Annals of Clinical and Translational Neurology (May 2019)

Neurofilament as a potential biomarker for spinal muscular atrophy

  • Basil T. Darras,
  • Thomas O. Crawford,
  • Richard S. Finkel,
  • Eugenio Mercuri,
  • Darryl C. De Vivo,
  • Maryam Oskoui,
  • Eduardo F. Tizzano,
  • Monique M. Ryan,
  • Francesco Muntoni,
  • Guolin Zhao,
  • John Staropoli,
  • Alexander McCampbell,
  • Marco Petrillo,
  • Christopher Stebbins,
  • Stephanie Fradette,
  • Wildon Farwell,
  • Charlotte J. Sumner

DOI
https://doi.org/10.1002/acn3.779
Journal volume & issue
Vol. 6, no. 5
pp. 932 – 944

Abstract

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Abstract Objective To evaluate plasma phosphorylated neurofilament heavy chain (pNF‐H) as a biomarker in spinal muscular atrophy (SMA). Methods Levels of pNF‐H were measured using the ProteinSimple® platform in plasma samples from infants with SMA enrolled in ENDEAR (NCT02193074) and infants/children without neurological disease. Results Median pNF‐H plasma level was 167.0 pg/mL (7.46–7,030; n = 34) in children without SMA (aged 7 weeks–18 years) and was higher in those aged < 1 versus 1–18 years (P = 0.0002). In ENDEAR participants with infantile‐onset SMA, median baseline pNF‐H level (15,400 pg/mL; 2390–50,100; n = 117) was ~10‐fold higher than that of age‐matched infants without SMA (P < 0.0001) and ~90‐fold higher than children without SMA (P < 0.0001). Higher pretreatment pNF‐H levels in infants with SMA were associated with younger age at symptom onset, diagnosis, and first dose; lower baseline Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders score; and lower peroneal compound muscle potential amplitude. Nusinersen treatment was associated with a rapid and greater decline in pNF‐H levels: nusinersen‐treated infants experienced a steep 71.9% decline at 2 months to 90.1% decline at 10 months; sham control–treated infants declined steadily by 16.2% at 2 months and 60.3% at 10 months. Interpretation Plasma pNF‐H levels are elevated in infants with SMA. Levels inversely correlate with age at first dose and several markers of disease severity. Nusinersen treatment is associated with a significant decline in pNF‐H levels followed by relative stabilization. Together these data suggest plasma pNF‐H is a promising marker of disease activity/treatment response in infants with SMA.