Predictive biomarkers are increasingly used to guide clinical trial design, diagnosis, and management of patients with neurodegenerative diseases. We profiled plasma from 632 ALS patients and 160 healthy controls using the NULISA CNS and Inflammation Panels and applied eXtreme Gradient Boosting (XGBoost) with nested cross-validation and SHapley Additive exPlanations (SHAP) to identify disease-associated proteins. A 12-protein candidate panel was refined using SHAP feature importance and absolute quantification, then evaluated in an independent validation cohort (144 ALS, 37 controls).
We identified a final 10-protein panel (NEFL, FOLR1, pTau-181, TREM1, VEGFA, NEFH, CALCA, NRGN, LAMP3, and PTX3) that achieved high classification performance (balanced accuracy 98.3%; AUC 0.992). Model performance was driven by plasma proteomic signatures rather than clinical variables and was not dependent on neurofilament light chain alone. Representing over 750 ALS cases, this study supports development of a clinically deployable blood-based ALS screening tool.
The authors thank the participants and their families for their contributions to this research. This work was supported by Hop On A Cure (83771), the American Brain Foundation (76524), the ALS Association (76524), the American Academy of Neurology (76524), and the Muscular Dystrophy Association (91705). Center for Neurodegenerative Diseases, Emory University, Atlanta, GA, USA Woo Jae Kim, Seneshaw Asress, Adam N.
Trautwig, Eric Dammer, Nicholas T. Thomas Department of Human Genetics, Emory University, Atlanta, GA, USA Woo Jae Kim, Mingee Chung & Zachary T. McEachin Laboratory of Translational Cell Biology, Emory University, Atlanta, GA, USA Department of Neurology, Emory University, Atlanta, GA, USA Christina N.
Thomas Department of Biochemistry, Emory University, Atlanta, GA, USA Correspondence to Jonathan D. The authors declare no competing interests. Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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