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Monitoring disease activity in multiple sclerosis using serum neurofilament light protein.

Journal article
Authors Lenka Novakova
Henrik Zetterberg
Peter Sundström
Markus Axelsson
Martin Gunnarsson
Clas Malmeström
Fredrik Piehl
Kaj Blennow
Jan Lycke
Published in Neurology
Volume 89
Issue 22
Pages 2230-2237
ISSN 1526-632X
Publication year 2017
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Pages 2230-2237
Language en
Keywords Adult, Aged, Disability Evaluation, Enzyme-Linked Immunosorbent Assay, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Monitoring, Physiologic, methods, Multiple Sclerosis, blood, cerebrospinal fluid, classification, diagnostic imaging, Neurofilament Proteins, blood, cerebrospinal fluid, ROC Curve, Statistics as Topic, Sweden, Young Adult
Subject categories Neurochemistry


To examine the effects of disease activity, disability, and disease-modifying therapies (DMTs) on serum neurofilament light (NFL) and the correlation between NFL concentrations in serum and CSF in multiple sclerosis (MS).NFL concentrations were measured in paired serum and CSF samples (n = 521) from 373 participants: 286 had MS, 45 had other neurologic conditions, and 42 were healthy controls (HCs). In 138 patients with MS, the serum and CSF samples were obtained before and after DMT treatment with a median interval of 12 months. The CSF NFL concentration was measured with the UmanDiagnostics NF-light enzyme-linked immunosorbent assay. The serum NFL concentration was measured with an in-house ultrasensitive single-molecule array assay.In MS, the correlation between serum and CSF NFL was r = 0.62 (p < 0.001). Serum concentrations were significantly higher in patients with relapsing-remitting MS (16.9 ng/L) and in patients with progressive MS (23 ng/L) than in HCs (10.5 ng/L, p < 0.001 and p < 0.001, respectively). Treatment with DMT reduced median serum NFL levels from 18.6 (interquartile range [IQR] 12.6-32.7) ng/L to 15.7 (IQR 9.6-22.7) ng/L (p < 0.001). Patients with relapse or with radiologic activity had significantly higher serum NFL levels than those in remission (p < 0.001) or those without new lesions on MRI (p < 0.001).Serum and CSF NFL levels were highly correlated, indicating that blood sampling can replace CSF taps for this particular marker. Disease activity and DMT had similar effects on serum and CSF NFL concentrations. Repeated NFL determinations in peripheral blood for detecting axonal damage may represent new possibilities in MS monitoring.

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