Inflammation PET and plasma neurofilament light predict survival in people with progressive supranuclear palsy.
Level 3 - non-randomized controlled study
Longitudinal observational cohort study evaluating prognostic biomarkers
PubMed 41416250 · doi:10.1093/braincomms/fcaf467
What was done
Researchers evaluated 59 participants with progressive supranuclear palsy (PSP) who had longitudinal structural MRI to assess the relationship between subcortical brain atrophy and survival. A subcohort of 16 participants also underwent cross-sectional [11C]-PK11195 translocator protein PET imaging (measuring neuroinflammation) and blood sampling for plasma neurofilament light chain (NfL). Statistical associations with survival were evaluated using principal component analyses, partial correlations, multivariate regression, and Bayesian modeling alongside clinical severity measured by the PSP rating scale (PSPRS).
What was found
In the full cohort (n = 59), participants survived an average of 3.2 years from the baseline MRI scan, and subcortical atrophy was significantly associated with shorter survival (r = -0.38, P = 0.001; β = -0.66, P = 0.001). In the 16-participant subcohort, shorter survival was significantly associated with higher subcortical neuroinflammation (rho = -0.49, P = 0.02, Bayes factor = 8.07) and higher baseline plasma NfL (rho = -0.57, P = 0.01, Bayes factor = 4.63). Baseline PSPRS clinical severity scores were not significant predictors of survival.
Why it matters
These findings suggest that biological markers of neurodegeneration and neuroinflammation (subcortical atrophy, TSPO PET, and plasma NfL) provide objective prognostic value in PSP that may outperform clinical severity scales, identifying potential endpoints or stratification tools for clinical trials.
Limits
The primary limitation is the very small sample size (n = 16) for the PET and plasma NfL analyses. PET and NfL assessments were cross-sectional rather than longitudinal, and potential clinical or demographic confounders were not detailed in the abstract.
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