See article --basically a new blood test that can determine disease activity and monitor DMT response that may replace spinal taps
SUMMARY AND COMMENT
Multiple Sclerosis Serum Biomarker Predictive of Disability and Disease Activity
Robert T. Naismith, MD Reviewing Disanto G et al., Ann Neurol 2017 Jun 81:857
Serum neurofilament light chain level is a clinically significant marker of axonal destruction.
July 7, 2017
Multiple Sclerosis Serum Biomarker Predictive of Disability and Disease Activity
Robert T. Naismith, MD Reviewing Disanto G et al., Ann Neurol 2017 Jun 81:857
Serum neurofilament light chain level is a clinically significant marker of axonal destruction.
Investigators used a highly sensitive single-molecule array assay suitable for use in blood rather than cerebrospinal fluid (CSF). Previously, CSF-based assays were required because serum neurofilament light chain (sNfL) concentration is 42-fold lower than in CSF. This study included a longitudinal cohort of 246 multiple sclerosis (MS) patients, a cross-sectional cohort of 142 MS patients who also had CSF available for comparison, and 254 healthy controls.
Serum NfL levels correlated well with CSF NfL (r=0.8, P<0.001) and increased with increasing numbers of T2 and enhancing lesions in brain and spinal cord. Serum NfL level also was independently associated with Expanded Disability Status Scale score and recent relapse and inversely with time on disease modifying therapy. Those with high sNfL had increased annualized relapse rate in the next 1 to 2 years and increased odds of worsening EDSS in the next 12 months. Serum NfL levels were higher for patients starting natalizumab and rituximab compared with those starting interferon, glatiramer acetate, and fingolimod. The levels decreased over time with all of these treatments. Serum NfL remained high in MS patients with progressive disease
NfL appears to be a viable serum biomarker of current and future disease activity and may be an indicator of treatment response. Obtaining serial CSF studies for NfL determination is difficult; the availability of this sensitive blood assay is a big breakthrough. Since NfL indicates neuronal or axonal injury, an important question is whether this marker can be a sensitive and early biomarker of neuroprotection for progressive MS. We can anticipate more information as clinical trials incorporate this assay into their outcome assays
National Multiple Sclerosis Society; National Institutes of Health
Citation(s):
Disanto G et al. Serum neurofilament light: A biomarker of neuronal damage in multiple sclerosis. Ann Neurol 2017 Jun; 81:857. (dx.doi.org/10.1002/ana.24954)
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