TY - JOUR
T1 - Blood GFAP as an emerging biomarker in brain and spinal cord disorders
AU - Abdelhak, Ahmed
AU - Foschi, Matteo
AU - Abu-Rumeileh, Samir
AU - Yue, John K.
AU - D’Anna, Lucio
AU - Huss, Andre
AU - Oeckl, Patrick
AU - Ludolph, Albert C.
AU - Kuhle, Jens
AU - Petzold, Axel
AU - Manley, Geoffrey T.
AU - Green, Ari J.
AU - Otto, Markus
AU - Tumani, Hayrettin
N1 - Funding Information: A.A. received research grants from the German Multiple Sclerosis Society (DMSG). P.O. received research support from the Michael J. Fox Foundation for Parkinson´s Research (grant ID MJFF-010349) and Alzheimer Forschung Initiative e.V. (20059CB). J.K. received speaker fees, research support, travel support and/or served on advisory boards of the Swiss MS Society, Swiss National Research Foundation (320030_189140/1), University of Basel, Progressive MS Alliance, Bayer, Biogen, Celgene, Merck, Novartis, Roche and Sanofi. G.T.M. reports funding from the US Department of Defense – TBI Endpoints Development Initiative (grant #W81XWH-14-2-0176), TRACK-TBI Precision Medicine (grant #W81XWH-18-2-0042), TRACK-TBI NETWORK (grant #W81XWH-15-9-0001), NIH-NINDS – TRACK-TBI (grant #U01NS086090), National Football League (NFL) Scientific Advisory Board, with support from the NFL for the research efforts of TRACK-TBI NETWORK. In addition, the US Department of Energy supports G.T.M. for a precision medicine collaboration, Abbott Laboratories has provided funding for TRACK-TBI clinical studies, NeuroTrauma Sciences LLC has provided funding to support TRACK-TBI data curation efforts, One Mind has provided funding for TRACK-TBI patients stipends and support to clinical sites. J.K.Y. received funding from NIH-NINDS – TRACK-TBI (grant #U01NS086090). A.J.G. reports personal fees from Bionure, Mylan, Neurona and Viela Bio; other support from Pipeline Therapeutics; and grants and other support from Inception Sciences outside the submitted work. M.O. gave scientific advice to Axon, Biogen Idec, Fujirebio and Roche. H.T. reports funding for research projects, lectures and travel from Bayer, Biogen, Genzyme, Merck Serono, Novartis, Roche and Teva, and received research support from DMSG and the German Ministry for Education and Research (BMBF). No other disclosures are reported. Publisher Copyright: © 2022, Springer Nature Limited.
PY - 2022/3
Y1 - 2022/3
N2 - Blood-derived biomarkers for brain and spinal cord diseases are urgently needed. The introduction of highly sensitive immunoassays led to a rapid increase in the number of potential blood-derived biomarkers for diagnosis and monitoring of neurological disorders. In 2018, the FDA authorized a blood test for clinical use in the evaluation of mild traumatic brain injury (TBI). The test measures levels of the astrocytic intermediate filament glial fibrillary acidic protein (GFAP) and neuroaxonal marker ubiquitin carboxy-terminal hydrolase L1. In TBI, blood GFAP levels are correlated with clinical severity and extent of intracranial pathology. Evidence also indicates that blood GFAP levels hold the potential to reflect, and might enable prediction of, worsening of disability in individuals with progressive multiple sclerosis. A growing body of evidence suggests that blood GFAP levels can be used to detect even subtle injury to the CNS. Most importantly, the successful completion of the ongoing validation of point-of-care platforms for blood GFAP might ameliorate the decision algorithms for acute neurological diseases, such as TBI and stroke, with important economic implications. In this Review, we provide a systematic overview of the evidence regarding the utility of blood GFAP as a biomarker in neurological diseases. We propose a model for GFAP concentration dynamics in different conditions and discuss the limitations that hamper the widespread use of GFAP in the clinical setting. In our opinion, the clinical use of blood GFAP measurements has the potential to contribute to accelerated diagnosis and improved prognostication, and represents an important step forward in the era of precision medicine.
AB - Blood-derived biomarkers for brain and spinal cord diseases are urgently needed. The introduction of highly sensitive immunoassays led to a rapid increase in the number of potential blood-derived biomarkers for diagnosis and monitoring of neurological disorders. In 2018, the FDA authorized a blood test for clinical use in the evaluation of mild traumatic brain injury (TBI). The test measures levels of the astrocytic intermediate filament glial fibrillary acidic protein (GFAP) and neuroaxonal marker ubiquitin carboxy-terminal hydrolase L1. In TBI, blood GFAP levels are correlated with clinical severity and extent of intracranial pathology. Evidence also indicates that blood GFAP levels hold the potential to reflect, and might enable prediction of, worsening of disability in individuals with progressive multiple sclerosis. A growing body of evidence suggests that blood GFAP levels can be used to detect even subtle injury to the CNS. Most importantly, the successful completion of the ongoing validation of point-of-care platforms for blood GFAP might ameliorate the decision algorithms for acute neurological diseases, such as TBI and stroke, with important economic implications. In this Review, we provide a systematic overview of the evidence regarding the utility of blood GFAP as a biomarker in neurological diseases. We propose a model for GFAP concentration dynamics in different conditions and discuss the limitations that hamper the widespread use of GFAP in the clinical setting. In our opinion, the clinical use of blood GFAP measurements has the potential to contribute to accelerated diagnosis and improved prognostication, and represents an important step forward in the era of precision medicine.
UR - http://www.scopus.com/inward/record.url?scp=85124362954&partnerID=8YFLogxK
U2 - https://doi.org/10.1038/s41582-021-00616-3
DO - https://doi.org/10.1038/s41582-021-00616-3
M3 - Review article
C2 - 35115728
SN - 1759-4758
VL - 18
SP - 158
EP - 172
JO - Nature Reviews Neurology
JF - Nature Reviews Neurology
IS - 3
ER -