Abdelhak Ahmed, Cordano Christian, Duncan Greg J, Emberley Katie, Nocera Sonia, Xin Wendy, Ananth Kirtana, Jabassini Nour, Ning Kiarra, Reinsberg Henriette, Oertel Frederike Cosima, Beaudry-Richard Alexandra, Kuhle Jens, Petzold Axel, Patel Praveen J, Ribeiro Reis Ana P, Foster Paul J, Watkins Trent, Chan Jonah R, Emery Ben, Green Ari J
Department of Neurology, Weill Institute for Neurosciences, University of California at San Francisco (UCSF), San Francisco, CA 94158, USA.
Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova 16132, Italy.
Brain. 2025 Aug 1;148(8):3011-3020. doi: 10.1093/brain/awaf144.
Neuroaxonal injury is a major driver of irreversible disability in demyelinating conditions. Accurate assessment of the association between demyelination and axonal pathology is critical for evaluating and developing effective therapeutic approaches. Measuring neurofilament light chain (NfL) in the blood could putatively allow longitudinal monitoring of neuroaxonal injury at 'single protein resolution' with high pathological specificity. Here, we demonstrate a robust association between blood and tissue NfL-based assessment of neuroaxonal injury and severity of inflammatory demyelination in experimental autoimmune encephalitis (EAE). In EAE, high levels of NfL were evident at the peak of demyelination and correlated with tissue evidence of NfL loss when using antibodies that target the same NfL epitopes. In addition, we validate the longitudinal NfL dynamics in relation to de- and remyelination in an inducible genetic model of inflammatory-independent myelin loss. Through inducible knockout of myelin regulatory factor (Myrf) in proteolipid protein (PLP) expressing cells in Myrffl/fl PLP1-CreERT (MyrfΔiPLP) mice, serum NfL peaked at the time of demyelination and reduced following effective remyelination. In people with multiple sclerosis, the most common demyelinating condition, we confirmed the association between NfL and myelin breakdown proteins in two independent cohorts using Olink proximity extension assays, the ReBUILD clinical trial and the multiple sclerosis participants in the UK-Biobank. Our study provides a translational framework to understand the biology behind NfL changes in the context of de- and remyelination and reveals novel aspects related to monitoring potentially reversible neuroaxonal pathology in humans and rodents.
神经轴突损伤是脱髓鞘疾病中导致不可逆残疾的主要因素。准确评估脱髓鞘与轴突病理之间的关联对于评估和开发有效的治疗方法至关重要。检测血液中的神经丝轻链(NfL)可能允许以“单一蛋白质分辨率”对神经轴突损伤进行纵向监测,且具有高度的病理特异性。在此,我们证明了在实验性自身免疫性脑脊髓炎(EAE)中,基于血液和组织NfL评估的神经轴突损伤与炎性脱髓鞘严重程度之间存在强有力的关联。在EAE中,脱髓鞘高峰期NfL水平明显升高,并且当使用靶向相同NfL表位的抗体时,其与NfL丢失的组织证据相关。此外,我们在炎症非依赖性髓鞘丢失的诱导性遗传模型中验证了与脱髓鞘和再髓鞘形成相关的NfL纵向动态变化。通过在Myrffl/fl PLP1-CreERT(MyrfΔiPLP)小鼠中表达蛋白脂蛋白(PLP)的细胞中诱导敲除髓鞘调节因子(Myrf),血清NfL在脱髓鞘时达到峰值,并在有效再髓鞘化后降低。在最常见的脱髓鞘疾病——多发性硬化症患者中,我们使用邻位延伸分析(Olink)、ReBUILD临床试验以及英国生物银行中的多发性硬化症参与者,在两个独立队列中证实了NfL与髓鞘破坏蛋白之间的关联。我们的研究提供了一个转化框架,以了解脱髓鞘和再髓鞘形成背景下NfL变化背后的生物学机制,并揭示了与监测人类和啮齿动物中潜在可逆性神经轴突病理相关的新方面。
J Mol Med (Berl). 2025-5-10
Acta Neuropathol Commun. 2024-12-4
J Neuroinflammation. 2025-8-1
Alzheimers Res Ther. 2025-2-19
Nat Commun. 2024-10-23
Nat Rev Neurol. 2024-5
Ann Clin Transl Neurol. 2024-3