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ELISA was utilized to measure NfL and protein misfolding cyclic amplification (PMCA) to detect \u03b1Syn oligomers in CSF collected at baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients were followed for a median of 3.9\u2009years. Five patients converted to MSA, 2 to PD, and 2 to DLB. NfL at baseline was elevated only in patients who later developed MSA, perfectly separating those from future PD and DLB converters as well as non\u2010converters. ASyn\u2010PMCA was positive in all but two cases (94%). The PMCA reaction was markedly different in five samples with maximum fluorescence and reaction kinetics previously described in MSA patients; all of these patients later developed MSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>\u03b1Syn\u2010PMCA is almost invariably positive in the CSF of patients with PAF establishing this condition as \u03b1\u2010synucleinopathy. Both NfL and the magnitude and reaction kinetics of \u03b1Syn PMCA faithfully predict which PAF patients will eventually phenoconvert to MSA. This finding has important implications not only for prognostication, but also for future trials of disease modifying therapies, allowing for differentiation of MSA from Lewy body synucleinopathies before motor symptoms develop. ANN NEUROL 2021;89:1212\u20131220<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.26089","type":"journal-article","created":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T00:05:47Z","timestamp":1619049947000},"page":"1212-1220","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":98,"title":["Alpha\u2010Synuclein Oligomers and Neurofilament Light Chain Predict Phenoconversion of Pure Autonomic Failure"],"prefix":"10.1002","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1263-6850","authenticated-orcid":false,"given":"Wolfgang","family":"Singer","sequence":"first","affiliation":[{"name":"Department of Neurology Mayo Clinic  Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann M.","family":"Schmeichel","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic  Rochester 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