Abstract
Multiple sclerosis (MS) is an autoimmune, inflammatory neurodegenerative disease of the central nervous system characterized by demyelination and axonal damage. Diagnosis and prognosis are mainly assessed through clinical examination and neuroimaging. However, more sensitive biomarkers are needed to measure disease activity and guide treatment decisions in MS. Prompt and individualized management can reduce inflammatory activity and delay disease progression. Neurofilament Light chain (NfL), a neuron-specific cytoskeletal protein that is released into the extracellular fluid following axonal injury, has been identified as a biomarker of disease activity in MS. Measurement of NfL levels can capture the extent of neuroaxonal damage, especially in early stages of the disease. A growing body of evidence has shown that NfL in cerebrospinal fluid (CSF) and serum can be used as reliable indicators of prognosis and treatment response. More recently, NfL has been shown to facilitate individualized treatment decisions for individuals with MS. In this review, we discuss the characteristics that make NfL a highly informative biomarker and depict the available technologies used for its measurement. We further discuss the growing role of serum and CSF NfL in MS research and clinical settings. Finally, we address some of the current topics of debate regarding the use of NfL in clinical practice and examine the possible directions that this biomarker may take in the future.
Highlights
The clinical use of biomarkers in the diagnostic work-up of neurodegenerative diseases has significantly increased in the last decades (Beart et al, 2017)
They found that Neurofilament Light chain (NfL) levels were closely associated with clinical and radiological activity, and in a significant proportion of individuals with progressive MS (PMS), elevated NfL was the only evidence of disease activity used in the treatment decision-making process
A recent study examining the clinical utility of combined CSF NfL (cNfL) and CXCL13 measurements concluded that these biomarkers continue to be evaluated in individuals with no clinical or radiological activity, which could complement the assessment of disease activity in people with MS (pwMS) (Novakova et al, 2020)
Summary
Multiple sclerosis (MS) is an autoimmune, inflammatory neurodegenerative disease of the central nervous system characterized by demyelination and axonal damage. More sensitive biomarkers are needed to measure disease activity and guide treatment decisions in MS. Neurofilament Light chain (NfL), a neuron-specific cytoskeletal protein that is released into the extracellular fluid following axonal injury, has been identified as a biomarker of disease activity in MS. A growing body of evidence has shown that NfL in cerebrospinal fluid (CSF) and serum can be used as reliable indicators of prognosis and treatment response. We further discuss the growing role of serum and CSF NfL in MS research and clinical settings. We address some of the current topics of debate regarding the use of NfL in clinical practice and examine the possible directions that this biomarker may take in the future
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