Urinary neopterin, a new marker of the neuroinflammatory status in amyotrophic lateral sclerosis

Christian Lunetta, Andrea Lizio, Francesca Gerardi, Claudia Tarlarini, Massimo Filippi, Nilo Riva, Lucio Tremolizzo, Susanna Diamanti, Cinzia Carla Dellanoce, Lorena Mosca, Valeria Ada Sansone, Jonica Campolo

Research output: Contribution to journalArticlepeer-review


Objective: To comprehensively assess whether neopterin in urine could be a candidate biomarker for determining the neuroinflammatory status in ALS. Methods: We performed an observational, cross-sectional study in 81 pALS, 68 age- and sex-comparable healthy controls (HC), 14 patients affected by MS and 24 OND patients. ALS patients underwent a neurological evaluation to assess the global functional status evaluated by Amyotrophic Lateral Sclerosis Functional Rating Scale—Revised (ALSFRS-R) and the disease progression rate. Urinary neopterin concentrations were determined by high-performance liquid chromatography method and were recorded at the time of first examination to assess their effect on disease severity and survival. Results: Urinary neopterin was significantly higher in pALS (263.90 [198.71–474.90]) compared to MS (155.28 [131.74–190.38], p = <.001), OND patients (205.60 [158.96–299.41], p = 0.04) and HC (169.55 [134.91–226.10], p <.001). Moreover, a significant negative correlation was found between neopterin level and the severity of symptoms evaluated by ALSFRS-R total score (r = − 0.46, p <.001) and its subscores (bulbar r = − 0.34, p = 0.002; motor r = − 0.33, p = 0.003; respiratory r = − 0.53, p <.001), also adjusting for the effect of sex, site of onset, age at evaluation and time from onset to evaluation. Conclusions: Our finding indicates that urine neopterin is elevated in ALS, emphasizing the role of the cell-mediated inflammation in the disease. Moreover, whether confirmed in further studies, our results will underline the neopterin’s potential use as non-invasive clinical biomarker of ALS, to discriminate patients possibly candidates to clinical interventions aimed to interfere the neuroinflammatory processes.

Original languageEnglish
Pages (from-to)3609-3616
Number of pages8
JournalJournal of Neurology
Issue number12
Publication statusPublished - Dec 2020


  • Amyotrophic lateral sclerosis
  • Biomarker
  • Neopterin
  • Prognosis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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