Abstract
Measurement of serum neurofilament light chain concentration (sNfL) promises to become a convenient, cost effective and meaningful adjunct for multiple sclerosis (MS) prognostication as well as monitoring disease activity in response to treatment. Despite the remarkable progress and an ever-increasing literature supporting the potential role of sNfL in MS over the last 5 years, a number of hurdles remain before this test can be integrated into routine clinical practice. In this review we highlight these hurdles, broadly classified by concerns relating to clinical validity and analytical validity. After setting out an aspirational roadmap as to how many of these issues can be overcome, we conclude by sharing our vision of the current and future role of sNfL assays in MS clinical practice.
Highlights
The spectrum of multiple sclerosis (MS) disease severity is broad, encompassing mild or even benign forms of the disease that may not require treatment at all (Sartori et al, 2017) to rapid progressors who accumulate irreversible worsening early-on unless drastic interventions are made (Atkins et al, 2016)
As early adopters of serum neurofilament light chain concentration (sNfL) testing in MS, in this review, we summarize what we see are key unknowns before the test could and should be deployed in routine clinical practice
The diurnal timing of blood collection may be an important consideration; in a study of 15 healthy males, one group found a more than 10% increase in plasma concentrations of Neurofilament light chain (NfL) in the morning compared to the evening, were surprised to find that elevation was not seen following acute sleep deprivation (Benedict et al, 2020)
Summary
The spectrum of multiple sclerosis (MS) disease severity is broad, encompassing mild or even benign forms of the disease that may not require treatment at all (Sartori et al, 2017) to rapid progressors who accumulate irreversible worsening early-on unless drastic interventions are made (Atkins et al, 2016). Higher sNfL has been associated with short and long term poorer outcomes, including relapses, EDSS score progression including progression independent of relapse-activity, clinical conversion to a progressive phenotype, poorer cognitive measures as well as both MRI lesion activity and atrophy (Disanto et al, 2017; Barro et al, 2018; Chitnis et al, 2018; Siller et al, 2018; Cantó et al, 2019; Lorscheider and Benkert, 2020; Thebault et al, 2020a) Some experts consider this test to be on the cusp of widespread clinical adoption (Leppert and Kuhle, 2019), while others remain skeptical (Javed and Stankiewicz, 2020). As early adopters of sNfL testing in MS, in this review, we summarize what we see are key unknowns before the test could and should be deployed in routine clinical practice
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
