New biomarker may predict conversion to multiple sclerosis

This study assessed the prognostic value of serum neurofilament light chains (NfL) to predict conversion of patients with clinically isolated syndrome (CIS) to multiple sclerosis (MS).

Study design

The retrospective assessment included data from 222 patients with clinically isolated syndrome, 186 of whom developed multiple sclerosis within 2 years. These patients were admitted to a single neurologic department between 2000 and 2015. Serum levels of neurofilament light chain were measured.

Outcomes

Serum neurofilament light chains were higher in patients who developed MS compared to those who did not develop MS (30.2 vs 9.7 pg/mL; P<0.001). The NfL levels in cerebrospinal fluid correlated with serum levels, especially in patients with Gd-enhancing lesions (P<0.001). Levels were noticeably increased in patients with CIS who recently relapsed and had a high number of T2 and Gd-enhancing lesions on MRI scan of the brain (both P<0.001).

Limitations

This study is limited by its retrospective design. Although these results have been validated internally, external validation is necessary before these nomograms can be applied to new patient populations.

Clinical significance

The authors conclude that serum NfL has a prognostic value for the conversion of CIS to MS, and may be a useful biomarker for the level of inflammatory activity in MS. If this marker becomes commercially available, it could help identify which patients with clinically isolated syndrome, such as optic neuritis, may be more likely to develop MS when no lesions are identified on brain and spinal cord MRI.