Neuron-specific enolase (NSE) is a dimeric glycolytic enzyme predominantly localized to neurons and neuroendocrine cells. It exists in two isoforms: γγ (neuron-specific) and αγ (neuroendocrine-specific).
NSE is a tumor marker in oncology, particularly for small-cell lung cancer (SCLC) and other neuroendocrine tumors (NETs). Serum elevations can assist in diagnosis, staging, prognostication, and monitoring treatment response, often correlating with tumor burden and metastatic disease. However, its specificity can be limited, and trends are generally more informative than isolated values over time.
In neurocritical care, NSE is used to assess neuronal injury. Following cardiac arrest, elevated serum NSE concentrations (especially when measured serially 48-72 hours after ROSC) may predict poor neurological outcomes. Similarly, increases in serum or cerebrospinal fluid (CSF) NSE have been associated with ischemic stroke, traumatic brain injury, seizures (including status epilepticus), and various neurodegenerative diseases.
Despite its utility, hemolysis, renal dysfunction, and neuroendocrine malignancies can falsely elevate levels. No single biomarker should replace a comprehensive neurological assessment that includes imaging, electrophysiology, and clinical examination.
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