Cerebrospinal fluid neurofilament light chain levels in children with acquired demyelinating syndrome

Wenlin Wu; Chi Hou; Wenxiao Wu; Huiling Shen; Yiru Zeng; Lianfeng Chen; Yinting Liao; Haixia Zhu; Yang Tian; Bingwei Peng; Wen-Xiong Chen; Xiaojing Li

doi:10.3389/fped.2024.1467020

Cerebrospinal fluid neurofilament light chain levels in children with acquired demyelinating syndrome

Front Pediatr. 2024 Nov 5:12:1467020. doi: 10.3389/fped.2024.1467020. eCollection 2024.

Authors

Wenlin Wu^#¹, Chi Hou^#¹, Wenxiao Wu^#¹, Huiling Shen^#¹, Yiru Zeng¹, Lianfeng Chen¹, Yinting Liao¹, Haixia Zhu¹, Yang Tian¹, Bingwei Peng¹, Wen-Xiong Chen¹, Xiaojing Li¹

Affiliation

¹ Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.

^# Contributed equally.

Abstract

Objective: To study the cerebrospinal fluid (CSF) neurofilament light chain (NfL) in pediatric acquired demyelinating syndrome (ADS) and its association with factors of laboratory and imaging results.

Methods: We analyzed clinical data from children with ADS collected from May 2020 to January 2021 at the Department of Neurology of Guangzhou Women and Children's Medical Center. Enzyme-linked immunosorbent assays were used to detect the CSF NfL of patients.

Results: Thirty pediatric ADS patients (17 male, 13 female) were included in the study. The most frequent diagnosis was uncategorized ADS (36.7%, 11/30), followed by acute disseminating encephalomyelitis (ADEM) (23.3%, 7/30), myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD) (20.0%, 6/30), NMO (6.7%, 2/30), multiple sclerosis (MS) (6.7%, 2/30), and neuromyelitis optic spectrum disorders (NMOSD) (6.7%, 2/30). The median CSF NfL for the first time was 7,425.28 pg/ml (interquartile range, 1,273.51, >10,000 pg/ml). CSF NfL increase over normal value (<290.00 pg/ml for people younger than 30 years old) was seen in 98.7% of patients. Patients were divided into uncategorized ADS, ADEM, MOGAD, and MS/NMO/NMOSD groups, with no significant difference in CSF NfL between each group. The CSF NfL positively correlated with the immunoglobulin (Ig) G (ρ = 0.473) and IgE (ρ = 0.366). However, the CSF NfL did not correlate with CSF white blood count and CSF protein. Furthermore, there was no significant difference between patients with oligoclonal bands positive and without. The CSF NfL negatively correlated with interferon γ (ρ = -0.501), CD45 ⁺ CD3⁺ T (ρ = -0.466), CD45 ⁺ CD3 ⁺ CD4⁺ T (ρ = -0.466), and CD45 ⁺ CD3 ⁺ CD8⁺ T cells (ρ = -0.521). However, it did not correlate with CD45 ⁺ CD19⁺ B cells. CSF NfL in patients with cerebral white matter lesions in MRI was higher than in patients without. Moreover, the CSF NfL positively correlated with the number of brain MRI locations (ρ = 0.362). Nine patients underwent multiple detections of CSF NfL, and their CSF NfL for the last detection was not significantly different from the first.

Conclusions: The CSF NfL increases significantly in pediatric ADS, and it can be a biomarker of neuro-axonal injury and a good indication of the extent of lesions.

Keywords: ADEM; MOGAD; NMOSD; acquired demyelinating syndrome; biomarker; children; neurofilament.

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article. The present study was supported by the Science and Technology Bureau Joint Colleges project foundation of Guangzhou City (Grant No. 202201020619), the basic and applied basic research project of Guangzhou Municipal Bureau of Science and Technology (Grant No. 202201011838), and the Basic and Applied Basic Research Foundation of Guangzhou City (Grant No. 202102020252). The funders had no role in the study concept, study design, data analysis, interpretation, or reporting of the results. The authors had full control of the data and information submitted for publication.