In recent years, neurology is experiencing great advances, both in the diagnosis and in the treatment of numerous diseases up to a few years with hardly any available treatments, such as Multiple sclerosis. One of the new tools that are contributing to improve the approach to these diseases are the new biomarkers that help, not only to diagnose, but also to measure the course of the disease.
In recent years it is becoming increasingly relevant are the Light in serum chain neurofilaments (SNFLS) that, as his revealed in the NeuroSummit 2025, attended by 168 specialists from all over Spain, is becoming a very useful tool to measure the course of the Multiple sclerosis (EM) and optical neuromyelitis (NMO) and it is believed that it could apply in many other diseases in which neuronal damage occurs, such as Dr. Luisa María Villar GuimeransChief of the Immunology Service of the Ramón y Cajal University Hospital in Madrid.
What are neurofilaments and what is measured with them
When there is a neuronal damageas in diseases such as multiple sclerosis or in optical neuromyelitis, parts of the neurons pass to the cerebrospinal fluid and, to a lesser extent, to the blood, as Dr. Villar explains very graphically Next. cytoskeleton. When an axon breaks that cytoskeleton destructure, among other things, in neurofilaments, which are part of that structure. “
From about 10 or 15 years, a series of people, including Luisa María Villar Guimerans, began working on this and saw that when neurofilaments increased in the cerebrospinal fluid, which is the liquid that bathes the central nervous system, There was damage to axons. And later, when high sensitivity methods appeared, they were able to detect in lesser measures, but in the same proportion, the Blood neurofilaments. They also realized that they could detect that damage before even that the patient had more symptoms, “the increase in these blood molecules predicts that there is damage, that inflammation, as in the case of multiple sclerosis, is producing damage to the axons. When a treatment begins and it works, it is normalized, and we no longer have damage caused by inflammation,” he explains.
The increase in these neurofilaments in blood predicts that inflammation, as in the case of multiple sclerosis, is producing damage to axons
Today the use of this marker has been demonstrated useful, above all, to monitor treatments, That is, knowing whether or not they are working even before the patient has an outbreak and develops a disability that, in the case of the sclerous multiple, is irreversible. It is also a almost invasive method, as it is a simple blood analysisnot a lumbar puncture, “the puncture to measure neurofilaments is done at the beginning, to diagnose and to see the level of damage, to know if it is losing fast or slow axons, but it does not help you to monitor the treatments, because you cannot be doing to the patients lumbar punctures every little time, and the resonance is done once a year,” he explains.
With a blood analysis, however, treatment can be monitored Every time the specialist requires itand if he observes that he is producing neuronal damage due to inflammation, changing the treatment, “measuring this serves to choose one treatment or another depending on whether patient is suffering damage High Axonal. And when you have already chosen the treatment, to monitor the patient and see how this is working. If it works, you leave it, but if it is observed that there is a high neuronal damage, it can be changed to another, even before the patient notices it at the physical level or that he has an outbreak, you get ahead of the clinic, you detect it before the patient gets worse. You can anticipate that the patient has disabilitybefore we could only know that the treatment did not work when the patient had symptoms, had outbreaks, had disabilities … “, he says,” and this is a very novel and very important thing. “
In the case of neurodegenerative diseasessuch as EM or NMO this is very important, because there are available treatments and are presented in outbreaks that cause a disability that accumulates. Avoiding an outbreak is, in the long term, avoiding or delaying disability, “this biomarker allows the damage that is associated with acute inflammation, because when there is acute damage, neurofilaments increase,” he explains.
It can be detected if there is elevated neuronal damage even before the patient notice it or has an outbreak, before worsening
Only the tip of the iceberg
The Neurofilament measurement It is used every time in the approach of multiple sclerosis, but the objective of researchers such as Dr. Luisa María Villar Guimerans is that it extends, “for now, it is not done in all places, but every time its use is extending for how useful it is. You have to have the equipment to do it, but our intention is that every time is implemented more in clinical practice “he explains.
In the future it does not rule out that you can even use to diagnose some cases, but more studies are needed, “for diagnosis we have other tests, but I know that I could use in the future in some cases. For example, in health centers, when you see a patient with a suspicion, Doing this test could bring those suspicions closer And send the specialist to the patient faster, but this is being studied, it has not been included in the last diagnostic criteria because we still do not have enough evidence, “he acknowledges.
Many studies are missing, but if there is something that Dr. Luisa María Villar is quite sure is that This biomarker will give much to talk about In the coming years, and not only in these two diseases, “neurofilaments speak of axonal damage, and there is not only axonal damage in multiple sclerosis and in optical neuromyelitis. We have the clearest data in these diseases, but now they are working on other pathologies such as SHE, parkinson, Alzhelles… where we hope that, together with other proteins that are being studied, both in the cerebrospinal fluid and in the serum, They help us evaluate the follow -up and to see how patients evolve. We are sure that multiple sclerosis is only the tip of the iceberg and that this will soon be used in other neurological pathologies, “says optimistic.
This iceberg tip could even go Beyond neurological diseasesalso even diseases that cause damage to the central nervous systemat the brain level, at the bone marrow level … and they are already, in fact, testing it in patients with Alzheimer’s, “this is very high interest, because hAsta now we had nothing to tell us that there was damage to the central nervous system in bloodwith a blood test, which is easy to do, so that the history of neurofilaments is only starting, that it will have many applications. We in treatments of some cancers are already seeing something, and we are sure that this is only the beginning. In Spain we have been lucky enough to play a pioneering role in these studies and we are very happy with the work we are doing, because We believe that it will help a lot to avoid disability. At the moment, in multiple sclerosis patients, and a very wide field opens to research in other pathologies. “
