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Öz F, Kaya İ, Tanır Y, Küçükgergin C, Aydın AF. Comparison of Serum Neurofilament Light Chain and Tau Protein Levels in Cases with Autism Spectrum Disorder and Their Healthy Siblings and Healthy Controls. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:502-511. [PMID: 39069690 PMCID: PMC11289602 DOI: 10.9758/cpn.23.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/03/2024] [Accepted: 04/22/2024] [Indexed: 07/30/2024]
Abstract
Objective : There is a growing interest among clinicians and researchers in identifying potential biomarkers associated with autism. Neurofilament light chain (NfL) and Tau protein, which are proteins associated with neurodegeneration and neuroaxonal degeneration, are particularly promising potential biomarker candidates in this field. Methods : In this study, we compared serum NfL (sNfL) and serum Tau (sTau) levels in Autism spectrum disorder (ASD) patients, their healthy siblings (HS), and healthy controls (HC), aimed to investigate their relationship with ASD severity. Our study included 43 ASD-diagnosed participants, 43 HS participants and 42 HC participants. Clinical characteristics of the participants were assesed by Kiddie Schedule for Affective Disorders and Schizophrenia, Childhood Autism Rating Scale, Aberrant Behavior Checklist, and Strengths and Difficulties Questionnaire. Serum samples were subjected to analysis via enzyme-linked immunosorbent assay to quantitatively measure the levels of NfL and Tau protein. Results : sNfL levels in the ASD group were significantly higher than both of the control groups. Regarding sTau levels, no significant difference was found between study and control groups. In addition, NfL and Tau levels were not significantly correlated with ASD symptom severity. Conclusion : Our findings may indicate that the sNfl levels associated with neuroaxonal damage may constitue a potential clinical biomarker rather than being an endophenotype phenomena.
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Affiliation(s)
- Fırat Öz
- Departmant of Child and Adolescent Psychiatry, Siirt Training and Research Hospital, Siirt, Turkey
| | - İlyas Kaya
- Department of Child and Adolescent Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yaşar Tanır
- Department of Child and Adolescent Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Canan Küçükgergin
- Departments of Medical Biochemistry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Abdurrahman Fatih Aydın
- Departments of Medical Biochemistry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Song Z, Zhang S, Pan H, Hu B, Liu X, Cui J, Zhang L. Global research trends on the links between NfL and neurological disorders: A bibliometric analysis and review. Heliyon 2024; 10:e34720. [PMID: 39157316 PMCID: PMC11327529 DOI: 10.1016/j.heliyon.2024.e34720] [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: 02/11/2024] [Revised: 06/22/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024] Open
Abstract
Background The global incidence of neurological diseases has been on the rise, creating an urgent need for a validated marker. Neurofilament Light Chain (NfL) holds promise as such a marker and has garnered significant attention in the field of neurological diseases over the past decades. Methods Corresponding articles from 2013 to 2023 were collected from the Web of Science database, and data were analyzed by CiteSpace and VOSviewer software. Results A total of 1350 articles were collected from 296 countries/regions, involving 7246 research organizations. Since 2013, among the top ten institutions and authors with the highest number of published papers, the most are from the US and the UK. The United States leads in the number of published papers, but England holds a more momentous position, because it has higher IF. Henrik Zetterberg is the most influential scholar in the field. Conclusions The output of papers mainly relies on researchers from developed countries, and scholars from the United States and England have contributed the largest number of papers. Until now, the importance of NfL in neurological diseases has attracted global attention. In addition, NfL contributes to the potential diagnosis of various neurological disorders and can be used to improve the accuracy of differential diagnosis and prognostic assessment as well as predict the response to treatments. More and more in-depth studies are highly needed in the future.
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Affiliation(s)
- Zhengxi Song
- Department of Neurology, The People' s Hospital of Jianyang city, Jianyang, 641400 China
| | - Shan Zhang
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China
| | - HongYu Pan
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China
| | - Bingshuang Hu
- School of Clinical Medicine, Chengdu Medical College, Chengdu, 610500, China
| | - XinLian Liu
- Development and Regeneration Key Laboratory of Sichuan Province, Institute of Neuroscience, Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, 610500, China
| | - Jia Cui
- Development and Regeneration Key Laboratory of Sichuan Province, Institute of Neuroscience, Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, 610500, China
| | - LuShun Zhang
- Development and Regeneration Key Laboratory of Sichuan Province, Institute of Neuroscience, Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, 610500, China
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Saucier L, Healy BC, Saxena S, Sanon E, Chitnis T. Glial fibrillary acidic protein and neurofilament light chain as biomarkers in pediatric multiple sclerosis. Mult Scler J Exp Transl Clin 2024; 10:20552173241274567. [PMID: 39193071 PMCID: PMC11348348 DOI: 10.1177/20552173241274567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 07/25/2024] [Indexed: 08/29/2024] Open
Abstract
Background Serum neurofilament light chain (sNfL) is a marker of neuroaxonal injury, and serum glial fibrillary acidic protein (sGFAP) reflects reactive astrogliosis. In adult multiple sclerosis (MS), sNfL correlates with relapsing disease activity while sGFAP correlates with progressive disease. Objectives We evaluate sNfL and sGFAP as biomarkers in pediatric-onset MS (POMS) compared to pediatric healthy controls (PHC), and correlations with the disease course. Methods In this single-center observational cross-sectional study, we extracted data from a longitudinal database and measured NfL and GFAP from bio-banked serum using single-molecule array technology. Results The analysis included 61 POMS patients and 45 PHC. Controlling for age and BMI, sNfL was 414% higher and sGFAP was 42.3% higher in POMS. Disability (EDSS) is associated with higher sNfL (β = 0.32, p = 0.002) and higher sGFAP (β = 0.11, p = 0.03). sNfL is associated with MRI lesion burden, recent disease activity (β =0.95, p < 0.001), and untreated status (β = 0.5, p = 0.006). Conclusion sNfL and sGFAP are elevated in POMS compared to PHC. Both biomarkers are associated with clinical disability. Elevated sGFAP may reflect early neurodegeneration in POMS, while sNfL reflects disease activity and DMT response. Elevated sNfL among some clinically and radiographically stable POMS patients suggests ongoing neuroaxonal injury with a potential role for sNfL monitoring disease stability.
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Affiliation(s)
- Laura Saucier
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Mass General Brigham Pediatric MS Center, Massachusetts General Hospital, Boston, MA, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Shrishti Saxena
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Eunnindy Sanon
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Mass General Brigham Pediatric MS Center, Massachusetts General Hospital, Boston, MA, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Bayoumy S, Verberk IMW, Vermunt L, Willemse E, den Dulk B, van der Ploeg AT, Pajkrt D, Nitz E, van den Hout JMP, van der Post J, Wolf NI, Beerepoot S, Groen EJN, Tüngler V, Teunissen CE. Neurofilament light protein as a biomarker for spinal muscular atrophy: a review and reference ranges. Clin Chem Lab Med 2024; 62:1252-1265. [PMID: 38215341 DOI: 10.1515/cclm-2023-1311] [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] [Received: 11/18/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
Spinal muscular atrophy (SMA) is the leading genetic cause of infant mortality, characterized by progressive neuromuscular degeneration resulting from mutations in the survival motor neuron (SMN1) gene. The availability of disease-modifying therapies for SMA therapies highlights the pressing need for easily accessible and cost-effective blood biomarkers to monitor treatment response and for better disease management. Additionally, the wide implementation of newborn genetic screening programs in Western countries enables presymptomatic diagnosis of SMA and immediate treatment administration. However, the absence of monitoring and prognostic blood biomarkers for neurodegeneration in SMA hinders effective disease management. Neurofilament light protein (NfL) is a promising biomarker of neuroaxonal damage in SMA and reflects disease progression in children with SMA undergoing treatment. Recently, the European Medicines Agency issued a letter of support endorsing the potential utilization of NfL as a biomarker of pediatric neurological diseases, including SMA. Within this review, we comprehensively assess the potential applications of NfL as a monitoring biomarker for disease severity and treatment response in pediatric-onset SMA. We provide reference ranges for normal levels of serum based NfL in neurologically healthy children aged 0-18 years. These reference ranges enable accurate interpretation of NfL levels in children and can accelerate the implementation of NfL into clinical practice.
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Affiliation(s)
- Sherif Bayoumy
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inge M W Verberk
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Lisa Vermunt
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Eline Willemse
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ben den Dulk
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ans T van der Ploeg
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dasja Pajkrt
- Organovir Labs, Department of Pediatric Infectious Diseases, Amsterdam University Medical Centers Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Elisa Nitz
- Department of Neuropediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Johanna M P van den Hout
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Julie van der Post
- Organovir Labs, Department of Pediatric Infectious Diseases, Amsterdam University Medical Centers Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole I Wolf
- Amsterdam Leukodystrophy Center, Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Center, VU University Amsterdam, and Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Amsterdam, The Netherlands
| | - Shanice Beerepoot
- Amsterdam Leukodystrophy Center, Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Center, VU University Amsterdam, and Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Amsterdam, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ewout J N Groen
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Victoria Tüngler
- Department of Neuropediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
- University Center for Rare Diseases, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Stukas S, Cooper J, Higgins V, Holmes D, Adeli K, Wellington CL. Pediatric reference intervals for serum neurofilament light and glial fibrillary acidic protein using the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. Clin Chem Lab Med 2024; 62:698-705. [PMID: 37882772 PMCID: PMC10895925 DOI: 10.1515/cclm-2023-0660] [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] [Received: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Blood biomarkers have the potential to transform diagnosis and prognosis for multiple neurological indications. Establishing normative data is a critical benchmark in the analytical validation process. Normative data are important in children as little is known about how brain development may impact potential biomarkers. The objective of this study is to generate pediatric reference intervals (RIs) for serum neurofilament light (NfL), an axonal marker, and glial fibrillary acidic protein (GFAP), an astrocytic marker. METHODS Serum from healthy children and adolescents aged 1 to <19 years were obtained from the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. Serum NfL (n=300) and GFAP (n=316) were quantified using Simoa technology, and discrete RI (2.5th and 97.5th percentiles) and continuous RI (5th and 95th percentiles) were generated. RESULTS While there was no association with sex, there was a statistically significant (p<0.0001) negative association between age and serum NfL (Rho -0.400) and GFAP (Rho -0.749). Two statistically significant age partitions were generated for NfL: age 1 to <10 years (lower, upper limit; 3.13, 20.6 pg/mL) and 10 to <19 years (1.82, 7.44 pg/mL). For GFAP, three statistically significant age partitions were generated: age 1 to <3.5 years (80.4, 601 pg/mL); 3.5 to <11 years (50.7, 224 pg/mL); and 11 to <19 years (26.2, 119 pg/mL). CONCLUSIONS Taken together with the literature on adults, NfL and GFAP display U-shaped curves with high levels in infants, decreasing levels during childhood, a plateau during adolescence and early adulthood and increasing levels in seniors. These normative data are expected to inform future pediatric studies on the importance of age on neurological blood biomarkers.
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Affiliation(s)
- Sophie Stukas
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Cooper
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Victoria Higgins
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Holmes
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, Providence Health, Vancouver, BC, Canada
| | - Khosrow Adeli
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cheryl L. Wellington
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering (SBME), University of British Columbia, Vancouver, BC, Canada
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Balanza N, Francis CK, Crowley VM, Weckman AM, Zhong K, Baro B, Varo R, Bassat Q, Kain KC. Reply to Zayet et al. J Infect Dis 2024; 229:296-297. [PMID: 37943681 DOI: 10.1093/infdis/jiad490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Núria Balanza
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Caroline K Francis
- Sandra-Rotman Centre for Global Health, Toronto General Research Institute, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
| | - Valerie M Crowley
- Sandra-Rotman Centre for Global Health, Toronto General Research Institute, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrea M Weckman
- Sandra-Rotman Centre for Global Health, Toronto General Research Institute, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Zhong
- Sandra-Rotman Centre for Global Health, Toronto General Research Institute, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
| | - Bàrbara Baro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu-University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Kevin C Kain
- Sandra-Rotman Centre for Global Health, Toronto General Research Institute, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ghezzi A, Neuteboom RF. Neurofilament Light Chain in Adult and Pediatric Multiple Sclerosis: A Promising Biomarker to Better Characterize Disease Activity and Personalize MS Treatment. Neurol Ther 2023; 12:1867-1881. [PMID: 37682513 PMCID: PMC10630260 DOI: 10.1007/s40120-023-00535-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023] Open
Abstract
Many biological markers have been explored in multiple sclerosis (MS) to better quantify disease burden and better evaluate response to treatments, beyond clinical and MRI data. Among these, neurofilament light chain (Nf-L), although non-specific for this disease and found to be increased in other neurological conditions, has been shown to be the most promising biomarker for assessing axonal damage in MS, with a definite role in predicting the development of MS in patients at the first neurological episode suggestive of MS, and also in a preclinical phase. There is strong evidence that Nf-L levels are increased more in relapsing versus stable MS patients, and that they predict future disease evolution (relapses, progression, MRI measures of activity/progression) in MS patients, providing information on response to therapy, helping to anticipate clinical decisions in patients with an apparently stable evolution, and identifying patient non-responders to disease-modifying treatments. Moreover, Nf-L can contribute to the better understanding of the mechanisms of demyelination and axonal damage in adult and pediatric MS. A fundamental requirement for its clinical use is the accurate standardization of normal values, corrected for confounding factors, in particular age, sex, body mass index, and presence of comorbidities. In this review, a guide is provided to update clinicians on the use of Nf-L in clinical activity.
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Affiliation(s)
- Angelo Ghezzi
- Dipartimento di Scienze della Salute, Università Piemonte Orientale A. Avogadro, Via Solaroli 17, 28100, Novara, Italy.
| | - R F Neuteboom
- Department of Neurology, ErasMS Center, Erasmus MC, PO Box 2040, 3000, Rotterdam, The Netherlands
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Huppke B, Reinert MC, Hummel-Abmeier H, Stark W, Gärtner J, Huppke P. Pretreatment Neurofilament Light Chain Serum Levels, Early Disease Severity, and Treatment Response in Pediatric Multiple Sclerosis. Neurology 2023; 101:e1873-e1883. [PMID: 37748882 PMCID: PMC10663003 DOI: 10.1212/wnl.0000000000207791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/12/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES High disease activity and frequent therapy failure in pediatric multiple sclerosis (MS) make prognostic biomarkers urgently needed. We investigated whether serum neurofilament light chain (sNfL) levels in treatment-naive pediatric patients with MS are associated with early disease severity and indicate treatment outcomes. METHODS A retrospective cohort study of patients seen in the Göttingen Center for MS in Childhood and Adolescence, Germany. Inclusion criteria were MS diagnosis according to the McDonald criteria, MS onset <18 years, and available pretreatment serum sample. sNfL levels were analyzed using a single-molecule array assay. Associations with clinical and MRI evidence of disease severity at sampling were evaluated using the Spearman correlations and nonparametric tests for group comparisons. Correlations between pretreatment sNfL and annualized relapse and new T2 lesion rate on first-line therapy, and odd ratios for switch to high-efficacy therapy were assessed. RESULTS A total of 178 patients (116 women [65%]) with a mean sampling age of 14.3 years were included in the study. Pretreatment sNfL levels were above the ≥90th percentile reported for healthy controls in 80% of patients (median 21.1 pg/mL) and correlated negatively with age, but no correlation was seen with sex, oligoclonal band status, or body mass index. High pretreatment sNfL levels correlated significantly with a high number of preceding relapses, a shorter first interattack interval, a high T2 lesion count, and recent gadolinium-enhancing lesions. Of interest, sNfL levels reflected more strongly MRI activity rather than clinical activity. Pretreatment sNfL levels also correlated significantly with the relapse rate and occurrence of new/enlarging T2 lesions while on first-line injectable therapy. Odds of future therapy escalation increased from 0.14 for sNfL below 7.5 pg/mL to 6.38 for sNfL above 15 pg/mL. In patients with a recent relapse, higher sNfL levels were associated with poorer recovery 3 months after attack. DISCUSSION The results of this study have 3 important implications: First, pretreatment sNfL levels are a valuable biomarker for underlying disease activity in pediatric patients with MS. Second, pretreatment sNfL levels in pediatric patients with MS have a predictive value for the response to first-line therapy and the necessity of future therapy escalation. Third, high sNfL levels during a relapse are associated with poor recovery in this age group.
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Affiliation(s)
- Brenda Huppke
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany.
| | - Marie-Christine Reinert
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany
| | - Hannah Hummel-Abmeier
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany
| | - Wiebke Stark
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany
| | - Jutta Gärtner
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany
| | - Peter Huppke
- From the Department of Pediatric Neurology (B.H.), University Hospital Jena; Department of Pediatrics and Adolescent Medicine (M.-C.R., H.H.-A., W.S., J.G.), Pediatric Neurology, University Medical Center Göttingen, Georg August University Göttingen; and Department of Neuropediatrics (P.H.), University Hospital Jena, Germany.
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Castillo Villagrán D, Yeh EA. Pediatric Multiple Sclerosis: Changing the Trajectory of Progression. Curr Neurol Neurosci Rep 2023; 23:657-669. [PMID: 37792206 DOI: 10.1007/s11910-023-01300-3] [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: 09/01/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW Multiple sclerosis is a chronic inflammatory disease of the central nervous system. When seen in children and adolescents, crucial stages of brain development and maturation may be affected. Prompt recognition of multiple sclerosis in this population is essential, as early intervention with disease-modifying therapies may change developmental trajectories associated with the disease. In this paper, we will review diagnostic criteria for pediatric multiple sclerosis, outcomes, differential diagnosis, and current therapeutic approaches. RECENT FINDINGS Recent studies have demonstrated the utility of newer structural and functional metrics in facilitating early recognition and diagnosis of pediatric MS. Knowledge about disease-modifying therapies in pediatric multiple sclerosis has expanded in recent years: important developmental impacts of earlier therapeutic intervention and use of highly effective therapies have been demonstrated. Pediatric MS is characterized by highly active disease and high disease burden. Advances in knowledge have led to early identification, diagnosis, and treatment. Lifestyle-related interventions and higher efficacy therapies are currently undergoing investigation.
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Affiliation(s)
- Daniela Castillo Villagrán
- Department of Pediatrics (Neurology), SickKids Research Institute, Division of Neurosciences and Mental Health, Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON, M5G1X8, Canada
| | - E Ann Yeh
- Department of Pediatrics (Neurology), SickKids Research Institute, Division of Neurosciences and Mental Health, Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON, M5G1X8, Canada.
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Tybirk L, Hviid CVB, Knudsen CS, Parkner T. Serum GFAP - pediatric reference interval in a cohort of Danish children. Clin Chem Lab Med 2023; 61:2041-2045. [PMID: 37195150 DOI: 10.1515/cclm-2023-0280] [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: 03/17/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Glial fibrillary acidic protein (GFAP) in blood is an emerging biomarker of brain injury and neurological disease. Its clinical use in children is limited by the lack of a reference interval (RI). Thus, the aim of the present study was to establish an age-dependent continuous RI for serum GFAP in children. METHODS Excess serum from routine allergy testing of 391 children, 0.4-17.9 years of age, was measured by a single-molecule array (Simoa) assay. A continuous RI was modelled using non-parametric quantile regression and presented both graphically and tabulated as discrete one-year RIs based on point estimates from the model. RESULTS Serum GFAP showed a strong age-dependency with declining levels and variability from infants to adolescents. The estimated median level decreased 66 % from four months to five years of age and another 65 % from five years to 17.9 years of age. No gender difference was observed. CONCLUSIONS The study establishes an age-dependent RI for serum GFAP in children showing high levels and variability in the first years of life.
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Affiliation(s)
- Lea Tybirk
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Vinter Bødker Hviid
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Tina Parkner
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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11
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Niculae AŞ, Niculae LE, Văcăraş C, Văcăraş V. Serum levels of neurofilament light chains in pediatric multiple sclerosis: a systematic review and meta-analysis. J Neurol 2023; 270:4753-4762. [PMID: 37394516 DOI: 10.1007/s00415-023-11841-9] [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] [Received: 04/29/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Multiple sclerosis is a neuro-inflammatory disease that affects adults and children and causes somatic and cognitive symptoms. Diagnosis after the first clinical symptoms is challenging, involves laboratory and magnetic resonance imaging work-up and is often inconclusive unless subsequent clinical attacks occur. Neurofilament light chains are structural proteins within neurons. Levels of this marker in cerebrospinal fluid, plasma and serum are consistently higher in patients with an initial clinical demyelinating attack that later go on to develop multiple sclerosis. Evidence concerning serum levels of this biomarker in children with multiple sclerosis is scarce. Our aim is to review and analyze the evidence available for patients with multiple sclerosis, under the age of 18. METHODS We conducted a systematic search of PubMed/Medline, Embase, Cochrane Database, and ProQuest. Human studies that provided data on serum levels of Neurofilament light chains in pediatric patients with MS, measured at the time of the first demyelinating attack and before treatment were included in meta-analysis. RESULTS Three studies satisfied the inclusion criteria. 157 pediatric patients with multiple sclerosis and 270 hospital-based controls that did not present with this condition were included in the analysis. A fixed effects meta-analysis showed that the standardized mean difference between patients and controls is 1.82, with a 95% confidence interval of [1.56-2.08]. CONCLUSION Pediatric patients with multiple sclerosis show higher levels of serum neurofilament light chains at their first clinical demyelinating attack compared to pediatric hospital-based controls.
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Affiliation(s)
- Alexandru-Ştefan Niculae
- Second Department of Pediatrics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Lucia-Elena Niculae
- Department of Neonatology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristiana Văcăraş
- Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vitalie Văcăraş
- Second Department of Neurology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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12
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Weinhofer I, Rommer P, Gleiss A, Ponleitner M, Zierfuss B, Waidhofer-Söllner P, Fourcade S, Grabmeier-Pfistershammer K, Reinert MC, Göpfert J, Heine A, Yska HAF, Casasnovas C, Cantarín V, Bergner CG, Mallack E, Forss-Petter S, Aubourg P, Bley A, Engelen M, Eichler F, Lund TC, Pujol A, Köhler W, Kühl JS, Berger J. Biomarker-based risk prediction for the onset of neuroinflammation in X-linked adrenoleukodystrophy. EBioMedicine 2023; 96:104781. [PMID: 37683329 PMCID: PMC10497986 DOI: 10.1016/j.ebiom.2023.104781] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND X-linked adrenoleukodystrophy (X-ALD) is highly variable, ranging from slowly progressive adrenomyeloneuropathy to severe brain demyelination and inflammation (cerebral ALD, CALD) affecting males with childhood peak onset. Risk models integrating blood-based biomarkers to indicate CALD onset, enabling timely interventions, are lacking. Therefore, we evaluated the prognostic value of blood biomarkers in addition to current neuroimaging predictors for early detection of CALD. METHODS We measured blood biomarkers in a retrospective, male CALD risk-assessment cohort consisting of 134 X-ALD patients and 66 controls and in a phenotype-blinded validation set (25 X-ALD boys, 4-13 years) using Simoa®and Luminex® technologies. FINDINGS Among 25 biomarkers indicating axonal damage, astrocye/microglia activation, or immune-cell recruitment, neurofilament light chain (NfL) had the highest prognostic value for early indication of childhood/adolescent CALD. A plasma NfL cut-off level of 8.33 pg/mL, determined in the assessment cohort, correctly discriminated CALD with an accuracy of 96% [95% CI: 80-100] in the validation group. Multivariable logistic regression models revealed that combining NfL with GFAP or cytokines/chemokines (IL-15, IL-12p40, CXCL8, CCL11, CCL22, and IL-4) that were significantly elevated in CALD vs healthy controls had no additional benefit for detecting neuroinflammation. Some cytokines/chemokines were elevated only in childhood/adolescent CALD and already upregulated in asymptomatic X-ALD children (IL-15, IL-12p40, and CCL7). In adults, NfL levels distinguished CALD but were lower than in childhood/adolescent CALD patients with similar (MRI) lesion severity. Blood GFAP did not differentiate CALD from non-inflammatory X-ALD. INTERPRETATION Biomarker-based risk prediction with a plasma NfL cut-off value of 8.33 pg/mL, determined by ROC analysis, indicates CALD onset with high sensitivity and specificity in childhood X-ALD patients. A specific pro-inflammatory cytokine/chemokine profile in asymptomatic X-ALD boys may indicate a primed, immanent inflammatory state aligning with peak onset of CALD. Age-related differences in biomarker levels in adult vs childhood CALD patients warrants caution in predicting onset and progression of CALD in adults. Further evaluations are needed to assess clinical utility of the NfL cut-off for risk prognosis of CALD onset. FUNDING Austrian Science Fund, European Leukodystrophy Association.
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Affiliation(s)
- Isabelle Weinhofer
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria.
| | - Paulus Rommer
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Institute of Clinical Biometrics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Markus Ponleitner
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Bettina Zierfuss
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria; Department of Neuroscience, Centre de Recherche du CHUM, Université de Montréal, Montréal, Canada
| | - Petra Waidhofer-Söllner
- Division of Immune Receptors and T Cell Activation, Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Stéphane Fourcade
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Katharina Grabmeier-Pfistershammer
- Division of Immune Receptors and T Cell Activation, Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Marie-Christine Reinert
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Jens Göpfert
- Applied Biomarkers and Immunoassays Working Group, NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Anne Heine
- Applied Biomarkers and Immunoassays Working Group, NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Hemmo A F Yska
- Department of Pediatric Neurology, Amsterdam Public Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Carlos Casasnovas
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Madrid, Spain; Neuromuscular Unit, Neurology Department, Hospital Universitario Bellvitge, Bellvitge Biomedical Research Unit, Barcelona, Spain
| | - Verónica Cantarín
- Infant Jesus Children´s Hospital and Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Caroline G Bergner
- Department of Neurology, Leukodystrophy Clinic, University of Leipzig Medical Center, Leipzig, Germany
| | - Eric Mallack
- Leukodystrophy Center, Division of Child Neurology, Department of Pediatrics, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Sonja Forss-Petter
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Patrick Aubourg
- Kremlin-Bicêtre-Hospital, University Paris-Saclay, Paris, France
| | - Annette Bley
- Department of Pediatrics, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Marc Engelen
- Department of Pediatric Neurology, Amsterdam Public Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Florian Eichler
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Troy C Lund
- Pediatric Blood and Marrow Transplant Program, Global Pediatrics, Division of Pediatric Blood and Marrow Transplantation, MCRB, University of Minnesota, Minneapolis, MN, USA
| | - Aurora Pujol
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Wolfgang Köhler
- Department of Neurology, Leukodystrophy Clinic, University of Leipzig Medical Center, Leipzig, Germany
| | - Jörn-Sven Kühl
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Berger
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria.
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Schjørring ME, Parkner T, Knudsen CS, Tybirk L, Hviid CVB. Neurofilament light chain: serum reference intervals in Danish children aged 0-17 years. Scand J Clin Lab Invest 2023; 83:403-407. [PMID: 37632388 DOI: 10.1080/00365513.2023.2251003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/07/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023]
Abstract
Elevated levels of neurofilament light chain (NfL) in the blood is an unspecific biomarker for damage to neuronal axons. The measurement of NfL levels in the blood can provide useful information for monitoring and prognostication of various neurological disorders in children, but a reference interval (RI) is needed before the clinical implementation of the biomarker. We aimed to establish a RI for children aged 0-17 years. Serum samples from 292 healthy reference subjects aged 0.4-17.9 years were analysed by a single-molecule array (Simoa®) established for routine clinical use. Non-parametric quantile regression was used to model a continuous RI, and a traditional age-partitioned non-parametric RI was established according to Clinical and Laboratory Standard Institute (CLSI) guideline C28-A3. Furthermore, we investigated the effect of hemolysis on assay performance. The traditional age-partitioned non-parametric RI for the age group <3 years was 3.5-16.6 ng/L and 2.1-13.9 ng/L in the age group ≥3 years, respectively. The continuous RI showed an age-dependent decrease in median NfL levels in the first three years of life which was also evident in the age-partitioning of the traditional RI. We found no difference between sexes and no impact of hemolysis on the NfL test results. This study establishes a pediatric RI for serum NfL and lays the groundwork for its future use in clinical practice.
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Affiliation(s)
- Mia Elbek Schjørring
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Tina Parkner
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | | | - Lea Tybirk
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Vinter Bødker Hviid
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Denmark
- Department of Clinical Medicine, Aalborg University, Denmark
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14
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Eva L, Pleș H, Covache-Busuioc RA, Glavan LA, Bratu BG, Bordeianu A, Dumitrascu DI, Corlatescu AD, Ciurea AV. A Comprehensive Review on Neuroimmunology: Insights from Multiple Sclerosis to Future Therapeutic Developments. Biomedicines 2023; 11:2489. [PMID: 37760930 PMCID: PMC10526343 DOI: 10.3390/biomedicines11092489] [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: 08/09/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
This review delves into neuroimmunology, focusing on its relevance to multiple sclerosis (MS) and potential treatment advancements. Neuroimmunology explores the intricate relationship between the immune system and the central nervous system (CNS). Understanding these mechanisms is vital for grasping the pathophysiology of diseases like MS and for devising innovative treatments. This review introduces foundational neuroimmunology concepts, emphasizing the role of immune cells, cytokines, and blood-brain barrier in CNS stability. It highlights how their dysregulation can contribute to MS and discusses genetic and environmental factors influencing MS susceptibility. Cutting-edge research methods, from omics techniques to advanced imaging, have revolutionized our understanding of MS, offering valuable diagnostic and prognostic tools. This review also touches on the intriguing gut-brain axis, examining how gut microbiota impacts neuroimmunological processes and its potential therapeutic implications. Current MS treatments, from immunomodulatory drugs to disease-modifying therapies, are discussed alongside promising experimental approaches. The potential of personalized medicine, cell-based treatments, and gene therapy in MS management is also explored. In conclusion, this review underscores neuroimmunology's significance in MS research, suggesting that a deeper understanding could pave the way for more tailored and effective treatments for MS and similar conditions. Continued research and collaboration in neuroimmunology are essential for enhancing patient outcomes.
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Affiliation(s)
- Lucian Eva
- Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu”, 700309 Iasi, Romania;
| | - Horia Pleș
- Department of Neurosurgery, Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - Luca Andrei Glavan
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - Andrei Bordeianu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - Antonio Daniel Corlatescu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 București, Romania; (L.A.G.); (B.-G.B.); (A.B.); (D.-I.D.); (A.D.C.); (A.V.C.)
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15
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Alecu JE, Saffari A, Ziegler M, Jordan C, Tam A, Kim S, Leung E, Szczaluba K, Mierzewska H, King SD, Santorelli FM, Yoon G, Trombetta B, Kivisäkk P, Zhang B, Sahin M, Ebrahimi-Fakhari D. Plasma Neurofilament Light Chain Is Elevated in Adaptor Protein Complex 4-Related Hereditary Spastic Paraplegia. Mov Disord 2023; 38:1742-1750. [PMID: 37482941 PMCID: PMC10529494 DOI: 10.1002/mds.29524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/15/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Adaptor protein complex 4-associated hereditary spastic paraplegia (AP-4-HSP) is caused by pathogenic biallelic variants in AP4B1, AP4M1, AP4E1, and AP4S1. OBJECTIVE The aim was to explore blood markers of neuroaxonal damage in AP-4-HSP. METHODS Plasma neurofilament light chain (pNfL) and glial fibrillary acidic protein (GFAP) levels were measured in samples from patients and age- and sex-matched controls (NfL: n = 46 vs. n = 46; GFAP: n = 14 vs. n = 21) using single-molecule array assays. Patients' phenotypes were systematically assessed using the AP-4-HSP natural history study questionnaires, the Spastic Paraplegia Rating Scale, and the SPATAX disability score. RESULTS pNfL levels increased in AP-4-HSP patients, allowing differentiation from controls (Mann-Whitney U test: P = 3.0e-10; area under the curve = 0.87 with a 95% confidence interval of 0.80-0.94). Phenotypic cluster analyses revealed a subgroup of individuals with severe generalized-onset seizures and developmental stagnation, who showed differentially higher pNfL levels (Mann-Whitney U test between two identified clusters: P = 2.5e-6). Plasma GFAP levels were unchanged in patients with AP-4-HSP. CONCLUSIONS pNfL is a potential disease marker in AP-4-HSP and can help differentiate between phenotypic subgroups. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Julian E. Alecu
- Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Afshin Saffari
- Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marvin Ziegler
- Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine Jordan
- Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Tam
- Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Soyoung Kim
- Sozialpaediatrisches Zentrum Frankfurt Mitte, Frankfurt am Main, Germany
| | - Edward Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Hanna Mierzewska
- Department of Neurology, Institute of Mother and Child, Warsaw, Poland
| | - Staci D. King
- Department of Neurology, Texas Children’s Hospital, Houston, Texas, USA
| | | | - Grace Yoon
- Divisions of Clinical and Metabolic Genetics and Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bianca Trombetta
- Alzheimer’s Clinical and Translational Research Unit, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pia Kivisäkk
- Alzheimer’s Clinical and Translational Research Unit, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bo Zhang
- Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- ICCTR Biostatistics and Research Design Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mustafa Sahin
- Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Rosamund Stone Zander Translational Neuroscience Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Intellectual and Developmental Disabilities Research Center, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Darius Ebrahimi-Fakhari
- Department of Neurology and F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Rosamund Stone Zander Translational Neuroscience Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Intellectual and Developmental Disabilities Research Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Movement Disorders Program, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Prajjwal P, M.D.M. M, Natarajan B, Inban P, Gadam S, Sowndarya D, John J, Abbas R, Vaja H, A.D.M. M, Amir Hussin O. Juvenile multiple sclerosis: addressing epidemiology, diagnosis, therapeutic, and prognostic updates along with cognitive dysfunction and quality of life. Ann Med Surg (Lond) 2023; 85:4433-4441. [PMID: 37663711 PMCID: PMC10473341 DOI: 10.1097/ms9.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 09/05/2023] Open
Abstract
Juvenile multiple sclerosis (JMS) is a rare but significant subtype of multiple sclerosis (MS) that affects a small percentage of patients under the age of 10 and 3-5% of all MS patients. Despite its rarity, JMS poses unique challenges in terms of diagnosis, treatment, and management, as it can significantly impact a child or adolescent's physical, cognitive, and emotional development. JMS presents with a varying spectrum of signs and symptoms such as coordination difficulties and permanent cognitive dysfunctions and may include atypical clinical features such as seizures, acute disseminated encephalomyelitis, and optic neuritis, making diagnostic evaluations challenging. Whilst the biology of JMS shares similarities with adult-onset MS, there exist notable distinctions in disease progression, clinical manifestations, and ultimate prognoses. The International Pediatric MS Study Group (IPMSSG) was founded in 2005 to improve understanding of JMS, but there remains a lack of knowledge and guidelines on the management of this condition. This review summarizes the current knowledge on JMS, including its epidemiology, clinical presentations, diagnostic challenges, current treatment options, and outcomes. Current treatment options for JMS include disease-modifying therapies, but JMS can also result in impaired quality of life and psychiatric comorbidity, highlighting the need for comprehensive care for affected children. Through gathering and analyzing scattered studies and recent updates on JMS, the authors aim to address the gaps in current knowledge on JMS and provide an improved understanding of appropriate care for affected children. By doing so, this review hopes to contribute to improving the quality of life and outcomes for JMS patients.
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Affiliation(s)
| | - Marsool M.D.M.
- University of Baghdad, Al-Kindy College of Medicine, Baghdad, Iraq
| | - Balaganesh Natarajan
- St. George’s University School of Medicine, University Centre Grenada, West Indies
| | - Pugazhendi Inban
- Internal Medicine, Government Medical College, Omandurar, Chennai
| | - Srikanth Gadam
- Internal Medicine, Postdoctoral Research Fellow, Mayo Clinic, USA
| | | | - Jobby John
- Somervell Memorial CSI Medical College and Hospital, Karakonam, Trivandrum
| | - Rahim Abbas
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - HariOm Vaja
- Internal Medicine, BJ Medical College, Ahmedabad, India
| | - Marsool A.D.M.
- University of Baghdad, Al-Kindy College of Medicine, Baghdad, Iraq
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17
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Abdelhak A, Petermeier F, Benkert P, Schädelin S, Oechtering J, Maleska Maceski A, Kabesch M, Geis T, Laub O, Leipold G, Gobbi C, Zecca C, Green A, Tumani H, Willemse E, Wiendl H, Granziera C, Kappos L, Leppert D, Waubant E, Wellmann S, Kuhle J. Serum neurofilament light chain reference database for individual application in paediatric care: a retrospective modelling and validation study. Lancet Neurol 2023; 22:826-833. [PMID: 37524100 DOI: 10.1016/s1474-4422(23)00210-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/30/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Neurological conditions represent an important driver of paediatric disability burden worldwide. Measurement of serum neurofilament light chain (sNfL) concentrations, a specific marker of neuroaxonal injury, has the potential to contribute to the management of children with such conditions. In this context, the European Medicines Agency recently declared age-adjusted reference values for sNfL a top research priority. We aimed to establish an age-adjusted sNfL reference range database in a population of healthy children and adolescents, and to validate this database in paediatric patients with neurological conditions to affirm its clinical applicability. METHODS To generate a paediatric sNfL reference dataset, sNfL values were measured in a population of healthy children and adolescents (aged 0-22 years) from two large cohorts in Europe (the Coronavirus Antibodies in Kids from Bavaria study, Germany) and North America (a US Network of Paediatric Multiple Sclerosis Centers paediatric case-control cohort). Children with active or previous COVID-19 infection or SARS-CoV-2 antibody positivity at the time of sampling, or a history of primary systemic or neurological conditions were excluded. Linear models were used to restrospectively study the effect of age and weight on sNfL concentrations. We modelled the distribution of sNfL concentrations as a function of age-related physiological changes to derive reference percentile and Z score values via a generalised additive model for location, scale, and shape. The clinical utility of the new reference dataset was assessed in children and adolescents (aged 1-19 years) with neurological diseases (epilepsy, traumatic brain injury, bacterial CNS infections, paediatric-onset multiple sclerosis, and myelin oligodendrocyte glycoprotein antibody-associated disease) from the paediatric neuroimmunology clinic at the University of California San Francisco (San Francisco, CA, USA) and the Children's Hospital of the University of Regensburg (Regensburg, Germany). FINDINGS Samples from 2667 healthy children and adolescents (1336 [50·1%] girls and 1331 [49·9%] boys; median age 8·0 years [IQR 4·0-12·0]) were used to generate the reference database covering neonatal age to adolescence (target age range 0-20 years). In the healthy population, sNfL concentrations decreased with age by an estimated 6·8% per year until age 10·3 years (estimated multiplicative effect per 1 year increase 0·93 [95% CI 0·93-0·94], p<0·0001) and was mostly stable thereafter up to age 22 years (1·00 [0·52-1·94], p>0·99). Independent of age, the magnitude of the effect of weight on sNfL concentrations was marginal. Samples from 220 children with neurological conditions (134 [60·9%] girls and 86 [39·1%] boys; median age 14·7 years [IQR 10·8-16·5]) were used to validate the clinical utility of the reference Z scores. In this population, age-adjusted sNfL Z scores were higher than in the reference population of healthy children and adolescents (p<0·0001) with higher effect size metrics (Cohen's d=1·56) compared with the application of raw sNfL concentrations (d=1·28). INTERPRETATION The established normative sNfL values in children and adolescents provide a foundation for the clinical application of sNfL in the paediatric population. Compared with absolute sNfL values, the use of sNfL Z score was associated with higher effect size metrics and allowed for more accurate estimation of the extent of ongoing neuroaxonal damage in individual patients. FUNDING Swiss National Science Foundation, US National Institutes of Health, and the National Multiple Sclerosis Society.
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Affiliation(s)
- Ahmed Abdelhak
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Franziska Petermeier
- University Children's Hospital Regensburg, Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Pascal Benkert
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine Schädelin
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Johanna Oechtering
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Aleksandra Maleska Maceski
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Michael Kabesch
- University Children's Hospital Regensburg, Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Tobias Geis
- University Children's Hospital Regensburg, Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Otto Laub
- Paediatric Office Laub, Rosenheim, Germany
| | | | - Claudio Gobbi
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Ari Green
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Hayrettin Tumani
- Department of Neurology, University of Ulm, Ulm, Germany; German Center for Neurodegenerative Diseases, Ulm, Germany
| | - Eline Willemse
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Cristina Granziera
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland; Translational Imaging in Neurology Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Leppert
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Emmanuelle Waubant
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Sven Wellmann
- University Children's Hospital Regensburg, Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany.
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland; Multiple Sclerosis Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
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18
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Hemingway C. Neurofilament as a biomarker - are we there yet? Eur J Paediatr Neurol 2023; 45:A5. [PMID: 37423817 DOI: 10.1016/j.ejpn.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Cheryl Hemingway
- Department of Neurology, Great Ormond Street Hospital, London, UK.
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Geis T, Gutzeit S, Fouzas S, Ambrosch A, Benkert P, Kuhle J, Wellmann S. Serum Neurofilament light chain (NfL) levels in children with and without neurologic diseases. Eur J Paediatr Neurol 2023; 45:9-13. [PMID: 37236127 DOI: 10.1016/j.ejpn.2023.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/10/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND/OBJECTIVE Serum neurofilament light chain (sNfL) is a specific biomarker of neuronal damage. Elevated sNfL levels have been reported in numerous neurologic diseases in adults, whereas data on sNfL in the pediatric population are incomplete. The aim of this study was to investigate sNfL levels in children with various acute and chronic neurologic disorders and describe the age dependence of sNfL from infancy to adolescence. METHODS The total study cohort of this prospective cross-sectional study consisted of 222 children aged from 0 to 17 years. Patients' clinical data were reviewed and patients were assigned to the following groups: 101 (45.5%) controls, 34 (15.3%) febrile controls, 23 (10.4%) acute neurologic conditions (meningitis, facial nerve palsy, traumatic brain injury, or shunt dysfunction in hydrocephalus), 37 (16.7%) febrile seizures, 6 (2.7%) epileptic seizures, 18 (8.1%) chronic neurologic conditions (autism, cerebral palsy, inborn mitochondrial disorder, intracranial hypertension, spina bifida, or chromosomal abnormalities), and 3 (1.4%) severe systemic disease. sNfL levels were measured using a sensitive single-molecule array assay. RESULTS There were no significant differences in sNfL levels between controls, febrile controls, febrile seizures, epileptic seizures, acute neurologic conditions, and chronic neurologic conditions. In children with severe systemic disorders, by far the highest NfL levels were found with an sNfL of 429 pg/ml in a patient with neuroblastoma, 126 pg/ml in a patient with cranial nerve palsy and pharyngeal Burkitt's lymphoma, and 42 pg/ml in a child with renal transplant rejection. The relationship between sNfL and age could be described by a second order polynomial with an R2 of 0.153 with a decrease of sNfL by 3.2% per year from birth to age 12 years and thereafter an increase by 2.7% per year until age 18 years. CONCLUSIONS In this study cohort, sNfL levels were not elevated in children with febrile or epileptic seizures, or various other neurologic diseases. Strikingly high sNfL levels were detected in children with oncologic disease or transplant rejection. A biphasic sNfL age-dependency was documented, with highest levels in infancy and late adolescence and the lowest levels in middle school age.
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Affiliation(s)
- Tobias Geis
- University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany.
| | - Svena Gutzeit
- University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Sotiris Fouzas
- Department of Pediatrics, University Hospital of Patras, Patras, Greece
| | - Andreas Ambrosch
- Institute of Laboratory Medicine, Microbiology and Hygiene, Hospital of the Order of St. John, Regensburg, Germany
| | - Pascal Benkert
- Neurologic Clinic and Policlinic, MS Centre and Research Centre for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, MS Centre and Research Centre for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Wellmann
- Research and Development Campus Regensburg (WECARE), at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany; Department of Neonatology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
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20
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Teleanu RI, Niculescu AG, Vladacenco OA, Roza E, Perjoc RS, Teleanu DM. The State of the Art of Pediatric Multiple Sclerosis. Int J Mol Sci 2023; 24:ijms24098251. [PMID: 37175954 PMCID: PMC10179691 DOI: 10.3390/ijms24098251] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023] Open
Abstract
Multiple sclerosis (MS) represents a chronic immune-mediated neurodegenerative disease of the central nervous system that generally debuts around the age of 20-30 years. Still, in recent years, MS has been increasingly recognized among the pediatric population, being characterized by several peculiar features compared to adult-onset disease. Unfortunately, the etiology and disease mechanisms are poorly understood, rendering the already limited MS treatment options with uncertain efficacy and safety in pediatric patients. Thus, this review aims to shed some light on the progress in MS therapeutic strategies specifically addressed to children and adolescents. In this regard, the present paper briefly discusses the etiology, risk factors, comorbidities, and diagnosis possibilities for pediatric-onset MS (POMS), further moving to a detailed presentation of current treatment strategies, recent clinical trials, and emerging alternatives. Particularly, promising care solutions are indicated, including new treatment formulations, stem cell therapies, and cognitive training methods.
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Affiliation(s)
- Raluca Ioana Teleanu
- "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Neurology, "Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Research Institute of the University of Bucharest-ICUB, University of Bucharest, 050657 Bucharest, Romania
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Oana Aurelia Vladacenco
- "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Neurology, "Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Eugenia Roza
- "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Neurology, "Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Radu-Stefan Perjoc
- "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Neurology, "Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Daniel Mihai Teleanu
- "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Neurosurgery, Emergency University Hospital, 050098 Bucharest, Romania
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21
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Ghezzi A, Neuteboom RF. The contribution of neurofilament light chain to better characterize pediatric multiple sclerosis (editorial on: Plasma neurofilament light chain in children with relapsing MS receiving teriflunomide or placebo: A post hoc analysis of the randomized TERIKIDS trial). Mult Scler 2023; 29:668-670. [PMID: 36960483 DOI: 10.1177/13524585231161148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- Angelo Ghezzi
- Dipartimento di Scienze della Salute, Università degli Studi del Piemonte Orientale "Amedeo Avogadro," Novara, Italy
| | - Rinze F Neuteboom
- Department of Neurology, Eras MS Center, Erasmus University Medical Center, Rotterdam, The Netherlands
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22
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Sen MK, Hossain MJ, Mahns DA, Brew BJ. Validity of serum neurofilament light chain as a prognostic biomarker of disease activity in multiple sclerosis. J Neurol 2023; 270:1908-1930. [PMID: 36520240 DOI: 10.1007/s00415-022-11507-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022]
Abstract
Multiple sclerosis (MS) is a chronic demyelinating and neuroinflammatory disease of the human central nervous system with complex pathoetiology, heterogeneous presentations and an unpredictable course of disease progression. There remains an urgent need to identify and validate a biomarker that can reliably predict the initiation and progression of MS as well as identify patient responses to disease-modifying treatments/therapies (DMTs). Studies exploring biomarkers in MS and other neurodegenerative diseases currently focus mainly on cerebrospinal fluid (CSF) analyses, which are invasive and impractical to perform on a repeated basis. Recent studies, replacing CSF with peripheral blood samples, have revealed that the elevation of serum neurofilament light chain (sNfL) in the clinical stages of MS is, potentially, an ideal prognostic biomarker for predicting disease progression and for possibly guiding treatment decisions. However, there are unresolved factors (the definition of abnormal values of sNfL concentration, the standardisation of measurement and the amount of change in sNfL concentration that is significant) that are preventing its use as a biomarker in routine clinical practice for MS. This updated review critiques these recent findings and highlights areas for focussed work to facilitate the use of sNfL as a prognostic biomarker in MS management.
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Affiliation(s)
- Monokesh K Sen
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Peter Duncan Neuroscience Research Unit, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, 2010, Australia
- Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Md Jakir Hossain
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - David A Mahns
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Bruce J Brew
- Peter Duncan Neuroscience Research Unit, St Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, 2010, Australia.
- School of Biomedical Sciences, UNSW Sydney, Sydney, NSW, 2052, Australia.
- Department of Neurology, St Vincent's Hospital, Darlinghurst, 2010, Australia.
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23
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Kuhle J, Chitnis T, Banwell B, Tardieu M, Arnold DL, Rawlings AM, Geertsen SS, Lublin AL, Saubadu S, Truffinet P, Kappos L. Plasma neurofilament light chain in children with relapsing MS receiving teriflunomide or placebo: A post hoc analysis of the randomized TERIKIDS trial. Mult Scler 2023; 29:385-394. [PMID: 36632983 PMCID: PMC9972233 DOI: 10.1177/13524585221144742] [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] [Indexed: 01/13/2023]
Abstract
BACKGROUND The phase 3 TERIKIDS study demonstrated efficacy and manageable safety for teriflunomide versus placebo in children with relapsing multiple sclerosis (RMS). OBJECTIVE Evaluate plasma neurofilament light chain (pNfL) concentrations in TERIKIDS. METHODS Patients received placebo or teriflunomide (14 mg adult equivalent) for up to 96 weeks in the double-blind (DB) period. In the open-label extension (OLE), all patients received teriflunomide until up to 192 weeks after randomization. pNfL was measured using single-molecule array assay (Simoa® NF-light™). RESULTS Baseline mean age was 14.5 years; 69.4% were female. Baseline geometric least square mean pNfL levels were similar for teriflunomide (n = 78) and placebo (n = 33) patients (19.83 vs 18.30 pg/mL). Over the combined DB and OLE periods, pNfL values were lower for teriflunomide versus placebo (analysis of variance p < 0.01; Week 192: 10.61 vs 17.32 pg/mL). Observed between-group pNfL differences were attenuated upon adjustment for gadolinium (Gd)-enhancing or new/enlarged T2 lesion counts at DB Week 24. Higher baseline pNfL levels were associated with shorter time since first MS symptom onset, higher baseline Gd-enhancing lesion counts and T2 lesion volume, and increased hazard of high magnetic resonance imaging activity or clinical relapse during the DB period. CONCLUSION Teriflunomide treatment was associated with significantly reduced pNfL levels in children with RMS. CLINICALTRIALS.GOV IDENTIFIER NCT02201108.
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Affiliation(s)
- Jens Kuhle
- J Kuhle MS Center, Neurology and Research
Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments
of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University
Hospital Basel and University Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Tanuja Chitnis
- Massachusetts General Hospital for Children,
Boston, MA, USA
| | - Brenda Banwell
- Children’s Hospital of Philadelphia, University
of Pennsylvania, Philadelphia, PA, USA
| | - Marc Tardieu
- Hôpitaux Universitaires Paris-Sud, Paris,
France
| | - Douglas L Arnold
- McGill University, Montréal, QC, Canada NeuroRx
Research, Montréal, QC, Canada
| | | | | | | | | | | | - Ludwig Kappos
- MS Center, Neurology and Research Center for
Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of
Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University
Hospital Basel and University Basel, Basel, Switzerland
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24
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Jacobs Sariyar A, van Pesch V, Nassogne MC, Moniotte S, Momeni M. Usefulness of serum neurofilament light in the assessment of neurologic outcome in the pediatric population: a systematic literature review. Eur J Pediatr 2023; 182:1941-1948. [PMID: 36602623 DOI: 10.1007/s00431-022-04793-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 01/06/2023]
Abstract
Children undergoing general anesthesia and surgery in the early years of life are exposed to the possible neurotoxicity of anesthetic agents. Prospective studies have shown deficits in behavior, executive function, social communication, and motor function in children undergoing anesthesia and surgery. Different biomarkers of neuronal injury have been evaluated neuronal injury in the pediatric population, among which neurofilaments represent a significant advantage as they are proteins exclusively expressed in neuronal tissue. Our aim was to evaluate the utility of serum neurofilament light (NfL) as a prognostic biomarker of neuronal injury in the pediatric population. A literature search was performed on PubMed, Embase, and Cochrane Databases in November 2022 for studies concerning serum NfL in the pediatric population in addition to a neurological assessment. Inclusion criteria were as follows: (1) prospective or retrospective studies, (2) studies including pediatric population until the age of 18 years, (3) serum NfL sampling, and (4) evaluation of neurological outcome. Data collection regarding study design, pediatric age, serum NfL levels, and results for neurological assessment were extracted from each study. Four manuscripts met the inclusion criteria and evaluated the prognostic utility of serum NfL in neonatal encephalopathy in correlation with the neurodevelopmental outcome that was assessed by the Bayley Scales of Infant Development until the age of 2 years. Children with neonatal encephalopathy showed significantly higher serum NfL vs. healthy controls and high serum NfL levels predicted an adverse neurological outcome. The decrease of serum NfL to a nadir point between 10 and 15 years old reflects the brain growth in healthy controls. No studies were available in the perioperative period. Conclusions: Serum NfL is a valuable biomarker in evaluating neuronal injury in the pediatric population. Further studies with perioperative serial sampling of serum NfL combined with standardized neurodevelopmental tests should be conducted to evaluate the neurotoxicity of anesthetic agents and monitor the effectiveness of specific neuroprotective strategies in pediatric patients undergoing anesthesia and surgery. What is Known: • Preclinical animal data have shown neurotoxicity of the anesthetic agents in the developing brain. • Data regarding anesthetic neurotoxicity in humans show limitations and no objective tools are available. What is New: • This systematic review showed that serum NfL is a valuable biomarker of neuronal injury in the pediatric population. • Perioperative use of serum NfL may be considered in future trials evaluating anesthetic neurotoxicity in the pediatric population and in monitoring neuroprotective strategies.
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Affiliation(s)
- Aurélie Jacobs Sariyar
- Department of Anesthesiology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Marie-Cécile Nassogne
- Department of Pediatrics, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Stéphane Moniotte
- Department of Pediatrics, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Mona Momeni
- Department of Anesthesiology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
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25
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Lotz-Havla AS, Katzdobler S, Nuscher B, Weiß K, Levin J, Havla J, Maier EM. Serum glial fibrillary acidic protein and neurofilament light chain in patients with early treated phenylketonuria. Front Neurol 2022; 13:1011470. [PMID: 36247773 PMCID: PMC9559705 DOI: 10.3389/fneur.2022.1011470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/12/2022] [Indexed: 12/01/2022] Open
Abstract
To pave the way for healthy aging in early treated phenylketonuria (ETPKU) patients, a better understanding of the neurological course in this population is needed, requiring easy accessible biomarkers to monitor neurological disease progression in large cohorts. The objective of this pilot study was to investigate the potential of glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) as blood biomarkers to indicate changes of the central nervous system in ETPKU. In this single-center cross-sectional study, GFAP and NfL concentrations in serum were quantified using the Simoa® multiplex technology in 56 ETPKU patients aged 6–36 years and 16 age matched healthy controls. Correlation analysis and hierarchical linear regression analysis were performed to investigate an association with disease-related biochemical parameters and retinal layers assessed by optical coherence tomography. ETPKU patients did not show significantly higher GFAP concentrations (mean 73 pg/ml) compared to healthy controls (mean 60 pg/ml, p = 0.140). However, individual pediatric and adult ETPKU patients had GFAP concentrations above the healthy control range. In addition, there was a significant association of GFAP concentrations with current plasma tyrosine concentrations (r = −0.482, p = 0.036), a biochemical marker in phenylketonuria, and the retinal inner nuclear layer volume (r = 0.451, p = 0.04). There was no evidence of NfL alterations in our ETPKU cohort. These pilot results encourage multicenter longitudinal studies to further investigate serum GFAP as a complementary tool to better understand and monitor neurological disease progression in ETPKU. Follow-up investigations on aging ETPKU patients are required to elucidate the potential of serum NfL as biomarker.
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Affiliation(s)
- Amelie S. Lotz-Havla
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Sabrina Katzdobler
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Brigitte Nuscher
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Weiß
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Johannes Levin
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases, site Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, University Hospital, LMU Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, LMU Munich, Munich, Germany
- *Correspondence: Joachim Havla
| | - Esther M. Maier
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- Esther M. Maier
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Abstract
Spinal muscular atrophy (SMA) is a neurodegenerative disorder caused by mutations in SMN1 (encoding survival motor neuron protein (SMN)). Reduced expression of SMN leads to loss of α-motor neurons, severe muscle weakness and often early death. Standard-of-care recommendations for multidisciplinary supportive care of SMA were established in the past few decades. However, improved understanding of the pathogenetic mechanisms of SMA has led to the development of different therapeutic approaches. Three treatments that increase SMN expression by distinct molecular mechanisms, administration routes and tissue biodistributions have received regulatory approval with others in clinical development. The advent of the new therapies is redefining standards of care as in many countries most patients are treated with one of the new therapies, leading to the identification of emerging new phenotypes of SMA and a renewed characterization of demographics owing to improved patient survival.
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Cui Y, Yu H, Bu Z, Wen L, Yan L, Feng J. Focus on the Role of the NLRP3 Inflammasome in Multiple Sclerosis: Pathogenesis, Diagnosis, and Therapeutics. Front Mol Neurosci 2022; 15:894298. [PMID: 35694441 PMCID: PMC9175009 DOI: 10.3389/fnmol.2022.894298] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/05/2022] [Indexed: 12/11/2022] Open
Abstract
Neuroinflammation is initiated with an aberrant innate immune response in the central nervous system (CNS) and is involved in many neurological diseases. Inflammasomes are intracellular multiprotein complexes that can be used as platforms to induce the maturation and secretion of proinflammatory cytokines and pyroptosis, thus playing a pivotal role in neuroinflammation. Among the inflammasomes, the nucleotide-binding oligomerization domain-, leucine-rich repeat- and pyrin domain-containing 3 (NLRP3) inflammasome is well-characterized and contributes to many neurological diseases, such as multiple sclerosis (MS), Alzheimer's disease (AD), and ischemic stroke. MS is a chronic autoimmune disease of the CNS, and its hallmarks include chronic inflammation, demyelination, and neurodegeneration. Studies have demonstrated a relationship between MS and the NLRP3 inflammasome. To date, the pathogenesis of MS is not fully understood, and clinical studies on novel therapies are still underway. Here, we review the activation mechanism of the NLRP3 inflammasome, its role in MS, and therapies targeting related molecules, which may be beneficial in MS.
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Eisenstein SA, Boodram RS, Sutphen CL, Lugar HM, Gordon BA, Marshall BA, Urano F, Fagan AM, Hershey T. Plasma Neurofilament Light Chain Levels Are Elevated in Children and Young Adults With Wolfram Syndrome. Front Neurosci 2022; 16:795317. [PMID: 35495027 PMCID: PMC9039397 DOI: 10.3389/fnins.2022.795317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
Wolfram syndrome is a rare disease caused by pathogenic variants in the WFS1 gene with progressive neurodegeneration. As an easily accessible biomarker of progression of neurodegeneration has not yet been found, accurate tracking of the neurodegenerative process over time requires assessment by costly and time-consuming clinical measures and brain magnetic resonance imaging (MRI). A blood-based measure of neurodegeneration, neurofilament light chain (NfL), is relatively inexpensive and can be repeatedly measured at remote sites, standardized, and measured in individuals with MRI contraindications. To determine whether NfL levels may be of use in disease monitoring and reflect disease activity in Wolfram syndrome, plasma NfL levels were compared between children and young adults with Wolfram syndrome (n = 38) and controls composed of their siblings and parents (n = 35) and related to clinical severity and selected brain region volumes within the Wolfram group. NfL levels were higher in the Wolfram group [median (interquartile range) NfL = 11.3 (7.8-13.9) pg/mL] relative to controls [5.6 (4.5-7.4) pg/mL]. Within the Wolfram group, higher NfL levels related to worse visual acuity, color vision and smell identification, smaller brainstem and thalamic volumes, and faster annual rate of decrease in thalamic volume over time. Our findings suggest that plasma NfL levels can be a powerful tool to non-invasively assess underlying neurodegenerative processes in children, adolescents and young adults with Wolfram syndrome.
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Affiliation(s)
- Sarah A. Eisenstein
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Raveena S. Boodram
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Courtney L. Sutphen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Heather M. Lugar
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian A. Gordon
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
- Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO, United States
| | - Bess A. Marshall
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
- Department of Cell Biology, Washington University School of Medicine, St. Louis, MO, United States
| | - Fumihiko Urano
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, MO, United States
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Anne M. Fagan
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
- Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO, United States
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, United States
| | - Tamara Hershey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
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Wendel EM, Bertolini A, Kousoulos L, Rauchenzauner M, Schanda K, Wegener-Panzer A, Baumann M, Reindl M, Otto M, Rostásy K. Serum neurofilament light-chain levels in children with monophasic myelin oligodendrocyte glycoprotein-associated disease, multiple sclerosis, and other acquired demyelinating syndrome. Mult Scler 2022; 28:1553-1561. [DOI: 10.1177/13524585221081090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess the diagnostic and prognostic potential of serum neurofilament light chain (sNfL) in children with first acquired demyelinating syndrome (ADS). Methods: We selected 129 children with first ADS including 19 children with myelin oligodendrocyte glycoprotein (MOG)-antibody associated disease (MOGAD), 36 MOG/AQP4-seronegative ADS, and 74 with multiple sclerosis (MS) from the BIOMARKER study cohort. All children had a complete set of clinical, radiological, laboratory data and serum for NfL measurement using a highly sensitive digital ELISA (SIMOA). A control group of 35 children with non-inflammatory neurological diseases was included. sNfL levels were compared across patient groups according to clinical, laboratory, neuroradiological features and outcome after 2 years. Results: sNfL levels were significantly increased in MOGAD, seronegative ADS and MS compared to controls ( p-value < 0.001), in particular in children with an acute disseminated encephalomyelitis (ADEM)-like magnetic resonance imaging (MRI) pattern ( p < 0.001) or longitudinally extensive myelitis ( p < 0.01). In pediatric MS, elevated sNfL levels were significantly associated with higher numbers of cerebral ( p < 0.001) and presence of spinal ( p < 0.05) MRI lesions at baseline and predicted a higher number of relapses ( p < 0.05). Conclusion: sNfL levels are significantly elevated in all three studied pediatric ADS subtypes indicating neuroaxonal injury. In pediatric MS high levels of sNfL are associated with risk factors for disease progression.
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Affiliation(s)
- Eva-Maria Wendel
- Department of Pediatrics, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Annikki Bertolini
- Department of Pediatric Neurology, Children’s Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Lampros Kousoulos
- Department of Pediatric Neurology, Children’s Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Markus Rauchenzauner
- Department of Pediatrics and Neonatology, Kliniken Ostallgäu-Kaufbeuren, Kaufbeuren, Germany/Division of Pediatric Neurology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Wegener-Panzer
- Department of Pediatric Radiology, Children`s Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Matthias Baumann
- Division of Pediatric Neurology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Otto
- Department of Neurology, University Hospital of Ulm, Ulm, Germany; Department of Neurology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Kevin Rostásy
- Department of Pediatric Neurology, Children’s Hospital Datteln, University Witten/Herdecke, Datteln, Germany
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Simone M, Palazzo C, Mastrapasqua M, Bollo L, Pompamea F, Gabellone A, Marzulli L, Giordano P, De Giacomo A, Frigeri A, Ruggieri M, Margari L. Serum Neurofilament Light Chain Levels and Myelin Oligodendrocyte Glycoprotein Antibodies in Pediatric Acquired Demyelinating Syndromes. Front Neurol 2021; 12:754518. [PMID: 34867740 PMCID: PMC8635987 DOI: 10.3389/fneur.2021.754518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: The relationship between serum neurofilament light chain (sNfL) and myelin oligodendrocyte glycoprotein antibody (MOG-Ab) status has not been yet investigated in children with the acquired demyelinating syndrome (ADS). Objective and Methods: The sNfL levels and MOG-Abs were measured by ultrasensitive single-molecule array and cell-based assay in a cohort of 37 children with ADS and negativity for serum anti-aquaporin 4 (AQP4) antibodies. The sNfL levels were compared in MOG-Ab+/MOG-Ab– and in two subgroups MOG-Ab+ with/without encephalopathy. Results: About 40% ADS resulted in MOG-Ab+. MOG-Ab+ were younger at sampling (median = 9.8; range = 2.17–17.5 vs. 14.7/9–17; p = 0.002) with lower frequency of cerebrospinal fluid oligoclonal bands positivity (27% vs. 70%; p = 0.013) compared to MOG-Ab–. About 53% of MOG-Ab+ presented encephalopathy at onset, 1/22 of MOG-Ab– (p = 0.0006). Higher sNfL levels (p = 0.0001) were found in MOG-Ab+ (median/range = 11.11/6.8–1,129) and MOG-Ab– (median/range = 11.6/4.3–788) compared to age-matched controls (median/range = 2.98/1–4.53), without significant difference. MOG-Ab+ with encephalopathy resulted significantly younger at sampling (median/range: 4.5/2.17–11.17 vs. 14.16/9.8–17.5; p = 0.004), had higher sNfL levels (median/range:75.24/9.1–1,129 vs. 10.22/6.83–50.53; p = 0.04), and showed a trend for higher MOG-Ab titer (0.28/0.04–0.69 vs. 0.05/0.04–0.28; p = 0.1) in comparison to those without encephalopathy. Discussion: We confirmed high sNfL levels in pediatric ADS independently from the MOG-Ab status. Encephalopathy at onset is associated more frequently with MOG Ab+ children with higher sNfL levels and MOG titer. These findings suggest a role of acute demyelination in association with axonal damage in the pathogenesis of encephalopathy in pediatric ADS.
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Affiliation(s)
- Marta Simone
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Claudia Palazzo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Mariangela Mastrapasqua
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Luca Bollo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Pompamea
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Alessandra Gabellone
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Lucia Marzulli
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Paola Giordano
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Andrea De Giacomo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Frigeri
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Maddalena Ruggieri
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Lucia Margari
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
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Yuan A, Nixon RA. Neurofilament Proteins as Biomarkers to Monitor Neurological Diseases and the Efficacy of Therapies. Front Neurosci 2021; 15:689938. [PMID: 34646114 PMCID: PMC8503617 DOI: 10.3389/fnins.2021.689938] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
Biomarkers of neurodegeneration and neuronal injury have the potential to improve diagnostic accuracy, disease monitoring, prognosis, and measure treatment efficacy. Neurofilament proteins (NfPs) are well suited as biomarkers in these contexts because they are major neuron-specific components that maintain structural integrity and are sensitive to neurodegeneration and neuronal injury across a wide range of neurologic diseases. Low levels of NfPs are constantly released from neurons into the extracellular space and ultimately reach the cerebrospinal fluid (CSF) and blood under physiological conditions throughout normal brain development, maturation, and aging. NfP levels in CSF and blood rise above normal in response to neuronal injury and neurodegeneration independently of cause. NfPs in CSF measured by lumbar puncture are about 40-fold more concentrated than in blood in healthy individuals. New ultra-sensitive methods now allow minimally invasive measurement of these low levels of NfPs in serum or plasma to track disease onset and progression in neurological disorders or nervous system injury and assess responses to therapeutic interventions. Any of the five Nf subunits - neurofilament light chain (NfL), neurofilament medium chain (NfM), neurofilament heavy chain (NfH), alpha-internexin (INA) and peripherin (PRPH) may be altered in a given neuropathological condition. In familial and sporadic Alzheimer's disease (AD), plasma NfL levels may rise as early as 22 years before clinical onset in familial AD and 10 years before sporadic AD. The major determinants of elevated levels of NfPs and degradation fragments in CSF and blood are the magnitude of damaged or degenerating axons of fiber tracks, the affected axon caliber sizes and the rate of release of NfP and fragments at different stages of a given neurological disease or condition directly or indirectly affecting central nervous system (CNS) and/or peripheral nervous system (PNS). NfPs are rapidly emerging as transformative blood biomarkers in neurology providing novel insights into a wide range of neurological diseases and advancing clinical trials. Here we summarize the current understanding of intracellular NfP physiology, pathophysiology and extracellular kinetics of NfPs in biofluids and review the value and limitations of NfPs and degradation fragments as biomarkers of neurodegeneration and neuronal injury.
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Affiliation(s)
- Aidong Yuan
- Center for Dementia Research, Nathan Kline Institute, Orangeburg, NY, United States
- Department of Psychiatry, NYU Neuroscience Institute, New York, NY, United States
| | - Ralph A. Nixon
- Center for Dementia Research, Nathan Kline Institute, Orangeburg, NY, United States
- Department of Psychiatry, NYU Neuroscience Institute, New York, NY, United States
- Department of Cell Biology, New York University Grossman School of Medicine, (NYU), Neuroscience Institute, New York, NY, United States
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32
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Nitz E, Smitka M, Schallner J, Akgün K, Ziemssen T, von der Hagen M, Tüngler V. Serum neurofilament light chain in pediatric spinal muscular atrophy patients and healthy children. Ann Clin Transl Neurol 2021; 8:2013-2024. [PMID: 34482646 PMCID: PMC8528467 DOI: 10.1002/acn3.51449] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of this study was to evaluate neurofilament light chain as blood biomarker for disease activity in children and adolescents with different types of spinal muscular atrophy (SMA) and establish pediatric reference values. Methods We measured neurofilament light chain levels in serum (sNfL) and cerebral spinal fluid (cNfL) of 18 children with SMA and varying numbers of SMN2 copies receiving nusinersen by single‐molecule array (SiMoA) assay and analyzed correlations with baseline characteristics and motor development. Additionally, we examined sNfL in 97 neurologically healthy children. Results Median sNfL levels in treatment‐naïve SMA patients with 2 SMN2 copies are higher than in those with >2 SMN2 copies (P < 0.001) as well as age‐matched controls (P = 0.010) and decline during treatment. The median sNfL concentration of healthy controls is 4.73 pg/mL with no differences in sex (P = 0.486) but age (P < 0.001). In all children with SMA, sNfL levels correlate strongly with cNfL levels (r = 0.7, P < 0.001). In children with SMA and 2 SMN2 copies, sNfL values correlate with motor function (r = –0.6, P = 0.134), in contrast to older SMA children with >2 SMN2 copies (r = –0.1, P = 0.744). Interpretation Reference sNfL values of our large pediatric control cohort may be applied for future studies. Strong correlations between sNfL and cNfL together with motor function suggest that sNfL may be a suitable biomarker for disease activity in children with 2 SMN2 copies and those with >2 SMN2 copies within their initial stages during early childhood.
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Affiliation(s)
- Elisa Nitz
- Department of Neuropediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Martin Smitka
- Department of Neuropediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Jens Schallner
- Department of Neuropediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Katja Akgün
- Department of Neurology, Center of Clinical Neuroscience, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Department of Neurology, Center of Clinical Neuroscience, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Maja von der Hagen
- Department of Neuropediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Victoria Tüngler
- Department of Neuropediatrics, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany.,University Center for Rare Diseases, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Jin J, Cui Y, Hong Y, Zhou D, He N, Mao Z, Mao S. Reference values for plasma neurofilament light chain in healthy Chinese children. Clin Chem Lab Med 2021; 60:e10-e12. [PMID: 34449172 DOI: 10.1515/cclm-2021-0804] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/27/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Jianing Jin
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, P.R. China
| | - Yiqin Cui
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, P.R. China
| | - Yi Hong
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, P.R. China
| | - Dongming Zhou
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, P.R. China
| | - Ni He
- Hangzhou KingMed for Clinical Laboratory Co., Ltd., Hangzhou, P.R. China
| | - Zhifeng Mao
- KingMed Center for Clinical Laboratory Co., Ltd., Guangzhou, P.R. China
| | - Shanshan Mao
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, P.R. China
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Jakimovski D, Dwyer MG, Bergsland N, Weinstock-Guttman B, Zivadinov R. Disease biomarkers in multiple sclerosis: current serum neurofilament light chain perspectives. Neurodegener Dis Manag 2021; 11:329-340. [PMID: 34196596 DOI: 10.2217/nmt-2020-0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The continuous neuroinflammatory and neurodegenerative pathology in multiple sclerosis (MS) results in irreversible accumulation of physical and cognitive disability. Reliable early detection of MS disease processes can aid in the diagnosis, monitoring and treatment management of MS patients. Recent assay technological advancements now allow reliable quantification of serum-based neurofilament light chain (sNfL) levels, which provide temporal information regarding the degree of neuroaxonal damage. The relationship and predictive value of sNfL with clinical and cognitive outcomes, other paraclinical measures and treatment response is reviewed. sNfL measurement is an emerging, noninvasive and disease-responsive MS biomarker that is currently utilized in research and clinical trial settings. Understanding sNfL confounders and further assay standardization will allow clinical implementation of this biomarker.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.,IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, 20148, Italy
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment & Research Center, Department of Neurology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.,Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
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Thebault S, Bose G, Booth R, Freedman MS. Serum neurofilament light in MS: The first true blood-based biomarker? Mult Scler 2021; 28:1491-1497. [PMID: 33565908 PMCID: PMC9315170 DOI: 10.1177/1352458521993066] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A simple blood-derived biomarker is desirable in the routine management
of multiple sclerosis (MS) patients and serum neurofilament light
chain (sNfL) is the most promising candidate. Although its utility was
first shown in cerebrospinal fluid (CSF), technological advancements
have enabled reliable detection in serum and less frequently plasma,
obviating the need for repeated lumbar punctures. In this review,
after defining the knowledge gap in MS management that many hope sNfL
could fill, we summarize salient studies demonstrating associations of
sNfL levels with outcomes of interest. We group these outcomes into
inflammatory activity, progression, treatment response, and
prediction/prognosis. Where possible we focus on data from real-world
perspective observational cohorts. While acknowledging the limitations
of sNfL and highlighting key areas for ongoing work, we conclude with
our opinion of the role for sNfL as an objective, convenient, and
cost-effective adjunct to clinical assessment. Paving the way for
other promising biomarkers both blood-derived and otherwise, sNfL is
an incremental step toward precision medicine for MS patients.
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Affiliation(s)
- Simon Thebault
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Gauruv Bose
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ronald Booth
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada/The University of Ottawa, Ottawa, ON, Canada
| | - Mark S Freedman
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada
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36
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Blood Neurofilament Light Chain: The Neurologist's Troponin? Biomedicines 2020; 8:biomedicines8110523. [PMID: 33233404 PMCID: PMC7700209 DOI: 10.3390/biomedicines8110523] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022] Open
Abstract
Blood neurofilament light chain (NfL) is a marker of neuro-axonal injury showing promising associations with outcomes of interest in several neurological conditions. Although initially discovered and investigated in the cerebrospinal fluid (CSF), the recent development of ultrasensitive digital immunoassay technologies has enabled reliable detection in serum/plasma, obviating the need for invasive lumbar punctures for longitudinal assessment. The most evidence for utility relates to multiple sclerosis (MS) where it serves as an objective measure of both the inflammatory and degenerative pathologies that characterise this disease. In this review, we summarise the physiology and pathophysiology of neurofilaments before focusing on the technological advancements that have enabled reliable quantification of NfL in blood. As the test case for clinical translation, we then highlight important recent developments linking blood NfL levels to outcomes in MS and the next steps to be overcome before this test is adopted on a routine clinical basis.
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37
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Barro C, Chitnis T, Weiner HL. Blood neurofilament light: a critical review of its application to neurologic disease. Ann Clin Transl Neurol 2020; 7:2508-2523. [PMID: 33146954 PMCID: PMC7732243 DOI: 10.1002/acn3.51234] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
Neuronal injury is a universal event that occurs in disease processes that affect both the central and peripheral nervous systems. A blood biomarker linked to neuronal injury would provide a critical measure to understand and treat neurologic diseases. Neurofilament light chain (NfL), a cytoskeletal protein expressed only in neurons, has emerged as such a biomarker. With the ability to quantify neuronal damage in blood, NfL is being applied to a wide range of neurologic conditions to investigate and monitor disease including assessment of treatment efficacy. Blood NfL is not specific for one disease and its release can also be induced by physiological processes. Longitudinal studies in multiple sclerosis, traumatic brain injury, and stroke show accumulation of NfL over days followed by elevated levels over months. Therefore, it may be hard to determine with a single measurement when the peak of NfL is reached and when the levels are normalized. Nonetheless, measurement of blood NfL provides a new blood biomarker for neurologic diseases overcoming the invasiveness of CSF sampling that restricted NfL clinical application. In this review, we examine the use of blood NfL as a biologic test for neurologic disease.
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Affiliation(s)
- Christian Barro
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Armangue T, Capobianco M, de Chalus A, Laetitia G, Deiva K. E.U. paediatric MOG consortium consensus: Part 3 - Biomarkers of paediatric myelin oligodendrocyte glycoprotein antibody-associated disorders. Eur J Paediatr Neurol 2020; 29:22-31. [PMID: 33191096 DOI: 10.1016/j.ejpn.2020.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
A first episode of acquired demyelinating disorder (ADS) in children is a diagnostic challenge as different diseases can express similar clinical features. Recently, antibodies against myelin oligodendrocyte glycoprotein (MOG) have emerged as a new ADS biomarker, which clearly allow the identification of monophasic and relapsing ADS forms different from MS predominantly in children. Due to the novelty of this antibody there are still challenges and controversies about its pathogenicity and best technique to detect it. In this manuscript we will discuss the recommendations and caveats on MOG antibody assays, role in the pathogenesis, and additionally discuss the usefulness of other potential new biomarkers in MOG-antibody associated disorders (MOGAD).
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Affiliation(s)
- Thaís Armangue
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Pediatric Neuroimmunology Unit, Neurology Department, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona, Barcelona, Spain.
| | - Marco Capobianco
- Department of Neurology and Regional Multiple Sclerosis Centre, University Hospital San Luigi Gonzaga, Orbassano, Italy
| | - Aliénor de Chalus
- Assistance Publique-Hôpitaux de Paris, Pediatric Neurology Department, University Hospitals Paris Saclay, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Giorgi Laetitia
- Assistance Publique-Hôpitaux de Paris, Pediatric Neurology Department, University Hospitals Paris Saclay, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Kumaran Deiva
- Assistance Publique-Hôpitaux de Paris, Pediatric Neurology Department, University Hospitals Paris Saclay, Bicêtre Hospital, Le Kremlin Bicêtre, France; French Reference Network of Rare Inflammatory Brain and Spinal Diseases, Le Kremlin Bicêtre, France and European Reference Network-RITA, France
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Evers KS, Hügli M, Fouzas S, Kasser S, Pohl C, Stoecklin B, Bernasconi L, Kuhle J, Wellmann S. Serum Neurofilament Levels in Children With Febrile Seizures and in Controls. Front Neurosci 2020; 14:579958. [PMID: 33132834 PMCID: PMC7550525 DOI: 10.3389/fnins.2020.579958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/04/2020] [Indexed: 12/31/2022] Open
Abstract
Objective Neuroaxonal damage is reflected by serum neurofilament light chain (sNfL) values in a variety of acute and degenerative diseases of the brain. The aim of this study was to investigate the impact of febrile and epileptic seizures on sNfL, serum copeptin, and prolactin levels in children compared with children with febrile infections without convulsions. Methods A prospective cross-sectional study was performed in children aging 6 months to 5 years presenting with fever (controls, n = 61), febrile seizures (FS, n = 78), or epileptic seizures (ES, n = 16) at our emergency department. sNfL, copeptin, and prolactin were measured within a few hours after the event in addition to standard clinical, neurophysiological, and laboratory assessment. All children were followed up for at least 1 year after presentation concerning recurrent seizures. Results Serum copeptin values were on average 4.1-fold higher in FS and 3.2-fold higher in ES compared with controls (both p < 0.01). Serum prolactin values were on average 1.3-fold higher in FS compared with controls ( p < 0.01) and without difference between ES and controls. There was no significant difference of mean sNfL values (95% CI) between all three groups, FS 21.7 pg/ml (19.6–23.9), ES 17.7 pg/ml (13.8–21.6), and controls 23.4 pg/ml (19.2–27.4). In multivariable analysis, age was the most important predictor of sNfL, followed by sex and C reactive protein. Neither the duration of seizures nor the time elapsed from seizure onset to blood sampling had an impact on sNfL. None of the three biomarkers were related to recurrent seizures. Significance Serum neurofilament light is not elevated during short recovery time after FS when compared with children presenting febrile infections without seizures. We demonstrate an age-dependent decrease of sNfL from early childhood until school age. In contrast to sNfL levels, copeptin and prolactin serum levels are elevated after FS.
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Affiliation(s)
- Katrina S Evers
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Melanie Hügli
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Sotirios Fouzas
- Paediatric Respiratory Unit and Department of Neonatology, University Hospital of Patras, Patras, Greece
| | - Severin Kasser
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Christian Pohl
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland.,Neonatal Intensive Care Unit, Perth Children's and King Edward Memorial Hospitals, Perth, WA, Australia
| | - Benjamin Stoecklin
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Wellmann
- Division of Neonatology and University of Basel Children's Hospital (UKBB), Basel, Switzerland.,Division of Neonatology, University Children's Hospital Regensburg (KUNO), University of Regensburg, Regensburg, Germany
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