Distinct prognostic implications of blood neuronal and astroglial biomarkers in neuromyelitis optica spectrum disorders versus multiple sclerosis

Research on neuronal and astroglial markers for predicting outcomes in aquaporin-4 antibody-seropositive neuromyelitis optica spectrum disorders (NMOSD) remains limited. We aimed to evaluate the prognostic value of blood biomarkers for neuronal and astroglial damage in NMOSD compared with multiple sclerosis (MS). Patients with NMOSD and MS were prospectively recruited, and baseline serum levels of neurofilament light (sNfL) and glial fibrillary acidic protein (sGFAP) were measured. The correlations between these biomarkers and neurological disability (Expanded Disability Status Scale, EDSS) and cognitive function (iPad-based processing speed test, PST) were analyzed at baseline and two years later. In this cohort of 41 NMOSD and 92 MS patients, blood biomarkers demonstrated distinct patterns of association with current and future outcomes. In NMOSD, sGFAP was consistently linked to neurological disability and cognitive impairment over time, reflecting astrocytopathy with minimal silent neurodegeneration. In MS, sGFAP did not correlate with baseline EDSS but showed associations with future scores. Notably, sNfL was more strongly associated with future PST scores than baseline scores (p = 0.005), suggesting ongoing neurodegeneration. These results underscore that blood biomarkers are predictive of both current and future outcomes in NMOSD and MS, with differing patterns reflecting the unique pathogenesis of each disease.