Cerebrospinal fluid neurofilament light chain levels predict visual outcome after optic neuritis

• Published in: Multiple sclerosis 2016-04, Vol.22 (5), p.590-598
• Main Authors: Modvig, S, Degn, M, Sander, B, Horwitz, H, Wanscher, B, Sellebjerg, F, Frederiksen, JL
• Format: Article
• Language: English
• Subjects: Acuity; Adult; Axons - pathology; Biomarkers; Cerebrospinal fluid; Chitinase; Colony-stimulating factor; Demyelination; Enzyme-linked immunosorbent assay; Female; Guanylate cyclase; Humans; Intermediate Filaments - metabolism; Magnetic resonance imaging; Male; Middle Aged; Multiple sclerosis; Multiple Sclerosis - cerebrospinal fluid; Multiple Sclerosis - pathology; Myelin; Myelin basic protein; Nerve Fibers - metabolism; Nerve Fibers - pathology; Neuritis; Neuroprotection; NMR; Nuclear magnetic resonance; Optic neuritis; Optic Neuritis - cerebrospinal fluid; Optic Neuritis - pathology; Osteopontin; Remission; Retina; Retina - pathology; Retinal Ganglion Cells - cytology; Tomography, Optical Coherence - methods; Visual Acuity - physiology
• ISSN: 1352-4585; 1477-0970
• DOI: 10.1177/1352458515599074

Background: Optic neuritis is a good model for multiple sclerosis relapse, but currently no tests can accurately predict visual outcome. Objective: The purpose of this study was to examine whether cerebrospinal fluid (CSF) biomarkers of tissue damage and remodelling (neurofilament light chain (NF-L), myelin basic protein, osteopontin and chitinase-3-like-1) predict visual outcome after optic neuritis. Methods: We included 47 patients with optic neuritis as a first demyelinating episode. Patients underwent visual tests, optical coherence tomography (OCT), magnetic resonance imaging (MRI) and lumbar puncture. Biomarkers were measured in CSF by enzyme-linked immunosorbent assay (ELISA). Patients were followed up six months after onset and this included visual tests and OCT. Outcome measures were inter-ocular differences in low contrast visual acuity (LCVA), retinal nerve fibre layer (RNFL) and ganglion cell layer+inner plexiform layer (GC-IPL) thicknesses. Results: CSF NF-L levels at onset predicted inter-ocular differences in follow-up LCVA (β=13.8, p=0.0008), RNFL (β=5.6, p=0.0004) and GC-IPL (β=4.0, p=0.0008). The acute-phase GC-IPL thickness also predicted follow-up LCVA (β=12.9, p=0.0021 for NF-L, β=−1.1, p=0.0150 for GC-IPL). Complete/incomplete remission was determined based on LCVA from 30 healthy controls. NF-L had a positive predictive value of 91% and an area under the curve (AUC) of 0.79 for incomplete remission. Conclusion: CSF NF-L is a promising biomarker of visual outcome after optic neuritis. This could aid neuroprotective/regenerative medical advancements.