Neuroaxonal damage is the pathological substrate of permanent disability in various neurological disorders. Reliable quantification and longitudinal follow-up of such damage are important for assessing disease activity, monitoring treatment responses, facilitating treatment development and determining prognosis. The neurofilament proteins have promise in this context because their levels rise upon neuroaxonal damage not only in the cerebrospinal fluid (CSF) but also in blood, and they indicate neuroaxonal injury independent of causal pathways. First-generation (immunoblot) and second-generation (enzyme-linked immunosorbent assay) neurofilament assays had limited sensitivity. Third-generation (electrochemiluminescence) and particularly fourth-generation (single-molecule array) assays enable the reliable measurement of neurofilaments throughout the range of concentrations found in blood samples. This technological advancement has paved the way to investigate neurofilaments in a range of neurological disorders. Here, we review what is known about the structure and function of neurofilaments, discuss analytical aspects and knowledge of age-dependent normal ranges of neurofilaments and provide a comprehensive overview of studies on neurofilament light chain as a marker of axonal injury in different neurological disorders, including multiple sclerosis, neurodegenerative dementia, stroke, traumatic brain injury, amyotrophic lateral sclerosis and Parkinson disease. We also consider work needed to explore the value of this axonal damage marker in managing neurological diseases in daily practice.

Amyotrophic lateral sclerosis (ALS) is a genetically heterogeneous neurodegenerative syndrome hallmarked by adult-onset loss of motor neurons. We performed exome sequencing of 252 familial ALS (fALS) and 827 control individuals. Gene-based rare variant analysis identified an exome-wide significant enrichment of eight loss-of-function (LoF) mutations in TBK1 (encoding TANK-binding kinase 1) in 13 fALS pedigrees. No enrichment of LoF mutations was observed in a targeted mutation screen of 1,010 sporadic ALS and 650 additional control individuals. Linkage analysis in four families gave an aggregate LOD score of 4.6. In vitro experiments confirmed the loss of expression of TBK1 LoF mutant alleles, or loss of interaction of the C-terminal TBK1 coiled-coil domain (CCD2) mutants with the TBK1 adaptor protein optineurin, which has been shown to be involved in ALS pathogenesis. We conclude that haploinsufficiency of TBK1 causes ALS and fronto-temporal dementia.

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Human lumbar CSF patterns of Ab peptides were analysed by urea-based b-amyloid sodium dodecyl sulphate polyacrylamide gel electrophoresis with western immunoblot (Ab-SDS-PAGE/immunoblot). A highly conserved pattern of carboxyterminally truncated Ab1-37/38/39 was found in addition to Ab1-40 and Ab1-42. Remarkably, Ab1-38 was present at a higher concentration than Ab1-42, being the second prominent Ab peptide species in CSF. Patients with Alzheimer's disease (AD, n ¼ 12) and patients with chronic inflammatory CNS disease (CID, n ¼ 10) were differentiated by unique CSF Ab peptide patterns from patients with other neuropsychiatric diseases (OND, n ¼ 37). This became evident only when we investigated the amount of Ab peptides relative to their total Ab peptide concentration (Ab1-x%, fractional Ab peptide pattern), which may reflect diseasespecific c-secretase activities. Remarkably, patients with AD and CID shared elevated Ab1-38% values, whereas otherwise the patterns were distinct, allowing separation of AD from CID or OND patients without overlap. The presence of one or two ApoE e4 alleles resulted in an overall reduction of CSF Ab peptides, which was pronounced for Ab1-42. The severity of dementia was significantly correlated to the fractional Ab peptide pattern but not to the absolute Ab peptide concentrations. Keywords: Alzheimer's disease (AD), b-amyloid protein precursor/metabolism, biological markers, cerebrospinal fluid, 2D-PAGE, western immunoblot.

Neurofilaments in CSF have a high relevance for the differential diagnosis of MNDs and should be included in the diagnostic work-up of patients. Their value as prognostic markers should be investigated further.