Serum NfL Detects Preclinical AD, Reflects Clinical Benefit

Alzforum
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Alzforum | November 17, 2017

It works! Neurofilament light chain (NfL) has emerged as the most promising fluid marker for tracking the progression of neurodegenerative disease. Unlike many other biomarkers, blood levels correlate closely with those in cerebrospinal fluid, raising the possibility of monitoring brain disease with a simple blood draw. Two recent Neurology papers broadened the potential applications for the marker, suggesting that serum NfL may detect both degeneration at early stages and response to treatment. In the October 25 Neurology, researchers led by Nick Fox at University College London reported that serum NfL starts to climb before symptoms emerge in people who carry a familial Alzheimer’s mutation. Meanwhile, researchers led by Lenka Nováková at the University of Gothenburg, Sweden, found that serum NfL levels dropped in response to disease remission or treatment in people with multiple sclerosis. That work appeared in the October 27 Neurology. “This could be a very accessible, non-disease-specific neurodegenerative marker,” Fox told Alzforum.

Other researchers agreed that the case for clinical use of this biomarker is growing. “I strongly believe that blood NfL concentration would be a valuable tool for clinical neurologists in a variety of scenarios to help gauge the presence of disease, some measure of severity, and potentially response to disease-modifying therapy,” Adam Boxer at the University of California, San Francisco, wrote to Alzforum. Christopher Shaw at King’s College London noted that in the field of neurodegenerative disease, “NfL is the best biomarker for disease activity that we have.” 

Numerous studies have correlated high NfL in CSF and in blood with the severity of neurodegenerative diseases such as AD (Nov 2015 newsJun 2016 newsMar 2017 news). NfL levels are elevated in people with mild cognitive impairment as well, but it was unclear how early in disease the biomarker rises.

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