1
|
Mousele C, Holden D, Gnanapavan S. Neurofilaments in neurologic disease. Adv Clin Chem 2024; 123:65-128. [PMID: 39181624 DOI: 10.1016/bs.acc.2024.06.010] [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: 08/27/2024]
Abstract
Neurofilaments (NFs), major cytoskeletal constituents of neurons, have emerged as universal biomarkers of neuronal injury. Neuroaxonal damage underlies permanent disability in various neurological conditions. It is crucial to accurately quantify and longitudinally monitor this damage to evaluate disease progression, evaluate treatment effectiveness, contribute to novel treatment development, and offer prognostic insights. Neurofilaments show promise for this purpose, as their levels increase with neuroaxonal damage in both cerebrospinal fluid and blood, independent of specific causal pathways. New assays with high sensitivity allow reliable measurement of neurofilaments in body fluids and open avenues to investigate their role in neurological disorders. This book chapter will delve into the evolving landscape of neurofilaments, starting with their structure and cellular functions within neurons. It will then provide a comprehensive overview of their broad clinical value as biomarkers in diseases affecting the central or peripheral nervous system.
Collapse
|
2
|
Jacobsen AB, Bostock H, Howells J, Cengiz B, Samusyte G, Koltzenburg M, Pia H, Fuglsang‐Frederiksen A, Blicher J, Obál I, Andersen H, Tankisi H. Threshold tracking transcranial magnetic stimulation and neurofilament light chain as diagnostic aids in ALS. Ann Clin Transl Neurol 2024; 11:1887-1896. [PMID: 38894662 PMCID: PMC11251469 DOI: 10.1002/acn3.52095] [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: 03/25/2024] [Revised: 04/21/2024] [Accepted: 05/04/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE There is a need for sensitive biomarkers in amyotrophic lateral sclerosis (ALS), to enable earlier diagnosis and to help assess potential treatments. The main objective of this study was to compare two potential biomarkers, threshold-tracking short-interval cortical inhibition (T-SICI), which has shown promise as a diagnostic aid, and neurofilament light chains (NfL). METHODS Ninety-seven patients with ALS (mean age 67.1 ± 11.5 years) and 53 ALS mimics (aged 62.4 ± 12.9) were included. Mean disease duration was 14 months ±14.1. Patients were evaluated with revised ALS functional rating score (ALSFRS-R), Penn upper motor neuron score (UMNS), muscle strength using the Medical Research Council (MRC) score and examined with T-SICI, quantitative electromyography (EMG), and NfL measured in spinal fluid. RESULTS NfL increased with increasing UMNS (rho = 0.45, p = 8.2 × 10-6) whereas T-SICI at 2.5 ms paradoxically increased toward normal values (rho = 0.53, p = 1.9 × 10-7). However, these two measures were uncorrelated. Discrimination between ALS patients and mimics was best for NfL (area under ROC curve 0.842, sensitivity 84.9%, specificity 83.5%), compared with T-SICI (0.675, 39.6%, 91.8%). For the patients with no UMN signs, NfL also discriminated best (0.884, 89.3%, 82.6%), compared with T-SICI (0.811, 71.4%, 82.6%). However, when combining NfL and T-SICI, higher AUCs of 0.854 and 0.922 and specificities of 93.8 and 100 were found when considering all patients and patients with no UMN signs, respectively. INTERPRETATION Both T-SICI and NfL correlated with UMN involvement and combined, they provided a strong discrimination between ALS patients and ALS mimics.
Collapse
Affiliation(s)
- Anna B. Jacobsen
- Department of Clinical NeurophysiologyAarhus University HospitalAarhus N8200Denmark
| | - Hugh Bostock
- UCL Queen SquareInstitute of NeurologyQueen SquareLondonWC1N 3BGUK
| | - James Howells
- Central Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNSW2006Australia
| | - Bülent Cengiz
- Department of NeurologyGazi University Faculty of MedicineBeşevler06570AnkaraTurkey
| | - Gintaute Samusyte
- Department of Neurology, Medical AcademyLithuanian University of Health SciencesKaunas44307Lithuania
- Department of NeurologyLithuanian University of Health Sciences Hospital Kauno KlinikosKaunas50161Lithuania
| | - Martin Koltzenburg
- UCL Queen SquareInstitute of NeurologyQueen SquareLondonWC1N 3BGUK
- Department of Clinical NeurophysiologyNational Hospital for Neurology and NeurosurgeryQueen SquareLondonWC1N 3BGUK
| | - Hossein Pia
- Department of Clinical NeurophysiologyAarhus University HospitalAarhus N8200Denmark
| | | | - Jakob Blicher
- Department of NeurologyAalborg University HospitalAalborg9000Denmark
| | - Izabella Obál
- Department of NeurologyAalborg University HospitalAalborg9000Denmark
| | - Henning Andersen
- Department of NeurologyAarhus University HospitalAarhus N8200Denmark
| | - Hatice Tankisi
- Department of Clinical NeurophysiologyAarhus University HospitalAarhus N8200Denmark
| |
Collapse
|
3
|
Liang J, Ma T, Li Y, Sun R, Zhao S, Shen Y, Gao H, Jing Y, Bai X, He M, Wang Q, Xi H, Shi R, Yang Y. Association between sleep duration and serum neurofilament light chain levels among adults in the United States. Heliyon 2024; 10:e30699. [PMID: 38770343 PMCID: PMC11103434 DOI: 10.1016/j.heliyon.2024.e30699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
Background Neurofilaments are neuron specific skeleton proteins maintaining axon transduction speed, leaked into cerebrospinal fluid and serum after axonal injury or neuron death. Sleep duration change has long related to many health issues but lack laboratory examination. Methods This study enrolled total 10,175 participants from 2013 to 2014 National Health and Nutrition Examination Survey and used a multi-variable linear model to analyze the relationship between sleep duration and serum neurofilament light chain (sNfL) level. Results There was a fixed relationship between sleep duration and sNfL level (β = 0.65, p = 0.0280). After adjusted for covariates, this relationship still (β = 0.82, p = 0.0052). Segmented regression showed that the turning point of sleep duration was 7 h 1 h decrease in sleep duration was significantly associated with -1.26 higher sNfL level (95 % CI: 2.25, -0.28; p = 0.0115) when sleep duration <7 h; however, 1 h increase in sleep duration was significantly associated with 3.20 higher sNfL level (95 % CI: 2.13, 4.27; p < 0.0001) when sleep duration >7 h. Furthermore, the stratified analysis indicated that the associations between sleep duration and sNfL level were stronger among those normal body mass index and trouble sleeping (p-interaction <0.0001 and 0.0003). Conclusion In summary, there was a J-shaped relationship between sleep duration and sNfL level in the United States of America representative group, these may suggest that extreme sleep duration can be deleterious judged by sNfL level. And still need large cohort study to determine the accurate relationship, and cluster analysis to infer the nervous disease connected with extreme sleep duration.
Collapse
Affiliation(s)
- Jiaxing Liang
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
| | - Tengchi Ma
- Medical School of Yan'an University, Yan'an, China
- The First Affiliated Hospital of Xi’an Jiao tong University Yulin Hospital, Yulin, China
| | - Youlei Li
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
| | - Ruixin Sun
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
- Medical School of Xi'an International University, Xi'an, China
| | - Shuaishuai Zhao
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
| | - Yuzhe Shen
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
| | - Hui Gao
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
| | - Yunhang Jing
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
- Imagining Department, Yan'an University Affiliated Hospital, Yan'an, China
| | - Xinyue Bai
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
| | - Mengze He
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
| | - Qingyan Wang
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
| | - Huilin Xi
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
| | - Rui Shi
- Department of Geriatrics Cardiology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Yanling Yang
- Medical School of Yan'an University, Yan'an, China
- Yan'an Key Laboratory of Neuroscience, Yan'an, China
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Tilsley P, Moutiez A, Brodovitch A, Mendili MME, Testud B, Zaaraoui W, Verschueren A, Attarian S, Guye M, Boucraut J, Grapperon AM, Stellmann JP. Neurofilament Light Chain Levels Interact with Neurodegenerative Patterns and Motor Neuron Dysfunction in Amyotrophic Lateral Sclerosis. AJNR Am J Neuroradiol 2024; 45:494-503. [PMID: 38548305 PMCID: PMC11288555 DOI: 10.3174/ajnr.a8154] [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: 03/27/2023] [Accepted: 11/08/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving rapid motor neuron degeneration leading to brain, primarily precentral, atrophy. Neurofilament light chains are a robust prognostic biomarker highly specific to ALS, yet associations between neurofilament light chains and MR imaging outcomes are not well-understood. We investigated the role of neurofilament light chains as mediators among neuroradiologic assessments, precentral neurodegeneration, and disability in ALS. MATERIALS AND METHODS We retrospectively analyzed a prospective cohort of 29 patients with ALS (mean age, 56 [SD, 12] years; 18 men) and 36 controls (mean age, 49 [SD, 11] years; 18 men). Patients underwent 3T (n = 19) or 7T (n = 10) MR imaging, serum (n = 23) and CSF (n = 15) neurofilament light chains, and clinical (n = 29) and electrophysiologic (n = 27) assessments. The control group had equivalent 3T (n = 25) or 7T (n = 11) MR imaging. Two trained neuroradiologists performed blinded qualitative assessments of MR imaging anomalies (n = 29 patients, n = 36 controls). Associations between precentral cortical thickness and neurofilament light chains and clinical and electrophysiologic data were analyzed. RESULTS We observed extensive cortical thinning in patients compared with controls. MR imaging analyses showed significant associations between precentral cortical thickness and bulbar or arm impairment following distributions corresponding to the motor homunculus. Finally, uncorrected results showed positive interactions among precentral cortical thickness, serum neurofilament light chains, and electrophysiologic outcomes. Qualitative MR imaging anomalies including global atrophy (P = .003) and FLAIR corticospinal tract hypersignal anomalies (P = .033), correlated positively with serum neurofilament light chains. CONCLUSIONS Serum neurofilament light chains may be an important mediator between clinical symptoms and neuronal loss according to cortical thickness. Furthermore, MR imaging anomalies might have underestimated prognostic value because they seem to indicate higher serum neurofilament light chain levels.
Collapse
Affiliation(s)
- Penelope Tilsley
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
| | - Antoine Moutiez
- Department of Neuroradiology (A.M., B.T., J.-P.S.), Assistance Publique-Marseille Hospitals, Hôpital de la Timone, Marseille, France
| | - Alexandre Brodovitch
- Immunology Laboratory (A.B., J.B.), Assistance Publique-Marseille Hospitals, Conception Hospital, Marseille, France
| | - Mohamed Mounir El Mendili
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
| | - Benoit Testud
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
- Department of Neuroradiology (A.M., B.T., J.-P.S.), Assistance Publique-Marseille Hospitals, Hôpital de la Timone, Marseille, France
| | - Wafaa Zaaraoui
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
| | - Annie Verschueren
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Referral Centre for Neuromuscular Diseases and ALS (A.V., S.A., A.-M.G.), Assistance Publique-Marseille Hospitals, Hôpital de la Timone, Marseille, France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS (A.V., S.A., A.-M.G.), Assistance Publique-Marseille Hospitals, Hôpital de la Timone, Marseille, France
- Institut National de la Santé et de la Recherche Médicale (S.A.,), Marseille Medical Genetics Center, Aix-Marseille University, Marseille, France
| | - Maxime Guye
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
| | - José Boucraut
- Immunology Laboratory (A.B., J.B.), Assistance Publique-Marseille Hospitals, Conception Hospital, Marseille, France
- Institut National de la Santé et de la Recherche Médicale (J.B.) Institut de Neurosciences des Systèmes Aix-Marseille University, Marseille, France
| | - Aude-Marie Grapperon
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Jan-Patrick Stellmann
- From the Centre de Résonance Magnétique Biologique et Médicale (P.T., M.M.E.M., B.T., W.Z., A.V., M.G., A.-M.G., J.-P.S.), Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
- Assistance Publique-Marseille Hospitals (P.T., M.M.E.M., B.T., W.Z., M.G., J.-P.S.), Hôpital de la Timone, CEMEREM, Marseille, France
- Department of Neuroradiology (A.M., B.T., J.-P.S.), Assistance Publique-Marseille Hospitals, Hôpital de la Timone, Marseille, France
| |
Collapse
|
6
|
Walia N, Eratne D, Loi SM, Farrand S, Li QX, Malpas CB, Varghese S, Walterfang M, Evans AH, Parker S, Collins SJ, Masters CL, Velakoulis D. Cerebrospinal fluid neurofilament light and cerebral atrophy in younger-onset dementia and primary psychiatric disorders. Intern Med J 2023; 53:1564-1569. [PMID: 36314730 DOI: 10.1111/imj.15956] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/03/2022] [Indexed: 09/26/2023]
Abstract
BACKGROUND AND AIMS Neurodegeneration underpins the pathological processes of younger-onset dementia (YOD) and has been implicated in primary psychiatric disorders (PSYs). Cerebrospinal fluid (CSF) neurofilament light (NfL) has been used to investigate neurodegeneration severity through correlation with structural brain changes in various conditions, but has seldom been evaluated in YOD and PSYs. METHODS This retrospective study included patients with YOD or PSYs with magnetic resonance imaging (MRI) of the brain and CSF NfL analysis. Findings from brain MRI were analysed using automated volumetry (volBrain) to measure white matter (WM), grey matter (GM) and whole brain (WB) volumes expressed as percentages of total intracranial volume. Correlations between NfL and brain volume measurements were computed whilst adjusting for age. RESULTS Seventy patients (47 with YOD and 23 with PSY) were identified. YOD types included Alzheimer disease and behavioural variant frontotemporal dementia. PSY included schizophrenia and major depressive disorder. MRI brain sequences were either fast spoiler gradient-echo (FSPGR) or magnetization-prepared rapid acquisition gradient-echo (MPRAGE). In the total cohort, higher NfL was associated with reduced WB in the FSPGR and MPRAGE sequences (r = -0.402 [95% confidence interval (CI), -0.593 to -0.147], P = 0.008 and r = -0.625 [95% CI, -0.828 to -0.395], P < 0.001, respectively). Higher NfL was related to reduced GM in FSPGR (r = 0.385 [95% CI, -0.649 to -0.014], P = 0.017) and reduced WM in MPRAGE (r = -0.650 [95% CI, -0.777 to -0.307], P < 0.001). Similar relationships were seen in YOD, but not in PSY. CONCLUSION Higher CSF NfL is related to brain atrophy in YOD, further supporting its use as a nonspecific marker of neurodegeneration severity.
Collapse
Affiliation(s)
- Nirbaanjot Walia
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha M Loi
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Farrand
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Qiao-Xin Li
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Charles B Malpas
- Clinical Outcomes Research Unit (CORe), Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Shiji Varghese
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Walterfang
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew H Evans
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Shaun Parker
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Steven J Collins
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Colin L Masters
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Negi D, Granak S, Shorter S, O'Leary VB, Rektor I, Ovsepian SV. Molecular Biomarkers of Neuronal Injury in Epilepsy Shared with Neurodegenerative Diseases. Neurotherapeutics 2023; 20:767-778. [PMID: 36884195 PMCID: PMC10275849 DOI: 10.1007/s13311-023-01355-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 03/09/2023] Open
Abstract
In neurodegenerative diseases, changes in neuronal proteins in the cerebrospinal fluid and blood are viewed as potential biomarkers of the primary pathology in the central nervous system (CNS). Recent reports suggest, however, that level of neuronal proteins in fluids also alters in several types of epilepsy in various age groups, including children. With increasing evidence supporting clinical and sub-clinical seizures in Alzheimer's disease, Lewy body dementia, Parkinson's disease, and in other less common neurodegenerative conditions, these findings call into question the specificity of neuronal protein response to neurodegenerative process and urge analysis of the effects of concomitant epilepsy and other comorbidities. In this article, we revisit the evidence for alterations in neuronal proteins in the blood and cerebrospinal fluid associated with epilepsy with and without neurodegenerative diseases. We discuss shared and distinctive characteristics of changes in neuronal markers, review their neurobiological mechanisms, and consider the emerging opportunities and challenges for their future research and diagnostic use.
Collapse
Affiliation(s)
- Deepika Negi
- Faculty of Engineering and Science, University of Greenwich London, Chatham Maritime, Kent, ME4 4TB, UK
| | - Simon Granak
- National Institute of Mental Health, Topolova 748, Klecany, 25067, Czech Republic
| | - Susan Shorter
- Faculty of Engineering and Science, University of Greenwich London, Chatham Maritime, Kent, ME4 4TB, UK
| | - Valerie B O'Leary
- Department of Medical Genetics, Third Faculty of Medicine, Charles University, Ruská 87, Prague, 10000, Czech Republic
| | - Ivan Rektor
- First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Multimodal and Functional Neuroimaging Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Saak V Ovsepian
- Faculty of Engineering and Science, University of Greenwich London, Chatham Maritime, Kent, ME4 4TB, UK.
| |
Collapse
|
8
|
Verde F, Milone I, Colombo E, Maranzano A, Solca F, Torre S, Doretti A, Gentile F, Manini A, Bonetti R, Peverelli S, Messina S, Maderna L, Morelli C, Poletti B, Ratti A, Silani V, Ticozzi N. Phenotypic correlates of serum neurofilament light chain levels in amyotrophic lateral sclerosis. Front Aging Neurosci 2023; 15:1132808. [PMID: 37009451 PMCID: PMC10050442 DOI: 10.3389/fnagi.2023.1132808] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectiveTo investigate the relationship between serum levels of the neuroaxonal degeneration biomarker neurofilament light chain (NFL) and phenotype in ALS.Materials and methodsSerum NFL (sNFL) concentration was quantified in 209 ALS patients and 46 neurologically healthy controls (NHCs).ResultssNFL was clearly increased in ALS patients and discriminated them from NHCs with AUC = 0.9694. Among ALS patients, females had higher sNFL levels, especially in case of bulbar onset. sNFL was more increased in phenotypes with both upper (UMN) and lower motor neuron (LMN) signs, and particularly in those with UMN predominance, compared to LMN forms. At the same time, primary lateral sclerosis (PLS) had significantly lower levels compared to UMN-predominant ALS (AUC = 0.7667). sNFL correlated negatively with disease duration at sampling and ALSFRS-R score, positively with disease progression rate, differed among King’s stages, and was negatively associated with survival. It also correlated with clinical/neurophysiological indices of UMN and LMN dysfunction (Penn UMN Score, LMN score, MRC composite score, active spinal denervation score). On the contrary, sNFL was not associated with cognitive deficits nor with respiratory parameters. Notably, we found a negative correlation between sNFL and estimated glomerular filtration rate (eGFR).InterpretationWe confirm that ALS is characterized by increased sNFL levels, whose main determinant is the rate of degeneration of both UMNs and LMNs. sNFL is a biomarker of only motor, not of extra-motor, disease. The negative correlation with kidney function might reflect varying renal clearance of the molecule and deserves further investigation before introducing sNFL measurement as routine test in clinical care of ALS patients.
Collapse
Affiliation(s)
- Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy
- *Correspondence: Federico Verde,
| | - Ilaria Milone
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Eleonora Colombo
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessio Maranzano
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alberto Doretti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Francesco Gentile
- Neurology Residency Program, Università degli Studi di Milano, Milan, Italy
| | - Arianna Manini
- Neurology Residency Program, Università degli Studi di Milano, Milan, Italy
| | - Ruggero Bonetti
- Neurology Residency Program, Università degli Studi di Milano, Milan, Italy
| | - Silvia Peverelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Messina
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Luca Maderna
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Claudia Morelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Antonia Ratti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
9
|
Diagnostic utility of neurofilament markers for MND is limited in restricted disease phenotype and for differentiation from compressive myeloradiculopathies. J Neurol 2023; 270:1600-1614. [PMID: 36456758 DOI: 10.1007/s00415-022-11504-1] [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: 09/12/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022]
Abstract
Misdiagnosis is frequent in early motor neuron disease (MND), typically compressive radiculopathy, or in patients with restricted MND phenotype. In this retrospective, single tertiary centre study, we measured levels of neurofilament light (NfL) and phosphorylated neurofilament heavy (p-NfH) chain in cerebrospinal fluid (CSF) and of p-NfH in serum with commercially available ELISA kits and assessed their respective diagnostic performance as a marker of MND. The entire study population (n = 164) comprised 71 MND patients, 30 patients with compressive myelo- or radiculopathy, and 63 disease controls (DC). Among MND patients, we specified subgroups with only lower motoneuron involvement (MND-LMN, n = 15) and with confounding nerve roots or spinal cord compression (MND-C, n = 18), representing clinical diagnostic pitfalls. MND-LMN displayed significantly lower CSF NfL (p = 0.003) and p-NFH (p = 0.017), but not serum p-NfH (p = 0.347) levels compared to other MND patients (n = 56). The discriminative ability (area under the curve-AUC) of both CSF Nfs towards all MND patients was comparable to each other but significantly higher than that of p-NfH in serum (ps < 0.001). AUC of both CSF Nfs between MND-LMN and DC and also between MND-C and myelo-/radiculopathies were reduced, as compared to AUC between other MND and DC or myelo-/radiculopathies, respectively. Our results suggest that both Nfs in CSF represent a reliable diagnostic marker in a general MND population, fulfilling Awaji criteria. As for diagnostic pitfalls, and also for p-NfH in serum, their discriminative ability and, therefore, clinical utility appears to be limited.
Collapse
|
10
|
Kawarabayashi T, Nakamura T, Miyashita K, Segawa T, Fukamachi I, Sugawara T, Oka H, Ishizawa K, Amari M, Kasahara H, Makioka K, Ikeda Y, Takatama M, Shoji M. Clinical Evaluation of Cerebrospinal Fluid p217tau and Neurofilament Light Chain Levels in Patients with Alzheimer's Disease or Other Neurological Diseases. J Alzheimers Dis 2023; 96:1623-1638. [PMID: 38007650 PMCID: PMC10741340 DOI: 10.3233/jad-230419] [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] [Accepted: 09/29/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The cerebrospinal fluid (CSF) levels of tau phosphorylated at threonine 217 (p217tau) or 181 (p181tau), and neurofilament light chain (NfL) are definite biomarkers of tauopathy and neurodegeneration in Alzheimer's disease (AD). OBJECTIVE To validate their utility in excluding other neurological diseases and age-related changes in clinical settings. METHODS We developed monoclonal antibodies against p217tau and NfL, established novel ELISAs, and analyzed 170 CSF samples from patients with AD or other neurological diseases. RESULTS In AD, p217tau is a more specific and abundant CSF component than p181tau. However, CSF NfL levels increase age-dependently and to a greater extent in central and peripheral nervous diseases than in AD. CONCLUSIONS CSF p217tau correlates better with AD neurodegeneration than other tau-related biomarkers and the major phosphorylated tau species. The clinical usage of NfL as a neurodegeneration biomarker in AD requires exclusion of various central and peripheral neurological diseases.
Collapse
Affiliation(s)
- Takeshi Kawarabayashi
- Department of Neurology, Dementia Research Center, Geriatrics Research Institute and Hospital, Maebashi, Japan
- Department of Neurology, Gunma University Hospital, Maebashi, Japan
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takumi Nakamura
- Department of Neurology, Gunma University Hospital, Maebashi, Japan
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | | | | | - Takashi Sugawara
- Department of Neurology, Dementia Research Center, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Hironori Oka
- Department of Neurology, Dementia Research Center, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Kunihiko Ishizawa
- Department of Neurology, Dementia Research Center, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Masakuni Amari
- Department of Neurology, Dementia Research Center, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Hiroo Kasahara
- Department of Neurology, Gunma University Hospital, Maebashi, Japan
| | - Kouki Makioka
- Department of Neurology, Gunma University Hospital, Maebashi, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Hospital, Maebashi, Japan
| | - Masamitsu Takatama
- Department of Neurology, Dementia Research Center, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Mikio Shoji
- Department of Neurology, Dementia Research Center, Geriatrics Research Institute and Hospital, Maebashi, Japan
- Department of Neurology, Gunma University Hospital, Maebashi, Japan
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
11
|
Sturmey E, Malaspina A. Blood biomarkers in ALS: challenges, applications and novel frontiers. Acta Neurol Scand 2022; 146:375-388. [PMID: 36156207 PMCID: PMC9828487 DOI: 10.1111/ane.13698] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 01/12/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease among adults. With diagnosis reached relatively late into the disease process, extensive motor cell loss narrows the window for therapeutic opportunities. Clinical heterogeneity in ALS and the lack of disease-specific biomarkers have so far led to large-sized clinical trials with long follow-up needed to define clinical outcomes. In advanced ALS patients, there is presently limited scope to use imaging or invasive cerebrospinal fluid (CSF) collection as a source of disease biomarkers. The development of more patient-friendly and accessible blood biomarker assays is hampered by analytical hurdles like the matrix effect of blood components. However, blood also provides the opportunity to identify disease-specific adaptive changes of the stoichiometry and conformation of target proteins and the endogenous immunological response to low-abundance brain peptides, such as neurofilaments (Nf). Among those biomarkers under investigation in ALS, the change in concentration before or after diagnosis of Nf has been shown to aid prognostication and to allow the a priori stratification of ALS patients into smaller sized and clinically more homogeneous cohorts, supporting more affordable clinical trials. Here, we discuss the technical hurdles affecting reproducible and sensitive biomarker measurement in blood. We also summarize the state of the art of non-CSF biomarkers in the study of prognosis, disease progression, and treatment response. We will then address the potential as disease-specific biomarkers of the newly discovered cryptic peptides which are formed down-stream of TDP-43 loss of function, the hallmark of ALS pathobiology.
Collapse
Affiliation(s)
- Ellie Sturmey
- Centre of Neuroscience, Surgery and Trauma, Queen Mary University of London, London, UK
| | - Andrea Malaspina
- Centre of Neuroscience, Surgery and Trauma, Queen Mary University of London, London, UK.,Queen Square Institute of Neurology, University College London, London, UK
| |
Collapse
|
12
|
Wendebourg MJ, Kuhle J, Hardmeier M. Case Report: A 72-Year-Old Woman With Progressive Motor Weakness, Dry Eyes and High Levels of Serum Neurofilament Light Chain. Front Neurol 2022; 13:889894. [PMID: 35899270 PMCID: PMC9309382 DOI: 10.3389/fneur.2022.889894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDiagnosis of Amyotrophic Lateral Sclerosis (ALS) is challenging as initial presentations are various and diagnostic biomarkers are lacking. The diagnosis relies on the presence of both upper and lower motor neuron signs and thorough exclusion of differential diagnoses, particularly as receiving an ALS diagnosis has major implications for the patient. Sjögren's syndrome may mimic peripheral ALS phenotypes and should be considered in the work-up.CaseA 72-year-old female presented with a mono-neuropathy of the right leg and a complaint of dry eyes and mouth. Initial diagnostic work-up confirmed a regional sensorimotor neuropathy and a Sjögren's syndrome; a causal relationship was assumed. However, motor symptoms spread progressively despite immunosuppressive treatment, eventually including both legs, both arms and the diaphragm. Clinically, unequivocal central signs were lacking, but further along in the disease course, the atrophy pattern followed a split phenotype and deep tendon reflexes were preserved. Nerve biopsy did not show vasculitic infiltration; however, serum neurofilament light chain (sNfL) concentrations were and remained persistently highly elevated despite immunosuppressive treatment. Electrodiagnostic re-evaluation confirmed denervation in 3 regions. A diagnosis of familial ALS was finally confirmed by a C9orf 72 repeat expansion. Stationary sensory symptoms were best explained by a neuropathy associated with concomitant Sjögren's syndromeDiscussionOur instructive case shows the difficulties of diagnosing ALS in the setting of a peripheral symptom onset and a concurrent but unrelated condition also causing neuropathy. Such cases require high clinical vigilance and readiness to reappraise diagnostic findings if the disease course deviates from expectation. Recently proposed simplified diagnostic criteria, genetic testing and body fluid biomarkers such as sNfL may facilitate the diagnostic process and lead to an earlier diagnosis of ALS.
Collapse
Affiliation(s)
- Maria Janina Wendebourg
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Martin Hardmeier
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- *Correspondence: Martin Hardmeier
| |
Collapse
|
13
|
Zecca C, Dell'Abate MT, Pasculli G, Capozzo R, Barone R, Arima S, Pollice A, Brescia V, Tortelli R, Logroscino G. Role of plasma phosphorylated neurofilament heavy chain (pNfH) in amyotrophic lateral sclerosis. J Cell Mol Med 2022; 26:3608-3615. [PMID: 35715961 PMCID: PMC9258711 DOI: 10.1111/jcmm.17232] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/26/2022] Open
Abstract
The phosphorylated neurofilament heavy chain (pNfH) is a promising biomarker in amyotrophic lateral sclerosis (ALS). We examined plasma pNfH concentrations in order to corroborate its role as a diagnostic and prognostic biomarker in ALS. Incident ALS cases enrolled in a population‐based registry were retrospectively selected and matched by sex and age with a cohort of healthy volunteers. Plasma pNfH levels were measured by an ELISA kit and correlated with clinical parameters. Discrimination ability of pNfH was tested using receiving operating characteristic (ROC) curves. Kaplan–Meier (KM) analysis and Cox proportional hazard models were used for survival analysis. Plasma pNfH was significantly higher in patients compared to controls. An optimal cut‐off of 39.74 pg/ml discriminated cases from controls with an elevated sensitivity and specificity. Bulbar‐onset cases had higher plasma pNfH compared to spinal onset (p = 0.0033). Furthermore, plasma pNfH positively correlated with disease progression rate (r = 0.19, p = 0.031). Baseline plasma pNfH did not influence survival in our cohort. Our findings confirmed the potential utility of plasma pNfH as a diagnostic biomarker in ALS. However, further studies with longitudinal data are needed to corroborate its prognostic value.
Collapse
Affiliation(s)
- Chiara Zecca
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card G. Panico" Hospital Tricase, Lecce, Italy
| | - Maria Teresa Dell'Abate
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card G. Panico" Hospital Tricase, Lecce, Italy
| | - Giuseppe Pasculli
- Department of Computer, Control, and Management Engineering Antonio Ruberti (DIAG) La Sapienza University, Rome, Italy
| | - Rosa Capozzo
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card G. Panico" Hospital Tricase, Lecce, Italy
| | - Roberta Barone
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card G. Panico" Hospital Tricase, Lecce, Italy
| | - Serena Arima
- Department of History, Society and Human Studies, University of Salento, Lecce, Italy
| | - Alessio Pollice
- Department of Economics and Finance, University of Bari "Aldo Moro", Lecce, Italy
| | - Vincenzo Brescia
- Unit of Laboratory Medicine, "Pia Fondazione Card.G. Panico" Hospital, Lecce, Italy
| | - Rosanna Tortelli
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card G. Panico" Hospital Tricase, Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card G. Panico" Hospital Tricase, Lecce, Italy.,Department of Basic Medicine Sciences, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| |
Collapse
|
14
|
Dreger M, Steinbach R, Otto M, Turner MR, Grosskreutz J. Cerebrospinal fluid biomarkers of disease activity and progression in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2022; 93:422-435. [PMID: 35105727 PMCID: PMC8921583 DOI: 10.1136/jnnp-2021-327503] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/29/2021] [Indexed: 12/04/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a relentlessly progressive neurodegenerative disease, and only modest disease-modifying strategies have been established to date. Numerous clinical trials have been conducted in the past years, but have been severely hampered by the wide-ranging heterogeneity of both the biological origins and clinical characteristics of the disease. Thus, reliable biomarkers of disease activity are urgently needed to stratify patients into homogenous groups with aligned disease trajectories to allow a more effective design of clinical trial. In this review, the most promising candidate biomarkers in the cerebrospinal fluid (CSF) of patients with ALS will be summarised. Correlations between biomarker levels and clinical outcome parameters are discussed, while highlighting potential pitfalls and intercorrelations of these clinical parameters. Several CSF molecules have shown potential as biomarkers of progression and prognosis, but large, international, multicentric and longitudinal studies are crucial for validation. A more standardised choice of clinical endpoints in these studies, as well as the application of individualised models of clinical progression, would allow the quantification of disease trajectories, thereby allowing a more accurate analysis of the clinical implications of candidate biomarkers. Additionally, a comparative analysis of several biomarkers and ideally the application of a multivariate analysis including comprehensive genotypic, phenotypic and clinical characteristics collectively contributing to biomarker levels in the CSF, could promote their verification. Thus, reliable prognostic markers and markers of disease activity may improve clinical trial design and patient management in the direction of precision medicine.
Collapse
Affiliation(s)
- Marie Dreger
- Department of Neurology, Jena University Hospital, Jena, Thüringen, Germany
| | - Robert Steinbach
- Department of Neurology, Jena University Hospital, Jena, Thüringen, Germany
| | - Markus Otto
- Department of Neurology, University of Halle (Saale), Halle (Saale), Germany
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, Oxfordshire, UK
| | - Julian Grosskreutz
- Precision Neurology, Department of Neurology, University of Luebeck Human Medicine, Luebeck, Schleswig-Holstein, Germany
| |
Collapse
|
15
|
Tendler BC, Hanayik T, Ansorge O, Bangerter-Christensen S, Berns GS, Bertelsen MF, Bryant KL, Foxley S, van den Heuvel MP, Howard AFD, Huszar IN, Khrapitchev AA, Leonte A, Manger PR, Menke RAL, Mollink J, Mortimer D, Pallebage-Gamarallage M, Roumazeilles L, Sallet J, Scholtens LH, Scott C, Smart A, Turner MR, Wang C, Jbabdi S, Mars RB, Miller KL. The Digital Brain Bank, an open access platform for post-mortem imaging datasets. eLife 2022; 11:e73153. [PMID: 35297760 PMCID: PMC9042233 DOI: 10.7554/elife.73153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Post-mortem magnetic resonance imaging (MRI) provides the opportunity to acquire high-resolution datasets to investigate neuroanatomy and validate the origins of image contrast through microscopy comparisons. We introduce the Digital Brain Bank (open.win.ox.ac.uk/DigitalBrainBank), a data release platform providing open access to curated, multimodal post-mortem neuroimaging datasets. Datasets span three themes-Digital Neuroanatomist: datasets for detailed neuroanatomical investigations; Digital Brain Zoo: datasets for comparative neuroanatomy; and Digital Pathologist: datasets for neuropathology investigations. The first Digital Brain Bank data release includes 21 distinctive whole-brain diffusion MRI datasets for structural connectivity investigations, alongside microscopy and complementary MRI modalities. This includes one of the highest-resolution whole-brain human diffusion MRI datasets ever acquired, whole-brain diffusion MRI in fourteen nonhuman primate species, and one of the largest post-mortem whole-brain cohort imaging studies in neurodegeneration. The Digital Brain Bank is the culmination of our lab's investment into post-mortem MRI methodology and MRI-microscopy analysis techniques. This manuscript provides a detailed overview of our work with post-mortem imaging to date, including the development of diffusion MRI methods to image large post-mortem samples, including whole, human brains. Taken together, the Digital Brain Bank provides cross-scale, cross-species datasets facilitating the incorporation of post-mortem data into neuroimaging studies.
Collapse
Affiliation(s)
- Benjamin C Tendler
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Taylor Hanayik
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Olaf Ansorge
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Sarah Bangerter-Christensen
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | | | - Mads F Bertelsen
- Centre for Zoo and Wild Animal Health, Copenhagen ZooFrederiksbergDenmark
| | - Katherine L Bryant
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Sean Foxley
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
- Department of Radiology, University of ChicagoChicagoUnited States
| | - Martijn P van den Heuvel
- Department of Complex Trait Genetics, Centre for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit AmsterdamAmsterdamNetherlands
- Department of Child Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamNetherlands
| | - Amy FD Howard
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Istvan N Huszar
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Alexandre A Khrapitchev
- Medical Research Council Oxford Institute for Radiation Oncology, University of OxfordOxfordUnited Kingdom
| | - Anna Leonte
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Paul R Manger
- School of Anatomical Sciences, Faculty of Health Sciences, University of the WitwatersrandJohannesburgSouth Africa
| | - Ricarda AL Menke
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Jeroen Mollink
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Duncan Mortimer
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Menuka Pallebage-Gamarallage
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Lea Roumazeilles
- Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of OxfordOxfordUnited Kingdom
| | - Jerome Sallet
- Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of OxfordOxfordUnited Kingdom
- Stem Cell and Brain Research Institute, Université Lyon 1, INSERMBronFrance
| | - Lianne H Scholtens
- Department of Complex Trait Genetics, Centre for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit AmsterdamAmsterdamNetherlands
| | - Connor Scott
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Adele Smart
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Martin R Turner
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Chaoyue Wang
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Saad Jbabdi
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Rogier B Mars
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
- Donders Institute for Brain, Cognition and Behaviour, Radboud University NijmegenNijmegenNetherlands
| | - Karla L Miller
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| |
Collapse
|
16
|
Zhang L, Ji T, Wu C, Zhang S, Tang L, Zhang N, Liu X, Fan D. Serum Neurofilament Light Chain Levels May Be a Marker of Lower Motor Neuron Damage in Amyotrophic Lateral Sclerosis. Front Neurol 2022; 13:833507. [PMID: 35280276 PMCID: PMC8905596 DOI: 10.3389/fneur.2022.833507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives The aims of this study were to investigate whether serum neurofilament light chain (NfL) levels were correlated with the severity of the axonal degeneration of lower motor neurons (LMNs) in the early symptomatic phase of amyotrophic lateral sclerosis (ALS). Methods In this prospective study, the serum samples used for NfL measurement were obtained from 103 sporadic ALS outpatients within 2 years of disease duration. The severity of axonal degeneration was assessed by assessing the decrease in the compound muscle action potentials (CMAPs) within a 1-month interval from serum sampling. Results The NfL levels showed a significant positive correlation with the relative score as a proxy for the axonal damage of LMNs in patients with ALS (coefficient: 0.264, p = 0.009). Furthermore, this correlation became stronger (coefficient: 0.582, p = 0.037) when estimated only among patients with disease subtypes that involve only LMNs, that is, patients with flail arm or leg syndrome (FAS or FLS). The levels of NfL increased with the severity of axonal damage of LMNs (F = 6.694, P = 0.0001). Conclusions Serum NfL levels mirrored the severity of the axonal degeneration of LMNs, particularly in patients with signs of predominant LMN involvement. These results may have a profound effect on the selection of patients and the monitoring of treatment efficacy in future disease-modifying clinical trials.
Collapse
Affiliation(s)
- Linjing Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Tuo Ji
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Chujun Wu
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuo Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Lu Tang
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Nan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiangyi Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China.,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China.,Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, Beijing, China
| |
Collapse
|
17
|
Salivary S100 calcium-binding protein beta (S100B) and neurofilament light (NfL) after acute exposure to repeated head impacts in collegiate water polo players. Sci Rep 2022; 12:3439. [PMID: 35236877 PMCID: PMC8891257 DOI: 10.1038/s41598-022-07241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/04/2022] [Indexed: 11/08/2022] Open
Abstract
Blood-based biomarkers of brain injury may be useful for monitoring brain health in athletes at risk for concussions. Two putative biomarkers of sport-related concussion, neurofilament light (NfL), an axonal structural protein, and S100 calcium-binding protein beta (S100B), an astrocyte-derived protein, were measured in saliva, a biofluid which can be sampled in an athletic setting without the risks and burdens associated with blood sampled by venipuncture. Samples were collected from men’s and women’s collegiate water polo players (n = 65) before and after a competitive tournament. Head impacts were measured using sensors previously evaluated for use in water polo, and video recordings were independently reviewed for the purpose of validating impacts recorded by the sensors. Athletes sustained a total of 107 head impacts, all of which were asymptomatic (i.e., no athlete was diagnosed with a concussion or more serious). Post-tournament salivary NfL was directly associated with head impact frequency (RR = 1.151, p = 0.025) and cumulative head impact magnitude (RR = 1.008, p = 0.014), while controlling for baseline salivary NfL. Change in S100B was not associated with head impact exposure (RR < 1.001, p > 0.483). These patterns suggest that repeated head impacts may cause axonal injury, even in asymptomatic athletes.
Collapse
|
18
|
Kessler C, Serna-Higuita LM, Wilke C, Rattay TW, Hengel H, Reichbauer J, Stransky E, Leyva-Gutiérrez A, Mengel D, Synofzik M, Schöls L, Martus P, Schüle R. Characteristics of serum neurofilament light chain as a biomarker in hereditary spastic paraplegia type 4. Ann Clin Transl Neurol 2022; 9:326-338. [PMID: 35171517 PMCID: PMC8935322 DOI: 10.1002/acn3.51518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 12/17/2022] Open
Abstract
Objective While the anticipated rise of disease‐modifying therapies calls for reliable trial outcome parameters, fluid biomarkers are lacking in spastic paraplegia type 4 (SPG4), the most prevalent form of hereditary spastic paraplegia. We therefore investigated serum neurofilament light chain (sNfL) as a potential therapy response, diagnostic, monitoring, and prognostic biomarker in SPG4. Methods: We assessed sNfL levels in 93 patients with SPG4 and 60 healthy controls. The longitudinal study of sNfL levels in SPG4 patients covered a baseline, 1‐year follow‐up and 2‐year follow‐up visit. Results Levels of sNfL were significantly increased in patients with genetically confirmed SPG4 compared to healthy controls matched in age and sex (p = 0.013, r = 0.2). Our cross‐sectional analysis revealed a greater difference in sNfL levels between patients and controls in younger ages with decreasing fold change of patient sNfL elevation at older ages. Over our observational period of 2 years, sNfL levels remained stable in SPG4 patients. Disease severity and progression did not correlate with sNfL levels. Interpretation: Our longitudinal data indicate a stable turnover of sNfL in manifest SPG4; therefore, sNfL levels are not suitable to monitor disease progression in SPG4. However, sNfL may be valuable as a therapy response biomarker, since its turnover could be modified by interventions. As the course of sNfL levels appears to be most dynamic around the onset of SPG4, the ability to detect a therapy response appears to be especially promising in younger patients, matching the need to initiate treatment in early disease stages.
Collapse
Affiliation(s)
- Christoph Kessler
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Lina Maria Serna-Higuita
- Department of Clinical Epidemiology and Applied Biostatistics, University of Tübingen, Tübingen, Germany
| | - Carlo Wilke
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Tim W Rattay
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Holger Hengel
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Jennifer Reichbauer
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Elke Stransky
- Center of Neurology, University of Tübingen, Tübingen, Germany
| | - Alejandra Leyva-Gutiérrez
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - David Mengel
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Ludger Schöls
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Peter Martus
- Department of Clinical Epidemiology and Applied Biostatistics, University of Tübingen, Tübingen, Germany
| | - Rebecca Schüle
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| |
Collapse
|
19
|
Ikenaka K, Maeda Y, Hotta Y, Nagano S, Yamada S, Ito D, Torii R, Kakuda K, Tatebe H, Atsuta N, Aguirre C, Kimura Y, Baba K, Tokuda T, Katsuno M, Kimura K, Sobue G, Mochizuki H. Serum asymmetric dimethyl arginine level correlates with the progression and prognosis of amyotrophic lateral sclerosis. Eur J Neurol 2022; 29:1410-1416. [PMID: 35128793 PMCID: PMC9305138 DOI: 10.1111/ene.15254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
Background and purpose: Methods Results Conclusion
Collapse
Affiliation(s)
- Kensuke Ikenaka
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Yasuhiro Maeda
- Center for Joint Research Facilities Support Fujita Health University Toyoake Japan
| | - Yuji Hotta
- Department of Hospital Pharmacy Nagoya City University Graduate School of Pharmaceutical Sciences Nagoya Japan
| | - Seiichi Nagano
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Shinichiro Yamada
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Daisuke Ito
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Ryota Torii
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Keita Kakuda
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Harutsugu Tatebe
- T Brothers Corporation T & Chiba Japan
- National Institutes for Quantum and Radiological Science and Technology (QST) Chiba Japan
| | - Naoki Atsuta
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
- Department of Neurology Aichi Medical University School of Medicine Nagakute Japan
| | - Cesar Aguirre
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Yasuyoshi Kimura
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Kousuke Baba
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Takahiko Tokuda
- T Brothers Corporation T & Chiba Japan
- National Institutes for Quantum and Radiological Science and Technology (QST) Chiba Japan
| | - Masahisa Katsuno
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
- Department of Clinical Research Education Nagoya University Graduate School of Medicine Nagoya Japan
| | - Kazunori Kimura
- Department of Hospital Pharmacy Nagoya City University Graduate School of Pharmaceutical Sciences Nagoya Japan
| | - Gen Sobue
- Research Division of Dementia and Neurodegenerative Disease Nagoya University Graduate School of Medicine Nagoya Japan
- Aichi Medical University Nagakute Japan
| | - Hideki Mochizuki
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| |
Collapse
|
20
|
Reyes-Leiva D, Dols-Icardo O, Sirisi S, Cortés-Vicente E, Turon-Sans J, de Luna N, Blesa R, Belbin O, Montal V, Alcolea D, Fortea J, Lleó A, Rojas-García R, Illán-Gala I. Pathophysiological Underpinnings of Extra-Motor Neurodegeneration in Amyotrophic Lateral Sclerosis: New Insights From Biomarker Studies. Front Neurol 2022; 12:750543. [PMID: 35115992 PMCID: PMC8804092 DOI: 10.3389/fneur.2021.750543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD) lie at opposing ends of a clinical, genetic, and neuropathological continuum. In the last decade, it has become clear that cognitive and behavioral changes in patients with ALS are more frequent than previously recognized. Significantly, these non-motor features can impact the diagnosis, prognosis, and management of ALS. Partially overlapping neuropathological staging systems have been proposed to describe the distribution of TAR DNA-binding protein 43 (TDP-43) aggregates outside the corticospinal tract. However, the relationship between TDP-43 inclusions and neurodegeneration is not absolute and other pathophysiological processes, such as neuroinflammation (with a prominent role of microglia), cortical hyperexcitability, and synaptic dysfunction also play a central role in ALS pathophysiology. In the last decade, imaging and biofluid biomarker studies have revealed important insights into the pathophysiological underpinnings of extra-motor neurodegeneration in the ALS-FTLD continuum. In this review, we first summarize the clinical and pathophysiological correlates of extra-motor neurodegeneration in ALS. Next, we discuss the diagnostic and prognostic value of biomarkers in ALS and their potential to characterize extra-motor neurodegeneration. Finally, we debate about how biomarkers could improve the diagnosis and classification of ALS. Emerging imaging biomarkers of extra-motor neurodegeneration that enable the monitoring of disease progression are particularly promising. In addition, a growing arsenal of biofluid biomarkers linked to neurodegeneration and neuroinflammation are improving the diagnostic accuracy and identification of patients with a faster progression rate. The development and validation of biomarkers that detect the pathological aggregates of TDP-43 in vivo are notably expected to further elucidate the pathophysiological underpinnings of extra-motor neurodegeneration in ALS. Novel biomarkers tracking the different aspects of ALS pathophysiology are paving the way to precision medicine approaches in the ALS-FTLD continuum. These are essential steps to improve the diagnosis and staging of ALS and the design of clinical trials testing novel disease-modifying treatments.
Collapse
Affiliation(s)
- David Reyes-Leiva
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Valencia, Spain
| | - Oriol Dols-Icardo
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Sonia Sirisi
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Elena Cortés-Vicente
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Valencia, Spain
| | - Janina Turon-Sans
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Valencia, Spain
| | - Noemi de Luna
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Valencia, Spain
| | - Rafael Blesa
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Olivia Belbin
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Victor Montal
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Ricard Rojas-García
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Valencia, Spain
| | - Ignacio Illán-Gala
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
- *Correspondence: Ignacio Illán-Gala
| |
Collapse
|
21
|
Welton T, Tan YJ, Saffari SE, Ng SYE, Chia NSY, Yong ACW, Choi X, Heng DL, Shih YC, Hartono S, Lee W, Xu Z, Tay KY, Au WL, Tan EK, Chan LL, Ng ASL, Tan LCS. Plasma Neurofilament Light Concentration Is Associated with Diffusion-Tensor MRI-Based Measures of Neurodegeneration in Early Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2135-2146. [PMID: 36057833 DOI: 10.3233/jpd-223414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Neurofilament light is a marker of axonal degeneration, whose measurement from peripheral blood was recently made possible by new assays. OBJECTIVE We aimed to determine whether plasma neurofilament light chain (NfL) concentration reflects brain white matter integrity in patients with early Parkinson's disease (PD). METHODS 137 early PD patients and 51 healthy controls were included. Plasma NfL levels were measured using ultrasensitive single molecule array. 3T MRI including diffusion tensor imaging was acquired for voxelwise analysis of association between NfL and both fractional anisotropy (FA) and mean diffusivity (MD) in white matter tracts and subcortical nuclei. RESULTS A pattern of brain microstructural changes consistent with neurodegeneration was associated with increased plasma NfL in most of the frontal lobe and right internal capsule, with decreased FA and increased MD. The same clusters were also associated with poorer global cognition. A significant cluster in the left putamen was associated with increased NfL, with a significantly greater effect in PD than controls. CONCLUSION Plasma NfL may be associated with brain microstructure, as measured using diffusion tensor imaging, in patients with early PD. Higher plasma NfL was associated with a frontal pattern of neurodegeneration that also correlates with cognitive performance in our cohort. This may support a future role for plasma NfL as an accessible biomarker for neurodegeneration and cognitive dysfunction in PD.
Collapse
Affiliation(s)
- Thomas Welton
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Neuroscience Academic Clinical Program, Duke-NUS Medical School, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
| | - Yi Jayne Tan
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
| | - Seyed Ehsan Saffari
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Samuel Y E Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
| | - Nicole S Y Chia
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
| | - Alisa C W Yong
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
| | - Xinyi Choi
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Dede Liana Heng
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Yao-Chia Shih
- Radiological Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan City, Taiwan
| | - Septian Hartono
- Neuroscience Academic Clinical Program, Duke-NUS Medical School, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Weiling Lee
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Zheyu Xu
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
| | - Kay Yaw Tay
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
| | - Wing Lok Au
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Ling Ling Chan
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
- Radiological Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
- Neuroscience and Behavioural Disorders Program, Duke-NUS Medical School, Singapore
| | - Adeline S L Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
- Neuroscience and Behavioural Disorders Program, Duke-NUS Medical School, Singapore
| | - Louis C S Tan
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Parkinson Disease and Movement Disorders Centre, Parkinson Foundation Center of Excellence, National Neuroscience Institute, Singapore, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
22
|
Shi J, Qin X, Chang X, Wang H, Guo J, Zhang W. Neurofilament markers in serum and cerebrospinal fluid of patients with amyotrophic lateral sclerosis. J Cell Mol Med 2021; 26:583-587. [PMID: 34866307 PMCID: PMC8743649 DOI: 10.1111/jcmm.17100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022] Open
Abstract
This study aims to determine the serum and cerebrospinal fluid (CSF) levels of neurofilament light chain (NFL) and phosphorylated neurofilament heavy chain (pNFH) in amyotrophic lateral sclerosis (ALS) patients, and to explore their feasibility as valid biomarkers for quantifying disease progression and predicting individual prognosis. 52 patients with ALS and 30 controls with noninflammatory neurological diseases were included. NFL and pNFH levels in serum and CSF were measured by enzyme‐linked immunosorbent assay. Our findings showed that serum and CSF levels of NFL and pNFH in ALS patients were significantly increased. These values were negatively correlated with disease duration (except CSF NFL with disease duration) and ALSFRS‐r score, and positively correlated with disease progression rate (DPR) and upper motor neuron (UMN) score, but did not correlate with bilateral median and ulnar nerve compound muscle action potential (cMAP) amplitudes (except a weak correlation between CSF NFL and cMAP amplitudes). The optimal cut‐off values with high sensitivity and specificity were obtained in ROC curve analysis to discriminate ALS from controls. Kaplan‐Meier survival curves illustrated that survival was significantly shorter for patients with higher neurofilament levels at diagnosis. The Cox proportional hazards regressions confirmed that NFL and pNFH were significant predictors of survival. Overall, NFL and pNFH in serum and CSF can be used as reliable biomarkers in ALS.
Collapse
Affiliation(s)
- Jiaying Shi
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Xiaohui Qin
- Department of Encephalopathy, Changzhi Hospital of Traditional Chinese Medicine, Changzhi, China
| | - Xueli Chang
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Hong Wang
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Junhong Guo
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Wei Zhang
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| |
Collapse
|
23
|
Amyotrophic lateral sclerosis: Correlations between fluid biomarkers of NfL, TDP-43, and tau, and clinical characteristics. PLoS One 2021; 16:e0260323. [PMID: 34843548 PMCID: PMC8629269 DOI: 10.1371/journal.pone.0260323] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/07/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES We previously reported the diagnostic and prognostic performance of neurofilament light chain (NfL), TAR DNA-binding protein 43 (TDP-43), and total tau (t-tau) in cerebrospinal fluid (CSF) and plasma as amyotrophic lateral sclerosis (ALS) biomarkers. The present study aimed to elucidate associations between clinical characteristics and the markers as well as mutual associations of the markers in ALS patients using the same dataset. METHODS NfL, TDP-43, and t-tau levels in CSF and plasma in 75 ALS patients were analyzed. The associations between those markers and clinical details were investigated by uni- and multivariate analyses. Correlations between the markers were analyzed univariately. RESULTS In multivariate analysis of CSF proteins, the disease progression rate (DPR) was positively correlated with NfL (β: 0.51, p = 0.007) and t-tau (β: 0.37, p = 0.03). Plasma NfL was correlated with age (β: 0.53, p = 0.005) and diagnostic grade (β: -0.42, p = 0.02) in multivariate analysis. Plasma TDP-43 was correlated negatively with split hand index (β: -0.48, p = 0.04) and positively with % vital capacity (β: 0.64, p = 0.03) in multivariate analysis. Regarding mutual biomarker analysis, a negative correlation between CSF-NfL and TDP-43 was identified (r: -0.36, p = 0.002). CONCLUSIONS Elevated NfL and t-tau levels in CSF may be biomarkers to predict rapid DPR from onset to sample collection. The negative relationship between CSF NfL and TDP-43 suggests that elevation of CSF TDP-43 in ALS is not a simple consequence of its release into CSF during neurodegeneration. The negative correlation between plasma TDP-43 and split hand index may support the pathophysiological association between plasma TDP-43 and ALS.
Collapse
|
24
|
Neurofilaments can differentiate ALS subgroups and ALS from common diagnostic mimics. Sci Rep 2021; 11:22128. [PMID: 34764380 PMCID: PMC8585882 DOI: 10.1038/s41598-021-01499-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022] Open
Abstract
Delayed diagnosis and misdiagnosis are frequent in people with amyotrophic lateral sclerosis (ALS), the most common form of motor neuron disease (MND). Neurofilament light chain (NFL) and phosphorylated neurofilament heavy chain (pNFH) are elevated in ALS patients. We retrospectively quantified cerebrospinal fluid (CSF) NFL, CSF pNFH and plasma NFL in stored samples that were collected at the diagnostic work-up of ALS patients (n = 234), ALS mimics (n = 44) and controls (n = 9). We assessed the diagnostic performance, prognostication value and relationship to the site of onset and genotype. CSF NFL, CSF pNFH and plasma NFL levels were significantly increased in ALS patients compared to patients with neuropathies & myelopathies, patients with myopathies and controls. Furthermore, CSF pNFH and plasma NFL levels were significantly higher in ALS patients than in patients with other MNDs. Bulbar onset ALS patients had significantly higher plasma NFL levels than spinal onset ALS patients. ALS patients with C9orf72HRE mutations had significantly higher plasma NFL levels than patients with SOD1 mutations. Survival was negatively correlated with all three biomarkers. Receiver operating characteristics showed the highest area under the curve for CSF pNFH for differentiating ALS from ALS mimics and for plasma NFL for estimating ALS short and long survival. All three biomarkers have diagnostic value in differentiating ALS from clinically relevant ALS mimics. Plasma NFL levels can be used to differentiate between clinical and genetic ALS subgroups.
Collapse
|
25
|
Vacchiano V, Mastrangelo A, Zenesini C, Masullo M, Quadalti C, Avoni P, Polischi B, Cherici A, Capellari S, Salvi F, Liguori R, Parchi P. Plasma and CSF Neurofilament Light Chain in Amyotrophic Lateral Sclerosis: A Cross-Sectional and Longitudinal Study. Front Aging Neurosci 2021; 13:753242. [PMID: 34744694 PMCID: PMC8569186 DOI: 10.3389/fnagi.2021.753242] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Neurofilament light chain (NfL) is a validated biofluid marker of neuroaxonal damage with great potential for monitoring patients with neurodegenerative diseases. We aimed to further validate the clinical utility of plasma (p) vs. CSF (c) NfL for distinguishing patients with Amyotrophic Lateral Sclerosis (ALS) from ALS mimics. We also assessed the association of biomarker values with clinical variables and survival and established the longitudinal changes of pNfL during the disease course. Methods: We studied 231 prospectively enrolled patients with suspected ALS who underwent a standardized protocol including neurological examination, electromyography, brain MRI, and lumbar puncture. Patients who received an alternative clinical diagnosis were considered ALS mimics. We classified the patients based on the disease progression rate (DPR) into fast (DPR > 1), intermediate (DPR 0.5–1), and slow progressors (DPR < 0.5). All patients were screened for the most frequent ALS-associated genes. Plasma and CSF samples were retrospectively analyzed; NfL concentrations were measured with the SIMOA platform using a commercial kit. Results: ALS patients (n = 171) showed significantly higher pNfL (p < 0.0001) and cNfL (p < 0.0001) values compared to ALS mimics (n = 60). Both cNfL and pNfL demonstrated a good diagnostic value in discriminating the two groups, although cNfL performed slightly better (cNfL: AUC 0.924 ± 0.022, sensitivity 86.8%, specificity 92.4; pNfL: AUC 0.873 ± 0.036, sensitivity 84.7%, specificity 83.3%). Fast progressors showed higher cNfL and pNfL as compared to intermediate (p = 0.026 and p = 0.001) and slow progressors (both p < 0.001). Accordingly, ALS patients with higher baseline cNfL and pNfL levels had a shorter survival (highest tertile of cNfL vs. lowest tertile, HR 4.58, p = 0.005; highest tertile of pNfL vs. lowest tertile, HR 2.59, p = 0.015). Moreover, there were positive associations between cNfL and pNfL levels and the number of body regions displaying UMN signs (rho = 0.325, p < 0.0001; rho = 0.308, p = 0.001). Finally, longitudinal analyses in 57 patients showed stable levels of pNfL during the disease course. Conclusion: Both cNfL and pNfL have excellent diagnostic and prognostic performance for symptomatic patients with ALS. The stable longitudinal trajectory of pNfL supports its use as a marker of drug effect in clinical trials.
Collapse
Affiliation(s)
- Veria Vacchiano
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Andrea Mastrangelo
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marco Masullo
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Corinne Quadalti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Patrizia Avoni
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Barbara Polischi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Arianna Cherici
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabrizio Salvi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Rocco Liguori
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Piero Parchi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| |
Collapse
|
26
|
Guedes VA, Lai C, Devoto C, Edwards KA, Mithani S, Sass D, Vorn R, Qu BX, Rusch HL, Martin CA, Walker WC, Wilde EA, Diaz-Arrastia R, Gill JM, Kenney K. Extracellular Vesicle Proteins and MicroRNAs Are Linked to Chronic Post-Traumatic Stress Disorder Symptoms in Service Members and Veterans With Mild Traumatic Brain Injury. Front Pharmacol 2021; 12:745348. [PMID: 34690777 PMCID: PMC8526745 DOI: 10.3389/fphar.2021.745348] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/06/2021] [Indexed: 01/20/2023] Open
Abstract
Symptoms of post-traumatic stress disorder (PTSD) are common in military populations, and frequently associated with a history of combat-related mild traumatic brain injury (mTBI). In this study, we examined relationships between severity of PTSD symptoms and levels of extracellular vesicle (EV) proteins and miRNAs measured in the peripheral blood in a cohort of military service members and Veterans (SMs/Vs) with chronic mTBI(s). Participants (n = 144) were divided into groups according to mTBI history and severity of PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5). We analyzed EV levels of 798 miRNAs (miRNAs) as well as EV and plasma levels of neurofilament light chain (NfL), Tau, Amyloid beta (Aβ) 42, Aβ40, interleukin (IL)-10, IL-6, tumor necrosis factor-alpha (TNFα), and vascular endothelial growth factor (VEGF). We observed that EV levels of neurofilament light chain (NfL) were elevated in participants with more severe PTSD symptoms (PCL-5 ≥ 38) and positive mTBI history, when compared to TBI negative controls (p = 0.024) and mTBI participants with less severe PTSD symptoms (p = 0.006). Levels of EV NfL, plasma NfL, and hsa-miR-139–5p were linked to PCL-5 scores in regression models. Our results suggest that levels of NfL, a marker of axonal damage, are associated with PTSD symptom severity in participants with remote mTBI. Specific miRNAs previously linked to neurodegenerative and inflammatory processes, and glucocorticoid receptor signaling pathways, among others, were also associated with the severity of PTSD symptoms. Our findings provide insights into possible signaling pathways linked to the development of persistent PTSD symptoms after TBI and biological mechanisms underlying susceptibility to PTSD.
Collapse
Affiliation(s)
- Vivian A Guedes
- Tissue Injury Branch, National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Chen Lai
- Tissue Injury Branch, National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Christina Devoto
- Tissue Injury Branch, National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD, United States.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, MD, United States
| | - Katie A Edwards
- Tissue Injury Branch, National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Sara Mithani
- Tissue Injury Branch, National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Dilorom Sass
- Tissue Injury Branch, National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Rany Vorn
- Tissue Injury Branch, National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Bao-Xi Qu
- Tissue Injury Branch, National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD, United States.,Center for Neuroscience and Rehabilitation Medicine, Uniformed Services University of the Health Sciences and National Institutes of Health, Bethesda, MD, United States
| | - Heather L Rusch
- Tissue Injury Branch, National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD, United States.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, MD, United States.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Carina A Martin
- Tissue Injury Branch, National Institutes of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - William C Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Elisabeth A Wilde
- CENC Neuroimaging Core, George E. Wahlen VA Salt Lake City Healthcare System and Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Jessica M Gill
- CENC Biorepository, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.,Johns Hopkins University School of Nursing and Medicine, Baltimore, MD, United States
| | - Kimbra Kenney
- CENC Biorepository, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.,Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| |
Collapse
|
27
|
Circulating Biomarkers in Neuromuscular Disorders: What Is Known, What Is New. Biomolecules 2021; 11:biom11081246. [PMID: 34439911 PMCID: PMC8393752 DOI: 10.3390/biom11081246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
The urgent need for new therapies for some devastating neuromuscular diseases (NMDs), such as Duchenne muscular dystrophy or amyotrophic lateral sclerosis, has led to an intense search for new potential biomarkers. Biomarkers can be classified based on their clinical value into different categories: diagnostic biomarkers confirm the presence of a specific disease, prognostic biomarkers provide information about disease course, and therapeutic biomarkers are designed to predict or measure treatment response. Circulating biomarkers, as opposed to instrumental/invasive ones (e.g., muscle MRI or nerve ultrasound, muscle or nerve biopsy), are generally easier to access and less “time-consuming”. In addition to well-known creatine kinase, other promising molecules seem to be candidate biomarkers to improve the diagnosis, prognosis and prediction of therapeutic response, such as antibodies, neurofilaments, and microRNAs. However, there are some criticalities that can complicate their application: variability during the day, stability, and reliable performance metrics (e.g., accuracy, precision and reproducibility) across laboratories. In the present review, we discuss the application of biochemical biomarkers (both validated and emerging) in the most common NMDs with a focus on their diagnostic, prognostic/predictive and therapeutic application, and finally, we address the critical issues in the introduction of new biomarkers.
Collapse
|
28
|
Puentes F, Lombardi V, Lu CH, Yildiz O, Fratta P, Isaacs A, Bobeva Y, Wuu J, Benatar M, Malaspina A. Humoral response to neurofilaments and dipeptide repeats in ALS progression. Ann Clin Transl Neurol 2021; 8:1831-1844. [PMID: 34318620 PMCID: PMC8419401 DOI: 10.1002/acn3.51428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022] Open
Abstract
Objective To appraise the utility as biomarkers of blood antibodies and immune complexes to neurofilaments and dipeptide repeat proteins, the products of translation of the most common genetic mutation in amyotrophic lateral sclerosis (ALS). Methods Antibodies and immune complexes against neurofilament light, medium, heavy chains as well as poly‐(GP)‐(GR) dipeptide repeats were measured in blood samples from the ALS Biomarkers (n = 107) and the phenotype–genotype biomarker (n = 129) studies and in 140 healthy controls. Target analyte levels were studied longitudinally in 37 ALS cases. Participants were stratified according to the rate of disease progression estimated before and after baseline and C9orf72 genetic status. Survival and longitudinal analyses were undertaken with reference to matched neurofilament protein expression. Results Compared to healthy controls, total neurofilament proteins and antibodies, neurofilament light immune complexes (p < 0.0001), and neurofilament heavy antibodies (p = 0.0061) were significantly elevated in ALS, patients with faster progressing disease (p < 0.0001) and in ALS cases with a C9orf72 mutation (p < 0.0003). Blood neurofilament light protein discriminated better ALS from healthy controls (AUC: 0.92; p < 0.0001) and faster from slower progressing ALS (AUC: 0.86; p < 0.0001) compared to heavy‐chain antibodies and light‐chain immune complexes (AUC: 0.79; p < 0.0001 and AUC: 0.74; p < 0.0001). Lower neurofilament heavy antibodies were associated with longer survival (Log‐rank Chi‐square: 7.39; p = 0.0065). Increasing levels of antibodies and immune complexes between time points were observed in faster progressing ALS. Conclusions We report a distinctive humoral response characterized by raising antibodies against neurofilaments and dipeptide repeats in faster progressing and C9orf72 genetic mutation carriers ALS patients. We confirm the significance of plasma neurofilament proteins in the clinical stratification of ALS.
Collapse
Affiliation(s)
- Fabiola Puentes
- Neurodegeneration Group, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, United Kingdom.,Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Vittoria Lombardi
- Neurodegeneration Group, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, United Kingdom.,Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Ching-Hua Lu
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom.,School of Medicine, China Medical University, 91 Xueshi Road, North District, Taichung City, 404, Taiwan
| | - Ozlem Yildiz
- Neurodegeneration Group, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, United Kingdom.,Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Pietro Fratta
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Adrian Isaacs
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Yoana Bobeva
- Neurodegeneration Group, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, United Kingdom.,Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Joanne Wuu
- Department of Neurology, University of Miami, Miami, Florida, USA
| | -
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | -
- Department of Neurology, University of Miami, Miami, Florida, USA
| | - Michael Benatar
- Department of Neurology, University of Miami, Miami, Florida, USA
| | - Andrea Malaspina
- Neurodegeneration Group, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, United Kingdom.,Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| |
Collapse
|
29
|
Elevated Tau in Military Personnel Relates to Chronic Symptoms Following Traumatic Brain Injury. J Head Trauma Rehabil 2021; 35:66-73. [PMID: 31033745 DOI: 10.1097/htr.0000000000000485] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To understand the relationships between traumatic brain injury (TBI), blood biomarkers, and symptoms of posttraumatic stress disorder (PTSD), depression, and postconcussive syndrome symptoms. DESIGN Cross-sectional cohort study using multivariate analyses. PARTICIPANTS One hundred nine military personnel and veterans, both with and without a history of TBI. MAIN MEASURES PTSD Checklist-Civilian Version (PCL-C); Neurobehavioral Symptom Inventory (NSI); Ohio State University TBI Identification Method; Patient Health Questionnaire-9 (PHQ-9); Simoa-measured concentrations of tau, amyloid-beta (Aβ) 40, Aβ42, and neurofilament light (NFL). RESULTS Controlling for age, sex, time since last injury (TSLI), and antianxiety/depression medication use, NFL was trending toward being significantly elevated in participants who had sustained 3 or more TBIs compared with those who had sustained 1 or 2 TBIs. Within the TBI group, partial correlations that controlled for age, sex, TSLI, and antianxiety/depression medication use showed that tau concentrations were significantly correlated with greater symptom severity, as measured with the NSI, PCL, and PHQ-9. CONCLUSIONS Elevations in tau are associated with symptom severity after TBI, while NFL levels are elevated in those with a history of repetitive TBIs and in military personnel and veterans. This study shows the utility of measuring biomarkers chronically postinjury. Furthermore, there is a critical need for studies of biomarkers longitudinally following TBI.
Collapse
|
30
|
Shin HR, Moon J, Lee WJ, Lee HS, Kim EY, Shin S, Lee ST, Jung KH, Park KI, Jung KY, Lee SK, Chu K. Serum neurofilament light chain as a severity marker for spinocerebellar ataxia. Sci Rep 2021; 11:13517. [PMID: 34188109 PMCID: PMC8241827 DOI: 10.1038/s41598-021-92855-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/16/2021] [Indexed: 01/27/2023] Open
Abstract
Since the serum neurofilament light (NfL) chain is known as a promising biomarker in neurodegenerative diseases, we aimed to evaluate serum NfL as a biomarker indicating neuronal damage in autosomal-dominant (AD) spinocerebellar ataxia (SCA). We reviewed patients diagnosed with AD SCA in the outpatient clinic of Seoul National University Hospital's (SNUH) Department of Neurology between May and August of 2019. We reviewed the demographic data, clinical characteristics, Scale for the Assessment and Rating of Ataxia (SARA) score, and brain magnetic resonance imaging (MRI) scans. The serum NfL was measured by electrochemiluminescence (ECL) immunoassay. Forty-nine patients with AD SCA were reviewed and their serum NfL level was determined. The median serum NfL level (109.5 pg/mL) was higher than control (41.1 pg/mL) (p-value < 0.001). Among the AD SCA patients, there was a positive correlation between the serum NfL level and the trinucleotide repeat number (r = 0.47, p-value = 0.001), disease duration (r = 0.35, p-value = 0.019), disease duration/age × trinucleotide repeat number (r = 0.330, p-value = 0.021), and SARA score (n = 33; r = 0.37, p-value = 0.033). This study shows that serum NfL is elevated in AD SCA patients and correlates with clinical severity.
Collapse
Affiliation(s)
- Hye-Rim Shin
- Department of Neurology, Dankook University Hospital, Cheonan, Chungnam, South Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Genomic Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Center for Hospital Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Center for Hospital Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Eun Young Kim
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Seoyi Shin
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Seoul National University Healthcare System Gangnam Center, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea. .,Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
| |
Collapse
|
31
|
Verde F, Otto M, Silani V. Neurofilament Light Chain as Biomarker for Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Front Neurosci 2021; 15:679199. [PMID: 34234641 PMCID: PMC8255624 DOI: 10.3389/fnins.2021.679199] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are two related currently incurable neurodegenerative diseases. ALS is characterized by degeneration of upper and lower motor neurons causing relentless paralysis of voluntary muscles, whereas in FTD, progressive atrophy of the frontal and temporal lobes of the brain results in deterioration of cognitive functions, language, personality, and behavior. In contrast to Alzheimer's disease (AD), ALS and FTD still lack a specific neurochemical biomarker reflecting neuropathology ex vivo. However, in the past 10 years, considerable progress has been made in the characterization of neurofilament light chain (NFL) as cerebrospinal fluid (CSF) and blood biomarker for both diseases. NFL is a structural component of the axonal cytoskeleton and is released into the CSF as a consequence of axonal damage or degeneration, thus behaving in general as a relatively non-specific marker of neuroaxonal pathology. However, in ALS, the elevation of its CSF levels exceeds that observed in most other neurological diseases, making it useful for the discrimination from mimic conditions and potentially worthy of consideration for introduction into diagnostic criteria. Moreover, NFL correlates with disease progression rate and is negatively associated with survival, thus providing prognostic information. In FTD patients, CSF NFL is elevated compared with healthy individuals and, to a lesser extent, patients with other forms of dementia, but the latter difference is not sufficient to enable a satisfying diagnostic performance at individual patient level. However, also in FTD, CSF NFL correlates with several measures of disease severity. Due to technological progress, NFL can now be quantified also in peripheral blood, where it is present at much lower concentrations compared with CSF, thus allowing less invasive sampling, scalability, and longitudinal measurements. The latter has promoted innovative studies demonstrating longitudinal kinetics of NFL in presymptomatic individuals harboring gene mutations causing ALS and FTD. Especially in ALS, NFL levels are generally stable over time, which, together with their correlation with progression rate, makes NFL an ideal pharmacodynamic biomarker for therapeutic trials. In this review, we illustrate the significance of NFL as biomarker for ALS and FTD and discuss unsolved issues and potential for future developments.
Collapse
Affiliation(s)
- Federico Verde
- Department of Neurology-Stroke Unit and Laboratory of Neuroscience, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Markus Otto
- Department of Neurology, Ulm University Hospital, Ulm, Germany
| | - Vincenzo Silani
- Department of Neurology-Stroke Unit and Laboratory of Neuroscience, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
32
|
Alagaratnam J, von Widekind S, De Francesco D, Underwood J, Edison P, Winston A, Zetterberg H, Fidler S. Correlation between CSF and blood neurofilament light chain protein: a systematic review and meta-analysis. BMJ Neurol Open 2021; 3:e000143. [PMID: 34223154 PMCID: PMC8211066 DOI: 10.1136/bmjno-2021-000143] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the overall pooled correlation coefficient estimate between cerebrospinal fluid (CSF) and blood neurofilament light (NfL) protein. METHODS We searched Medline, Embase and Web of Science for published articles, from their inception to 9 July 2019, according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies reporting the correlation between CSF and blood NfL in humans were included. We conducted a random-effects meta-analysis to calculate the overall pooled correlation coefficient estimate, accounting for correlation technique and assay used. Heterogeneity was assessed using the I2 statistic test. In sensitivity analyses, we calculated the pooled correlation coefficient estimate according to blood NfL assay: single-molecule array digital immunoassay (Simoa), electrochemiluminescence (ECL) assay or ELISA. RESULTS Data were extracted from 36 articles, including 3961 paired CSF and blood NfL samples. Overall, 26/36 studies measured blood NfL using Simoa, 8/36 ECL, 1/36 ELISA and 1 study reported all three assay results. The overall meta-analysis demonstrated that the pooled correlation coefficient estimate for CSF and blood NfL was r=0.72. Heterogeneity was significant: I2=83%, p<0.01. In sensitivity analyses, the pooled correlation coefficient was similar for studies measuring blood NfL using Simoa and ECL (r=0.69 and r=0.68, respectively) but weaker for ELISA (r=0.35). CONCLUSION Moderate correlations are demonstrated between CSF and blood NfL, especially when blood NfL was measured using Simoa and ECL. Given its high analytical sensitivity, Simoa is the preferred assay for measuring NfL, especially at low or physiological concentrations, and this meta-analysis supports its use as the current most advanced surrogate measure of CSF NfL. PROSPERO REGISTRATION NUMBER CRD42019140469.
Collapse
Affiliation(s)
- Jasmini Alagaratnam
- Department of Infectious Disease, Imperial College London, London, UK
- Department of Genitourinary Medicine & HIV, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Jonathan Underwood
- Department of Infectious Disease, Imperial College London, London, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Paul Edison
- Department of Brain Sciences, Imperial College London, London, UK
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, UK
- Department of Genitourinary Medicine & HIV, Imperial College Healthcare NHS Trust, London, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- Department of Psychiatry and Neurochemistry, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, London, UK
- Department of Genitourinary Medicine & HIV, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
33
|
Panman JL, Venkatraghavan V, van der Ende EL, Steketee RME, Jiskoot LC, Poos JM, Dopper EGP, Meeter LHH, Donker Kaat L, Rombouts SARB, Vernooij MW, Kievit AJA, Premi E, Cosseddu M, Bonomi E, Olives J, Rohrer JD, Sánchez-Valle R, Borroni B, Bron EE, Van Swieten JC, Papma JM, Klein S. Modelling the cascade of biomarker changes in GRN-related frontotemporal dementia. J Neurol Neurosurg Psychiatry 2021; 92:494-501. [PMID: 33452053 PMCID: PMC8053353 DOI: 10.1136/jnnp-2020-323541] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/19/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Progranulin-related frontotemporal dementia (FTD-GRN) is a fast progressive disease. Modelling the cascade of multimodal biomarker changes aids in understanding the aetiology of this disease and enables monitoring of individual mutation carriers. In this cross-sectional study, we estimated the temporal cascade of biomarker changes for FTD-GRN, in a data-driven way. METHODS We included 56 presymptomatic and 35 symptomatic GRN mutation carriers, and 35 healthy non-carriers. Selected biomarkers were neurofilament light chain (NfL), grey matter volume, white matter microstructure and cognitive domains. We used discriminative event-based modelling to infer the cascade of biomarker changes in FTD-GRN and estimated individual disease severity through cross-validation. We derived the biomarker cascades in non-fluent variant primary progressive aphasia (nfvPPA) and behavioural variant FTD (bvFTD) to understand the differences between these phenotypes. RESULTS Language functioning and NfL were the earliest abnormal biomarkers in FTD-GRN. White matter tracts were affected before grey matter volume, and the left hemisphere degenerated before the right. Based on individual disease severities, presymptomatic carriers could be delineated from symptomatic carriers with a sensitivity of 100% and specificity of 96.1%. The estimated disease severity strongly correlated with functional severity in nfvPPA, but not in bvFTD. In addition, the biomarker cascade in bvFTD showed more uncertainty than nfvPPA. CONCLUSION Degeneration of axons and language deficits are indicated to be the earliest biomarkers in FTD-GRN, with bvFTD being more heterogeneous in disease progression than nfvPPA. Our data-driven model could help identify presymptomatic GRN mutation carriers at risk of conversion to the clinical stage.
Collapse
Affiliation(s)
- Jessica L Panman
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands .,Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vikram Venkatraghavan
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Rebecca M E Steketee
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lize C Jiskoot
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jackie M Poos
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Elise G P Dopper
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lieke H H Meeter
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Laura Donker Kaat
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Serge A R B Rombouts
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Institute for Psychology, Leiden University, Leiden, The Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anneke J A Kievit
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Enrico Premi
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Maura Cosseddu
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Elisa Bonomi
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Jaume Olives
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Raquel Sánchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Esther E Bron
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - John C Van Swieten
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Klein
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | |
Collapse
|
34
|
Donath H, Woelke S, Schubert R, Kieslich M, Theis M, Auburger G, Duecker RP, Zielen S. Neurofilament Light Chain Is a Biomarker of Neurodegeneration in Ataxia Telangiectasia. THE CEREBELLUM 2021; 21:39-47. [PMID: 33893614 PMCID: PMC8885493 DOI: 10.1007/s12311-021-01257-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
Ataxia telangiectasia (A-T) is a progressive and life-limiting disease associated with cerebellar ataxia due to progressive cerebellar degeneration. In addition to ataxia, which is described in detail, the presence of chorea, dystonia, oculomotor apraxia, athetosis, parkinsonism, and myoclonia are typical manifestations of the disease. The study aimed to evaluate the specificity and sensitivity of neurofilament light chain (NfL) as a biomarker of neurodegeneration in relation to SARA score. In this prospective trial, one visit of 42 A-T patients aged 1.3–25.6 years (mean 11.6 ± 7.3 years) was performed, in which NfL was determined from serum by ELISA. Additionally, a neurological examination of the patients was performed. Blood was collected from 19 healthy volunteers ≥ 12 years of age. We found significantly increased levels of NfL in patients with A-T compared to healthy controls (21.5 ± 3.6 pg/mL vs. 9.3 ± 0.49 pg/mL, p ≤ 0.01). There was a significant correlation of NfL with age, AFP, and SARA. NfL is a new potential progression biomarker in blood for neurodegeneration in A-T which increases with age.
Collapse
Affiliation(s)
- H Donath
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany.
| | - S Woelke
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - R Schubert
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - M Kieslich
- Division of Pediatric Neurology, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - M Theis
- Division of Pediatric Neurology, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - G Auburger
- Experimental Neurology, Medical School, Goethe University, Frankfurt, Germany
| | - R P Duecker
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - S Zielen
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| |
Collapse
|
35
|
Raffin J, Rolland Y, Aggarwal G, Nguyen AD, Morley JE, Li Y, Bateman RJ, Vellas B, Barreto PDS. Associations Between Physical Activity, Blood-Based Biomarkers of Neurodegeneration, and Cognition in Healthy Older Adults: The MAPT Study. J Gerontol A Biol Sci Med Sci 2021; 76:1382-1390. [PMID: 33864068 DOI: 10.1093/gerona/glab094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Indexed: 01/12/2023] Open
Abstract
Physical activity (PA) demonstrated benefits on brain health, but its relationship with blood biomarkers of neurodegeneration remains poorly investigated. We explored the cross-sectional associations of PA with blood concentrations of neurofilament light chain (NFL) and beta amyloid (Aβ)42/40. We further examined whether the interaction between PA and these biomarkers was longitudinally related to cognition. Four-hundred and sixty-five nondemented older adults engaged in an interventional study and who had a concomitant assessment of PA levels and blood measurements of NFL (pg/mL) and Aβ 42/40 were analyzed. A composite Z-score combining 4 cognitive tests was used for cognitive assessment up to a 4-year follow-up. Multiple linear regressions demonstrated that people achieving 500-999 and 2000+ MET-min/week of PA had lower (ln)NFL concentrations than their inactive peers. Logistic regressions revealed that achieving at least 90 MET-min/week of PA was associated with a lower probability of having high NFL concentrations (ie, ≥91.961 pg/mL [third quartile]). PA was not associated with (Aβ)42/40. Mixed-model linear regressions demonstrated that the reverse relationship between PA and cognitive decline tended to be more pronounced as Aβ 42/40 increased, while it was dampened with increasing levels of (ln)NFL concentrations. This study demonstrates that PA is associated with blood NFL but not with Aβ 42/40. Furthermore, it suggests that PA may attenuate the negative association between amyloid load and cognition, while having high NFL levels mitigates the favorable relationship between PA and cognition. More investigations on non demented older adults are required for further validation of the present findings.
Collapse
Affiliation(s)
- Jérémy Raffin
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR INSERM, 1027 University of Toulouse III and Faculté de Médecine, France
| | - Geetika Aggarwal
- Division of Geriatric Medicine, Saint Louis University School of Medicine, Missouri, USA.,Henry and Amelia Nasrallah Center for Neuroscience, Saint Louis University, Missouri, USA
| | - Andrew D Nguyen
- Division of Geriatric Medicine, Saint Louis University School of Medicine, Missouri, USA.,Henry and Amelia Nasrallah Center for Neuroscience, Saint Louis University, Missouri, USA
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, Missouri, USA
| | - Yan Li
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.,Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Randall J Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR INSERM, 1027 University of Toulouse III and Faculté de Médecine, France
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR INSERM, 1027 University of Toulouse III and Faculté de Médecine, France
| | | |
Collapse
|
36
|
Dreger M, Steinbach R, Gaur N, Metzner K, Stubendorff B, Witte OW, Grosskreutz J. Cerebrospinal Fluid Neurofilament Light Chain (NfL) Predicts Disease Aggressiveness in Amyotrophic Lateral Sclerosis: An Application of the D50 Disease Progression Model. Front Neurosci 2021; 15:651651. [PMID: 33889072 PMCID: PMC8056017 DOI: 10.3389/fnins.2021.651651] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a relentlessly progressive neurodegenerative disorder. As previous therapeutic trials in ALS have been severely hampered by patients’ heterogeneity, the identification of biomarkers that reliably reflect disease progression represents a priority in ALS research. Here, we used the D50 disease progression model to investigate correlations between cerebrospinal fluid (CSF) neurofilament light chain (NfL) levels and disease aggressiveness. The D50 model quantifies individual disease trajectories for each ALS patient. The value D50 provides a unified measure of a patient’s overall disease aggressiveness (defined as time taken in months to lose 50% of functionality). The relative D50 (rD50) reflects the individual disease covered and can be calculated for any time point in the disease course. We analyzed clinical data from a well-defined cohort of 156 patients with ALS. The concentration of NfL in CSF samples was measured at two different laboratories using the same procedure. Based on patients’ individual D50 values, we defined subgroups with high (<20), intermediate (20–40), or low (>40) disease aggressiveness. NfL levels were compared between these subgroups via analysis of covariance, using an array of confounding factors: age, gender, clinical phenotype, frontotemporal dementia, rD50-derived disease phase, and analyzing laboratory. We found highly significant differences in NfL concentrations between all three D50 subgroups (p < 0.001), representing an increase of NfL levels with increasing disease aggressiveness. The conducted analysis of covariance showed that this correlation was independent of gender, disease phenotype, and phase; however, age, analyzing laboratory, and dementia significantly influenced NfL concentration. We could show that CSF NfL is independent of patients’ disease covered at the time of sampling. The present study provides strong evidence for the potential of NfL to reflect disease aggressiveness in ALS and in addition proofed to remain at stable levels throughout the disease course. Implementation of CSF NfL as a potential read-out for future therapeutic trials in ALS is currently constrained by its demonstrated susceptibility to (pre-)analytical variations. Here we show that the D50 model enables the discovery of correlations between clinical characteristics and CSF analytes and can be recommended for future studies evaluating potential biomarkers.
Collapse
Affiliation(s)
- Marie Dreger
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Robert Steinbach
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Nayana Gaur
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Klara Metzner
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| |
Collapse
|
37
|
Kessler C, Serna-Higuita LM, Rattay TW, Maetzler W, Wurster I, Hayer S, Wilke C, Hengel H, Reichbauer J, Armbruster M, Schöls L, Martus P, Schüle R. Neurofilament light chain is a cerebrospinal fluid biomarker in hereditary spastic paraplegia. Ann Clin Transl Neurol 2021; 8:1122-1131. [PMID: 33819388 PMCID: PMC8108414 DOI: 10.1002/acn3.51358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/22/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022] Open
Abstract
Objective Despite the need for diagnostics and research, data on fluid biomarkers in hereditary spastic paraplegia (HSP) are scarce. We, therefore, explore Neurofilament light chain (NfL) levels in cerebrospinal fluid (CSF) of patients with hereditary spastic paraplegia and provide information on the influence of demographic factors. Methods The study recruited 59 HSP cases (33 genetically confirmed) and 59 controls matched in age and sex. Neurofilament light chain levels were assessed by enzyme‐linked immunosorbent assay. The statistical analysis included the effects of age, sex, and genetic status (confirmed vs. not confirmed). Results Levels of CSF NfL were significantly increased in patients with hereditary spastic paraplegia compared to controls (median 741 pg/mL vs. 387 pg/mL, p < 0.001). Age (1.4% annual increase) and male sex (81% increase) impacted CSF NfL levels in patients. The age‐dependent increase of CSF NfL levels was steeper in controls (2.6% annual increase). Thus, the CSF NfL ratio of patients and matched controls—expressing patients’ fold increases in CSF NfL—declined considerably with age. Interpretation CSF NfL is a reliable cross‐sectional biomarker in hereditary spastic paraplegia. Sex is a relevant factor to consider, as male patients have remarkably higher CSF NfL levels. While levels also increase with age, the gap between patients and controls is narrowing in older subjects. This indicates distinct temporal dynamics of CSF NfL in patients with hereditary spastic paraplegia, with a rise around phenotypic conversion and comparatively static levels afterward.
Collapse
Affiliation(s)
- Christoph Kessler
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Lina M Serna-Higuita
- Department of Clinical Epidemiology and Applied Biostatistics, University of Tübingen, Tübingen, Germany
| | - Tim W Rattay
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Kiel University and University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Isabel Wurster
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Stefanie Hayer
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Carlo Wilke
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Holger Hengel
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Jennifer Reichbauer
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | | | - Ludger Schöls
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Peter Martus
- Department of Clinical Epidemiology and Applied Biostatistics, University of Tübingen, Tübingen, Germany
| | - Rebecca Schüle
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,Center of Neurology, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| |
Collapse
|
38
|
Gagliardi D, Faravelli I, Meneri M, Saccomanno D, Govoni A, Magri F, Ricci G, Siciliano G, Pietro Comi G, Corti S. Diagnostic and prognostic value of CSF neurofilaments in a cohort of patients with motor neuron disease: A cross-sectional study. J Cell Mol Med 2021; 25:3765-3771. [PMID: 33609080 PMCID: PMC8051694 DOI: 10.1111/jcmm.16240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022] Open
Abstract
Motor neuron disease (MND) is a rare group of disorders characterized by degeneration of motor neurons (MNs). The most common form of MND, amyotrophic lateral sclerosis (ALS), is an incurable disease with a variable rate of progression. The search of robust biomarkers able to discriminate among different ALS forms is paramount to properly stratify patients, and to identify those who could most likely benefit from experimental therapies. Phosphorylated‐neurofilament heavy chain (p‐NfH) and neurofilament light chain (NfL) are neuron‐specific components of the cytoskeleton and may represent reliable markers of neuronal injury in neurological disorders. In this study, we described our cohort of ALS patients in order to investigate whether and how cerebrospinal fluid (CSF) p‐NfH and NfL levels may reflect progression rate, MN involvement and the extent of neurodegeneration. CSF p‐NfH and NfL were significantly increased in ALS compared with healthy and disease controls, including patients with other forms of MND, and were higher in patients with more aggressive disease course, reflecting progression rate. We also evaluated neurofilament diagnostic accuracy in our centre, identifying with high sensitivity and 100% specificity cut‐off values of 0.652 ng/mL for CSF p‐NfH (P < .0001) and of 1261 pg/mL for NfL (P < .0001) in discriminating ALS from healthy controls. CSF neurofilaments were significantly correlated with ALS progression rate. Overall, CSF neurofilaments appear to reflect the burden of neurodegeneration in MND and represent reliable diagnostic and prognostic biomarkers in ALS.
Collapse
Affiliation(s)
- Delia Gagliardi
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Milan, Italy
| | - Irene Faravelli
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Milan, Italy
| | - Megi Meneri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Domenica Saccomanno
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Alessandra Govoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy.,Neurological Clinics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Magri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Giulia Ricci
- Neurological Clinics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Neurological Clinics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giacomo Pietro Comi
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Stefania Corti
- Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| |
Collapse
|
39
|
Flynn S, Leete J, Shahim P, Pattinson C, Guedes VA, Lai C, Devoto C, Qu BX, Greer K, Moore B, van der Merwe A, Ekanayake V, Gill J, Chan L. Extracellular vesicle concentrations of glial fibrillary acidic protein and neurofilament light measured 1 year after traumatic brain injury. Sci Rep 2021; 11:3896. [PMID: 33594224 PMCID: PMC7887207 DOI: 10.1038/s41598-021-82875-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/08/2021] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) is linked to long-term symptoms in a sub-set of patients who sustain an injury, but this risk is not universal, leading us and others to question the nature of individual variability in recovery trajectories. Extracellular vesicles (EVs) are a promising, novel avenue to identify blood-based biomarkers for TBI. Here, our aim was to determine if glial fibrillary acidic protein (GFAP) and neurofilament light (NfL) measured 1-year postinjury in EVs could distinguish patients from controls, and whether these biomarkers relate to TBI severity or recovery outcomes. EV GFAP and EV NfL were measured using an ultrasensitive assay in 72 TBI patients and 20 controls. EV GFAP concentrations were elevated in moderate and severe TBI compared to controls (p’s < 0.001) and could distinguish controls from moderate (AUC = 0.86) or severe TBI (AUC = 0.88). Increased EV GFAP and EV NfL levels were associated with lower 1-year Glasgow Outcome Scale–Extended (GOS-E) score (p’s < 0.05). These findings suggest that blood-derived EV concentrations of GFAP and NfL drawn even 1 year after injury are higher in TBI patients compared to controls, and are related to injury severity and poor recovery outcomes, suggesting that TBIs alter the activity of these biomarkers, likely contributing to individual variability in recovery.
Collapse
Affiliation(s)
- Spencer Flynn
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Jacqueline Leete
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Pashtun Shahim
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA. .,Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA.
| | - Cassandra Pattinson
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Vivian A Guedes
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Chen Lai
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Christina Devoto
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Bao-Xi Qu
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Kisha Greer
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Brian Moore
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Andre van der Merwe
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Vindhya Ekanayake
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jessica Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA.,Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA
| |
Collapse
|
40
|
Falzone YM, Russo T, Domi T, Pozzi L, Quattrini A, Filippi M, Riva N. Current application of neurofilaments in amyotrophic lateral sclerosis and future perspectives. Neural Regen Res 2021; 16:1985-1991. [PMID: 33642372 PMCID: PMC8343335 DOI: 10.4103/1673-5374.308072] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Motor neuron disease includes a heterogeneous group of relentless progressive neurological disorders defined and characterized by the degeneration of motor neurons. Amyotrophic lateral sclerosis is the most common and aggressive form of motor neuron disease with no effective treatment so far. Unfortunately, diagnostic and prognostic biomarkers are lacking in clinical practice. Neurofilaments are fundamental structural components of the axons and neurofilament light chain and phosphorylated neurofilament heavy chain can be measured in both cerebrospinal fluid and serum. Neurofilament light chain and phosphorylated neurofilament heavy chain levels are elevated in amyotrophic lateral sclerosis, reflecting the extensive damage of motor neurons and axons. Hence, neurofilaments are now increasingly recognized as the most promising candidate biomarker in amyotrophic lateral sclerosis. The potential usefulness of neurofilaments regards various aspects, including diagnosis, prognosis, patient stratification in clinical trials and evaluation of treatment response. In this review paper, we review the body of literature about neurofilaments measurement in amyotrophic lateral sclerosis. We also discuss the open issues concerning the use of neurofilaments clinical practice, as no overall guideline exists to date; finally, we address the most recent evidence and future perspectives.
Collapse
Affiliation(s)
- Yuri Matteo Falzone
- Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute; Neurology and Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Tommaso Russo
- Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute; Neurology and Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Teuta Domi
- Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Laura Pozzi
- Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Quattrini
- Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neurology and Neurorehabilitation Unit; Neurophysiology Unit, IRCCS San Raffaele Scientific Institute; Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute; Vita-Salute San Rafaele University, Milan, Italy
| | - Nilo Riva
- Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute; Neurology and Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
41
|
Saraste M, Bezukladova S, Matilainen M, Tuisku J, Rissanen E, Sucksdorff M, Laaksonen S, Vuorimaa A, Kuhle J, Leppert D, Airas L. High serum neurofilament associates with diffuse white matter damage in MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 8:8/1/e926. [PMID: 33293460 PMCID: PMC7803327 DOI: 10.1212/nxi.0000000000000926] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/21/2020] [Indexed: 01/24/2023]
Abstract
Objective To evaluate to which extent serum neurofilament light chain (NfL) increase is
related to diffusion tensor imaging–MRI measurable diffuse
normal-appearing white matter (NAWM) damage in MS. Methods Seventy-nine patients with MS and 10 healthy controls underwent MRI including
diffusion tensor sequences and serum NfL determination by single molecule
array (Simoa). Fractional anisotropy and mean, axial, and radial
diffusivities were calculated within the whole and segmented (frontal,
parietal, temporal, occipital, cingulate, and deep) NAWM. Spearman
correlations and multiple regression models were used to assess the
associations between diffusion tensor imaging, volumetric MRI data, and
NfL. Results Elevated NfL correlated with decreased fractional anisotropy and increased
mean, axial, and radial diffusivities in the entire and segmented NAWM (for
entire NAWM ρ = −0.49, p = 0.005;
ρ = 0.49, p = 0.005; ρ = 0.43,
p = 0.018; and ρ = 0.48,
p = 0.006, respectively). A multiple regression
model examining the effect of diffusion tensor indices on NfL showed
significant associations when adjusted for sex, age, disease type, the
expanded disability status scale, treatment, and presence of relapses. In
the same model, T2 lesion volume was similarly associated with NfL. Conclusions Our findings suggest that elevated serum NfL in MS results from neuroaxonal
damage both within the NAWM and focal T2 lesions. This pathologic
heterogeneity ought to be taken into account when interpreting NfL findings
at the individual patient level.
Collapse
Affiliation(s)
- Maija Saraste
- From the Turku PET Centre, Turku University Hospital and University of Turku (M. Saraste, S.B., M.M., J.T., E.R., M. Sucksdorff, S.L., A.V., L.A.); Division of Clinical Neurosciences (E.R., M. Sucksdorff, S.L., A.V., L.A.), Turku University Hospital, Finland; and Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic (J.K., D.L.), University Hospital Basel, Switzerland.
| | - Svetlana Bezukladova
- From the Turku PET Centre, Turku University Hospital and University of Turku (M. Saraste, S.B., M.M., J.T., E.R., M. Sucksdorff, S.L., A.V., L.A.); Division of Clinical Neurosciences (E.R., M. Sucksdorff, S.L., A.V., L.A.), Turku University Hospital, Finland; and Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic (J.K., D.L.), University Hospital Basel, Switzerland
| | - Markus Matilainen
- From the Turku PET Centre, Turku University Hospital and University of Turku (M. Saraste, S.B., M.M., J.T., E.R., M. Sucksdorff, S.L., A.V., L.A.); Division of Clinical Neurosciences (E.R., M. Sucksdorff, S.L., A.V., L.A.), Turku University Hospital, Finland; and Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic (J.K., D.L.), University Hospital Basel, Switzerland
| | - Jouni Tuisku
- From the Turku PET Centre, Turku University Hospital and University of Turku (M. Saraste, S.B., M.M., J.T., E.R., M. Sucksdorff, S.L., A.V., L.A.); Division of Clinical Neurosciences (E.R., M. Sucksdorff, S.L., A.V., L.A.), Turku University Hospital, Finland; and Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic (J.K., D.L.), University Hospital Basel, Switzerland
| | - Eero Rissanen
- From the Turku PET Centre, Turku University Hospital and University of Turku (M. Saraste, S.B., M.M., J.T., E.R., M. Sucksdorff, S.L., A.V., L.A.); Division of Clinical Neurosciences (E.R., M. Sucksdorff, S.L., A.V., L.A.), Turku University Hospital, Finland; and Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic (J.K., D.L.), University Hospital Basel, Switzerland
| | - Marcus Sucksdorff
- From the Turku PET Centre, Turku University Hospital and University of Turku (M. Saraste, S.B., M.M., J.T., E.R., M. Sucksdorff, S.L., A.V., L.A.); Division of Clinical Neurosciences (E.R., M. Sucksdorff, S.L., A.V., L.A.), Turku University Hospital, Finland; and Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic (J.K., D.L.), University Hospital Basel, Switzerland
| | - Sini Laaksonen
- From the Turku PET Centre, Turku University Hospital and University of Turku (M. Saraste, S.B., M.M., J.T., E.R., M. Sucksdorff, S.L., A.V., L.A.); Division of Clinical Neurosciences (E.R., M. Sucksdorff, S.L., A.V., L.A.), Turku University Hospital, Finland; and Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic (J.K., D.L.), University Hospital Basel, Switzerland
| | - Anna Vuorimaa
- From the Turku PET Centre, Turku University Hospital and University of Turku (M. Saraste, S.B., M.M., J.T., E.R., M. Sucksdorff, S.L., A.V., L.A.); Division of Clinical Neurosciences (E.R., M. Sucksdorff, S.L., A.V., L.A.), Turku University Hospital, Finland; and Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic (J.K., D.L.), University Hospital Basel, Switzerland
| | - Jens Kuhle
- From the Turku PET Centre, Turku University Hospital and University of Turku (M. Saraste, S.B., M.M., J.T., E.R., M. Sucksdorff, S.L., A.V., L.A.); Division of Clinical Neurosciences (E.R., M. Sucksdorff, S.L., A.V., L.A.), Turku University Hospital, Finland; and Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic (J.K., D.L.), University Hospital Basel, Switzerland
| | - David Leppert
- From the Turku PET Centre, Turku University Hospital and University of Turku (M. Saraste, S.B., M.M., J.T., E.R., M. Sucksdorff, S.L., A.V., L.A.); Division of Clinical Neurosciences (E.R., M. Sucksdorff, S.L., A.V., L.A.), Turku University Hospital, Finland; and Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic (J.K., D.L.), University Hospital Basel, Switzerland
| | - Laura Airas
- From the Turku PET Centre, Turku University Hospital and University of Turku (M. Saraste, S.B., M.M., J.T., E.R., M. Sucksdorff, S.L., A.V., L.A.); Division of Clinical Neurosciences (E.R., M. Sucksdorff, S.L., A.V., L.A.), Turku University Hospital, Finland; and Departments of Medicine, Biomedicine and Clinical Research, Neurologic Clinic and Policlinic (J.K., D.L.), University Hospital Basel, Switzerland
| |
Collapse
|
42
|
Wang SY, Chen W, Xu W, Li JQ, Hou XH, Ou YN, Yu JT, Tan L. Neurofilament Light Chain in Cerebrospinal Fluid and Blood as a Biomarker for Neurodegenerative Diseases: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2020; 72:1353-1361. [PMID: 31744001 DOI: 10.3233/jad-190615] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neurofilament light chain (NFL) as a potential biomarker of neurodegenerative diseases has been studied in a number of studies. Thus, a comprehensive meta-analysis is warranted to assess NFL performance in neurodegenerative diseases. OBJECTIVE To assess the performance of NFL in blood and cerebrospinal fluid (CSF) as a biomarker for neurodegenerative diseases. METHODS A total of 36 studies with comparison of NFL level between individuals with neurodegenerative diseases and controls were retrieved from PubMed, Web of Science and Science Direct, and the ratio of means method and delta method based on the random-effect model were used to analyze the differentiation of NFL between patients and controls. RESULTS Differentiation of CSF NFL between patients with neurodegenerative diseases and controls showed significant results. Although a few studies on blood NFL available were included in the meta-analysis, the results still showed a distinct possibility that NFL could be a potential biomarker for neurodegenerative diseases. NFL levels were increased significantly in dementias, amyotrophic lateral sclerosis, Creutzfeldt-Jakob disease, and Huntington's disease. By contrast, NFL levels were not increased in Parkinson's disease (PD), although they were increased significantly in PD-related disorders (multiple system atrophy and progressive supranuclear palsy). CONCLUSIONS In our study, in addition to PD, NFL was suggested to be a global diagnostic biomarker for neurodegenerative diseases. Moreover, it could be used in differential diagnosis of PD and PD-related disorders. However, it was worth noting that NFL was not appropriate for diagnosis or differential diagnosis without clinical symptoms and other auxiliary examinations.
Collapse
Affiliation(s)
- Shao-Yang Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei Chen
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jie-Qiong Li
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xiao-He Hou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| |
Collapse
|
43
|
Spotorno N, Lindberg O, Nilsson C, Landqvist Waldö M, van Westen D, Nilsson K, Vestberg S, Englund E, Zetterberg H, Blennow K, Lätt J, Markus N, Lars-Olof W, Alexander S. Plasma neurofilament light protein correlates with diffusion tensor imaging metrics in frontotemporal dementia. PLoS One 2020; 15:e0236384. [PMID: 33108404 PMCID: PMC7591030 DOI: 10.1371/journal.pone.0236384] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/12/2020] [Indexed: 12/02/2022] Open
Abstract
Neurofilaments are structural components of neurons and are particularly abundant in highly myelinated axons. The levels of neurofilament light chain (NfL) in both cerebrospinal fluid (CSF) and plasma have been related to degeneration in several neurodegenerative conditions including frontotemporal dementia (FTD) and NfL is currently considered as the most promising diagnostic and prognostic fluid biomarker in FTD. Although the location and function of filaments in the healthy nervous system suggests a link between increased NfL and white matter degeneration, such a claim has not been fully elucidated in vivo, especially in the context of FTD. The present study provides evidence of an association between the plasma levels of NfL and white matter involvement in behavioral variant FTD (bvFTD) by relating plasma concentration of NfL to diffusion tensor imaging (DTI) metrics in a group of 20 bvFTD patients. The results of both voxel-wise and tract specific analysis showed that increased plasma NfL concentration is associated with a reduction in fractional anisotropy (FA) in a widespread set of white matter tracts including the superior longitudinal fasciculus, the fronto-occipital fasciculus the anterior thalamic radiation and the dorsal cingulum bundle. Plasma NfL concentration also correlated with cortical thinning in a portion of the right medial prefrontal cortex and of the right lateral orbitofrontal cortex. These results support the hypothesis that blood NfL levels reflect the global level of neurodegeneration in bvFTD and help to advance our understanding of the association between this blood biomarker for FTD and the disease process.
Collapse
Affiliation(s)
- Nicola Spotorno
- Department of Neurology, Penn Frontotemporal Degeneration Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Olof Lindberg
- Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
| | - Christer Nilsson
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Maria Landqvist Waldö
- Department of clinical Sciences, Clinical Sciences Helsingborg, Lund, Lund University, Lund, Sweden
| | - Danielle van Westen
- Department of Diagnostic Radiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Karin Nilsson
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | | | - Elisabet Englund
- Division of Pathology, Department of Clinical Sciences, Lund, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & 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, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jimmy Lätt
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Nilsson Markus
- Department of Diagnostic Radiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Wahlund Lars-Olof
- Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
| | - Santillo Alexander
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| |
Collapse
|
44
|
Zucchi E, Bonetto V, Sorarù G, Martinelli I, Parchi P, Liguori R, Mandrioli J. Neurofilaments in motor neuron disorders: towards promising diagnostic and prognostic biomarkers. Mol Neurodegener 2020; 15:58. [PMID: 33059698 PMCID: PMC7559190 DOI: 10.1186/s13024-020-00406-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/18/2020] [Indexed: 12/11/2022] Open
Abstract
Motor neuron diseases (MNDs) are etiologically and biologically heterogeneous diseases. The pathobiology of motor neuron degeneration is still largely unknown, and no effective therapy is available. Heterogeneity and lack of specific disease biomarkers have been appointed as leading reasons for past clinical trial failure, and biomarker discovery is pivotal in today's MND research agenda.In the last decade, neurofilaments (NFs) have emerged as promising biomarkers for the clinical assessment of neurodegeneration. NFs are scaffolding proteins with predominant structural functions contributing to the axonal cytoskeleton of myelinated axons. NFs are released in CSF and peripheral blood as a consequence of axonal degeneration, irrespective of the primary causal event. Due to the current availability of highly-sensitive automated technologies capable of precisely quantify proteins in biofluids in the femtomolar range, it is now possible to reliably measure NFs not only in CSF but also in blood.In this review, we will discuss how NFs are impacting research and clinical management in ALS and other MNDs. Besides contributing to the diagnosis at early stages by differentiating between MNDs with different clinical evolution and severity, NFs may provide a useful tool for the early enrolment of patients in clinical trials. Due to their stability across the disease, NFs convey prognostic information and, on a larger scale, help to stratify patients in homogenous groups. Shortcomings of NFs assessment in biofluids will also be discussed according to the available literature in the attempt to predict the most appropriate use of the biomarker in the MND clinic.
Collapse
Affiliation(s)
- Elisabetta Zucchi
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Bonetto
- Department of Biochemistry and Molecular Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Gianni Sorarù
- Neuromuscular Center, Department of Neurosciences, University of Padova, Padua, Italy.,Clinica Neurologica, Azienda Ospedaliera di Padova, Padua, Italy
| | - Ilaria Martinelli
- Department of Neurosciences, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Piero Parchi
- IRCCS Istituto delle Scienze Neurologiche, Ospedale Bellaria, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche, Ospedale Bellaria, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Jessica Mandrioli
- Department of Neurosciences, Azienda Ospedaliero Universitaria Modena, Modena, Italy.
| |
Collapse
|
45
|
van Ballegoij WJC, van de Stadt SIW, Huffnagel IC, Kemp S, Willemse EAJ, Teunissen CE, Engelen M. Plasma NfL and GFAP as biomarkers of spinal cord degeneration in adrenoleukodystrophy. Ann Clin Transl Neurol 2020; 7:2127-2136. [PMID: 33047897 PMCID: PMC7664277 DOI: 10.1002/acn3.51188] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the potential of neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) as biomarkers of spinal cord degeneration in adrenoleukodystrophy, as objective treatment-outcome parameters are needed. METHODS Plasma NfL and GFAP levels were measured in 45 male and 47 female ALD patients and compared to a reference cohort of 73 healthy controls. For male patients, cerebrospinal fluid (CSF) samples (n = 33) and 1-year (n = 39) and 2-year (n = 18) follow-up data were also collected. Severity of myelopathy was assessed with clinical parameters: Expanded Disability Status Scale (EDSS), Severity Scoring system for Progressive Myelopathy (SSPROM), and timed up-and-go. RESULTS NfL and GFAP levels were higher in male (P < 0.001, effect size (partial ƞ2 ) NfL = 0.49, GFAP = 0.13) and female (P < 0.001, effect size NfL = 0.19, GFAP = 0.23) patients compared to controls; levels were higher in both symptomatic and asymptomatic patients. In male patients, NfL levels were associated with all three clinical parameters of severity of myelopathy (EDSS, SSPROM, and timed up-and go), while GFAP in male and NfL and GFAP in female patients were not. Changes in clinical parameters during follow-up did not correlate with (changes in) NfL or GFAP levels. Plasma and CSF NfL were strongly correlated (r = 0.60, P < 0.001), but plasma and CSF GFAP were not (r = 0.005, P = 0.98). INTERPRETATION Our study illustrates the potential of plasma NfL as biomarker of spinal cord degeneration in adrenoleukodystrophy, which was superior to plasma GFAP in our cohort.
Collapse
Affiliation(s)
- Wouter J C van Ballegoij
- Department of Paediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, OLVG Hospital, Amsterdam, The Netherlands
| | - Stephanie I W van de Stadt
- Department of Paediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene C Huffnagel
- Department of Paediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephan Kemp
- Department of Paediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam University Medical Centers, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands
| | - Eline A J Willemse
- Neurochemistry lab and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry lab and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Marc Engelen
- Department of Paediatric Neurology, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
46
|
Sun Q, Zhao X, Li S, Yang F, Wang H, Cui F, Huang X. CSF Neurofilament Light Chain Elevation Predicts ALS Severity and Progression. Front Neurol 2020; 11:919. [PMID: 32982935 PMCID: PMC7484044 DOI: 10.3389/fneur.2020.00919] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives: This study compared neurofilament light chain (NFL) levels in the cerebrospinal fluid (CSF) of patients with sporadic amyotrophic lateral sclerosis (sALS) with levels in patients with other neurological diseases and healthy controls and assessed correlations between NFL levels and clinical indicators of sALS. Methods: We used enzyme-linked immunosorbent assays to determine the NFL levels in the CSF of 45 patients with sALS, 21 patients with other central nervous system diseases (OCNSDs), 18 with immune-mediated peripheral neuropathy (IMPN), 14 with non-immune-mediated peripheral neuropathy (NIMPN), and 19 healthy controls (HCs). Results: The median NFL levels in the CSF of the sALS, OCNSD, IMPN, NIMPN, and HC groups were 6510, 5372, 4320, 1477, and 756 pg/mL, respectively. The CSF NFL levels did not differ significantly among the sALS, IMPN, and OCNSD groups, but were significantly higher than those of the NIMPN and HC groups. The NFL CSF levels were significantly higher in the NIMPN group than the HCs. There was a negative correlation between the NFL level and ALS function score (ALSFRS-R), and a positive correlation with the disease progression rate in patients with sALS. Conclusion: CSF NFL may not be sufficient to distinguish ALS from other central nervous system diseases or peripheral neuropathy, but it predicts ALS severity and progression.
Collapse
Affiliation(s)
- Qionghua Sun
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
| | - Xue Zhao
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
| | - Siyuan Li
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fei Yang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongfen Wang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fang Cui
- Neurological Department of Hainan Hospital, Chinese PLA General Hospital, Sanya, China
| | - Xusheng Huang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
| |
Collapse
|
47
|
Different Clinical Contexts of Use of Blood Neurofilament Light Chain Protein in the Spectrum of Neurodegenerative Diseases. Mol Neurobiol 2020; 57:4667-4691. [PMID: 32772223 DOI: 10.1007/s12035-020-02035-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Abstract
One of the most pressing challenges in the clinical research of neurodegenerative diseases (NDDs) is the validation and standardization of pathophysiological biomarkers for different contexts of use (CoUs), such as early detection, diagnosis, prognosis, and prediction of treatment response. Neurofilament light chain (NFL) concentration is a particularly promising candidate, an indicator of axonal degeneration, which can be analyzed in peripheral blood with advanced ultrasensitive methods. Serum/plasma NFL concentration is closely correlated with cerebrospinal fluid NFL and directly reflects neurodegeneration within the central nervous system. Here, we provide an update on the feasible CoU of blood NFL in NDDs and translate recent findings to potentially valuable clinical practice applications. As NFL is not a disease-specific biomarker, however, blood NFL is an easily accessible biomarker with promising different clinical applications for several NDDs: (1) early detection and diagnosis (i.e., amyotrophic lateral sclerosis, Creutzfeldt-Jakob disease, atypical parkinsonisms, sporadic late-onset ataxias), (2) prognosis (Huntington's disease and Parkinson's disease), and (3) prediction of time to symptom onset (presymptomatic mutation carriers in genetic Alzheimer's disease and spinocerebellar ataxia type 3).
Collapse
|
48
|
Wilke C, Haas E, Reetz K, Faber J, Garcia‐Moreno H, Santana MM, van de Warrenburg B, Hengel H, Lima M, Filla A, Durr A, Melegh B, Masciullo M, Infante J, Giunti P, Neumann M, de Vries J, Pereira de Almeida L, Rakowicz M, Jacobi H, Schüle R, Kaeser SA, Kuhle J, Klockgether T, Schöls L, Barro C, Hübener‐Schmid J, Synofzik M. Neurofilaments in spinocerebellar ataxia type 3: blood biomarkers at the preataxic and ataxic stage in humans and mice. EMBO Mol Med 2020; 12:e11803. [PMID: 32510847 PMCID: PMC7338806 DOI: 10.15252/emmm.201911803] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 12/13/2022] Open
Abstract
With molecular treatments coming into reach for spinocerebellar ataxia type 3 (SCA3), easily accessible, cross-species validated biomarkers for human and preclinical trials are warranted, particularly for the preataxic disease stage. We assessed serum levels of neurofilament light (NfL) and phosphorylated neurofilament heavy (pNfH) in ataxic and preataxic subjects of two independent multicentric SCA3 cohorts and in a SCA3 knock-in mouse model. Ataxic SCA3 subjects showed increased levels of both NfL and pNfH. In preataxic subjects, NfL levels increased with proximity to the individual expected onset of ataxia, with significant NfL elevations already 7.5 years before onset. Cross-sectional NfL levels correlated with both disease severity and longitudinal disease progression. Blood NfL and pNfH increases in human SCA3 were each paralleled by similar changes in SCA3 knock-in mice, here also starting already at the presymptomatic stage, closely following ataxin-3 aggregation and preceding Purkinje cell loss in the brain. Blood neurofilaments, particularly NfL, might thus provide easily accessible, cross-species validated biomarkers in both ataxic and preataxic SCA3, associated with earliest neuropathological changes, and serve as progression, proximity-to-onset and, potentially, treatment-response markers in both human and preclinical SCA3 trials.
Collapse
|
49
|
Guedes VA, Kenney K, Shahim P, Qu BX, Lai C, Devoto C, Walker WC, Nolen T, Diaz-Arrastia R, Gill JM. Exosomal neurofilament light: A prognostic biomarker for remote symptoms after mild traumatic brain injury? Neurology 2020; 94:e2412-e2423. [PMID: 32461282 PMCID: PMC7455370 DOI: 10.1212/wnl.0000000000009577] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To measure exosomal and plasma levels of candidate blood biomarkers in veterans with history of mild traumatic brain injury (mTBI) and test their relationship with chronic symptoms. METHODS Exosomal and plasma levels of neurofilament light (NfL) chain, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and vascular endothelial growth factor (VEGF) were measured using an ultrasensitive assay in a cohort of 195 veterans, enrolled in the Chronic Effects of Neurotrauma Consortium Longitudinal Study. We examined relationships between candidate biomarkers and symptoms of postconcussive syndrome (PCS), posttraumatic stress disorder (PTSD), and depression. Biomarker levels were compared among those with no traumatic brain injury (TBI) (controls), 1-2 mTBIs, and repetitive (3 or more) mTBIs. RESULTS Elevated exosomal and plasma levels of NfL were associated with repetitive mTBIs and with chronic PCS, PTSD, and depression symptoms. Plasma TNF-α levels correlated with PCS and PTSD symptoms. The total number of mTBIs correlated with exosomal and plasma NfL levels and plasma IL-6. Increased number of years since the most recent TBI correlated with higher exosomal NfL and lower plasma IL-6 levels, while increased number of years since first TBI correlated with higher levels of exosomal and plasma NfL, as well as plasma TNF-α and VEGF. CONCLUSION Repetitive mTBIs are associated with elevated exosomal and plasma levels of NfL, even years following these injuries, with the greatest elevations in those with chronic PCS, PTSD, and depression symptoms. Our results suggest a possible neuroinflammatory and axonal disruptive basis for symptoms that persist years after mTBI, especially repetitive.
Collapse
Affiliation(s)
- Vivian A Guedes
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Kimbra Kenney
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia.
| | - Pashtun Shahim
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Bao-Xi Qu
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Chen Lai
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Christina Devoto
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - William C Walker
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Tracy Nolen
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Ramon Diaz-Arrastia
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Jessica M Gill
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| |
Collapse
|
50
|
Serum neurofilament light chain levels are associated with white matter integrity in autosomal dominant Alzheimer's disease. Neurobiol Dis 2020; 142:104960. [PMID: 32522711 PMCID: PMC7363568 DOI: 10.1016/j.nbd.2020.104960] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/03/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022] Open
Abstract
Neurofilament light chain (NfL) is a protein that is selectively expressed in neurons. Increased levels of NfL measured in either cerebrospinal fluid or blood is thought to be a biomarker of neuronal damage in neurodegenerative diseases. However, there have been limited investigations relating NfL to the concurrent measures of white matter (WM) decline that it should reflect. White matter damage is a common feature of Alzheimer's disease. We hypothesized that serum levels of NfL would associate with WM lesion volume and diffusion tensor imaging (DTI) metrics cross-sectionally in 117 autosomal dominant mutation carriers (MC) compared to 84 non-carrier (NC) familial controls as well as in a subset (N = 41) of MC with longitudinal NfL and MRI data. In MC, elevated cross-sectional NfL was positively associated with WM hyperintensity lesion volume, mean diffusivity, radial diffusivity, and axial diffusivity and negatively with fractional anisotropy. Greater change in NfL levels in MC was associated with larger changes in fractional anisotropy, mean diffusivity, and radial diffusivity, all indicative of reduced WM integrity. There were no relationships with NfL in NC. Our results demonstrate that blood-based NfL levels reflect WM integrity and supports the view that blood levels of NfL are predictive of WM damage in the brain. This is a critical result in improving the interpretability of NfL as a marker of brain integrity, and for validating this emerging biomarker for future use in clinical and research settings across multiple neurodegenerative diseases. Serum NfL levels reflect white matter integrity in autosomal dominant Alzheimer disease. Associations between NfL and white matter imaging are present throughout all brain regions. Longitudinal white matter alterations are associated with changes in blood NfL. Results improve interpretability of NfL as a marker of brain integrity.
Collapse
|