorimotor converters, than asymptomatic or sensory converters irrespective of time (all p < .001). Symptomatic or sensorimotor converters were discriminated from asymptomatic patients by NfL concentrations >64.5 pg/ml (sensitivity= 91.9%, specificity = 88.5%), whereas asymptomatic patients could only be discriminated from sensory or sensorimotor converters or symptomatic individuals by a NfL concentration >88.9 pg/ml (sensitivity = 62.9%, specificity = 96.2%) However, an NfL increment of 17% over 6 months could discriminate asymptomatic from sensory or sensorimotor converters (sensitivity = 88.9%, specificity = 80.0%). NfL reduced with treatment by 36%/year and correlated with TTR suppression (r = 0.64, p = .008). CONCLUSIONS This data validates the use of serum NfL to identify conversion to symptomatic disease in ATTRv-PN. NfL levels can guide assessment of disease progression and response to therapies.
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Affiliation(s)
- Antonia S Carroll
- Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
- Centre for Neuromuscular disease, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Yousuf Razvi
- National Amyloidosis Centre, UCL Division of Medicine, Royal Free Hospital, London, UK
| | - Luke O'Donnell
- Centre for Neuromuscular disease, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Elena Veleva
- UK Dementia Research Institute at UCL, London, UK
| | - Amanda Heslegrave
- UK Dementia Research Institute at UCL, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, 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
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- WI Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Steve Vucic
- Brain and Nerve Research Centre, Concord Hospital, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alexander M Rossor
- Centre for Neuromuscular disease, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, UCL Division of Medicine, Royal Free Hospital, London, UK
| | - Mary M Reilly
- Centre for Neuromuscular disease, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
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Määttä LL, Andersen ST, Parkner T, Hviid CVB, Bjerg L, Kural MA, Charles M, Søndergaard E, Kuhle J, Tankisi H, Witte DR, Jensen TS. Longitudinal Change in Serum Neurofilament Light Chain in Type 2 Diabetes and Early Diabetic Polyneuropathy: ADDITION-Denmark. Diabetes Care 2024; 47:986-994. [PMID: 38502878 DOI: 10.2337/dc23-2208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/22/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To investigate the longitudinal development of neurofilament light chain (NfL) levels in type 2 diabetes with and without diabetic polyneuropathy (+/-DPN) and to explore the predictive potential of NfL as a biomarker for DPN. RESEARCH DESIGN AND METHODS We performed retrospective longitudinal case-control analysis of data from 178 participants of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care-Denmark (ADDITION-Denmark) cohort of people with screen-detected type 2 diabetes. Biobank samples acquired at the ADDITION-Denmark 5- and 10-year follow-ups were analyzed for serum NfL (s-NfL) using single-molecule array, and the results were compared with established reference material to obtain NfL z-scores. DPN was diagnosed according to Toronto criteria for confirmed DPN at the 10-year follow-up. RESULTS s-NfL increased over time in +DPN (N = 39) and -DPN participants (N = 139) at levels above normal age-induced s-NfL increase. Longitudinal s-NfL change was greater in +DPN than in -DPN participants (17.4% [95% CI 4.3; 32.2] or 0.31 SD [95% CI 0.03; 0.60] higher s-NfL or NfL z-score increase in +DPN compared with -DPN). s-NfL at the 5-year follow-up was positively associated with nerve conduction studies at the 10-year follow-up (P = 0.02 to <0.001), but not with DPN risk. Areas under the curve (AUCs) for s-NfL were not inferior to AUCs for the Michigan Neuropathy Screening Instrument questionnaire score or vibration detection thresholds. Higher yearly s-NfL increase was associated with higher DPN risk (odds ratio 1.36 [95% CI 1.08; 1.71] per 1 ng/L/year). CONCLUSIONS Our findings suggest that preceding s-NfL trajectories differ slightly between those with and without DPN and imply a possible biomarker value of s-NfL trajectories in DPN.
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Affiliation(s)
- Laura L Määttä
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Signe T Andersen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Tina Parkner
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Claus V B Hviid
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Lasse Bjerg
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mustafa A Kural
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Charles
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Esben Søndergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Kuhle
- Department of Neurology, University of Basel, Basel, Switzerland
- Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, Basel, Switzerland
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel R Witte
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Troels S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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7
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Woo MS, Engler JB, Friese MA. The neuropathobiology of multiple sclerosis. Nat Rev Neurosci 2024:10.1038/s41583-024-00823-z. [PMID: 38789516 DOI: 10.1038/s41583-024-00823-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
Chronic low-grade inflammation and neuronal deregulation are two components of a smoldering disease activity that drives the progression of disability in people with multiple sclerosis (MS). Although several therapies exist to dampen the acute inflammation that drives MS relapses, therapeutic options to halt chronic disability progression are a major unmet clinical need. The development of such therapies is hindered by our limited understanding of the neuron-intrinsic determinants of resilience or vulnerability to inflammation. In this Review, we provide a neuron-centric overview of recent advances in deciphering neuronal response patterns that drive the pathology of MS. We describe the inflammatory CNS environment that initiates neurotoxicity by imposing ion imbalance, excitotoxicity and oxidative stress, and by direct neuro-immune interactions, which collectively lead to mitochondrial dysfunction and epigenetic dysregulation. The neuronal demise is further amplified by breakdown of neuronal transport, accumulation of cytosolic proteins and activation of cell death pathways. Continuous neuronal damage perpetuates CNS inflammation by activating surrounding glia cells and by directly exerting toxicity on neighbouring neurons. Further, we explore strategies to overcome neuronal deregulation in MS and compile a selection of neuronal actuators shown to impact neurodegeneration in preclinical studies. We conclude by discussing the therapeutic potential of targeting such neuronal actuators in MS, including some that have already been tested in interventional clinical trials.
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Affiliation(s)
- Marcel S Woo
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Broder Engler
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Manuel A Friese
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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8
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Monteiro I, Nicolella V, Fiorenza M, Novarella F, Carotenuto A, Lanzillo R, Mauriello L, Scalia G, Castaldo G, Terracciano D, Brescia Morra V, Moccia M. The ocrelizumab wearing-off phenomenon is associated with reduced immunomodulatory response and increased neuroaxonal damage in multiple sclerosis. J Neurol 2024:10.1007/s00415-024-12434-w. [PMID: 38777960 DOI: 10.1007/s00415-024-12434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The wearing-off phenomenon is common in people with multiple sclerosis (MS) treated with ocrelizumab. We aim to evaluate the presence and severity of wearing-off to ocrelizumab in relation to demographic and MS clinical variables, immune profiling, and a marker of neuroaxonal damage (plasma neurofilament light chain (pNfl)). METHODS This cross-sectional study included MS patients treated with ocrelizumab from at least 1 year. Wearing-off questionnaire and blood samples were collected between 21 and 23 weeks after the previous ocrelizumab infusion. Lymphocyte subpopulations were evaluated on peripheral blood using flow cytometry. PNfl was evaluated using fully automated chemiluminescent enzyme immunoassay. RESULTS We included 106 people with MS (age 49.5 ± 11.6 years; females 42.3%; wearing-off 57.6%). On regression models, wearing-off was associated with higher pNfl, CD8, CD3, and CD3CD27 lymphocytes. Most frequent wearing-off symptoms were cognitive, sensory, and balance problems; wearing-off started < 1 week (9.4%), 1-4 weeks (10.7%) or > 4 weeks (10.7%) before infusion; 44.8% of the complaints were moderate to severe. Severity of wearing-off was associated with higher pNfl and CD8 lymphocytes. CONCLUSIONS Wearing-off is common in people with MS treated with ocrelizumab, and is associated with reduced immunomodulation (higher T lymphocytes) and increased neuroaxonal damage, suggesting reduced treatment response.
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Affiliation(s)
- Isabel Monteiro
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Neurology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Valerio Nicolella
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Mariano Fiorenza
- Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Federica Novarella
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Antonio Carotenuto
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | | | - Giulia Scalia
- Centre for Advanced Biotechnology (CEINGE), Naples, Italy
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
- Centre for Advanced Biotechnology (CEINGE), Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Marcello Moccia
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy.
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy.
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9
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Beydoun MA, Noren Hooten N, Georgescu MF, Beydoun HA, Eid SM, Fanelli-Kuczmarski MT, Evans MK, Zonderman AB. Serum neurofilament light chain as a prognostic marker of all-cause mortality in a national sample of US adults. Eur J Epidemiol 2024:10.1007/s10654-024-01131-7. [PMID: 38771439 DOI: 10.1007/s10654-024-01131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Abstract
Neurofilament light chain (NfL) is a neuron-specific structural protein released into the extracellular space, including body fluids, upon neuroaxonal damage. Despite evidence of a link in neurological disorders, few studies have examined the association of serum NfL with mortality in population-based studies. Data from the National Health and Nutrition Survey were utilized including 2,071 Non-Hispanic White, Non-Hispanic Black and Hispanic adult participants and adult participants of other ethnic groups (20-85 years) with serum NfL measurements who were followed for ≤ 6 years till 2019. We tested the association of serum NfL with mortality in the overall population and stratified by sex with the addition of potential interactive and mediating effects of cardio-metabolic risk factors and nutritional biomarkers. Elevated serum NfL levels (above median group) were associated with mortality risk compared to the below median NfL group in the overall sample (P = 0.010), with trends observed within each sex group (P < 0.10). When examining Loge NfL as a continuum, one standard deviation of Loge NfL was associated with an increased mortality risk (HR = 1.88, 95% CI 1.60-2.20, P < 0.001) in the reduced model adjusted for age, sex, race, and poverty income ratio; a finding only slightly attenuated with the adjustment of lifestyle and health-related factors. Four-way decomposition indicated that there was, among others, mediated interaction between NfL and HbA1c and a pure inconsistent mediation with 25(OH)D3 in predicting all-cause mortality, in models adjusted for all other covariates. Furthermore, urinary albumin-to-creatinine ratio interacted synergistically with NfL in relation to mortality risk both on the additive and multiplicative scales. These data indicate that elevated serum NfL levels were associated with all-cause mortality in a nationally representative sample of US adults.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, USA.
- NIH Biomedical Research Center, National Institute on Aging, IRP, 251 Bayview Blvd., Suite 100, Room #: 04B118, Baltimore, MD, 21224, USA.
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, USA
| | - Michael F Georgescu
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Shaker M Eid
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, USA
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10
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Bi Z, Meng Y, Ji Q, Zhang A, Liu M, Xu X, Zhan Y. Association between volatile organic compounds and serum neurofilament light chain in US adults. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 926:171893. [PMID: 38531449 DOI: 10.1016/j.scitotenv.2024.171893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE This study aimed to investigate the associations between exposure to blood volatile organic compounds (VOCs) and the level of serum neurofilament light chain (NfL) in adults. METHODS We analyzed data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), including 2008 participants aged 20 to 75 years old. Multiple linear regression models were used to examine the associations between 28 VOCs and NfL after adjusting for multiple potential confounders. Restricted cubic spline (RCS) was used to examine the potential non-linear associations. RESULTS The linear regression models showed that higher levels of 2,5-dimethylfuran (β = 0.042, 95 % confidence interval [CI]: 0.001, 0.096), ethyl acetate (β = 0.118, 95 % CI = 0.008, 0.304), and m-/p-xylene (β = 0.043, 95%CI = 0.012, 0.074) were associated with higher NfL levels. These estimates were largely consistent after adjusting for multiple confounders. CONCLUSION The findings of our study suggest a potential association between certain volatile organic compounds (2,5-dimethylfuran, ethyl acetate, and m-/p-xylene) and blood NfL levels, implying that they may have a role in revealing neurodegeneration and influencing neurological health.
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Affiliation(s)
- Zhuochang Bi
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong 518107, China
| | - Yaxian Meng
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong 518107, China
| | - Qianqian Ji
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong 518107, China
| | - Aijie Zhang
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong 518107, China
| | - Miao Liu
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong 518107, China.
| | - Xiaowei Xu
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong 518107, China.
| | - Yiqiang Zhan
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong 518107, China.
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11
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Zivadinov R, Jakimovski D, Burnham A, Kuhle J, Weinstock Z, Wicks TR, Ramanathan M, Sciortino T, Ostrem M, Suchan C, Dwyer MG, Reilly J, Bergsland N, Schweser F, Kennedy C, Young-Hong D, Eckert S, Hojnacki D, Benedict RHB, Weinstock-Guttman B. Neuroimaging assessment of facility-bound severely-affected MS reveals the critical role of cortical gray matter pathology: results from the CASA-MS case-controlled study. J Neurol 2024:10.1007/s00415-024-12420-2. [PMID: 38758279 DOI: 10.1007/s00415-024-12420-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND A subgroup of people with multiple sclerosis (pwMS) will develop severe disability. The pathophysiology underlying severe MS is unknown. The comprehensive assessment of severely affected MS (CASA-MS) was a case-controlled study that compared severely disabled in skilled nursing (SD/SN) (EDSS ≥ 7.0) to less-disabled (EDSS 3.0-6.5) community dwelling (CD) progressive pwMS, matched on age-, sex- and disease-duration (DDM). OBJECTIVES To identify neuroimaging and molecular biomarker characteristics that distinguish SD/SN from DDM-CD progressive pwMS. METHODS This study was carried at SN facility and at a tertiary MS center. The study collected clinical, molecular (serum neurofilament light chain, sNfL and glial acidic fibrillary protein, sGFAP) and MRI quantitative lesion-, brain volume-, and tissue integrity-derived measures. Statistical analyses were controlled for multiple comparisons. RESULTS 42 SD/SN and 42 DDM-CD were enrolled. SD/SN pwMS showed significantly lower cortical volume (CV) (p < 0.001, d = 1.375) and thalamic volume (p < 0.001, d = 0.972) compared to DDM-CD pwMS. In a logistic stepwise regression model, the SD/SN pwMS were best differentiated from the DDM-CD pwMS by lower CV (p < 0.001) as the only significant predictor, with the accuracy of 82.3%. No significant differences between the two groups were observed for medulla oblongata volume, a proxy for spinal cord atrophy and white matter lesion burden, while there was a statistical trend for numerically higher sGFAP in SD/SN pwMS. CONCLUSIONS The CASA-MS study showed significantly more gray matter atrophy in severe compared to less-severe progressive MS.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 77 Goodell Street, Suite 450, Buffalo, NY, 14203, USA.
- Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 77 Goodell Street, Suite 450, Buffalo, NY, 14203, USA
| | | | - Jens Kuhle
- Neurologic Clinic and Policlinic, Department of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Zachary Weinstock
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 77 Goodell Street, Suite 450, Buffalo, NY, 14203, USA
| | - Taylor R Wicks
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 77 Goodell Street, Suite 450, Buffalo, NY, 14203, USA
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Tommaso Sciortino
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 77 Goodell Street, Suite 450, Buffalo, NY, 14203, USA
| | | | - Christopher Suchan
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 77 Goodell Street, Suite 450, Buffalo, NY, 14203, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 77 Goodell Street, Suite 450, Buffalo, NY, 14203, USA
- Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | | | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 77 Goodell Street, Suite 450, Buffalo, NY, 14203, USA
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 77 Goodell Street, Suite 450, Buffalo, NY, 14203, USA
- Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Cheryl Kennedy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 77 Goodell Street, Suite 450, Buffalo, NY, 14203, USA
| | | | - Svetlana Eckert
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - David Hojnacki
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ralph H B Benedict
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA
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12
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Maglio G, D’Agostino M, Caronte FP, Pezone L, Casamassimi A, Rienzo M, Di Zazzo E, Nappo C, Medici N, Molinari AM, Abbondanza C. Multiple Sclerosis: From the Application of Oligoclonal Bands to Novel Potential Biomarkers. Int J Mol Sci 2024; 25:5412. [PMID: 38791450 PMCID: PMC11121866 DOI: 10.3390/ijms25105412] [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: 04/10/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Multiple sclerosis is a chronic immune-mediated disorder of the central nervous system with a high heterogeneity among patients. In the clinical setting, one of the main challenges is a proper and early diagnosis for the prediction of disease activity. Current diagnosis is based on the integration of clinical, imaging, and laboratory results, with the latter based on the presence of intrathecal IgG oligoclonal bands in the cerebrospinal fluid whose detection via isoelectric focusing followed by immunoblotting represents the gold standard. Intrathecal synthesis can also be evidenced by the measurement of kappa free light chains in the cerebrospinal fluid, which has reached similar diagnostic accuracy compared to that of oligoclonal bands in the identification of patients with multiple sclerosis; moreover, recent studies have also highlighted its value for early disease activity prediction. This strategy has significant advantages as compared to using oligoclonal band detection, even though some issues remain open. Here, we discuss the current methods applied for cerebrospinal fluid analysis to achieve the most accurate diagnosis and for follow-up and prognosis evaluation. In addition, we describe new promising biomarkers, currently under investigation, that could contribute both to a better diagnosis of multiple sclerosis and to its monitoring of the therapeutic treatment response.
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Affiliation(s)
- Grazia Maglio
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
| | - Marina D’Agostino
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
| | - Francesco Pio Caronte
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
| | - Luciano Pezone
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
| | - Amelia Casamassimi
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Monica Rienzo
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | - Erika Di Zazzo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Carmela Nappo
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
| | - Nicola Medici
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Anna Maria Molinari
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Ciro Abbondanza
- Unit of Clinical and Molecular Pathology, A.O.U. University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.); (M.D.); (F.P.C.); (L.P.); (C.N.); (N.M.); (A.M.M.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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13
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Wolf E, Wicklein R, Aly L, Schmaderer C, Afzali AM, Mardin C, Korn T, Hemmer B, Hofauer B, Knier B. Optical coherence tomography angiography suggests different retinal pathologies in multiple sclerosis and Sjögren's syndrome. J Neurol 2024:10.1007/s00415-024-12414-0. [PMID: 38743089 DOI: 10.1007/s00415-024-12414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND While retinal vessel changes are evident in the eyes of patients with relapsing-remitting multiple sclerosis (RRMS), changes in the vasculature of possible MS mimics such as primary Sjögren's syndrome (pSS) remain to be determined. We investigated the potential of retinal optical coherence tomography (OCT) angiography (OCTA) as diagnostic tool to differentiate between patients with RRMS and pSS. METHODS This cross-sectional study included patients with RRMS (n = 36), pSS (n = 36) and healthy controls (n = 30). Participants underwent clinical examination, assessment of visual acuity, retinal OCT, OCTA, and serum markers of glial and neuronal damage. We investigated the associations between OCTA parameters, visual functions, and serum markers. Eyes with a history of optic neuritis (ON) were excluded from analysis. RESULTS We observed a significant thinning of the combined ganglion cell and inner plexiform layer in the eyes of patients with RRMS but not with pSS, when compared to healthy controls. Retinal vessel densities of the superficial vascular complex (SVC) were reduced in both patients with RRMS and pSS. However, retinal vessel rarefication of the deep vascular complex (DVC) was only evident in patients with pSS but not RRMS. Using multivariate regression analysis, we found that DVC vessel loss in pSS patients was associated with worse visual acuity. CONCLUSIONS Compared to patients with RRMS, rarefication of deep retinal vessels is a unique characteristic of pSS and associated with worse visual function. Assuming a disease-specific retinal vessel pathology, these data are indicative of a differential affliction of the gliovascular complex in the retina of RRMS and pSS patients.
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Affiliation(s)
- Elisabeth Wolf
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Rebecca Wicklein
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Ali Maisam Afzali
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christian Mardin
- Department of Ophthalmology, University Hospital of Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Korn
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Institute for Experimental Neuroimmunology, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Benedikt Hofauer
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Otorhinolaryngology/Head and Neck Surgery, Tirol Kliniken, Universitätskliniken Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Benjamin Knier
- Department of Neurology, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
- Department of Neurology, Diakonie-Klinkum Schwäbisch Hall, Schwäbisch Hall, Germany.
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14
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Serrano PDL, Rodrigues TDPV, Pinto LD, Pereira IC, Farias IB, Cavalheiro RBR, Mendes PM, Peixoto KO, Barile JP, Seneor DD, Correa Silva EG, Oliveira ASB, Pinto WBVDR, Sgobbi P. Assessing Chitinases and Neurofilament Light Chain as Biomarkers for Adult-Onset Leukodystrophies. Curr Issues Mol Biol 2024; 46:4309-4323. [PMID: 38785530 PMCID: PMC11120026 DOI: 10.3390/cimb46050262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
Leukodystrophies represent a large and complex group of inherited disorders affecting the white matter of the central nervous system. Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is a rare leukodystrophy which still needs the proper identification of diagnostic, prognostic, and monitoring biomarkers. The aim of this study was to determine the diagnostic and prognostic value of chitinases and neurofilament light chain as biomarkers for ALSP. A cross-sectional study was performed to analyze cerebrospinal fluid levels of chitinases (chitotriosidase and chitinase 3-like 2) and neurofilament light chain in five different groups: (i) normal health individuals; (ii) patients with definitive diagnosis of ALSP and genetic confirmation; (iii) asymptomatic patients with CSF1R variants; (iv) patients with other adult-onset leukodystrophies; and (v) patients with amyotrophic lateral sclerosis (external control group). Chitinase levels showed a statistical correlation with clinical assessment parameters in ALSP patients. Chitinase levels were also distinct between ALSP and the other leukodystrophies. Significant differences were noted in the levels of chitinases and neurofilament light chain comparing symptomatic (ALSP) and asymptomatic individuals with CSF1R variants. This study is the first to establish chitinases as a potential biomarker for ALSP and confirms neurofilament light chain as a good biomarker for primary microgliopathies.
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Affiliation(s)
- Paulo de Lima Serrano
- PSEG Centro de Pesquisa Clínica, São Paulo 04038-002, SP, Brazil; (P.d.L.S.); (T.d.P.V.R.); (L.D.P.); (I.C.P.); (E.G.C.S.)
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo 04039-060, SP, Brazil; (I.B.F.); (R.B.R.C.); (P.M.M.); (K.O.P.); (J.P.B.); (D.D.S.); (A.S.B.O.); (W.B.V.d.R.P.)
| | | | - Leslyê Donato Pinto
- PSEG Centro de Pesquisa Clínica, São Paulo 04038-002, SP, Brazil; (P.d.L.S.); (T.d.P.V.R.); (L.D.P.); (I.C.P.); (E.G.C.S.)
| | - Indiara Correia Pereira
- PSEG Centro de Pesquisa Clínica, São Paulo 04038-002, SP, Brazil; (P.d.L.S.); (T.d.P.V.R.); (L.D.P.); (I.C.P.); (E.G.C.S.)
| | - Igor Braga Farias
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo 04039-060, SP, Brazil; (I.B.F.); (R.B.R.C.); (P.M.M.); (K.O.P.); (J.P.B.); (D.D.S.); (A.S.B.O.); (W.B.V.d.R.P.)
| | - Renan Brandão Rambaldi Cavalheiro
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo 04039-060, SP, Brazil; (I.B.F.); (R.B.R.C.); (P.M.M.); (K.O.P.); (J.P.B.); (D.D.S.); (A.S.B.O.); (W.B.V.d.R.P.)
| | - Patrícia Marques Mendes
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo 04039-060, SP, Brazil; (I.B.F.); (R.B.R.C.); (P.M.M.); (K.O.P.); (J.P.B.); (D.D.S.); (A.S.B.O.); (W.B.V.d.R.P.)
| | - Kaliny Oliveira Peixoto
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo 04039-060, SP, Brazil; (I.B.F.); (R.B.R.C.); (P.M.M.); (K.O.P.); (J.P.B.); (D.D.S.); (A.S.B.O.); (W.B.V.d.R.P.)
| | - João Paulo Barile
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo 04039-060, SP, Brazil; (I.B.F.); (R.B.R.C.); (P.M.M.); (K.O.P.); (J.P.B.); (D.D.S.); (A.S.B.O.); (W.B.V.d.R.P.)
| | - Daniel Delgado Seneor
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo 04039-060, SP, Brazil; (I.B.F.); (R.B.R.C.); (P.M.M.); (K.O.P.); (J.P.B.); (D.D.S.); (A.S.B.O.); (W.B.V.d.R.P.)
| | | | - Acary Souza Bulle Oliveira
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo 04039-060, SP, Brazil; (I.B.F.); (R.B.R.C.); (P.M.M.); (K.O.P.); (J.P.B.); (D.D.S.); (A.S.B.O.); (W.B.V.d.R.P.)
| | - Wladimir Bocca Vieira de Rezende Pinto
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo 04039-060, SP, Brazil; (I.B.F.); (R.B.R.C.); (P.M.M.); (K.O.P.); (J.P.B.); (D.D.S.); (A.S.B.O.); (W.B.V.d.R.P.)
| | - Paulo Sgobbi
- PSEG Centro de Pesquisa Clínica, São Paulo 04038-002, SP, Brazil; (P.d.L.S.); (T.d.P.V.R.); (L.D.P.); (I.C.P.); (E.G.C.S.)
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo 04039-060, SP, Brazil; (I.B.F.); (R.B.R.C.); (P.M.M.); (K.O.P.); (J.P.B.); (D.D.S.); (A.S.B.O.); (W.B.V.d.R.P.)
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15
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Pernice HF, Knorz AL, Wetzel PJ, Herrmann C, Muratovic H, Rieber F, Asaad E, Fiß G, Barzen G, Blüthner E, Knebel F, Spethmann S, Messroghli D, Heidecker B, Brand A, Wetz C, Tschöpe C, Hahn K. Neurological affection and serum neurofilament light chain in wild type transthyretin amyloidosis. Sci Rep 2024; 14:10111. [PMID: 38698025 PMCID: PMC11066119 DOI: 10.1038/s41598-024-60025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024] Open
Abstract
In contrast to inherited transthyretin amyloidosis (A-ATTRv), neuropathy is not a classic leading symptom of wild type transthyretin amyloidosis (A-ATTRwt). However, neurological symptoms are increasingly relevant in A-ATTRwt as well. To better understand the role of neurological symptoms in A-ATTRwt, A-ATTRwt patients were prospectively characterized at Amyloidosis Center Charité Berlin (ACCB) between 2018 and 2023 using detailed neurological examination, quality of life questionnaires, and analysis of age- and BMI-adapted serum neurofilament light chain (NFL) levels. 16 out of 73 (21.9%) patients presented with a severe neuropathy which we defined by a Neuropathy Impairment Score (NIS) of 20 or more. In this group, quality of life was reduced, peripheral neuropathy was more severe, and spinal stenosis and joint replacements were frequent. Age- and BMI matched serum NFL levels were markedly elevated in patients with a NIS ≥ 20. We therefore conclude that highly abnormal values in neuropathy scores such as the NIS occur in A-ATTRwt, and have an important impact on quality of life. Both peripheral neuropathy and spinal canal stenosis are likely contributors. Serum NFL may serve as a biomarker for neurological affection in patients with A-ATTRwt. It will be important to consider neurological aspects of A-ATTRwt for diagnosis, clinical follow-up, and future treatment development.
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Affiliation(s)
- Helena F Pernice
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité (BIH)-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Adrian L Knorz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Charitéplatz 1, 10117, Berlin, Germany
| | - Paul J Wetzel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Charitéplatz 1, 10117, Berlin, Germany
| | - Carolin Herrmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany
| | - Harisa Muratovic
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Charitéplatz 1, 10117, Berlin, Germany
| | - Finn Rieber
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
| | - Eleonora Asaad
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Charitéplatz 1, 10117, Berlin, Germany
| | - Gunnar Fiß
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Charitéplatz 1, 10117, Berlin, Germany
| | - Gina Barzen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Elisabeth Blüthner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medical Clinic m.S. Hepatology and Gastroenterology CCM/CVK, Berlin, Germany
| | - Fabian Knebel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Charitéplatz 1, 10117, Berlin, Germany
- Klinik für Innere Medizin mit Schwerpunkt Kardiologie, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Sebastian Spethmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Daniel Messroghli
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bettina Heidecker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, 12203, Berlin, Germany
- Berlin Institute of Health at Charité (BIH)-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Anna Brand
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Christoph Wetz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Nuclear Medicine, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Carsten Tschöpe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité (BIH)-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Katrin Hahn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Amyloidosis Center Charité Berlin (ACCB), Charitéplatz 1, 10117, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin Institute of Health at Charité (BIH)-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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16
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Moccia M, Terracciano D, Brescia Morra V, Castaldo G. Neurofilament in clinical practice: Is the multiple sclerosis community ready? Mult Scler 2024; 30:643-645. [PMID: 38605490 DOI: 10.1177/13524585241246536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Marcello Moccia
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
- Centre for Advanced Biotechnology (CEINGE), Naples, Italy
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17
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Kang MJY, Eratne D, Wannan C, Santillo AF, Velakoulis D, Pantelis C, Cropley V. Plasma neurofilament light chain is not elevated in people with first-episode psychosis or those at ultra-high risk for psychosis. Schizophr Res 2024; 267:269-272. [PMID: 38581830 DOI: 10.1016/j.schres.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 02/02/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Neurofilament light chain (NfL), a blood biomarker of neuronal injury, shows promise in distinguishing neurodegenerative disorders from psychiatric conditions. This is especially relevant in psychosis, given neurological conditions such as autoimmune encephalitis and Niemann Pick Type C disease (NPC) may initially present with psychotic symptoms. Whilst NfL levels have been studied in established schizophrenia cases, their levels in first-episode psychosis (FEP) and ultra-high risk (UHR) for psychosis individuals remain largely unexplored. This study aimed to compare plasma NfL in people with FEP or UHR with healthy controls, as well as explore its associations with clinical data. METHOD We retrospectively analysed plasma NfL in 63 participants, consisting of 29 individuals with FEP, 10 individuals with UHR, and 24 healthy controls. We used general linear models (GLM), which were bootstrapped, to compute bias-corrected and accelerated (BCa) 95 % confidence intervals (CIs). RESULTS Mean NfL levels were 5.2 pg/mL in FEP, 4.9 pg/mL in UHR, and 5.9 pg/mL in healthy controls. Compared to healthy controls, there were no significant differences in NfL levels in the FEP group (β = -0.22, 95 % CI [-0.86, 0.39], p = 0.516) nor UHR group (β = -0.37, 95 % CI [-0.90, 0.19], p = 0.182). There were no significant associations between NfL levels and clinical variables in the FEP group. DISCUSSION Our study is the first to demonstrate that plasma NfL levels are not significantly elevated in individuals at UHR for psychosis compared to healthy controls, a finding also observed in the FEP cohort. These findings bolster the potential diagnostic utility of NfL in differentiating between psychiatric and neurodegenerative disorders.
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Affiliation(s)
- Matthew J Y Kang
- Neuropsychiatry Centre, Royal Melbourne Hospital, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia.
| | - Dhamidhu Eratne
- Neuropsychiatry Centre, Royal Melbourne Hospital, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia.
| | - Cassandra Wannan
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | | | - Dennis Velakoulis
- Neuropsychiatry Centre, Royal Melbourne Hospital, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia.
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia.
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
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18
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Zamecnik CR, Sowa GM, Abdelhak A, Dandekar R, Bair RD, Wade KJ, Bartley CM, Kizer K, Augusto DG, Tubati A, Gomez R, Fouassier C, Gerungan C, Caspar CM, Alexander J, Wapniarski AE, Loudermilk RP, Eggers EL, Zorn KC, Ananth K, Jabassini N, Mann SA, Ragan NR, Santaniello A, Henry RG, Baranzini SE, Zamvil SS, Sabatino JJ, Bove RM, Guo CY, Gelfand JM, Cuneo R, von Büdingen HC, Oksenberg JR, Cree BAC, Hollenbach JA, Green AJ, Hauser SL, Wallin MT, DeRisi JL, Wilson MR. An autoantibody signature predictive for multiple sclerosis. Nat Med 2024; 30:1300-1308. [PMID: 38641750 DOI: 10.1038/s41591-024-02938-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
Although B cells are implicated in multiple sclerosis (MS) pathophysiology, a predictive or diagnostic autoantibody remains elusive. In this study, the Department of Defense Serum Repository (DoDSR), a cohort of over 10 million individuals, was used to generate whole-proteome autoantibody profiles of hundreds of patients with MS (PwMS) years before and subsequently after MS onset. This analysis defines a unique cluster in approximately 10% of PwMS who share an autoantibody signature against a common motif that has similarity with many human pathogens. These patients exhibit antibody reactivity years before developing MS symptoms and have higher levels of serum neurofilament light (sNfL) compared to other PwMS. Furthermore, this profile is preserved over time, providing molecular evidence for an immunologically active preclinical period years before clinical onset. This autoantibody reactivity was validated in samples from a separate incident MS cohort in both cerebrospinal fluid and serum, where it is highly specific for patients eventually diagnosed with MS. This signature is a starting point for further immunological characterization of this MS patient subset and may be clinically useful as an antigen-specific biomarker for high-risk patients with clinically or radiologically isolated neuroinflammatory syndromes.
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Affiliation(s)
- Colin R Zamecnik
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Gavin M Sowa
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Department of Medicine, McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | - Ahmed Abdelhak
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Ravi Dandekar
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca D Bair
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kristen J Wade
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher M Bartley
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kerry Kizer
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Danillo G Augusto
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Asritha Tubati
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Refujia Gomez
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Camille Fouassier
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Chloe Gerungan
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Colette M Caspar
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica Alexander
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Anne E Wapniarski
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Rita P Loudermilk
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Erica L Eggers
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Kirtana Ananth
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nora Jabassini
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sabrina A Mann
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub San Francisco, San Francisco, CA, USA
| | - Nicholas R Ragan
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Adam Santaniello
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Roland G Henry
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sergio E Baranzini
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Scott S Zamvil
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph J Sabatino
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Riley M Bove
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Chu-Yueh Guo
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey M Gelfand
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Richard Cuneo
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - H-Christian von Büdingen
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jorge R Oksenberg
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce A C Cree
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jill A Hollenbach
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Ari J Green
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen L Hauser
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mitchell T Wallin
- Department of Veterans Affairs, Multiple Sclerosis Center of Excellence, Washington, DC, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub San Francisco, San Francisco, CA, USA
| | - Michael R Wilson
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
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19
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Johnsson M, Stenberg YT, Farman HH, Blennow K, Zetterberg H, Malmeström C, Sandgren S, Rosenstein I, Lycke J, Axelsson M, Novakova L. Serum neurofilament light for detecting disease activity in individual patients in multiple sclerosis: A 48-week prospective single-center study. Mult Scler 2024; 30:664-673. [PMID: 38481083 PMCID: PMC11071597 DOI: 10.1177/13524585241237388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/05/2024] [Accepted: 02/18/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Serum neurofilament light (sNfL) reflects neuroaxonal damage and is now used as an outcome in treatment trials of relapsing-remitting multiple sclerosis (RRMS). However, the diagnostic properties of sNfL for monitoring disease activity in individual patients warrant further investigations. METHOD Patients with suspected relapse and/or contrast-enhancing lesions (CELs) were consecutively included and performed magnetic resonance imaging (MRI) of the brain at baseline and weeks 28 and 48. Serum was obtained at baseline and 2, 4, 8, 16, 24, and 48 weeks. Neurofilament light concentration was measured using Single molecule array technology. RESULTS We included 44 patients, 40 with RRMS and 4 with clinically isolated syndrome. The median sNfL level peaked at 2 weeks post-baseline (14.6 ng/L, interquartile range (IQR); 9.3-31.6) and reached nadir at 48 weeks (9.1 ng/L, IQR; 5.5-15.0), equivalent to the median sNfL of controls (9.1 ng/L, IQR; 7.4-12). A baseline Z-score of more than 1.1 (area under the curve; 0.78, p < 0.0001) had a sensitivity of 81% and specificity of 70% to detect disease activity. CONCLUSION One out of five patients with relapse and/or CELs did not change significantly in post-baseline sNfL levels. The utility of repeated sNfL measurements to monitor disease activity is complementary rather than a substitute for clinical and MRI measures.
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Affiliation(s)
- M Johnsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital and Region Västra Götaland, Gothenburg, Sweden
| | - YT Stenberg
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - HH Farman
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - K Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - H Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- UK Dementia Research Institute, University College London, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - C Malmeström
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital and Region Västra Götaland, Gothenburg, Sweden
- Laboratory for Clinical Immunology, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S Sandgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital and Region Västra Götaland, Gothenburg, Sweden
| | - I Rosenstein
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital and Region Västra Götaland, Gothenburg, Sweden
| | - J Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital and Region Västra Götaland, Gothenburg, Sweden
| | - M Axelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital and Region Västra Götaland, Gothenburg, Sweden
| | - L Novakova
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital and Region Västra Götaland, Gothenburg, Sweden
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20
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Skarstein I, Ulvestad E, Solheim AM, Vedeler C, Ljøstad U, Mygland Å, Eikeland R, Reiso H, Lorentzen ÅR, Bos SD. Serum neurofilament light chain associates with symptom burden in Lyme neuroborreliosis patients: a longitudinal cohort study from Norway. J Neurol 2024; 271:2768-2775. [PMID: 38407594 PMCID: PMC11055709 DOI: 10.1007/s00415-024-12237-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Serum neurofilament light chain (sNfL), an indicator of neuronal damage, is increasingly recognized as a potential biomarker for disease activity in neurodegenerative disorders. In this study, we wanted to investigate sNfL as a prognostic marker in a large, well-defined population of 90 patients with Lyme neuroborreliosis (LNB). In addition, we sought to explore associations between symptoms and sNfL levels during the acute phase of LNB. MATERIALS AND METHODS Patients diagnosed with definite or possible LNB were recruited from a double-blinded, placebo-controlled, multi-center trial, in which the participants were randomly assigned to 2 or 6 weeks of oral doxycycline treatment. The sNfL levels were measured using a single molecule array assay at both diagnosis and 6-month follow-up, and analysed against clinical parameters, variations in symptom burden and long-term complaints as assessed by a composite clinical score. RESULTS At the time of diagnosis, approximately 60% of the patients had elevated sNfL levels adjusted for age. Notably, mean sNfL levels were significantly higher at diagnosis (52 pg/ml) compared to 6 months after treatment (12 pg/ml, p < 0.001), when sNfL levels had normalized in the majority of patients. Patients with objective signs of spinal radiculitis had significantly higher baseline sNfL levels compared to patients without spinal radiculitis (p = 0.033). CONCLUSION Our findings suggest that sNfL can serve as a biomarker for peripheral nerve tissue involvement in the acute phase of LNB. As found in an earlier study, we confirm normalization of sNfL levels in blood after treatment. We found no prognostic value of acute-phase sNfL levels on patient outcome.
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Affiliation(s)
- Ingerid Skarstein
- Department of Microbiology, Haukeland University Hospital, Post Box 1400, 5021, Bergen, Norway.
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Elling Ulvestad
- Department of Microbiology, Haukeland University Hospital, Post Box 1400, 5021, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne Marit Solheim
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Vedeler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Unn Ljøstad
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Åse Mygland
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Section of Habilitation, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Randi Eikeland
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Harald Reiso
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Åslaug Rudjord Lorentzen
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Steffan Daniel Bos
- Department of Microbiology, Haukeland University Hospital, Post Box 1400, 5021, Bergen, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Cancer Registry of Norway, The Norwegian Institute of Public Health, Oslo, Norway
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21
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Plantone D, Primiano G. Serum neurofilament light chain and small fiber neuropathy: Every cloud has a silver lining. Eur J Neurol 2024; 31:e16244. [PMID: 38344915 DOI: 10.1111/ene.16244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/30/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Domenico Plantone
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Guido Primiano
- Neurology Unit, Fondazione Policlinico Universitario 'A.Gemelli' IRCCS, Rome, Italy
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22
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Khalil M, Teunissen CE, Lehmann S, Otto M, Piehl F, Ziemssen T, Bittner S, Sormani MP, Gattringer T, Abu-Rumeileh S, Thebault S, Abdelhak A, Green A, Benkert P, Kappos L, Comabella M, Tumani H, Freedman MS, Petzold A, Blennow K, Zetterberg H, Leppert D, Kuhle J. Neurofilaments as biomarkers in neurological disorders - towards clinical application. Nat Rev Neurol 2024; 20:269-287. [PMID: 38609644 DOI: 10.1038/s41582-024-00955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
Neurofilament proteins have been validated as specific body fluid biomarkers of neuro-axonal injury. The advent of highly sensitive analytical platforms that enable reliable quantification of neurofilaments in blood samples and simplify longitudinal follow-up has paved the way for the development of neurofilaments as a biomarker in clinical practice. Potential applications include assessment of disease activity, monitoring of treatment responses, and determining prognosis in many acute and chronic neurological disorders as well as their use as an outcome measure in trials of novel therapies. Progress has now moved the measurement of neurofilaments to the doorstep of routine clinical practice for the evaluation of individuals. In this Review, we first outline current knowledge on the structure and function of neurofilaments. We then discuss analytical and statistical approaches and challenges in determining neurofilament levels in different clinical contexts and assess the implications of neurofilament light chain (NfL) levels in normal ageing and the confounding factors that need to be considered when interpreting NfL measures. In addition, we summarize the current value and potential clinical applications of neurofilaments as a biomarker of neuro-axonal damage in a range of neurological disorders, including multiple sclerosis, Alzheimer disease, frontotemporal dementia, amyotrophic lateral sclerosis, stroke and cerebrovascular disease, traumatic brain injury, and Parkinson disease. We also consider the steps needed to complete the translation of neurofilaments from the laboratory to the management of neurological diseases in clinical practice.
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Affiliation(s)
- Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria.
| | - Charlotte E Teunissen
- Neurochemistry Laboratory Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Sylvain Lehmann
- LBPC-PPC, Université de Montpellier, INM INSERM, IRMB CHU de Montpellier, Montpellier, France
| | - Markus Otto
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Simon Thebault
- Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ahmed Abdelhak
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Ari Green
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Pascal Benkert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Manuel Comabella
- Neurology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hayrettin Tumani
- Department of Neurology, CSF Laboratory, Ulm University Hospital, Ulm, Germany
| | - Mark S Freedman
- Department of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Axel Petzold
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
- Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery and the Queen Square Institute of Neurology, UCL, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Paris Brain Institute, ICM, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Neurodegenerative Disorder Research Center, Division of Life Sciences and Medicine, and Department of Neurology, Institute on Aging and Brain Disorders, University of Science and Technology of China and First Affiliated Hospital of USTC, Hefei, P. R. China
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - David Leppert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland.
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23
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D’Onghia D, Colangelo D, Bellan M, Tonello S, Puricelli C, Virgilio E, Apostolo D, Minisini R, Ferreira LL, Sozzi L, Vincenzi F, Cantello R, Comi C, Pirisi M, Vecchio D, Sainaghi PP. Gas6/TAM system as potential biomarker for multiple sclerosis prognosis. Front Immunol 2024; 15:1362960. [PMID: 38745659 PMCID: PMC11091300 DOI: 10.3389/fimmu.2024.1362960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/03/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction The protein growth arrest-specific 6 (Gas6) and its tyrosine kinase receptors Tyro-3, Axl, and Mer (TAM) are ubiquitous proteins involved in regulating inflammation and apoptotic body clearance. Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system leading to progressive and irreversible disability if not diagnosed and treated promptly. Gas6 and TAM receptors have been associated with neuronal remyelination and stimulation of oligodendrocyte survival. However, few data are available regarding clinical correlation in MS patients. We aimed to evaluate soluble levels of these molecules in the cerebrospinal fluid (CSF) and serum at MS diagnosis and correlate them with short-term disease severity. Methods In a prospective cohort study, we enrolled 64 patients with a diagnosis of clinical isolated syndrome (CIS), radiological isolated syndrome (RIS) and relapsing-remitting (RR) MS according to the McDonald 2017 Criteria. Before any treatment initiation, we sampled the serum and CSF, and collected clinical data: disease course, presence of gadolinium-enhancing lesions, and expanded disability status score (EDSS). At the last clinical follow-up, we assessed EDSS and calculated MS severity score (MSSS) and age-related MS severity (ARMSS). Gas6 and TAM receptors were determined using an ELISA kit (R&D Systems) and compared to neurofilament (NFLs) levels evaluated with SimplePlex™ fluorescence-based immunoassay. Results At diagnosis, serum sAxl was higher in patients receiving none or low-efficacy disease-modifying treatments (DMTs) versus patients with high-efficacy DMTs (p = 0.04). Higher CSF Gas6 and serum sAXL were associated with an EDSS <3 at diagnosis (p = 0.04; p = 0.037). Serum Gas6 correlates to a lower MSSS (r2 = -0.32, p = 0.01). Serum and CSF NFLs were confirmed as disability biomarkers in our cohort according to EDSS (p = 0.005; p = 0.002) and MSSS (r2 = 0.27, p = 0.03; r2 = 0.39, p = 0.001). Results were corroborated using multivariate analysis. Conclusions Our data suggest a protective role of Gas6 and its receptors in patients with MS and suitable severity disease biomarkers.
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Affiliation(s)
- Davide D’Onghia
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
- Center for Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
| | - Donato Colangelo
- Department of Health Sciences, Pharmacology, University of Piemonte Orientale (UPO), Novara, Italy
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale (UPO), Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
- Center for Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliera Universitaria (AOU) “Maggiore della Carita”, Novara, Italy
| | - Stelvio Tonello
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
- Center for Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
| | - Chiara Puricelli
- Department of Health Sciences, Clinical Biochemistry, University of Piemonte Orientale (UPO), Novara, Italy
| | - Eleonora Virgilio
- Department of Translational Medicine, Neurology Unit, Maggiore Della Carità Hospital, University of Piemonte Orientale, Novara, Italy
| | - Daria Apostolo
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Rosalba Minisini
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Luciana L. Ferreira
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Leonardo Sozzi
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Federica Vincenzi
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Roberto Cantello
- Department of Translational Medicine, Neurology Unit, Maggiore Della Carità Hospital, University of Piemonte Orientale, Novara, Italy
| | - Cristoforo Comi
- Department of Translational Medicine, Neurology Unit, S. Andrea Hospital, University of Piemonte Orientale (UPO), Vercelli, Italy
| | - Mario Pirisi
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
- Center for Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliera Universitaria (AOU) “Maggiore della Carita”, Novara, Italy
| | - Domizia Vecchio
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale (UPO), Novara, Italy
- Department of Translational Medicine, Neurology Unit, Maggiore Della Carità Hospital, University of Piemonte Orientale, Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
- Center for Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale (UPO), Novara, Italy
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliera Universitaria (AOU) “Maggiore della Carita”, Novara, Italy
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Barakovic M, Weigel M, Cagol A, Schaedelin S, Galbusera R, Lu PJ, Chen X, Melie-Garcia L, Ocampo-Pineda M, Bahn E, Stadelmann C, Palombo M, Kappos L, Kuhle J, Magon S, Granziera C. A novel imaging marker of cortical "cellularity" in multiple sclerosis patients. Sci Rep 2024; 14:9848. [PMID: 38684744 PMCID: PMC11059177 DOI: 10.1038/s41598-024-60497-6] [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: 09/01/2023] [Accepted: 04/23/2024] [Indexed: 05/02/2024] Open
Abstract
Pathological data showed focal inflammation and regions of diffuse neuronal loss in the cortex of people with multiple sclerosis (MS). In this work, we applied a novel model ("soma and neurite density imaging (SANDI)") to multishell diffusion-weighted MRI data acquired in healthy subjects and people with multiple sclerosis (pwMS), in order to investigate inflammation and degeneration-related changes in the cortical tissue of pwMS. We aimed to (i) establish whether SANDI is applicable in vivo clinical data; (ii) investigate inflammatory and degenerative changes using SANDI soma fraction (fsoma)-a marker of cellularity-in both cortical lesions and in the normal-appearing-cortex and (iii) correlate SANDI fsoma with clinical and biological measures in pwMS. We applied a simplified version of SANDI to a clinical scanners. We then provided evidence that pwMS exhibited an overall decrease in cortical SANDI fsoma compared to healthy subjects, suggesting global degenerative processes compatible with neuronal loss. On the other hand, we have found that progressive pwMS showed a higher SANDI fsoma in the outer part of the cortex compared to relapsing-remitting pwMS, possibly supporting current pathological knowledge of increased innate inflammatory cells in these regions. A similar finding was obtained in subpial lesions in relapsing-remitting patients, reflecting existing pathological data in these lesion types. A significant correlation was found between SANDI fsoma and serum neurofilament light chain-a biomarker of inflammatory axonal damage-suggesting a relationship between SANDI soma fraction and inflammatory processes in pwMS again. Overall, our data show that SANDI fsoma is a promising biomarker to monitor changes in cellularity compatible with neurodegeneration and neuroinflammation in the cortex of MS patients.
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Affiliation(s)
- Muhamed Barakovic
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Matthias Weigel
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Alessandro Cagol
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Riccardo Galbusera
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Po-Jui Lu
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Xinjie Chen
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lester Melie-Garcia
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Mario Ocampo-Pineda
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Erik Bahn
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | | | - Marco Palombo
- School of Psychology, Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, UK
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
| | - Ludwig Kappos
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefano Magon
- Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.
- Department of Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
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25
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Koerbel K, Maiworm M, Schaller-Paule M, Schäfer JH, Jakob J, Friedauer L, Steffen F, Bittner S, Foerch C, Yalachkov Y. Evaluating the utility of serum NfL, GFAP, UCHL1 and tTAU as estimates of CSF levels and diagnostic instrument in neuroinflammation and multiple sclerosis. Mult Scler Relat Disord 2024; 87:105644. [PMID: 38701697 DOI: 10.1016/j.msard.2024.105644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND This study aimed to evaluate the utility of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCHL1) and total tau (tTAU) serum concentrations as approximation for cerebrospinal fluid (CSF) concentrations of the respective biomarkers in the context of neuroinflammation and multiple sclerosis (MS). METHODS NfL, GFAP, UCHL1 and tTAU concentrations in serum and CSF were measured in 183 patients (122 with neuroinflammatory disease and 61 neurological or somatoform disease controls) using the single molecule array HD-1 analyzer (Quanterix, Boston, MA). Spearman's rank correlations were computed between serum and CSF concentrations. In a second step, the effects of age, BMI, gadolinium-enhancing lesions in MRI, integrity of the blood-brain barrier (BBB) and presence of acute relapse were accounted for by computing partial correlations. The analyses were repeated for a subsample consisting of MS phenotype patients only (n = 118). EDSS, MS disease activity and acute relapse were considered as additional covariates. Receiver operating characteristic (ROC) analysis was performed for each serum/CSF biomarker concentration to assess how well the particular biomarker concentration differentiates MS patients from somatoform disease controls. Correlations between serum and CSF levels as well as area under the curve (AUC) values were compared for the different biomarkers using z-test statistics. RESULTS Serum concentrations correlated positively with CSF levels for NfL (r = 0.705, p < 0.01) as well as for GFAP (r = 0.259, p < 0.01). Correlation coefficients were significantly higher for NfL than for GFAP (z = 5.492, p < 0.01). We found no significant serum-CSF correlations for UCHL1 or tTAU. After adjusting for covariates, the results remained unchanged. In the analysis focusing only on MS patients, the results were replicated. ROC analysis demonstrated similarly acceptable performance of serum and CSF NfL values in differentiating MS phenotype patients from somatoform disease controls. AUC values were significantly higher for serum and CSF NfL compared to other biomarkers. CONCLUSION NfL and GFAP but not UCHL1 or tTAU serum concentrations are associated with CSF levels of the respective biomarker. NfL exhibits more robust correlations between its serum and CSF concentrations as compared to GFAP independently from BBB integrity, clinical and radiological covariates. Both serum and CSF NfL values differentiate between MS and controls.
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Affiliation(s)
- Kimberly Koerbel
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany.
| | - Michelle Maiworm
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany
| | - Martin Schaller-Paule
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany; Practice for Neurology and Psychiatry Eltville, Eltville am Rhein, Germany
| | - Jan Hendrik Schäfer
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany
| | - Jasmin Jakob
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (RMN2), Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lucie Friedauer
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (RMN2), Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (RMN2), Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christian Foerch
- Department of Neurology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Yavor Yalachkov
- Department of Neurology, Goethe University Frankfurt, University Hospital, Schleusenweg 2-16, Frankfurt am Main 60528, Germany
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26
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Monreal E, Ruiz PD, San Román IL, Rodríguez-Antigüedad A, Moya-Molina MÁ, Álvarez A, García-Arcelay E, Maurino J, Shepherd J, Cabrera ÁP, Villar LM. Value contribution of blood-based neurofilament light chain as a biomarker in multiple sclerosis using multi-criteria decision analysis. Front Public Health 2024; 12:1397845. [PMID: 38711771 PMCID: PMC11073490 DOI: 10.3389/fpubh.2024.1397845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease that represents a leading cause of non-traumatic disability among young and middle-aged adults. MS is characterized by neurodegeneration caused by axonal injury. Current clinical and radiological markers often lack the sensitivity and specificity required to detect inflammatory activity and neurodegeneration, highlighting the need for better approaches. After neuronal injury, neurofilament light chains (NfL) are released into the cerebrospinal fluid, and eventually into blood. Thus, blood-based NfL could be used as a potential biomarker for inflammatory activity, neurodegeneration, and treatment response in MS. The objective of this study was to determine the value contribution of blood-based NfL as a biomarker in MS in Spain using the Multi-Criteria Decision Analysis (MCDA) methodology. Materials and methods A literature review was performed, and the results were synthesized in the evidence matrix following the criteria included in the MCDA framework. The study was conducted by a multidisciplinary group of six experts. Participants were trained in MCDA and scored the evidence matrix. Results were analyzed and discussed in a group meeting through reflective MCDA discussion methodology. Results MS was considered a severe condition as it is associated with significant disability. There are unmet needs in MS as a disease, but also in terms of biomarkers since no blood biomarker is available in clinical practice to determine disease activity, prognostic assessment, and response to treatment. The results of the present study suggest that quantification of blood-based NfL may represent a safe option to determine inflammation, neurodegeneration, and response to treatments in clinical practice, as well as to complement data to improve the sensitivity of the diagnosis. Participants considered that blood-based NfL could result in a lower use of expensive tests such as magnetic resonance imaging scans and could provide cost-savings by avoiding ineffective treatments. Lower indirect costs could also be expected due to a lower impact of disability consequences. Overall, blood-based NfL measurement is supported by high-quality evidence. Conclusion Based on MCDA methodology and the experience of a multidisciplinary group of six stakeholders, blood-based NfL measurement might represent a high-value-option for the management of MS in Spain.
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Affiliation(s)
- Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Red Española de Esclerosis Múltiple, Red de Enfermedades Inflamatorias, Universidad de Alcalá, Madrid, Spain
| | - Pilar Díaz Ruiz
- Department of Pharmacy, Hospital Nuestra Señora de Candelaria, Tenerife, Spain
| | | | | | | | | | | | | | | | | | - Luisa María Villar
- Department of Immunology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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27
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Sartorelli J, Travaglini L, Macchiaiolo M, Garone G, Gonfiantini MV, Vecchio D, Sinibaldi L, Frascarelli F, Ceccatelli V, Petrillo S, Piemonte F, Piccolo G, Novelli A, Longo D, Pro S, D’Amico A, Bertini ES, Nicita F. Spectrum of ERCC6-Related Cockayne Syndrome (Type B): From Mild to Severe Forms. Genes (Basel) 2024; 15:508. [PMID: 38674442 PMCID: PMC11050085 DOI: 10.3390/genes15040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Cockayne syndrome (CS) is an ultra-rare multisystem disorder, classically subdivided into three forms and characterized by a clinical spectrum without a clear genotype-phenotype correlation for both the two causative genes ERCC6 (CS type B) and ERCC8 (CS type A). We assessed this, presenting a series of patients with genetically confirmed CSB. (2) Materials and Methods: We retrospectively collected demographic, clinical, genetic, neuroimaging, and serum neurofilament light-chain (sNFL) data about CSB patients; diagnostic and severity scores were also determined. (3) Results: Data of eight ERCC6/CSB patients are presented. Four patients had CS I, three patients CS II, and one patient CS III. Various degrees of ataxia and spasticity were cardinal neurologic features, with variably combined systemic characteristics. Mean age at diagnosis was lower in the type II form, in which classic CS signs were more evident. Interestingly, sNFL determination appeared to reflect clinical classification. Two novel premature stop codon and one novel missense variants were identified. All CS I subjects harbored the p.Arg735Ter variant; the milder CS III subject carried the p.Leu764Ser missense change. (4) Conclusion: Our work confirms clinical variability also in the ERCC6/CSB type, where manifestations may range from severe involvement with prenatal or neonatal onset to normal psychomotor development followed by progressive ataxia. We propose, for the first time in CS, sNFL as a useful peripheral biomarker, with increased levels compared to currently available reference values and with the potential ability to reflect disease severity.
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Affiliation(s)
- Jacopo Sartorelli
- Unit of Neuromuscular and Neurodegenerative Disease, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Lorena Travaglini
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Marina Macchiaiolo
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giacomo Garone
- Neurology, Epilepsy and Movement Disorder Unit, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Davide Vecchio
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Lorenzo Sinibaldi
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Flaminia Frascarelli
- Rehabilitation Unit, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Viola Ceccatelli
- Rehabilitation Unit, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Sara Petrillo
- Unit of Neuromuscular and Neurodegenerative Disease, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Fiorella Piemonte
- Unit of Neuromuscular and Neurodegenerative Disease, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Gabriele Piccolo
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Daniela Longo
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children’s Hospital, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Stefano Pro
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Adele D’Amico
- Unit of Neuromuscular and Neurodegenerative Disease, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Enrico Silvio Bertini
- Unit of Neuromuscular and Neurodegenerative Disease, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
| | - Francesco Nicita
- Unit of Neuromuscular and Neurodegenerative Disease, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165 Rome, Italy
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28
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Yuan Y, Li H, Sreeram K, Malankhanova T, Boddu R, Strader S, Chang A, Bryant N, Yacoubian TA, Standaert DG, Erb M, Moore DJ, Sanders LH, Lutz MW, Velmeshev D, West AB. Single molecule array measures of LRRK2 kinase activity in serum link Parkinson's disease severity to peripheral inflammation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.15.589570. [PMID: 38659797 PMCID: PMC11042295 DOI: 10.1101/2024.04.15.589570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background LRRK2-targeting therapeutics that inhibit LRRK2 kinase activity have advanced to clinical trials in idiopathic Parkinson's disease (iPD). LRRK2 phosphorylates Rab10 on endolysosomes in phagocytic cells to promote some types of immunological responses. The identification of factors that regulate LRRK2-mediated Rab10 phosphorylation in iPD, and whether phosphorylated-Rab10 levels change in different disease states, or with disease progression, may provide insights into the role of Rab10 phosphorylation in iPD and help guide therapeutic strategies targeting this pathway. Methods Capitalizing on past work demonstrating LRRK2 and phosphorylated-Rab10 interact on vesicles that can shed into biofluids, we developed and validated a high-throughput single-molecule array assay to measure extracellular pT73-Rab10. Ratios of pT73-Rab10 to total Rab10 measured in biobanked serum samples were compared between informative groups of transgenic mice, rats, and a deeply phenotyped cohort of iPD cases and controls. Multivariable and weighted correlation network analyses were used to identify genetic, transcriptomic, clinical, and demographic variables that predict the extracellular pT73-Rab10 to total Rab10 ratio. Results pT73-Rab10 is absent in serum from Lrrk2 knockout mice but elevated by LRRK2 and VPS35 mutations, as well as SNCA expression. Bone-marrow transplantation experiments in mice show that serum pT73-Rab10 levels derive primarily from circulating immune cells. The extracellular ratio of pT73-Rab10 to total Rab10 is dynamic, increasing with inflammation and rapidly decreasing with LRRK2 kinase inhibition. The ratio of pT73-Rab10 to total Rab10 is elevated in iPD patients with greater motor dysfunction, irrespective of disease duration, age, sex, or the usage of PD-related or anti-inflammatory medications. pT73-Rab10 to total Rab10 ratios are associated with neutrophil activation, antigenic responses, and the suppression of platelet activation. Conclusions The extracellular ratio of pT73-Rab10 to total Rab10 in serum is a novel pharmacodynamic biomarker for LRRK2-linked innate immune activation associated with disease severity in iPD. We propose that those iPD patients with higher serum pT73-Rab10 levels may benefit from LRRK2-targeting therapeutics to mitigate associated deleterious immunological responses.
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29
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Lazzarotto A, Hamzaoui M, Tonietto M, Dubessy AL, Khalil M, Pirpamer L, Ropele S, Enzinger C, Battaglini M, Stromillo ML, De Stefano N, Filippi M, Rocca MA, Gallo P, Gasperini C, Stankoff B, Bodini B. Time is myelin: early cortical myelin repair prevents atrophy and clinical progression in multiple sclerosis. Brain 2024; 147:1331-1343. [PMID: 38267729 PMCID: PMC10994569 DOI: 10.1093/brain/awae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/15/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024] Open
Abstract
Cortical myelin loss and repair in multiple sclerosis (MS) have been explored in neuropathological studies, but the impact of these processes on neurodegeneration and the irreversible clinical progression of the disease remains unknown. Here, we evaluated in vivo cortical demyelination and remyelination in a large cohort of people with all clinical phenotypes of MS followed up for 5 years using magnetization transfer imaging (MTI), a technique that has been shown to be sensitive to myelin content changes in the cortex. We investigated 140 people with MS (37 clinically isolated syndrome, 71 relapsing-MS, 32 progressive-MS), who were clinically assessed at baseline and after 5 years and, along with 84 healthy controls, underwent a 3 T-MRI protocol including MTI at baseline and after 1 year. Changes in cortical volume over the radiological follow-up were computed with a Jacobian integration method. Magnetization transfer ratio was employed to calculate for each patient an index of cortical demyelination at baseline and of dynamic cortical demyelination and remyelination over the follow-up period. The three indices of cortical myelin content change were heterogeneous across patients but did not significantly differ across clinical phenotypes or treatment groups. Cortical remyelination, which tended to fail in the regions closer to CSF (-11%, P < 0.001), was extensive in half of the cohort and occurred independently of age, disease duration and clinical phenotype. Higher indices of cortical dynamic demyelination (β = 0.23, P = 0.024) and lower indices of cortical remyelination (β = -0.18, P = 0.03) were significantly associated with greater cortical atrophy after 1 year, independently of age and MS phenotype. While the extent of cortical demyelination predicted a higher probability of clinical progression after 5 years in the entire cohort [odds ratio (OR) = 1.2; P = 0.043], the impact of cortical remyelination in reducing the risk of accumulating clinical disability after 5 years was significant only in the subgroup of patients with shorter disease duration and limited extent of demyelination in cortical regions (OR = 0.86, P = 0.015, area under the curve = 0.93). In this subgroup, a 30% increase in cortical remyelination nearly halved the risk of clinical progression at 5 years, independently of clinical relapses. Overall, our results highlight the critical role of cortical myelin dynamics in the cascade of events leading to neurodegeneration and to the subsequent accumulation of irreversible disability in MS. Our findings suggest that early-stage myelin repair compensating for cortical myelin loss has the potential to prevent neuro-axonal loss and its long-term irreversible clinical consequences in people with MS.
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Affiliation(s)
- Andrea Lazzarotto
- Department of Neuroscience, Sorbonne Université, Paris Brain Institute, CNRS, Inserm, 75013 Paris, France
- AP-HP, Hôpital Universitaire Pitié-Salpêtrière, 75013 Paris, France
- Padova Neuroscience Center, University of Padua, 35122 Padua, Italy
| | - Mariem Hamzaoui
- Department of Neuroscience, Sorbonne Université, Paris Brain Institute, CNRS, Inserm, 75013 Paris, France
| | - Matteo Tonietto
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Service Hospitalier Frédéric Joliot, 91400 Orsay, France
- Roche Pharma Research & Early Development, F. Hoffmann-La Roche Ltd., CH-4070 Basel, Switzerland
| | | | - Michael Khalil
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, CH-4051 Basel, Switzerland
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, 8036 Graz, Austria
| | | | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Maria Laura Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Paolo Gallo
- Padova Neuroscience Center, University of Padua, 35122 Padua, Italy
- Multiple Sclerosis Centre of Veneto Region, 35128 Padua, Italy
| | | | - Bruno Stankoff
- Department of Neuroscience, Sorbonne Université, Paris Brain Institute, CNRS, Inserm, 75013 Paris, France
- AP-HP, Hôpital Universitaire Pitié-Salpêtrière, 75013 Paris, France
| | - Benedetta Bodini
- Department of Neuroscience, Sorbonne Université, Paris Brain Institute, CNRS, Inserm, 75013 Paris, France
- AP-HP, Hôpital Universitaire Pitié-Salpêtrière, 75013 Paris, France
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Ontaneda D, Chitnis T, Rammohan K, Obeidat AZ. Identification and management of subclinical disease activity in early multiple sclerosis: a review. J Neurol 2024; 271:1497-1514. [PMID: 37864717 PMCID: PMC10972995 DOI: 10.1007/s00415-023-12021-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/23/2023]
Abstract
IMPORTANCE Early treatment initiation in multiple sclerosis (MS) is crucial in preventing irreversible neurological damage and disability progression. The current assessment of disease activity relies on relapse rates and magnetic resonance imaging (MRI) lesion activity, but inclusion of other early, often "hidden," indicators of disease activity may describe a more comprehensive picture of MS. OBSERVATIONS Early indicators of MS disease activity other than relapses and MRI activity, such as cognitive impairment, brain atrophy, and fatigue, are not typically captured by routine disease monitoring. Furthermore, silent progression (neurological decline not clearly captured by standard methods) may occur undetected by relapse and MRI lesion activity monitoring. Consequently, patients considered to have no disease activity actually may have worsening disease, suggesting a need to revise MS management strategies with respect to timely initiation and escalation of disease-modifying therapy (DMT). Traditionally, first-line MS treatment starts with low- or moderate-efficacy therapies, before escalating to high-efficacy therapies (HETs) after evidence of breakthrough disease activity. However, multiple observational studies have shown that early initiation of HETs can prevent or reduce disability progression. Ongoing randomized clinical trials are comparing escalation and early HET approaches. CONCLUSIONS AND RELEVANCE There is an urgent need to reassess how MS disease activity and worsening are measured. A greater awareness of "hidden" indicators, potentially combined with biomarkers to reveal silent disease activity and neurodegeneration underlying MS, would provide a more complete picture of MS and allow for timely therapeutic intervention with HET or switching DMTs to address suboptimal treatment responses.
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Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
| | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kottil Rammohan
- Division of Multiple Sclerosis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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Arroyo Pereiro P, Muñoz-Vendrell A, León Moreno I, Bau L, Matas E, Romero-Pinel L, Martínez Yélamos A, Martínez Yélamos S, Andrés-Benito P. Baseline serum neurofilament light chain levels differentiate aggressive from benign forms of relapsing-remitting multiple sclerosis: a 20-year follow-up cohort. J Neurol 2024; 271:1599-1609. [PMID: 38085343 PMCID: PMC10973070 DOI: 10.1007/s00415-023-12135-w] [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: 10/08/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVES Serum biomarkers are emerging as useful prognostic tools for multiple sclerosis (MS); however, long-term studies are lacking. We aimed to evaluate the long-term prognostic value of the serum levels of neurofilament light chain (NfL), total tau, glial fibrillary acidic protein (GFAP), and chitinase 3-like-1 (CHI3L1) measured close to the time of MS onset. METHODS In this retrospective, exploratory, observational, case and controls study, patients with relapsing-remitting MS (RRMS) with available baseline serum samples and prospectively follow-up in our MS unit for a long time were selected based on their clinical evolution to form two groups: (1) a benign RRMS (bRRMS) group, defined as patients with an Expanded Disability Status Scale (EDSS) score of ≤ 3 at ≥ 10 years of follow-up; (2) an aggressive RRMS (aRRMS) group, defined as patients with an EDSS score of ≥ 6 at ≤ 15 years of follow-up. An age-matched healthy control (HC) group was selected. NfL, total tau, and GFAP serum levels were quantified using a single-molecule array (SIMOA), and CHI3L1 was quantified using ELISA. RESULTS Thirty-one patients with bRRMS, 19 with aRRMS, and 10 HC were included. The median follow-up time from sample collection was 17.74 years (interquartile range, 14.60-20.37). Bivariate and multivariate analyses revealed significantly higher NfL and GFAP levels in the aRRMS group than in the bRRMS group. A receiver operating characteristic curve analysis identified serum NfL level as the most efficient marker for distinguishing aRRMS from bRRMS. DISCUSSION This proof-of-concept study comparing benign and aggressive RRMS groups reinforces the potential role of baseline NfL serum levels as a promising long-term disability prognostic marker. In contrast, serum GFAP, total tau, and CHI3L1 levels demonstrated a lower or no ability to differentiate between the long-term outcomes of RRMS.
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Affiliation(s)
- Pablo Arroyo Pereiro
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Albert Muñoz-Vendrell
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Isabel León Moreno
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Laura Bau
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Elisabet Matas
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Lucía Romero-Pinel
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Antonio Martínez Yélamos
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Sergio Martínez Yélamos
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Pol Andrés-Benito
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
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Bauer A, Hegen H, Reindl M. Body fluid markers for multiple sclerosis and differential diagnosis from atypical demyelinating disorders. Expert Rev Mol Diagn 2024; 24:283-297. [PMID: 38533708 DOI: 10.1080/14737159.2024.2334849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Body fluid markers could be helpful to predict the conversion into clinically definite multiple sclerosis (MS) in people with a first demyelinating event of the central nervous system (CNS). Consequently, biomarkers such as oligoclonal bands, which are integrated in the current MS diagnostic criteria, could assist early MS diagnosis. AREAS COVERED This review examines existing knowledge on a broad spectrum of body fluid markers in people with a first CNS demyelinating event, explores their potential to predict conversion to MS, to assess MS disease activity, as well as their utility to differentiate MS from atypical demyelinating disorders such as neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein associated disease. EXPERT OPINION This field of research has shown a dramatic increase of evidence, especially in the last decade. Some biomarkers are already established in clinical routine (e.g. oligoclonal bands) while others are currently implemented (e.g. kappa free light chains) or considered as breakthroughs (e.g. neurofilament light). Determination of biomarkers poses challenges for continuous monitoring, especially if exclusively detectable in cerebrospinal fluid. A handful of biomarkers are measurable in blood which holds a significant potential.
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Affiliation(s)
- Angelika Bauer
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Cortese R, Testa G, Assogna F, De Stefano N. Magnetic Resonance Imaging Evidence Supporting the Efficacy of Cladribine Tablets in the Treatment of Relapsing-Remitting Multiple Sclerosis. CNS Drugs 2024; 38:267-279. [PMID: 38489020 PMCID: PMC10980660 DOI: 10.1007/s40263-024-01074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/17/2024]
Abstract
Numerous therapies are currently available to modify the disease course of multiple sclerosis (MS). Magnetic resonance imaging (MRI) plays a pivotal role in assessing treatment response by providing insights into disease activity and clinical progression. Integrating MRI findings with clinical and laboratory data enables a comprehensive assessment of the disease course. Among available MS treatments, cladribine is emerging as a promising option due to its role as a selective immune reconstitution therapy, with a notable impact on B cells and a lesser effect on T cells. This work emphasizes the assessment of MRI's contribution to MS treatment, particularly focusing on the influence of cladribine tablets on imaging outcomes, encompassing data from pivotal and real-world studies. The evidence highlights that cladribine, compared with placebo, not only exhibits a reduction in inflammatory imaging markers, such as T1-Gd+, T2 and combined unique active (CUA) lesions, but also mitigates the effect on brain volume loss, particularly within grey matter. Importantly, cladribine reveals early action by reducing CUA lesions within the first months of treatment, regardless of a patient's initial conditions. The selective mechanism of action, and sustained efficacy beyond year 2, combined with its early onset of action, collectively position cladribine tablets as a pivotal component in the therapeutic paradigm for MS. Overall, MRI, along with clinical measures, has played a substantial role in showcasing the effectiveness of cladribine in addressing both the inflammatory and neurodegenerative aspects of MS.
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Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Giovanna Testa
- Merck Serono S.p.A. Italy, An Affiliate of Merck KGaA, Rome, Italy
| | | | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy.
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Queissner R, Buchmann A, Demjaha R, Tafrali C, Benkert P, Kuhle J, Jerkovic A, Dalkner N, Fellendorf F, Birner A, Platzer M, Tmava-Berisha A, Maget A, Stross T, Lenger M, Häussl A, Khalil M, Reininghaus E. Serum neurofilament light as a potential marker of illness duration in bipolar disorder. J Affect Disord 2024; 350:366-371. [PMID: 38215991 DOI: 10.1016/j.jad.2024.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Investigation on specific biomarkers for diagnostic or prognostic usage in mental diseases and especially bipolar disorder BD seems to be one outstanding field in current research. Serum neurofilament light (sNfL), a marker for neuro-axonal injury, is increased in various acute and chronic neurological disorders, but also neuro-psychiatric conditions, including affective disorders. The aim of our study was to determine a potential relation between a neuron-specific marker like sNfL and different clinical states of BD. METHODS In the current investigation, 51 patients with BD and 35 HC were included. Mood ratings with the Hamilton depression scale (HAMD) and the Young mania rating scale (YMRS) have been included. Illness duration was defined as the period from the time of diagnosis out of self-report and medical records. sNFL was quantified by a commercial ultrasensitive single molecule array (Simoa). RESULTS There was a significant positive correlation between the number of manic episodes in the past and sNfL, controlled for age and duration of illness. (R = 0.49, p = 0.03) Depressive episodes were not associated to sNfL values. (R = 0.311, p = n.s.) Patients with >3 years of illness duration showed significantly higher levels of sNfL (M18.59; SD 11.89) than patients with shorter illness duration (M = 12.38, p = 0.03) and HC (M = 11.35, p = 0.02). Patients with <3 years of illness and HC did not differ significantly in sNfL levels. DISCUSSION Interestingly, individuals with BD and HC did not differ in sNFL levels in general. Nevertheless, looking at the BD cohort more specifically, we found that individuals with BD with longer duration of illness (>3 years) had higher levels of sNfL than those with an illness duration below 3 years. Our results confirm previous reports on the relation of neuro-axonal injury as evidenced by sNfL and illness specific variables in bipolar disorder. Further studies are needed to clarify if sNfL may predict the disease course and/or indicated response to treatment regimes.
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Affiliation(s)
- R Queissner
- Medical University of Graz, Department for Psychiatry, Austria
| | - A Buchmann
- Medical University of Graz, Department for Neurology, Austria
| | - R Demjaha
- Medical University of Graz, Department for Neurology, Austria
| | - C Tafrali
- Medical University of Graz, Department for Neurology, Austria
| | - P Benkert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - J Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - A Jerkovic
- Institute of Molecular Biosciences, University of Graz, Austria
| | - N Dalkner
- Medical University of Graz, Department for Psychiatry, Austria
| | - F Fellendorf
- Medical University of Graz, Department for Psychiatry, Austria
| | - A Birner
- Medical University of Graz, Department for Psychiatry, Austria
| | - M Platzer
- Medical University of Graz, Department for Psychiatry, Austria
| | - A Tmava-Berisha
- Medical University of Graz, Department for Psychiatry, Austria
| | - A Maget
- Medical University of Graz, Department for Psychiatry, Austria
| | - T Stross
- Medical University of Graz, Department for Psychiatry, Austria
| | - M Lenger
- Medical University of Graz, Department for Psychiatry, Austria
| | - A Häussl
- Medical University of Graz, Department for Psychiatry, Austria
| | - M Khalil
- Medical University of Graz, Department for Neurology, Austria.
| | - E Reininghaus
- Medical University of Graz, Department for Psychiatry, Austria
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van Tilburg SJ, Teunissen CE, Maas CCHM, Thomma RCM, Walgaard C, Heijst H, Huizinga R, van Doorn PA, Jacobs BC. Dynamics and prognostic value of serum neurofilament light chain in Guillain-Barré syndrome. EBioMedicine 2024; 102:105072. [PMID: 38518653 PMCID: PMC10980997 DOI: 10.1016/j.ebiom.2024.105072] [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: 08/22/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Neurofilament light chain (NfL) is a biomarker for axonal damage in several neurological disorders. We studied the longitudinal changes in serum NfL in patients with Guillain-Barré syndrome (GBS) in relation to disease severity, electrophysiological subtype, treatment response, and prognosis. METHODS We included patients with GBS who participated in a double-blind, randomised, placebo-controlled trial that evaluated the effects of a second course of intravenous immunoglobulin (IVIg) on clinical outcomes. Serum NfL levels were measured before initiation of treatment and at one, two, four, and twelve weeks using a Simoa HD-X Analyzer. Serum NfL dynamics were analysed using linear mixed-effects models. Logistic regression was employed to determine the associations of serum NfL with clinical outcome and the prognostic value of serum NfL after correcting for known prognostic markers included in the modified Erasmus GBS Outcome Score (mEGOS). FINDINGS NfL levels were tested in serum from 281 patients. Serum NfL dynamics were associated with disease severity and electrophysiological subtype. Strong associations were found between high levels of serum NfL at two weeks and inability to walk unaided at four weeks (OR = 1.74, 95% CI = 1.27-2.45), and high serum NfL levels at four weeks and inability to walk unaided at 26 weeks (OR = 2.79, 95% CI = 1.72-4.90). Baseline serum NfL had the most significant prognostic value for ability to walk, independent of predictors included in the mEGOS. The time to regain ability to walk unaided was significantly longer for patients with highest serum NfL levels at baseline (p = 0.0048) and week 2 (p < 0.0001). No differences in serum NfL were observed between patients that received a second IVIg course vs. IVIg and placebo. INTERPRETATION Serum NfL levels are associated with disease severity, axonal involvement, and poor outcome in GBS. Serum NfL potentially represents a biomarker to monitor neuronal damage in GBS and an intermediate endpoint to evaluate the effects of treatment. FUNDING Prinses Beatrix Spierfonds W.OR19-24.
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Affiliation(s)
- Sander J van Tilburg
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Carolien C H M Maas
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Robin C M Thomma
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Christa Walgaard
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Hans Heijst
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruth Huizinga
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bart C Jacobs
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Montalban X, Piasecka-Stryczynska K, Kuhle J, Benkert P, Arnold DL, Weber MS, Seitzinger A, Guehring H, Shaw J, Tomic D, Hyvert Y, Harlow DE, Dyroff M, Wolinsky JS. Efficacy and safety results after >3.5 years of treatment with the Bruton's tyrosine kinase inhibitor evobrutinib in relapsing multiple sclerosis: Long-term follow-up of a Phase II randomised clinical trial with a cerebrospinal fluid sub-study. Mult Scler 2024; 30:558-570. [PMID: 38436271 PMCID: PMC11080380 DOI: 10.1177/13524585241234783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Evobrutinib - an oral, central nervous system (CNS)-penetrant, and highly selective Bruton's tyrosine kinase inhibitor - has shown efficacy in a 48-week, double-blind, Phase II trial in patients with relapsing MS. OBJECTIVE Report results of the Phase II open-label extension (OLE; up to week 192 from randomisation) and a cerebrospinal fluid (CSF) sub-study. METHODS In the 48-week double-blind period (DBP), patients received evobrutinib 25 mg once-daily, 75 mg once-daily, 75 mg twice-daily or placebo (switched to evobrutinib 25 mg once-daily after week 24). Patients could then enter the OLE, receiving evobrutinib 75 mg once-daily (mean (± standard deviation (SD)) duration = 50.6 weeks (±6.0)) before switching to 75 mg twice-daily. RESULTS Of 164 evobrutinib-treated patients who entered the OLE, 128 (78.0%) completed ⩾192 weeks of treatment. Patients receiving DBP evobrutinib 75 mg twice-daily: annualised relapse rate at week 48 (0.11 (95% confidence interval (CI) = 0.04-0.25)) was maintained with the OLE twice-daily dose up to week 192 (0.11 (0.05-0.22)); Expanded Disability Status Scale score remained stable; serum neurofilament light chain fell to levels like a non-MS population (Z-scores); T1 gadolinium-enhancing lesion numbers remained low. No new safety signals were identified. In the OLE, evobrutinib was detected in the CSF of all sub-study patients. CONCLUSION Long-term evobrutinib treatment was well tolerated and associated with a sustained low level of disease activity. Evobrutinib was present in CSF at concentrations similar to plasma.
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Affiliation(s)
- Xavier Montalban
- Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | | | - Jens Kuhle
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada; NeuroRx, Montreal, QC, Canada
| | - Martin S Weber
- Institute of Neuropathology, Department of Neurology, University Medical Center, University of Göttingen, Göttingen, Germany; Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany
| | | | | | - Jamie Shaw
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA
| | - Davorka Tomic
- Ares Trading SA, Eysins, Switzerland, an affiliate of Merck KGaA
| | | | - Danielle E Harlow
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA
| | - Martin Dyroff
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA
| | - Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
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Kuhle J, Leppert D, Comi G, de Stefano N, Kappos L, Freedman MS, Seitzinger A, Roy S. Serum neurofilament light chain correlations in patients with a first clinical demyelinating event in the REFLEX study: a post hoc analysis. Ther Adv Neurol Disord 2024; 17:17562864241239101. [PMID: 38560407 PMCID: PMC10981258 DOI: 10.1177/17562864241239101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
Background In REFLEX, subcutaneous interferon beta-1a (sc IFN β-1a) delayed the onset of multiple sclerosis (MS) in patients with a first clinical demyelinating event (FCDE). Objectives This post hoc analysis aimed to determine whether baseline serum neurofilament light (sNfL) chain can predict conversion to MS and whether correlations exist between baseline sNfL and magnetic resonance imaging (MRI) metrics. Methods sNfL was measured for 494 patients who received sc IFN β-1a 44 μg once weekly (qw; n = 168), three times weekly (tiw; n = 161), or placebo (n = 165) over 24 months. Median baseline sNfL (26.1 pg/mL) was used to define high/low sNfL subgroups. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox's proportional hazard model to determine factors influencing the risk of conversion to MS. Kaplan-Meier estimates calculated median time-to-conversion to MS (McDonald 2005 criteria) or clinically definite MS (CDMS; Poser criteria). Correlations between sNfL and MRI findings were assessed using Spearman's rank correlation coefficient (r). Results Multivariable models indicated that high baseline sNfL was associated with the likelihood of converting to MS and inversely to time-to-conversion (HR = 1.3, 95% CI: 1.03-1.64; p = 0.024). Significant additional factors affecting conversion to McDonald MS were on-study treatment (sc IFN β-1a/placebo; qw: HR = 0.59, 95% CI: 0.46-0.76; tiw: HR = 0.45, 95% CI: 0.34-0.59), classification of FCDE (monofocal/multifocal; HR = 0.69, 95% CI: 0.55-0.85), and most baseline imaging findings (T2 and T1 gadolinium-enhancing [Gd+] lesions; HR = 1.02, 95% CI: 1.01-1.03 and HR = 1.07, 95% CI: 1.03-1.11); all p ⩽ 0.001. Conversion to CDMS showed similar results. At month 24, sNfL was strongly correlated with a mean number of combined unique active (r = 0.71), new T2 (r = 0.72), and new T1 Gd+ (r = 0.60) lesions; weak correlations were observed between sNfL and clinical outcomes for all treatment groups. Conclusion Higher baseline sNfL was associated with an increased risk of MS conversion, a risk that was mitigated by treatment with sc IFN β-1a tiw. Trial registration ClinicalTrials.gov identifier: NCT00404352. Date registered: 28 November 2006.
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Affiliation(s)
- Jens Kuhle
- Department of Neurology, University Hospital Basel, Petersgraben 4, Basel CH-4031, Switzerland
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Spitalstrasse 2, Basel CH-4031, Switzerland
| | - David Leppert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Giancarlo Comi
- Casa di Cura Privata del Policlinico, Università Vita-Salute San Raffaele, Milan, Italy
| | - Nicola de Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Ludwig Kappos
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Mark S. Freedman
- Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Sanjeev Roy
- Global Clinical Development – Immunology, Ares Trading S.A. (an affiliate of Merck KGaA), Eysins, Switzerland
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Berends M, Nienhuis HLA, Adams D, Karam C, Luigetti M, Polydefkis M, Reilly MM, Sekijima Y, Hazenberg BPC. Neurofilament Light Chains in Systemic Amyloidosis: A Systematic Review. Int J Mol Sci 2024; 25:3770. [PMID: 38612579 PMCID: PMC11011627 DOI: 10.3390/ijms25073770] [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: 02/17/2024] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Peripheral and autonomic neuropathy are common disease manifestations in systemic amyloidosis. The neurofilament light chain (NfL), a neuron-specific biomarker, is released into the blood and cerebrospinal fluid after neuronal damage. There is a need for an early and sensitive blood biomarker for polyneuropathy, and this systematic review provides an overview on the value of NfL in the early detection of neuropathy, central nervous system involvement, the monitoring of neuropathy progression, and treatment effects in systemic amyloidosis. A literature search in PubMed, Embase, and Web of Science was performed on 14 February 2024 for studies investigating NfL levels in patients with systemic amyloidosis and transthyretin gene-variant (TTRv) carriers. Only studies containing original data were included. Included were thirteen full-text articles and five abstracts describing 1604 participants: 298 controls and 1306 TTRv carriers or patients with or without polyneuropathy. Patients with polyneuropathy demonstrated higher NfL levels compared to healthy controls and asymptomatic carriers. Disease onset was marked by rising NfL levels. Following the initiation of transthyretin gene-silencer treatment, NfL levels decreased and remained stable over an extended period. NfL is not an outcome biomarker, but an early and sensitive disease-process biomarker for neuropathy in systemic amyloidosis. Therefore, NfL has the potential to be used for the early detection of neuropathy, monitoring treatment effects, and monitoring disease progression in patients with systemic amyloidosis.
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Affiliation(s)
- Milou Berends
- Department of Internal Medicine, Amyloidosis Center of Expertise, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (M.B.); (H.L.A.N.)
| | - Hans L. A. Nienhuis
- Department of Internal Medicine, Amyloidosis Center of Expertise, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (M.B.); (H.L.A.N.)
| | - David Adams
- Service de Neurologie, CHU Bicêtre, Assistance Publique—Hôpitaux de Paris, University Paris-Saclay, CERAMIC, Le Kremlin-Bicêtre, 94270 Paris, France;
| | - Chafic Karam
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Marco Luigetti
- UOC Neurologia, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Michael Polydefkis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Mary M. Reilly
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK;
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto 390-8621, Japan;
| | - Bouke P. C. Hazenberg
- Department of Rheumatology & Clinical Immunology, Amyloidosis Center of Expertise, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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Stukas S, Cooper J, Higgins V, Holmes D, Adeli K, Wellington CL. Pediatric reference intervals for serum neurofilament light and glial fibrillary acidic protein using the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. Clin Chem Lab Med 2024; 62:698-705. [PMID: 37882772 PMCID: PMC10895925 DOI: 10.1515/cclm-2023-0660] [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: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Blood biomarkers have the potential to transform diagnosis and prognosis for multiple neurological indications. Establishing normative data is a critical benchmark in the analytical validation process. Normative data are important in children as little is known about how brain development may impact potential biomarkers. The objective of this study is to generate pediatric reference intervals (RIs) for serum neurofilament light (NfL), an axonal marker, and glial fibrillary acidic protein (GFAP), an astrocytic marker. METHODS Serum from healthy children and adolescents aged 1 to <19 years were obtained from the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. Serum NfL (n=300) and GFAP (n=316) were quantified using Simoa technology, and discrete RI (2.5th and 97.5th percentiles) and continuous RI (5th and 95th percentiles) were generated. RESULTS While there was no association with sex, there was a statistically significant (p<0.0001) negative association between age and serum NfL (Rho -0.400) and GFAP (Rho -0.749). Two statistically significant age partitions were generated for NfL: age 1 to <10 years (lower, upper limit; 3.13, 20.6 pg/mL) and 10 to <19 years (1.82, 7.44 pg/mL). For GFAP, three statistically significant age partitions were generated: age 1 to <3.5 years (80.4, 601 pg/mL); 3.5 to <11 years (50.7, 224 pg/mL); and 11 to <19 years (26.2, 119 pg/mL). CONCLUSIONS Taken together with the literature on adults, NfL and GFAP display U-shaped curves with high levels in infants, decreasing levels during childhood, a plateau during adolescence and early adulthood and increasing levels in seniors. These normative data are expected to inform future pediatric studies on the importance of age on neurological blood biomarkers.
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Affiliation(s)
- Sophie Stukas
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Cooper
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Victoria Higgins
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Holmes
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, Providence Health, Vancouver, BC, Canada
| | - Khosrow Adeli
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cheryl L. Wellington
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering (SBME), University of British Columbia, Vancouver, BC, Canada
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Bavato F, Barro C, Schnider LK, Simrén J, Zetterberg H, Seifritz E, Quednow BB. Introducing neurofilament light chain measure in psychiatry: current evidence, opportunities, and pitfalls. Mol Psychiatry 2024:10.1038/s41380-024-02524-6. [PMID: 38503931 DOI: 10.1038/s41380-024-02524-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
The recent introduction of new-generation immunoassay methods allows the reliable quantification of structural brain markers in peripheral matrices. Neurofilament light chain (NfL), a neuron-specific cytoskeletal component released in extracellular matrices after neuroaxonal impairment, is considered a promising blood marker of active brain pathology. Given its sensitivity to a wide range of neuropathological alterations, NfL has been suggested for the use in clinical practice as a highly sensitive, but unspecific tool to quantify active brain pathology. While large efforts have been put in characterizing its clinical profile in many neurological conditions, NfL has received far less attention as a potential biomarker in major psychiatric disorders. Therefore, we briefly introduce NfL as a marker of neuroaxonal injury, systematically review recent findings on cerebrospinal fluid and blood NfL levels in patients with primary psychiatric conditions and highlight the opportunities and pitfalls. Current evidence suggests an elevation of blood NfL levels in patients with major depression, bipolar disorder, psychotic disorders, anorexia nervosa, and substance use disorders compared to physiological states. However, blood NfL levels strongly vary across diagnostic entities, clinical stage, and patient subgroups, and are influenced by several demographic, clinical, and analytical factors, which require accurate characterization. Potential clinical applications of NfL measure in psychiatry are seen in diagnostic and prognostic algorithms, to exclude neurodegenerative disease, in the assessment of brain toxicity for different pharmacological compounds, and in the longitudinal monitoring of treatment response. The high inter-individual variability of NfL levels and the lack of neurobiological understanding of its release are some of the main current limitations. Overall, this primer aims to introduce researchers and clinicians to NfL measure in the psychiatric field and to provide a conceptual framework for future research directions.
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Affiliation(s)
- Francesco Bavato
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Christian Barro
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura K Schnider
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Joel Simrén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- 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
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics; Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
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Plantone D, Stufano A, Righi D, Locci S, Iavicoli I, Lovreglio P, De Stefano N. Neurofilament light chain and glial fibrillary acid protein levels are elevated in post-mild COVID-19 or asymptomatic SARS-CoV-2 cases. Sci Rep 2024; 14:6429. [PMID: 38499607 PMCID: PMC10948776 DOI: 10.1038/s41598-024-57093-z] [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: 10/17/2023] [Accepted: 03/14/2024] [Indexed: 03/20/2024] Open
Abstract
Given the huge impact of the COVID-19 pandemic, it appears of paramount importance to assess the cognitive effects on the population returning to work after COVID-19 resolution. Serum levels of neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) represent promising biomarkers of neuro-axonal damage and astrocytic activation. In this cohort study, we explored the association between sNfL and sGFAP concentrations and cognitive performance in a group of 147 adult workers with a previous asymptomatic SARS-CoV-2 infection or mild COVID-19, one week and, in 49 of them, ten months after SARS-Cov2 negativization and compared them to a group of 82 age and BMI-matched healthy controls (HCs). sNfL and sGFAP concentrations were assessed using SimoaTM assay Neurology 2-Plex B Kit. COVID-19 patients were interviewed one-on-one by trained physicians and had to complete a list of questionnaires, including the Cognitive Failure Questionnaire (CFQ). At the first assessment (T0), sNfL and sGFAP levels were significantly higher in COVID-19 patients than in HCs (p < 0.001 for both). The eleven COVID-19 patients with cognitive impairment had significantly higher levels of sNfL and sGFAP than the others (p = 0.005 for both). At the subsequent follow-up (T1), sNfL and sGFAP levels showed a significant decrease (median sNfL 18.3 pg/mL; median sGFAP 77.2 pg/mL), although they were still higher than HCs (median sNfL 7.2 pg/mL, median sGFAP 63.5 pg/mL). Our results suggest an ongoing damage involving neurons and astrocytes after SARS-Cov2 negativization, which reduce after ten months even if still evident compared to HCs.
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Affiliation(s)
- Domenico Plantone
- Department of Medicine, Surgery, Neuroscience University of Siena, Siena, Italy.
| | - Angela Stufano
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Delia Righi
- Department of Medicine, Surgery, Neuroscience University of Siena, Siena, Italy
| | - Sara Locci
- Department of Medicine, Surgery, Neuroscience University of Siena, Siena, Italy
| | - Ivo Iavicoli
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Piero Lovreglio
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery, Neuroscience University of Siena, Siena, Italy
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Jalaleddini K, Jakimovski D, Keshavan A, McCurdy S, Leyden K, Qureshi F, Ghoreyshi A, Bergsland N, Dwyer MG, Ramanathan M, Weinstock-Guttman B, Benedict RH, Zivadinov R. Proteomic signatures of physical, cognitive, and imaging outcomes in multiple sclerosis. Ann Clin Transl Neurol 2024; 11:729-743. [PMID: 38234075 DOI: 10.1002/acn3.51996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND A quantitative measurement of serum proteome biomarkers that would associate with disease progression endpoints can provide risk stratification for persons with multiple sclerosis (PwMS) and supplement the clinical decision-making process. MATERIALS AND METHODS In total, 202 PwMS were enrolled in a longitudinal study with measurements at two time points with an average follow-up time of 5.4 years. Clinical measures included the Expanded Disability Status Scale, Timed 25-foot Walk, 9-Hole Peg, and Symbol Digit Modalities Tests. Subjects underwent magnetic resonance imaging to determine the volumetric measures of the whole brain, gray matter, deep gray matter, and lateral ventricles. Serum samples were analyzed using a custom immunoassay panel on the Olink™ platform, and concentrations of 18 protein biomarkers were measured. Linear mixed-effects models and adjustment for multiple comparisons were performed. RESULTS Subjects had a significant 55.6% increase in chemokine ligand 20 (9.7 pg/mL vs. 15.1 pg/mL, p < 0.001) and neurofilament light polypeptide (10.5 pg/mL vs. 11.5 pg/mL, p = 0.003) at the follow-up time point. Additional changes in CUB domain-containing protein 1, Contactin 2, Glial fibrillary acidic protein, Myelin oligodendrocyte glycoprotein, and Osteopontin were noted but did not survive multiple comparison correction. Worse clinical performance in the 9-HPT was associated with neurofilament light polypeptide (p = 0.001). Increases in several biomarker candidates were correlated with greater neurodegenerative changes as measured by different brain volumes. CONCLUSION Multiple proteins, selected from a disease activity test that represent diverse biological pathways, are associated with physical, cognitive, and radiographic outcomes. Future studies should determine the utility of multiple protein assays in routine clinical care.
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Affiliation(s)
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | | | | | | | | | | | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Murali Ramanathan
- Department of Pharmaceutical Sciences, State University of New York, Buffalo, Buffalo, New York, USA
| | - Bianca Weinstock-Guttman
- Jacobs MS Center, Department of Neurology, Jacobs School of Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Ralph Hb Benedict
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
- Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, New York, USA
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Freedman MS, Gnanapavan S, Booth RA, Calabresi PA, Khalil M, Kuhle J, Lycke J, Olsson T. Guidance for use of neurofilament light chain as a cerebrospinal fluid and blood biomarker in multiple sclerosis management. EBioMedicine 2024; 101:104970. [PMID: 38354532 PMCID: PMC10875256 DOI: 10.1016/j.ebiom.2024.104970] [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: 01/16/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024] Open
Abstract
Neurofilament light chain (NfL) is a long-awaited blood biomarker that can provide clinically useful information about prognosis and therapeutic efficacy in multiple sclerosis (MS). There is now substantial evidence for this biomarker to be used alongside magnetic resonance imaging (MRI) and clinical measures of disease progression as a decision-making tool for the management of patients with MS. Serum NfL (sNfL) has certain advantages over traditional measures of MS disease progression such as MRI because it is relatively noninvasive, inexpensive, and can be repeated frequently to monitor activity and treatment efficacy. sNfL levels can be monitored regularly in patients with MS to determine change from baseline and predict subclinical disease activity, relapse risk, and the development of gadolinium-enhancing (Gd+) lesions. sNfL does not replace MRI, which provides information related to spatial localisation and lesion stage. Laboratory platforms are starting to be made available for clinical application of sNfL in several countries. Further work is needed to resolve issues around comparisons across testing platforms (absolute values) and normalisation (reference ranges) in order to guide interpretation of the results.
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Affiliation(s)
- Mark S Freedman
- Department of Medicine (Neurology), University of Ottawa, and the Ottawa Hospital Research Institute, Ontario, Canada.
| | | | - Ronald A Booth
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital & Eastern Ontario Regional Laboratory Association, Ontario, Canada
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Jens Kuhle
- Multiple Sclerosis Centre, Neurology, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, Switzerland
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden
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Lattau SSJ, Borsch LM, Auf dem Brinke K, Klose C, Vinhoven L, Nietert M, Fitzner D. Plasma Lipidomic Profiling Using Mass Spectrometry for Multiple Sclerosis Diagnosis and Disease Activity Stratification (LipidMS). Int J Mol Sci 2024; 25:2483. [PMID: 38473733 DOI: 10.3390/ijms25052483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
This investigation explores the potential of plasma lipidomic signatures for aiding in the diagnosis of Multiple Sclerosis (MS) and evaluating the clinical course and disease activity of diseased patients. Plasma samples from 60 patients with MS (PwMS) were clinically stratified to either a relapsing-remitting (RRMS) or a chronic progressive MS course and 60 age-matched controls were analyzed using state-of-the-art direct infusion quantitative shotgun lipidomics. To account for potential confounders, data were filtered for age and BMI correlations. The statistical analysis employed supervised and unsupervised multivariate data analysis techniques, including a principal component analysis (PCA), a partial least squares discriminant analysis (oPLS-DA) and a random forest (RF). To determine whether the significant absolute differences in the lipid subspecies have a relevant effect on the overall composition of the respective lipid classes, we introduce a class composition visualization (CCV). We identified 670 lipids across 16 classes. PwMS showed a significant increase in diacylglycerols (DAG), with DAG 16:0;0_18:1;0 being proven to be the lipid with the highest predictive ability for MS as determined by RF. The alterations in the phosphatidylethanolamines (PE) were mainly linked to RRMS while the alterations in the ether-bound PEs (PE O-) were found in chronic progressive MS. The amount of CE species was reduced in the CPMS cohort whereas TAG species were reduced in the RRMS patients, both lipid classes being relevant in lipid storage. Combining the above mentioned data analyses, distinct lipidomic signatures were isolated and shown to be correlated with clinical phenotypes. Our study suggests that specific plasma lipid profiles are not merely associated with the diagnosis of MS but instead point toward distinct clinical features in the individual patient paving the way for personalized therapy and an enhanced understanding of MS pathology.
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Affiliation(s)
| | - Lisa-Marie Borsch
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany
| | | | | | - Liza Vinhoven
- Department of Medical Bioinformatics, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Manuel Nietert
- Department of Medical Bioinformatics, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Dirk Fitzner
- Department of Neurology, University Medical Center Göttingen, 37075 Göttingen, Germany
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Solís-Tarazona L, Raket LL, Cabello-Murgui J, Reddam S, Navarro-Quevedo S, Gil-Perotin S. Predictive value of individual serum neurofilament light chain levels in short-term disease activity in relapsing multiple sclerosis. Front Neurol 2024; 15:1354431. [PMID: 38426169 PMCID: PMC10903281 DOI: 10.3389/fneur.2024.1354431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
Background The assessment of serum neurofilament light chain (sNFL) has emerged as a diagnostic and prognostic tool in monitoring multiple sclerosis (MS). However, the application of periodic measurement in daily practice remains unclear. Objective To evaluate the predictive value of individual sNFL levels in determining disease activity in patients with relapsing MS (RMS). Methods In this two-year prospective study, 129 RMS patients underwent quarterly sNFL assessments and annual MRI scans. The study analyzed the correlation between individual NFL levels and past, current, and future disease activity. Group-level Z-scores were employed as a comparative measure. Results Among the 37 participants, a total of 61 episodes of disease activity were observed. sNFL levels proved valuable in distinct ways; they were confirmatory of previous and current clinical and/or radiological activity and demonstrated a high negative predictive value for future 90 days activity. Interestingly, Z-scores marginally outperformed sNFL levels in terms of predictive accuracy, indicating the potential for alternative approaches in disease activity assessment. In our cohort, sNFL cut-offs of 10.8 pg./mL (sensitivity 27%, specificity 90%) and 14.3 pg./mL (sensitivity 15%, specificity 95%) correctly identified 7 and 4 out of 26 cases of radiological activity within 90 days, respectively, with 14 and 15% false negatives. When using lower cut-off values, individuals with sNFL levels below 5 pg/mL (with a sensitivity of 92%, specificity of 25%, and negative predictive value of 94%) were less likely to experience radiological activity within the next 3 months. Conclusion Individual sNFL levels may potentially confirm prior or current disease activity and predict short-term future radiological activity in RMS. These findings underscore its periodic measurement as a valuable tool in RMS management and decision-making, enhancing the precision of clinical evaluation in routine practice.
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Affiliation(s)
- Luis Solís-Tarazona
- Research Group in Immunotherapy and Biomodels for Autoimmunity, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Lars Lau Raket
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Javier Cabello-Murgui
- Research Group in Immunotherapy and Biomodels for Autoimmunity, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Salma Reddam
- Research Group in Immunotherapy and Biomodels for Autoimmunity, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | | | - Sara Gil-Perotin
- Research Group in Immunotherapy and Biomodels for Autoimmunity, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Multiple Sclerosis Unit, Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Consorcio Centro de Investigación Biomédica en Red (CIBER), CB06/05/1131, Instituto de Salud Carlos III, Madrid, Spain
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Galbusera R, Bahn E, Weigel M, Cagol A, Lu PJ, Schaedelin SA, Franz J, Barakovic M, Rahmanzadeh R, Dechent P, Nair G, Brück W, Kuhle J, Kappos L, Stadelmann C, Granziera C. Characteristics, Prevalence, and Clinical Relevance of Juxtacortical Paramagnetic Rims in Patients With Multiple Sclerosis. Neurology 2024; 102:e207966. [PMID: 38165297 PMCID: PMC11097762 DOI: 10.1212/wnl.0000000000207966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES A subgroup of patients with multiple sclerosis (MS) presents focal paramagnetic rims at the border between cortex and white matter (juxtacortical paramagnetic rims [JPRs]). We investigated the presence of this finding in our in vivo MS cohort and explored its potential clinical relevance. Moreover, we exploited postmortem MRI of fixed whole MS brains to (1) detect those rims and (2) investigate their histologic correlation. METHODS Quantitative susceptibility mapping (QSM) and magnetization-prepared 2 rapid acquisition gradient-echo (MP2RAGE) images at 3T-MRI of 165 patients with MS from the in vivo cohort were screened for JPRs and the presence of cortical lesions. Five postmortem brains from patients with MS were imaged with 3T-MRI to obtain QSM and MP2RAGE sequences. Tissue blocks containing JPRs were excised and paraffin-embedded slices stained by immunohistochemistry for myelin basic protein (for myelin) and anti-CR3/43 (for major histocompatibility complex II-positive microglia/macrophages). DAB-Turnbull stain was performed to detect iron. RESULTS JPRs are present in approximately 10% of in vivo patients and are associated with increased cortical lesion load. One of the 5 postmortem brains showed JPRs. Histologically, JPRs correspond to an accumulation of activated iron-laden phagocytes and are associated with demyelination of the whole overlying cortical ribbon. DISCUSSION JPRs are a novel potential MRI biomarker of focal cortical demyelination, which seems related to global cortical pathology and might be useful for diagnostic and stratification purposes in a clinical setting.
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Affiliation(s)
- Riccardo Galbusera
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Erik Bahn
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Matthias Weigel
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Alessandro Cagol
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Po-Jui Lu
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Sabine A Schaedelin
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Jonas Franz
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Muhamed Barakovic
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Reza Rahmanzadeh
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Peter Dechent
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Govind Nair
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Wolfgang Brück
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Jens Kuhle
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Ludwig Kappos
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Christine Stadelmann
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
| | - Cristina Granziera
- From the Neurology Clinic and Policlinic (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Departments of Medicine, Clinical Research and Biomedical Engineering, Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, (R.G., M.W., A.C., P.-J.L., M.B., L.K., C.G.), Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB) Basel (R.G., M.W., A.C., P.-J.L., M.B., J.K., L.K., C.G.), Radiological Physics, Department of Radiology (M.W.), and Department of Clinical Research (S.A.S.), University Hospital Basel and University of Basel, Switzerland; Institute of Neuropathology (E.B., J.F., W.B., C.S.), University Medical Center Göttingen, Germany; Department of Cognitive Neurology (P.D.), MR-Research in Neurosciences, University Medical Center Göttingen, Germany; Institute of Diagnostic and Interventional Neuroradiology (R.R.), Bern University Hospital, University of Bern, Switzerland; and National Institute of Neurological Disorders and Stroke (G.N.), Bethesda, MD
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Zhu N, Zhu J, Lin S, Yu H, Cao C. Correlation analysis between smoke exposure and serum neurofilament light chain in adults: a cross-sectional study. BMC Public Health 2024; 24:353. [PMID: 38308244 PMCID: PMC10835908 DOI: 10.1186/s12889-024-17811-8] [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: 11/15/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Smoke exposure is a prevalent and well-documented risk factor for various diseases across different organ systems. Serum neurofilament light chain (sNfL) has emerged as a promising biomarker for a multitude of nervous system disorders. However, there is a notable paucity of research exploring the associations between smoke exposure and sNfL levels. METHODS We conducted a comprehensive analysis of the National Health and Nutrition Examination Survey (NHANES) cross-sectional data spanning the years 2013 to 2014. Serum cotinine levels were classified into the following three groups: < 0.05, 0.05-2.99, and ≥ 3 ng/ml. Multiple linear regression models were employed to assess the relationships between serum cotinine levels and sNfL levels. Additionally, we utilized restricted cubic spline analyses to elucidate the potential nonlinear relationship between serum cotinine and sNfL levels. RESULTS A total of 2053 participants were included in our present research. Among these individuals, the mean age was 47.04 ± 15.32 years, and males accounted for 48.2% of the total study population. After adjusting the full model, serum cotinine was positively correlated with sNfl in the second group (β = 0.08, 95%CI 0.01-0.15) and in the highest concentration of serum cotinine (β = 0.10, 95%CI 0.01-0.19) compared to the group with the lowest serum cotinine concentrations. Current smokers, in comparison to non-smokers, exhibited a trend toward elevated sNfL levels (β = 0.07, 95%CI 0.01-0.13). Furthermore, subgroup analyses revealed interactions between serum cotinine levels and different age groups (P for interaction = 0.001) and gender stratification (P for interaction = 0.015) on sNfL levels. CONCLUSION The study suggested that serum cotinine was significantly and positively associated with sNfl levels in adult participants. Furthermore, current smokers tend to exhibit elevated sNfL levels. This research sheds light on the potential implications of smoke exposure on neurological function impairment and underscores the importance of further exploration in this area.
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Affiliation(s)
- Ning Zhu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, 315010, Ningbo, Zhejiang, China
| | - Jing Zhu
- Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - Shanhong Lin
- Department of Ultrasound, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Hang Yu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, 315010, Ningbo, Zhejiang, China
| | - Chao Cao
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, 315010, Ningbo, Zhejiang, China.
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48
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Abdelhak A, Antweiler K, Kowarik MC, Senel M, Havla J, Zettl UK, Kleiter I, Skripuletz T, Haarmann A, Stahmann A, Huss A, Gingele S, Krumbholz M, Benkert P, Kuhle J, Friede T, Ludolph AC, Ziemann U, Kümpfel T, Tumani H. Serum glial fibrillary acidic protein and disability progression in progressive multiple sclerosis. Ann Clin Transl Neurol 2024; 11:477-485. [PMID: 38111972 PMCID: PMC10863922 DOI: 10.1002/acn3.51969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/29/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE Progression prediction is a significant unmet need in people with progressive multiple sclerosis (pwPMS). Studies on glial fibrillary acidic protein (GFAP) have either been limited to single center with relapsing MS or were based solely on Expanded Disability Status Scale (EDSS), which limits its generalizability to state-of-the-art clinical settings and trials applying combined outcome parameters. METHODS Serum GFAP and NfL (neurofilament light chain) were investigated in EmBioProMS participants with primary (PP) or secondary progressive MS. Six months confirmed disability progression (CDP) was defined using combined outcome parameters (EDSS, timed-25-foot walk test (T25FW), and nine-hole-peg-test (9HPT)). RESULTS 243 subjects (135 PPMS, 108 SPMS, age 55.5, IQR [49.7-61.2], 135 female, median follow-up: 29.3 months [17.9-40.9]) were included. NfL (age-) and GFAP (age- and sex-) adjusted Z scores were higher in pwPMS compared to HC (p < 0.001 for both). 111 (32.8%) CDP events were diagnosed in participants with ≥3 visits (n = 169). GFAP Z score >3 was associated with higher risk for CDP in participants with low NfL Z score (i.e., ≤1.0) (HR: 2.38 [1.12-5.08], p = 0.025). In PPMS, GFAP Z score >3 was associated with higher risk for CDP (HR: 2.88 [1.21-6.84], p = 0.016). Risk was further increased in PPMS subjects with high GFAP when NfL is low (HR: 4.31 [1.53-12.13], p = 0.006). INTERPRETATION Blood GFAP may help identify pwPPMS at risk of progression. Combination of high GFAP and low NfL levels could distinguish non-active pwPMS with particularly high progression risk.
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Affiliation(s)
- Ahmed Abdelhak
- Department of NeurologyUniversity of California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Department of NeurologyUniversity Hospital of UlmUlmGermany
| | - Kai Antweiler
- Department of Medical StatisticsUniversity Medical Centre GöttingenGöttingenGermany
| | - Markus C. Kowarik
- Department of Neurology and StrokeUniversity Hospital of TübingenTübingenGermany
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Makbule Senel
- Department of NeurologyUniversity Hospital of UlmUlmGermany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU HospitalLudwig‐Maximilians UniversityMunichGermany
| | - Uwe K. Zettl
- Department of Neurology, Neuroimmunological SectionUniversity of RostockRostockGermany
| | - Ingo Kleiter
- Marianne‐Strauß‐KlinikBehandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbHBergGermany
| | | | - Axel Haarmann
- Department of NeurologyUniversity Hospital WürzburgWürzburgGermany
| | - Alexander Stahmann
- Forschungs‐ und Projektentwicklungs‐gGmbHMS‐Registry by the German MS‐SocietyHanoverGermany
| | - Andre Huss
- Department of NeurologyUniversity Hospital of UlmUlmGermany
| | - Stefan Gingele
- Department of NeurologyHannover Medical SchoolHanoverGermany
| | - Markus Krumbholz
- Department of Neurology and StrokeUniversity Hospital of TübingenTübingenGermany
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
- Department of Neurology and Pain Treatment, Multiple Sclerosis Center, Center for Translational Medicine, Immanuel Klinik RüdersdorfUniversity Hospital of the Brandenburg Medical School Theodor FontaneRüdersdorf bei BerlinGermany
- Faculty of Health Sciences BrandenburgBrandenburg Medical School Theodor FontaneRüdersdorf bei BerlinGermany
| | - Pascal Benkert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Department of BiomedicineUniversity Hospital and University of BaselBaselSwitzerland
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Department of Clinical ResearchUniversity Hospital and University of BaselBaselSwitzerland
- Department of NeurologyUniversity Hospital and University of BaselBaselSwitzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Department of BiomedicineUniversity Hospital and University of BaselBaselSwitzerland
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Department of Clinical ResearchUniversity Hospital and University of BaselBaselSwitzerland
- Department of NeurologyUniversity Hospital and University of BaselBaselSwitzerland
| | - Tim Friede
- Department of Medical StatisticsUniversity Medical Centre GöttingenGöttingenGermany
| | - Albert C. Ludolph
- Department of NeurologyUniversity Hospital of UlmUlmGermany
- German Center for Neurodegenerative DiseasesUlmGermany
| | - Ulf Ziemann
- Department of Neurology and StrokeUniversity Hospital of TübingenTübingenGermany
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU HospitalLudwig‐Maximilians UniversityMunichGermany
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49
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Hermesdorf M, Wulms N, Maceski A, Leppert D, Benkert P, Wiendl H, Kuhle J, Berger K. Serum neurofilament light and white matter characteristics in the general population: a longitudinal analysis. GeroScience 2024; 46:463-472. [PMID: 37285009 PMCID: PMC10828306 DOI: 10.1007/s11357-023-00846-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/24/2023] [Indexed: 06/08/2023] Open
Abstract
Neurofilament light polypeptide (NfL) is a component of the neuronal cytoskeleton and particularly abundant in large-caliber axons. When axonal injury occurs, NfL is released and reaches the cerebrospinal fluid and the blood. Associations between NfL and white matter alterations have previously been observed in studies based on patients with neurological diseases. The current study aimed to explore the relationship between serum NfL (sNfL) and white matter characteristics in a population-based sample. The cross-sectional associations between sNfL as dependent variable, fractional anisotropy (FA), and white matter lesion (WML) volume were analyzed with linear regression models in 307 community-dwelling adults aged between 35 and 65 years. These analyses were repeated with additional adjustment for the potential confounders age, sex, and body mass index (BMI). Longitudinal associations over a mean follow-up of 5.39 years were analyzed with linear mixed models. The unadjusted cross-sectional models yielded significant associations between sNfL, WML volume, and FA, respectively. However, after the adjustment for confounders, these associations did not reach significance. In the longitudinal analyses, the findings corroborated the baseline findings showing no significant associations between sNfL and white matter macrostructure and microstructure beyond the effects of age. In synopsis with previous studies in patients with acute neurological diseases showing a significant association of sNfL with white matter changes beyond the effects of age, the present results based on a sample from the general population suggest the perspective that changes in sNfL reflect age-related effects that also manifest in altered white matter macrostructure and microstructure.
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Affiliation(s)
- Marco Hermesdorf
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
| | - Niklas Wulms
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Aleksandra Maceski
- Multiple Sclerosis Centre, Neurology, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Leppert
- Multiple Sclerosis Centre, Neurology, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Heinz Wiendl
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Jens Kuhle
- Multiple Sclerosis Centre, Neurology, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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50
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Kang MJY, Eratne D, Dobson H, Malpas CB, Keem M, Lewis C, Grewal J, Tsoukra V, Dang C, Mocellin R, Kalincik T, Santillo AF, Zetterberg H, Blennow K, Stehmann C, Varghese S, Li QX, Masters CL, Collins S, Berkovic SF, Evans A, Kelso W, Farrand S, Loi SM, Walterfang M, Velakoulis D. Cerebrospinal fluid neurofilament light predicts longitudinal diagnostic change in patients with psychiatric and neurodegenerative disorders. Acta Neuropsychiatr 2024; 36:17-28. [PMID: 37114460 DOI: 10.1017/neu.2023.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE People with neuropsychiatric symptoms often experience delay in accurate diagnosis. Although cerebrospinal fluid neurofilament light (CSF NfL) shows promise in distinguishing neurodegenerative disorders (ND) from psychiatric disorders (PSY), its accuracy in a diagnostically challenging cohort longitudinally is unknown. METHODS We collected longitudinal diagnostic information (mean = 36 months) from patients assessed at a neuropsychiatry service, categorising diagnoses as ND/mild cognitive impairment/other neurological disorders (ND/MCI/other) and PSY. We pre-specified NfL > 582 pg/mL as indicative of ND/MCI/other. RESULTS Diagnostic category changed from initial to final diagnosis for 23% (49/212) of patients. NfL predicted the final diagnostic category for 92% (22/24) of these and predicted final diagnostic category overall (ND/MCI/other vs. PSY) in 88% (187/212), compared to 77% (163/212) with clinical assessment alone. CONCLUSIONS CSF NfL improved diagnostic accuracy, with potential to have led to earlier, accurate diagnosis in a real-world setting using a pre-specified cut-off, adding weight to translation of NfL into clinical practice.
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Affiliation(s)
- Matthew J Y Kang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Hannah Dobson
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Charles B Malpas
- Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Michael Keem
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Courtney Lewis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Jasleen Grewal
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Vivian Tsoukra
- Department of Neurology, Evangelismos Hospital, Athens, Greece
| | - Christa Dang
- National Ageing Research Institute, University of Melbourne, Parkville, VIC, Australia
| | | | - Tomas Kalincik
- Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Alexander F Santillo
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmo, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Christiane Stehmann
- The Australian National CJD Registry, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Shiji Varghese
- National Dementia Diagnostic Laboratory, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Qiao-Xin Li
- National Dementia Diagnostic Laboratory, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Colin L Masters
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Steven Collins
- Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- National Dementia Diagnostic Laboratory, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Samuel F Berkovic
- Department of Medicine, Austin Health, Epilepsy Research Centre, The University of Melbourne, Heidelberg, VIC, Australia
| | - Andrew Evans
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
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