Moving from CSF to blood: monitoring disease activity in MS using serum neurofilament light protein
ECTRIMS Online Library. Lycke J. 09/13/19; 279544; 282
Assoc. Prof. Jan Lycke
Assoc. Prof. Jan Lycke
Contributions Biography
Abstract

Abstract: 282

Type: Scientific Session

Abstract Category: Scientific Session 13: Soluble and electrophysiological biomarkers

J. Lycke

Clinical Neuroscience, Gothenburg University/Institution of Neuroscience and Physiology, Gothenburg, Sweden

Neurofilament light (NFL) has the potential to become the first soluble biomarker to monitor disease activity and treatment response in clinical practice of multiple sclerosis (MS). This step was achieved by the evolution of ultrasensitive immunoassays for determination of neuro-specific proteins in blood, making NFL a more accessible biomarker. This may completely change the perspectives of monitoring disease activity and therapeutic interventions in MS. NFL specifically reflect neuro-axonal damage and degeneration and may serve as a biomarker during all stages of MS. Previous studies show that NFL may predict the risk of conversion from radiologically isolated syndrome to clinically isolated syndrome and relapsing remitting (RR) MS. The NFL level at disease onset is associated with disease severity, disability development and risk of conversion from RRMS to secondary progressive (SP) MS. NFL levels at clinical onset also correlate with brain and spinal cord atrophy development. Although NFL may predict the rate of degeneration, NFL is predominantly a disease activity marker in MS. Highest NFL levels are associated with relapses and correlate with number of contrast enhancing lesions and number of new T2 lesions. Disease modifying therapies (DMTs) reduce NFL to similar levels as found in healthy controls. In clinical trials and in observational studies NFL levels reflect the efficacy of the treatment. Compared to inflammatory soluble biomarkers, NFL is not directly influenced by immunomodulatory or immunosuppressive therapies, but reflects instead the extent of the autoimmune attack. Furthermore, NFL is not dependent on the pathological process of MS but may also be useful in the evaluation of therapies that directly reduce neurodegeneration. In the current evaluation of patients and for monitoring therapeutic efficacy clinical and cerebral MRI measures may not detect activity that cause diffuse neuro-axonal degeneration, spinal cord involvement or cortical lesions. Determination of NFL in blood may improve the assessment of patients and should be considered as part of No Evidence of Disease Activity (NEDA).
Disclosure: JL has received travel support and/or lecture honoraria from Biogen, Novartis, Teva and Genzyme/SanofiAventis; has served on scientific advisory boards for Almirall, Teva, Biogen, Novartis and Genzyme/SanofiAventis; serves on the editorial board of the Acta Neurologica Scandinavica; has received unconditional research grantsfrom Biogen, Novartis and Teva.

Abstract: 282

Type: Scientific Session

Abstract Category: Scientific Session 13: Soluble and electrophysiological biomarkers

J. Lycke

Clinical Neuroscience, Gothenburg University/Institution of Neuroscience and Physiology, Gothenburg, Sweden

Neurofilament light (NFL) has the potential to become the first soluble biomarker to monitor disease activity and treatment response in clinical practice of multiple sclerosis (MS). This step was achieved by the evolution of ultrasensitive immunoassays for determination of neuro-specific proteins in blood, making NFL a more accessible biomarker. This may completely change the perspectives of monitoring disease activity and therapeutic interventions in MS. NFL specifically reflect neuro-axonal damage and degeneration and may serve as a biomarker during all stages of MS. Previous studies show that NFL may predict the risk of conversion from radiologically isolated syndrome to clinically isolated syndrome and relapsing remitting (RR) MS. The NFL level at disease onset is associated with disease severity, disability development and risk of conversion from RRMS to secondary progressive (SP) MS. NFL levels at clinical onset also correlate with brain and spinal cord atrophy development. Although NFL may predict the rate of degeneration, NFL is predominantly a disease activity marker in MS. Highest NFL levels are associated with relapses and correlate with number of contrast enhancing lesions and number of new T2 lesions. Disease modifying therapies (DMTs) reduce NFL to similar levels as found in healthy controls. In clinical trials and in observational studies NFL levels reflect the efficacy of the treatment. Compared to inflammatory soluble biomarkers, NFL is not directly influenced by immunomodulatory or immunosuppressive therapies, but reflects instead the extent of the autoimmune attack. Furthermore, NFL is not dependent on the pathological process of MS but may also be useful in the evaluation of therapies that directly reduce neurodegeneration. In the current evaluation of patients and for monitoring therapeutic efficacy clinical and cerebral MRI measures may not detect activity that cause diffuse neuro-axonal degeneration, spinal cord involvement or cortical lesions. Determination of NFL in blood may improve the assessment of patients and should be considered as part of No Evidence of Disease Activity (NEDA).
Disclosure: JL has received travel support and/or lecture honoraria from Biogen, Novartis, Teva and Genzyme/SanofiAventis; has served on scientific advisory boards for Almirall, Teva, Biogen, Novartis and Genzyme/SanofiAventis; serves on the editorial board of the Acta Neurologica Scandinavica; has received unconditional research grantsfrom Biogen, Novartis and Teva.

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