Patients with neuromyelitis optica spectrum disorder (NMOSD) have significantly higher levels of plasma neurofilament light chain (pNfL) and plasma glial fibrillary acidic protein (pGFAP) compared to healthy controls, as found by researchers in China.

These 2 proteins could serve as biomarkers for disease activity and treatment effects.

“The dynamics of pNfL and pGFAP may help decide adjustments of disease-modifying drugs in individualized treatments,” the authors said in a study published in Therapeutic Advances in Neurological Disorders.

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These proteins have already been proposed as biomarkers of NMOSD. However, the link between their levels in plasma and the activity of the disease, as well as the effect of treatment, was not clear.

To explore the predictive value of the levels of these 2 proteins on disease activity and investigate the effects of disease-modifying treatments on them, a team of researchers led by Chao Zhang, PhD, conducted a longitudinal treatment responsiveness study.

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They measured the levels of pNfL and pGFAP in 72 patients with NMOSD and 38 healthy controls. Of the patients with NMOSD, 29 received tocilizumab treatment, 23 received rituximab treatment, 16 received oral prednisone, and 4 received oral azathioprine or mycophenolate mofetil.

They found that the levels of pNfL and pGFAP ranged between 11.2–39 pg/mL and 88.6–406.5 pg/mL, respectively, in patients with NMOSD vs between 7.0–23.3 pg/mL and 59.4–80.8 pg/mL, respectively, in healthy controls.

Statistical analyses revealed that the concentration of pNfL at baseline was associated with age, patients’ score on the Expanded Disability Status Scale (EDSS), and recent relapses. The concentration of pGFAP at baseline was also associated with EDSS score and recent relapses. 

Treatment with tocilizumab and rituximab significantly reduced levels of pNfL and pGFAP compared to prednisone. In the case of pNfL, the levels were reduced to those of healthy controls. 


Zhang TX, Chen JS, Du C, et al. Longitudinal treatment responsiveness on plasma neurofilament light chain and glial fibrillary acidic protein levels in neuromyelitis optica spectrum disorder. Ther Adv Neurol Disord. 2021;3:14. doi:10.1177/17562864211054952