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Longitudinal assessment of sNfL and sGFAP in severe NMOSD treated with allogeneic stem cell transplantation
Barbora Srpova1, Eva Krasulova1, Libuse Noskova2
1Department of Neurology and Centre of Clinical Neuroscience, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czechia.
Background And Objectives:
Serum neurofilament light chain (sNfL) and serum glial fibrillary acidic protein (sGFAP) in neuromyelitis optica spectrum disorder (NMOSD) have recently emerged as potential biomarkers of disease activity, although their clinical relevance remains uncertain. Our aim was to assess longitudinal sNfL and sGFAP dynamics at the individual level in a patient with a severe course of aquaporin-4-antibody-positive (AQP4-IgG) NMOSD who failed common therapeutic approaches and consequently required autologous (ASCT) and ultimately allogeneic (alloSCT) stem cell transplantation.
Methods:
We retrospectively analyzed sNfL and sGFAP levels in 34 longitudinal serum samples collected from a single female patient over an eight-year observation period. Levels of sNfL and sGFAP were measured using the Single Molecule Array (Simoa). Statistical analyses were performed using R software.
Results:
The median sNfL was 25.21 pg/mL (IQR 32.74), and the median sGFAP level was 358.03 pg/mL (IQR 1954.06). A positive correlation was observed between sNfL levels and the Expanded Disability Status Scale (EDSS) (r = 0.41, p = 0.0149). Elevated sGFAP levels were associated with clinical relapses.
Discussion:
This single-patient study provides unique longitudinal data on sNfL and sGFAP in a highly aggressive course of AQP4-IgG-positive NMOSD requiring allogeneic stem cell transplantation. The findings suggest that sNfL may reflect cumulative disability progression, whereas sGFAP appears to more reliably capture disease activity. These observations should be interpreted cautiously as descriptive and hypothesis-generating only.
