Neurofilament Light Chain as a Biomarker in Neurology

Area of Science:

• Neuroscience
• Biomarker Discovery
• Neurology

Background:

• Neurofilament light chain (NfL) is a sensitive indicator of neuroaxonal injury.
• NfL levels rise with axonal damage and correlate with disease progression in various neurological conditions.
• Glial fibrillary acidic protein (GFAP) offers complementary insights into astrocytic damage.

Purpose of the Study:

• To review the diagnostic, prognostic, and therapeutic-monitoring utility of NfL in neurological disorders.
• To outline the clinical limitations of NfL and highlight the role of GFAP.
• To explore the integration of NfL with multimodal biomarkers for enhanced accuracy.

Main Methods:

• Literature review synthesizing current evidence on NfL and GFAP.
• Analysis of NfL's role in multiple sclerosis, Alzheimer's disease, ALS, Parkinson's disease, TBI, and stroke.
• Discussion of physiological variability and limitations in NfL interpretation.

Main Results:

• NfL is elevated in diverse neurological conditions, reflecting neurodegeneration and injury.
• NfL correlates with disease severity, disability progression, and survival.
• GFAP/NfL ratio may help differentiate conditions like MS from NMOSD.

Conclusions:

• NfL is a valuable biomarker, but interpretation requires considering physiological variability.
• Integrating NfL with GFAP and other biomarkers can improve diagnostic and prognostic accuracy.
• Future research should focus on reference intervals, longitudinal thresholds, and therapeutic monitoring frameworks.