Advances on the Neurofilament Light Chain as a Biomarker in Ischemic Stroke

Ischemic stroke remains a predominant global cause of morbidity and mortality. Neurofilament light chain (NfL), a sensitive biomarker of axonal injury, aids in diagnosis and prognosis for ischemic stroke but requires further study due to variability and lack of standardization. This study systematically reviews the molecular characteristics of NfL, detection methodologies, and its clinical applications in ischemic stroke, with a particular focus on its role in diagnosis, severity assessment, prognosis prediction, and post-stroke cognitive impairment (PSCI). Additionally, the limitations of NfL and future research directions are discussed. A comprehensive literature review was conducted to analyze the molecular properties of NfL, its release pattern following ischemic stroke, and its correlation with neuronal injury. Furthermore, clinical studies evaluating its role in diagnosis, prognosis, and disease monitoring were systematically assessed. NfL demonstrates high specificity for neuronal injury, and its elevated levels are closely associated with stroke diagnosis, severity, infarct volume, early neurological deterioration, poor prognosis, and PSCI. Advances in detection technologies have improved the sensitivity of peripheral blood NfL measurement; however, factors such as age-related variability, blood–brain barrier integrity, and the influence of secondary inflammation pose challenges to its clinical application. NfL is a promising biomarker for stroke diagnosis and severity assessment. Future research should focus on the dynamic changes in NfL, optimization of detection technologies, and multi-omics integration to enhance diagnostic accuracy. Additionally, large-scale prospective studies are required to validate its clinical utility and establish standardized application guidelines.