Cerebral Clues: Serum Neurofilament Light Chain (sNfL) As a Novel Biomarker for Immune Check Point Inhibitor (ICI) Mediated Seronegative Encephalitis

Overview

Journal Oxf Med Case Reports

Specialty General Medicine

Date 2024 Jun 11

PMID 38860018

Authors

Anza Zahid

Sudhakar Tummala

Affiliations

Soon will be listed here.

Abstract

Immune checkpoint inhibitor (ICI) mediated encephalitides are increasingly being recognized in the literature, but atypical cases may be missed or misdiagnosed. Recent efforts are directed to identify biomarkers to help elucidate early diagnosis and treatment. Herein, we describe two cases of antibody negative ICI-mediated encephalitis with elevated serum Neurofilament light chain (sNfL) levels. Practical Implication: Baseline and longitudinal measurements of serum neurofilament light chains can help determine treatment strategies and prognosis in patients with suspected immune checkpoint inhibitor encephalitis.

References

Giovannini G, Bedin R, Ferraro D, Vaudano A, Mandrioli J, Meletti S . Serum neurofilament light as biomarker of seizure-related neuronal injury in status epilepticus. Epilepsia. 2021; 63(1):e23-e29. PMC: 9299158. DOI: 10.1111/epi.17132. View

Vermunt L, Otte M, Verberk I, Killestein J, Lemstra A, van der Flier W . Age- and disease-specific reference values for neurofilament light presented in an online interactive support interface. Ann Clin Transl Neurol. 2022; 9(11):1832-1837. PMC: 9639622. DOI: 10.1002/acn3.51676. View

De Marchis G, Katan M, Barro C, Fladt J, Traenka C, Seiffge D . Serum neurofilament light chain in patients with acute cerebrovascular events. Eur J Neurol. 2017; 25(3):562-568. DOI: 10.1111/ene.13554. View

Nissen M, Ryding M, Nilsson A, Madsen J, Olsen D, Halekoh U . CSF-Neurofilament Light Chain Levels in NMDAR and LGI1 Encephalitis: A National Cohort Study. Front Immunol. 2022; 12:719432. PMC: 8716734. DOI: 10.3389/fimmu.2021.719432. View

Sauer B, Schmalstieg W, Howe C . Axons are injured by antigen-specific CD8(+) T cells through a MHC class I- and granzyme B-dependent mechanism. Neurobiol Dis. 2013; 59:194-205. PMC: 3788647. DOI: 10.1016/j.nbd.2013.07.010. View

Ferreira-Atuesta C, Reyes S, Giovanonni G, Gnanapavan S . The Evolution of Neurofilament Light Chain in Multiple Sclerosis. Front Neurosci. 2021; 15:642384. PMC: 8055958. DOI: 10.3389/fnins.2021.642384. View

Vogrig A, Muniz-Castrillo S, Joubert B, Picard G, Rogemond V, Marchal C . Central nervous system complications associated with immune checkpoint inhibitors. J Neurol Neurosurg Psychiatry. 2020; 91(7):772-778. DOI: 10.1136/jnnp-2020-323055. View

Budhram A, Britton J, Liebo G, Dubey D, Zekeridou A, Flanagan E . Use of diffusion-weighted imaging to distinguish seizure-related change from limbic encephalitis. J Neurol. 2020; 267(11):3337-3342. DOI: 10.1007/s00415-020-10007-1. View

Bjursten S, Zhao Z, Al Remawi H, Studahl M, Pandita A, Simren J . Concentrations of S100B and neurofilament light chain in blood as biomarkers for checkpoint inhibitor-induced CNS inflammation. EBioMedicine. 2024; 100:104955. PMC: 10796943. DOI: 10.1016/j.ebiom.2023.104955. View

10.

Khalil M, Teunissen C, Otto M, Piehl F, Sormani M, Gattringer T . Neurofilaments as biomarkers in neurological disorders. Nat Rev Neurol. 2018; 14(10):577-589. DOI: 10.1038/s41582-018-0058-z. View

11.

Graus F, Titulaer M, Balu R, Benseler S, Bien C, Cellucci T . A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016; 15(4):391-404. PMC: 5066574. DOI: 10.1016/S1474-4422(15)00401-9. View

12.

Kortvelyessy P, Pruss H, Thurner L, Maetzler W, Vittore-Welliong D, Schultze-Amberger J . Biomarkers of Neurodegeneration in Autoimmune-Mediated Encephalitis. Front Neurol. 2018; 9:668. PMC: 6156245. DOI: 10.3389/fneur.2018.00668. View

13.

Xiao J, Fu P, Li Z . Clinical and imaging analysis to evaluate the response of patients with anti-DPPX encephalitis to immunotherapy. BMC Neurol. 2022; 22(1):129. PMC: 8981927. DOI: 10.1186/s12883-022-02649-7. View

14.

Gaetani L, Blennow K, Calabresi P, Di Filippo M, Parnetti L, Zetterberg H . Neurofilament light chain as a biomarker in neurological disorders. J Neurol Neurosurg Psychiatry. 2019; 90(8):870-881. DOI: 10.1136/jnnp-2018-320106. View

15.

Liu C, Ji S, Gao H, Bi Z, Zhang Q, Shang K . Efficacy of tacrolimus as long-term immunotherapy for neuronal surface antibody-mediated autoimmune encephalitis. Ther Adv Chronic Dis. 2022; 13:20406223211063055. PMC: 8755929. DOI: 10.1177/20406223211063055. View

16.

Velasco R, Villagran M, Jove M, Simo M, Vilarino N, Alemany M . Encephalitis Induced by Immune Checkpoint Inhibitors: A Systematic Review. JAMA Neurol. 2021; 78(7):864-873. DOI: 10.1001/jamaneurol.2021.0249. View