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Abstract Details

Neurofilament light chain levels differentiate between ischemic and inflammatory optic neuropathies
Neuro-ophthalmology/Neuro-otology
P17 - Poster Session 17 (11:45 AM-12:45 PM)
2-003
To determine if serum neurofilament light chain (NfL) can differentiate NAION from aquaporin-4 (AQP4)-IgG and myelin oligodendrocyte glycoprotein (MOG)-IgG associated optic neuritis, and if NfL levels correlate with visual outcomes.
Serum neurofilament light chain (NfL) levels may be useful for detecting neuroaxonal damage in patients with acute optic neuropathies.
Patients with acute, isolated, unilateral or bilateral optic neuropathy with: 1) AQP4-IgG or MOG-IgG positive optic neuritis by fluorescence-activated cell sorting (FACS); or 2) a clinical diagnosis of NAION, with serum collected within 90 days of acute attack from Mayo Clinic, were included and compared to 24 unaffected age- and sex- matched controls. Serum NfL levels were measured using an ultrasensitive enzyme-linked immunosorbent assay. Outcomes included visual acuity at attack nadir and at follow-up (3-12 months).
66 patients were included: 13 AQP4-IgG+, 13 MOG-IgG+, 16 NAION, and 24 unaffected controls.  Serum NfL levels were higher in the optic neuropathies compared to controls (AQP4: 10.1 [range 6.2-44.1], MOG: 16.0 pg/mL [range 5.8-33.4]; NAION: 34.6 [range 11.4-135]; unaffected controls: 6.5 [range 2.2-11.3];  p<0.001). There was a significant difference in NfL levels between optic neuritis (AQP4-IgG and MOG-IgG-associated optic neuritis) and NAION (median 11.6[5.8-44.1] versus 34.6[11.4-135], p<0.001). A cutoff of 32 picograms/milliliter yielded a sensitivity of NfL of 56% and specificity 88% (Youden’s index 0.45; area under curve 0.82) with a positive likelihood ratio of 4.7, negative likelihood ratio of 0.5 for differentiating NAION from optic neuritis. NfL levels were correlated with visual acuity at attack nadir and long-term visual acuity before and after adjusting for type of optic nerve pathology (model R2 0.21; p=0.028 and model R2 0.48; p<0.001).
Serum NfL levels can discriminate NAION and optic  neuritis associated with AQP4-IgG and MOG-IgG with good accuracy. Moreover, serum NfL during attacks was correlated with long-term visual impairment and may provide important prognostic value.
Authors/Disclosures
Shailee S. Shah, MD
PRESENTER 		Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Shah has received publishing royalties from a publication relating to health care.
Sara Mariotto, MD, PhD (Neurology Unit, University of Verona) Dr. Mariotto has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen, Sanofi, Alexion, Roche, TSF, Dynamics, UCB, Novartis, Amgen, AAN. The institution of Dr. Mariotto has received research support from Ministero della Salute Italiano. The institution of Dr. Mariotto has received research support from TSF. The institution of Dr. Mariotto has received research support from GJF. The institution of Dr. Mariotto has received research support from Lundbeck. The institution of Dr. Mariotto has received research support from Euroimmun. The institution of Dr. Mariotto has received research support from FISM.
Elia Sechi, MD (University of Sassari) Dr. Sechi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Sechi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Argenx.
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology) Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic) The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to AAN interests or activities.
M. Tariq Bhatti, MD (Kaiser Permanente, Northern California) Dr. Bhatti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Receptos . Dr. Bhatti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH LHON gene therapy study .
John Chen John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. John Chen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB.