Longitudinal Plasma Biomarker Profiles Predict Neurological Outcome in Traumatic Spinal Cord Injury

Area of Science:

• Neuroscience
• Biomarker Discovery
• Clinical Diagnostics

Background:

• Traumatic spinal cord injury (SCI) diagnosis relies on imaging and clinical scoring (American Spinal Injury Association Impairment Scale - AIS), which have limited prognostic capabilities.
• Accurate prognosis is crucial for patient management, clinical trial stratification, and treatment planning in SCI.

Purpose of the Study:

• To evaluate the prognostic value of plasma neurofilament-light (NfL), glial fibrillary acidic protein (GFAP), and contactin-1 (CNTN-1) in patients with traumatic SCI.
• To determine if these biomarkers can predict neurological recovery and injury severity over time.

Main Methods:

• Plasma samples were collected from 37 traumatic SCI patients and 22 healthy controls at various time points (0-4 days to 18 weeks post-injury).
• NfL and GFAP levels were measured using single molecule array (Simoa) technology, and CNTN-1 using Luminex.
• Baseline and outcome American Spinal Injury Association Impairment Scale (AIS) and motor scores were recorded to assess injury severity and recovery.

Main Results:

• NfL, GFAP, and CNTN-1 exhibited distinct kinetic profiles in SCI patients.
• Baseline NfL + GFAP levels identified AIS-A patients and discriminated motor score changes.
• Longitudinal NfL measurements predicted AIS status and motor score changes up to 18 weeks post-SCI.
• Combined biomarkers accurately predicted AIS conversion (AUC 0.863) and motor score change (AUC 0.857), with sustained predictive ability in later stages.

Conclusions:

• Plasma NfL, GFAP, and CNTN-1 are promising prognostic biomarkers for traumatic SCI.
• These biomarkers can improve patient stratification for clinical trials.
• They facilitate prediction of neurological outcomes and support informed decision-making in SCI treatment and rehabilitation.