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Updated: Jul 9, 2026

Experimental Approaches for Biochemical Analysis of Glial Fibrillary Acidic Protein and Its Disease-associated Variants
Published on: November 28, 2025
Glial Fibrillary Acid Protein Reflects Disease Activity in Autoimmune Encephalitis
Johannes Piepgras1, Marlene L Piepgras2, Falk Steffen1
1Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
The NfL/GFAP ratio in serum and CSF shows promise as a biomarker for diagnosing autoimmune encephalitis (AE) and monitoring disease activity. This ratio aids in distinguishing AE from multiple sclerosis and identifying active AE cases.
Area of Science:
- Neurology
- Biomarker Discovery
- Neuroimmunology
Background:
- Autoimmune encephalitis (AE) diagnosis and management are hindered by the absence of reliable biomarkers.
- Glial fibrillary acid protein (GFAP) and neurofilament light chain (NfL) are emerging biomarkers for neurological conditions.
Purpose of the Study:
- To evaluate the combined utility of GFAP and NfL in cerebrospinal fluid (CSF) and serum for diagnosing AE.
- To assess the potential of the NfL/GFAP ratio in differentiating AE from multiple sclerosis (MS) and monitoring disease activity.
Main Methods:
- CSF and serum GFAP and NfL levels were measured in 42 AE patients.
- Correlations with CSF markers of neuroinflammation were analyzed.
- NfL/GFAP ratios were compared between AE patients, MS patients, and controls, and between stable and active AE.
Main Results:
- CSF GFAP (cGFAP) correlated strongly with intrathecal inflammation markers.
- The NfL/GFAP ratio provided better discrimination between AE, MS, and controls compared to individual biomarkers.
- Serum NfL/GFAP ratios effectively distinguished active from stable AE.
Conclusions:
- The NfL/GFAP ratio, particularly in serum, shows potential as a blood-based biomarker for AE diagnosis and disease monitoring.
- This ratio may identify CNS-compartmentalized neuronal injury in AE patients.
- The NfL/GFAP ratio can assist clinicians in managing AE.
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