Neurofilament light chain and total tau in the differential diagnosis and prognostic evaluation of acute and chronic inflammatory polyneuropathies

Ivan Kmezic; Kristin Samuelsson; Anja Finn; Zane Upate; Kaj Blennow; Henrik Zetterberg; Rayomand Press

doi:10.1111/ene.15428

Neurofilament light chain and total tau in the differential diagnosis and prognostic evaluation of acute and chronic inflammatory polyneuropathies

Eur J Neurol. 2022 Sep;29(9):2810-2822. doi: 10.1111/ene.15428. Epub 2022 Jun 20.

Authors

Ivan Kmezic^{1

2}, Kristin Samuelsson^{1

2}, Anja Finn², Zane Upate³, Kaj Blennow^{4

5}, Henrik Zetterberg^{4

5

6

7

8}, Rayomand Press^{1

2}

Affiliations

¹ Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
² Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
³ Department of Neurophysiology, Karolinska University Hospital, Stockholm, Sweden.
⁴ Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
⁵ Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Psychology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
⁶ Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.
⁷ UK Dementia Research Institute at UCL, London, UK.
⁸ Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China.

Abstract

Background and purpose: To investigate the diagnostic and prognostic value of axonal injury biomarkers in patients with inflammatory polyneuropathies.

Methods: Neurofilament light chain (NfL) and total tau (T-tau) were measured in the cerebrospinal fluid (CSF) and plasma in 41 patients with Guillain-Barré syndrome (GBS), 32 patients with chronic inflammatory demyelinating polyneuropathy (CIDP), 10 with paraproteinemia-related demyelinating polyneuropathy (PDN), and 8 with multifocal motor neuropathy (MMN), in comparison with 39 disease-free controls and 59 other controls. Outcome was measured with the GBS-disability score (GBS-ds) or Inflammatory Neuropathy Cause and Treatment (INCAT) disability score.

Results: Neurofilament light chain levels in CSF and plasma were higher in GBS, CIDP, and PDN vs. disease-free controls. Patients with MMN had higher NfL levels in plasma vs. disease-free controls, but lower levels in CSF and plasma vs. patients with amyotrophic lateral sclerosis (ALS). T-tau levels in plasma were higher in GBS, CIDP, PDN, and MMN vs. all control groups. Neurofilament light chain levels in CSF and plasma in patients with GBS correlated with GBS-ds, as higher levels were associated with inability to run after 6 and 12 months. NfL levels in CSF and plasma in CIDP did not correlate significantly with outcome.

Conclusions: Acute and chronic inflammatory neuropathies are associated with an increase in levels of NfL in CSF and plasma, but NfL is validated as a prognostic biomarker only in GBS. NfL could be used in differentiating patients with MMN from ALS. T-tau in plasma is a novel biomarker that could be used in a diagnostic assessment of patients with acute and chronic inflammatory polyneuropathies.

Keywords: CSF and plasma; Guillain-Barré syndrome (GBS); NfL; T-tau; chronic inflammatory demyelinating polyneuropathy (CIDP); diagnosis and prognosis; multifocal motor neuropathy (MMN); paraproteinemia-related demyelinating polyneuropathy (PDN).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Amyotrophic Lateral Sclerosis*
Biomarkers / cerebrospinal fluid
Diagnosis, Differential
Guillain-Barre Syndrome* / diagnosis
Humans
Intermediate Filaments
Neurofilament Proteins / cerebrospinal fluid
Polyneuropathies* / diagnosis
Polyradiculoneuropathy, Chronic Inflammatory Demyelinating* / diagnosis
Prognosis

Substances

Biomarkers
Neurofilament Proteins