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Serum NfL – MS Biomarker — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationSerum NfL – MS BiomarkerSCE Neurology

A 50-year-old man with MS has had a stable EDSS of 3.0 for 5 years on ocrelizumab. He has no relapses and no MRI activity. His neurologist wants to check whether his disease is truly inactive or whether there is ongoing subclinical neurodegeneration. What biomarker is emerging for monitoring neuro-axonal damage in MS?

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Correct answer: A — Serum neurofilament light chain (NfL) — a structural protein released from damaged axons into the CSF and blood; elevated levels indicate active neuro-axonal damage and correlate with disease activity, relapse, and disability progression

Neurofilament light chain (NfL) is a cytoskeletal protein specific to neurons and axons. When axons are damaged (from any cause — inflammation, degeneration, trauma), NfL is released into the CSF and blood. In MS, serum NfL levels: (1) correlate with relapse activity, (2) predict disability progression, (3) correlate with MRI lesion activity and brain atrophy, (4) can monitor treatment response (levels decrease on effective DMT). NfL is being incorporated into clinical practice as a blood-based biomarker for monitoring disease activity and treatment response. SIENA (brain volume measurement) is the imaging equivalent. A: ESR is non-specific. C: CRP is non-specific. D: Ferritin is iron storage. E: HbA1c is glucose control.

Reference: ABN MS Guidelines; Khalil et al. NfL in MS