Abstract
Multiple sclerosis (MS) is an autoimmune, inflammatory, and degenerative disease of the central nervous system. Axonal degeneration is triggered by inflammation and is the pathological substrate of progressive disability in patients with MS. Therapeutic interventions can reduce inflammatory activity, thus delaying neurodegeneration and the progression of disability. Disease activity and neurodegeneration are assessed mainly through clinical evaluation and magnetic resonance imaging. These measures lack sensitivity and accuracy, so new biomarkers are necessary. Several markers have been studied and to date the most promising is neurofilament light (NfL), a component of the axonal cytoskeleton, which is released into cerebrospinal fluid (CSF) following axonal damage. In the present study, we review the current knowledge about CSF NfL determination in MS, clinically isolated syndrome, and radiologically isolated syndrome, and critically discuss how CSF NfL measurement may contribute to therapeutic decision-making in these patients.
Highlights
Multiple sclerosis (MS) is an autoimmune, inflammatory, and degenerative disease of the central nervous system
Significant reduction in cerebrospinal fluid (CSF) neurofilament light (NfL) levels was reported in 43 MS patients receiving fingolimod for 4-12 months, and those previously treated with first-line drugs[34,35]
One study showed that clinically isolated syndrome (CIS) patients with NfL levels above 900 ng/L had a higher risk of developing MS over a two-year follow-up period[37]
Summary
The ability of CSF NfL to predict an MS diagnosis has been studied. A recent meta-analysis identified 10 studies comparing CSF NfL between MS patients and controls[14]. There was a great variability in the NfL levels of MS patients between different studies[15] This suggests that there was a great methodological variation in the measurement of this biomarker between the different studies. It suggests there was a great variability in the MS populations included in these studies. Four studies demonstrated higher serum NfL levels in MS patients when compared with controls[15]. Future comparative studies are still necessary to establish if serum or CSF NfL can discriminate between MS and other potentially confounding diseases but, at this point, NfL can not be considered a good candidate for an MS diagnosis biomarker
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