Evaluation of plasma neurofilament light chain and glial fibrillary acidic protein in myasthenia gravis: A controlled cohort study

Abstract

Aims To evaluate plasma neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) as candidate biomarkers in myasthenia gravis (MG). Methods Ninety MG patients and 40 healthy controls were recruited. Disease severity was assessed by the Myasthenia Gravis Foundation of America (MGFA) classification, Myasthenia Gravis Composite (MGC) score, and Myasthenia Gravis Activities of Daily Living (MG-ADL) scale. Plasma NfL and GFAP were quantified using Single Molecule Array (Simoa) assays. Results NfL and GFAP plasma concentration did not differ between MG and controls ( p  > 0.05). Neither biomarker correlated with MG-ADL or MGC, and no differences were observed across MGFA classes (p > 0.05). Biomarker levels were unrelated to myasthenic crisis history or treatment exposure. Conclusion Plasma NfL and GFAP, although informative in other neuroimmunological and neurodegenerative conditions, do not distinguish MG from healthy controls and show no association with disease severity. This study adds to the emerging literature on NfL in MG and represents one of the larger controlled analyses incorporating both NfL and GFAP biomarkers in this disease. The findings argue against adopting NfL or GFAP for MG monitoring and highlight the need for MG-specific biomarker strategies.