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Ultrasensitive assay technology and fluid biomarkers for the evaluation of peripheral nerve disease
  1. Roberto Bellanti1,2,
  2. Stephen Keddie3,
  3. Michael P Lunn2,4,
  4. Simon Rinaldi1
  1. 1 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  2. 2 Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
  3. 3 Department of Neuromuscular Diseases, The Royal London Hospital, London, UK
  4. 4 Department of Neuroinflammation, National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to Dr Simon Rinaldi, Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK; simon.rinaldi{at}


The field of biomarker discovery is rapidly expanding. The introduction of ultrasensitive immunoassays and the growing precision of genetic technologies are poised to revolutionise the assessment and monitoring of many diseases. Given the difficulties in imaging and tissue diagnosis, there is mounting interest in serum and cerebrospinal fluid biomarkers of peripheral neuropathy. Realised and potential fluid biomarkers of peripheral nerve disease include neuronal biomarkers of axonal degeneration, glial biomarkers for peripheral demyelinating disorders, immunopathogenic biomarkers (such as the presence and titre of antibodies or the levels of cytokines) and genetic biomarkers. Several are already starting to inform clinical practice, whereas others remain under evaluation as potential indicators of disease activity and treatment response. As more biomarkers become available for clinical use, it has become increasingly difficult for clinicians and researchers to keep up-to-date with the most recent discovery and interpretation. In this review, we aim to inform practising neurologists, neuroscientists and other clinicians about recent advances in fluid biomarker technology, with a focus on single molecule arrays (Simoa), chemiluminescent enzyme immunoassays (CLEIA), electrochemiluminescence (ECL), proximity extension assays (PEA), and microfluidic technology. We discuss established and emerging fluid biomarkers of peripheral neuropathy, their clinical applications, limitations and potential future developments.

  • neuropathy
  • neurobiology
  • neuropathology
  • neuroimmunology

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  • Contributors RB and SR wrote the original draft of the manuscript. SK and MPL contributed to subsequent drafts and revisions. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.