14.11.2025

A research team from the University Hospital Bonn and Alfried Krupp Hospital Essen has demonstrated that combining two blood biomarkers, serum neurofilament light chain (sNfL) and cardiac troponin T (cTnT), significantly increases diagnostic accuracy in amyotrophic lateral sclerosis (ALS). The study, published in Annals of Neurology, may improve early ALS detection.

Three people are standing together in a hospital corridor; Copyrigtht: University Hospital Bonn (UKB)

Researchers at the University Hospital Bonn and Alfried Krupp Hospital Essen have identified that combining sNfL and cTnT blood biomarkers enhances diagnostic precision and provides new insights into ALS progression.

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Understanding the diagnostic advantage

The biomarker sNfL is well-established as an indicator of neuroaxonal injury but is not specific to ALS. Conversely, cTnT, typically used as a cardiac biomarker, is also elevated in ALS due to muscle-related changes, without evidence of heart disease. By combining both markers, researchers achieved a more specific and reliable ALS diagnosis.

Study design and key findings

The research analyzed data from 293 ALS patients, 85 individuals with other neurodegenerative conditions, and 29 healthy controls. An independent validation cohort of 501 ALS patients confirmed the results.

Using ROC curve analysis, the team found that combining sNfL and cTnT improved differentiation between ALS and other diseases. Additionally, an ALS-specific cutoff value for cTnT was identified at 8.35 ng/L, significantly below the cardiological standard of 14 ng/L. This adjustment enhanced the sensitivity of ALS diagnosis and allowed more cases to be correctly identified at an earlier stage.

Prognostic and clinical implications

The combined biomarker approach not only refines diagnosis but also provides insights into disease progression.

Patients with normal biomarker levels (“biomarker-negative”) had a median disease duration of 73 months.
Biomarker-positive patients showed a median survival of 18 months and faster progression.

“Our results demonstrate that combining sNfL and cTnT improves diagnostic accuracy in ALS and also provides valuable insights into disease progression,” says PD Dr. Patrick Weydt, Head of the ALS and Other Motor Neuron Disease Clinic at UKB.

“In everyday clinical practice, it is crucial to reliably differentiate ALS from other neurological diseases at an early stage. The combination of sNfL and cTnT offers a real diagnostic advantage – using established, routine laboratory methods,” adds Dr. Torsten Grehl from the Alfried Krupp Hospital Essen.

MEDICA-tradefair.com; Source: University Hospital Bonn

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