Plasma NfL and GFAP as biomarkers of spinal cord degeneration in adrenoleukodystrophy

Wouter J.C. van Ballegoij*, Stephanie I.W. van de Stadt, Irene C. Huffnagel, Stephan Kemp, Eline A.J. Willemse, Charlotte E. Teunissen, Marc Engelen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: To explore the potential of neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) as biomarkers of spinal cord degeneration in adrenoleukodystrophy, as objective treatment-outcome parameters are needed. Methods: Plasma NfL and GFAP levels were measured in 45 male and 47 female ALD patients and compared to a reference cohort of 73 healthy controls. For male patients, cerebrospinal fluid (CSF) samples (n = 33) and 1-year (n = 39) and 2-year (n = 18) follow-up data were also collected. Severity of myelopathy was assessed with clinical parameters: Expanded Disability Status Scale (EDSS), Severity Scoring system for Progressive Myelopathy (SSPROM), and timed up-and-go. Results: NfL and GFAP levels were higher in male (P < 0.001, effect size (partial ƞ2) NfL = 0.49, GFAP = 0.13) and female (P < 0.001, effect size NfL = 0.19, GFAP = 0.23) patients compared to controls; levels were higher in both symptomatic and asymptomatic patients. In male patients, NfL levels were associated with all three clinical parameters of severity of myelopathy (EDSS, SSPROM, and timed up-and go), while GFAP in male and NfL and GFAP in female patients were not. Changes in clinical parameters during follow-up did not correlate with (changes in) NfL or GFAP levels. Plasma and CSF NfL were strongly correlated (r = 0.60, P < 0.001), but plasma and CSF GFAP were not (r = 0.005, P = 0.98). Interpretation: Our study illustrates the potential of plasma NfL as biomarker of spinal cord degeneration in adrenoleukodystrophy, which was superior to plasma GFAP in our cohort.

Original languageEnglish
Pages (from-to)2127-2136
Number of pages10
JournalAnnals of Clinical and Translational Neurology
Issue number11
Publication statusPublished - Nov 2020

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