12 Axonal injury releases neurofilament into the

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Neurofilament is an intermediate filament protein, integral for radial growth of axons during development, and the cytoarchitecture and transport functions within mature neuronal axons.12 Axonal injury releases neurofilament into the extracellular space, where neurofilament light chain (NfL) can be measured in CSF as a biomarker of axonal degeneration. Optimised assays, and now the ability to measure NfL levels in blood, have increased its potential for translation to clinical practice.13 18 However, MS is a heterogeneous disease, with subtypes and trajectories, in flux between relapse, remission, stability and progression.19 Age, gender and comorbidities can influence any potential biomarker, and DMTs (with differing mechanisms of action) are widely prescribed. Disparities within measures used to classify the disease (disability scales, clinical staging and MRI) add a further hurdle in standardisation.

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