SERPINA1 and amyotrophic lateral sclerosis: In amyotrophic lateral sclerosis, one of the earliest studies identified CST3 and transthyretin (TTR) as potential biomarkers.113 A meta-analysis of this study and 10 subsequent studies in amyotrophic lateral sclerosis spanning a 10-year period (2005–16) identified 10 proteins (c-reactive protein, CST3, α-globin, β-globin, osteopontin, serpin A1, transferrin, TTR, nerve-growth factor and zinc-alpha-2-glycoprotein) as potential biomarkers in at least two independent studies135 (Fig. 2).