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Du Y, Chen L, Jiao Y, Cheng Y. Cerebrospinal fluid and blood Aβ levels in Down syndrome patients with and without dementia: a meta-analysis study. Aging (Albany NY) 2019; 11:12202-12212. [PMID: 31860872 PMCID: PMC6949072 DOI: 10.18632/aging.102560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/20/2019] [Indexed: 12/30/2022]
Abstract
Abnormal β-amyloid (Aβ) levels were found in patients with Down syndrome (DS). However, Aβ levels in patients with DS and DS with dementia (DSD) vary considerably across studies. Therefore, we performed a systematic literature review and quantitatively summarized the clinical Aβ data on the cerebrospinal fluid (CSF) and blood of patients with DS and those with DSD using a meta-analytical technique. We performed a systematic search of the PubMed and Web of Science and identified 27 studies for inclusion in the meta-analysis. Random-effects meta-analysis indicated that the levels of blood Aβ1-40 and Aβ1-42 were significantly elevated in patients with DS compared with those in healthy control (HC) subjects. In contrast, there were no significant differences between patients with DS and those with DSD in the blood Aβ1-40 and Aβ1-42 levels. The CSF Aβ1-42 levels were significantly decreased in patients with DS compared to those in HC subjects. Further, CSF Aβ1-42 levels were significantly decreased in patients with DSD compared to those with DS, with a large effect size. Taken together, our results demonstrated that blood Aβ1-40 and Aβ1-42 levels were significantly increased in patients with DS while CSF Aβ1-42, but not Aβ1-40 levels were significantly decreased in patients with DS.
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Affiliation(s)
- Yang Du
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing 100081, China
| | - Lei Chen
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing 100081, China
| | - Yuguo Jiao
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing 100081, China
| | - Yong Cheng
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing 100081, China
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Geng M, Xiao H, Liu J, Song Y, Fu P, Cheng X, Zhang J, Wang G. The diagnostic role and dynamic changes in cerebrospinal fluid neopterin during treatment of patients with primary central nervous system lymphoma. Cancer Med 2018; 7:3889-3898. [PMID: 29982995 PMCID: PMC6089159 DOI: 10.1002/cam4.1581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/03/2018] [Accepted: 05/06/2018] [Indexed: 12/28/2022] Open
Abstract
This study aimed at evaluating the diagnostic and prognostic role of neopterin (Npt) concentration in the cerebrospinal fluid (CSF) of patients with primary central nervous system lymphoma (PCNSL). Ninety‐nine patients were enrolled in this retrospective study; these included patients with PCNSL (n = 21), other brain tumors (n = 44), and inflammatory diseases (n = 34). CSF Npt concentration was measured using ELISA. Receiver operating characteristic (ROC) curve analysis was performed to assess the discriminative ability of CSF Npt concentration for the diagnosis of PCNSL. CSF Npt concentration in patients with PCNSL was significantly higher than that in patients with other brain tumors and inflammatory diseases (P < .001). On ROC curve analysis, the optimal cutoff CSF Npt level of 10.77 ng/mL for the diagnosis of PCNSL and the diagnostic yield of MRI were increased when used in conjunction with CSF Npt concentration. The CSF Npt concentrations in PCNSL patients with multiple lesions were significantly higher than those in patients with a single lesion. Changes in CSF Npt concentration were consistent with post‐treatment changes in tumor sizes. The CSF Npt concentration may be a good biomarker for the diagnosis, for monitoring of disease course, and for prognostic evaluation of patients with PCNSL.
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Affiliation(s)
- Mingying Geng
- Cancer Center, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - He Xiao
- Cancer Center, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiaqi Liu
- Department of Clinical Laboratory, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yang Song
- Cancer Center, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ping Fu
- Department of Pathology, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqin, China
| | - Xing Cheng
- Department of Neurosurgery, Chongqing Cancer Hospital, Chongqing, China
| | - Jinwei Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ge Wang
- Cancer Center, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Aberrations in circulating inflammatory cytokine levels in patients with Down syndrome: a meta-analysis. Oncotarget 2017; 8:84489-84496. [PMID: 29137441 PMCID: PMC5663613 DOI: 10.18632/oncotarget.21060] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/03/2017] [Indexed: 11/27/2022] Open
Abstract
Evidence suggests that immune system alterations in Down syndrome (DS) may be early events that drive neuropathological and cognitive changes of Alzheimer's disease. The primary objective of this meta-analysis was to investigate whether there is an abnormal cytokine profile in DS patients when compared with healthy control (HC) subjects. A systematic search of Pubmed and Web of Science identified 19 studies with 957 DS patients and 541 HC subjects for this meta-analysis. Random effects meta-analysis demonstrated that patients with DS had significantly increased circulating tumor necrosis factor-α (Hedges’ g = 1.045, 95% confidence interval (CI) = 0.192 to 1.898, p = 0.016), interleukin (IL)-1β (Hedges’ g = 0.696, 95% confidence CI = 0.149 to 1.242, p = 0.013), interferon-γ (Hedges’ g = 0.978, 95% CI = 0.417 to 1.539, p = 0.001) and neopterin (Hedges’ g = 0.815, 95% CI = 0.423 to 1.207, p < 0.001) levels compared to HC subjects. No significant differences were found between patients with DS and controls for concentrations of IL-4, IL-6, IL8 and IL-10. In addition, most of the cytokine data in this meta-analysis were from children with DS and HC, and subgroup analysis showed that children with DS had elevated tumor necrosis factor-α, IL-1β and interferon-γ levels when compared with controls. Taken together, these results demonstrated that patients (children) with DS are accompanied by increased circulating cytokine tumor necrosis factor-α, IL-1β and interferon-γ levels, strengthening the clinical evidence that patients (children) with DS are accompanied by an abnormal inflammatory response.
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Zis P, Strydom A, Buckley D, Adekitan D, McHugh PC. Cognitive ability in Down syndrome and its relationship to urinary neopterin, a marker of activated cellular immunity. Neurosci Lett 2016; 636:254-257. [PMID: 27851899 DOI: 10.1016/j.neulet.2016.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/19/2016] [Accepted: 11/09/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Neopterin is an unconjugated pteridine that is secreted in large quantities by activated macrophages and can be used as a clinical marker of activated cellular immunity and oxidative stress. We aimed to investigate whether urinary neopterin levels are associated with cognitive function in people with Down syndrome (DS). METHODS Out of 32 adults with DS who originally participated in a longitudinal study, 25 were followed up at 4 years. Informants rated their adaptive behavior (ABAS) and the adults with DS attempted assessments of language skills and memory at both baseline and follow-up time points (Modified Memory Object Task, MOMT), and receptive vocabulary (British Picture Vocabulary Scale, BPVS). RESULTS Neopterin/creatinine levels were negatively correlated with change in the MOMT total score (Spearman's Rho=-0.517, p=0.020) and change in the MOMT delayed recall score (Spearman's Rho=-0.577, p=0.008) over time, i.e. higher neopterin/creatinine level was associated with worse performance on a test of cognitive ability over time. CONCLUSION Urine neopterin may have potential as a biomarker for memory decline in Down syndrome, and could potentially also help to track progression of mild cognitive impairment (MCI) to Alzheimer's disease in other high risk populations.
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Affiliation(s)
- Panagiotis Zis
- University College London, Division of Psychiatry, London, United Kingdom; Sheffield Teaching Hospitals NHS Trust, Department of Neurology, Sheffield, United Kingdom.
| | - André Strydom
- University College London, Division of Psychiatry, London, United Kingdom; The LonDowns Consortium, United Kingdom
| | - David Buckley
- Centre for Biomarker Research, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Daniel Adekitan
- Centre for Biomarker Research, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Patrick C McHugh
- Centre for Biomarker Research, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
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Parker DC, Mielke MM, Yu Q, Rosenberg PB, Jain A, Lyketsos CG, Fedarko NS, Oh ES. Plasma neopterin level as a marker of peripheral immune activation in amnestic mild cognitive impairment and Alzheimer's disease. Int J Geriatr Psychiatry 2013; 28:149-54. [PMID: 22539447 PMCID: PMC3505262 DOI: 10.1002/gps.3802] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 02/27/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Alterations of the immune system play important roles in Alzheimer's disease (AD). The primary purpose of this study was to compare the plasma levels of neopterin, a marker of cellular immune activity, in amnestic mild cognitive impairment (aMCI), early (mild to moderate) AD, and cognitively normal controls. In addition, the correlation of plasma neopterin with interferon-gamma (IFN-γ) and interleukin-6 (IL-6) was also examined. METHODS Plasma samples from patients with mild-to-moderate AD (N = 34), aMCI (N = 27), and cognitively normal controls (N = 30) were obtained from the Johns Hopkins Alzheimer's Disease Research Center. Plasma neopterin, IFN-γ, and IL-6 levels were measured using commercially available ELISAs. Multiple linear regression was performed to study differences in the baseline neopterin levels between normal, aMCI, and AD patients. Pearson correlation coefficients were estimated for neopterin and IFN-γ and IL-6 levels. All analyses were conducted using SAS (SAS Institute, Inc., Cary, NC) and GraphPad Prism version 5.00 for Window (GraphPad Software, San Diego, CA, USA). RESULTS AD subjects had significantly higher neopterin values compared with aMCI (β = 0.202, p = 0.004) and normal (β = 0.263, p = 0.0004) subjects. There was no statistically significant difference between normal and aMCI subjects. Significant associations between neopterin and IFN-γ (r = 0.41, p < 0.0001) and IL-6 (r = 0.35, p = 0.0006) levels were found. CONCLUSIONS Our study demonstrates that peripheral immune response may be stronger in later stages of AD pathophysiology, when dementia has developed.
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Affiliation(s)
- Daniel C. Parker
- Eastern Virginia Medical School, 700 W. Olney Road, Norfolk, VA, USA
| | - Michelle M. Mielke
- Department of Psychiatry, The Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD, USA,Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Qilu Yu
- Department of Medicine, The Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD, USA
| | - Paul B. Rosenberg
- Department of Psychiatry, The Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD, USA
| | - Alka Jain
- Department of Medicine, The Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD, USA
| | - Constantine G. Lyketsos
- Department of Psychiatry, The Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD, USA
| | - Neal S. Fedarko
- Department of Medicine, The Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD, USA
| | - Esther S. Oh
- Department of Psychiatry, The Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD, USA,Department of Medicine, The Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD, USA,Department of Pathology, The Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD, USA,Contact information of the corresponding author: Esther S. Oh: Department of Medicine, Division of Geriatric Medicine and Gerontology, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA,(tel) 410-550-1318 (fax) 410-550-8701
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Coppus AM, Fekkes D, Verhoeven WM, Evenhuis HM, van Duijn CM. Neopterin and the risk of dementia in persons with Down syndrome. Neurosci Lett 2009; 458:60-4. [DOI: 10.1016/j.neulet.2009.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 03/29/2009] [Accepted: 04/09/2009] [Indexed: 10/20/2022]
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Blasko I, Knaus G, Weiss E, Kemmler G, Winkler C, Falkensammer G, Griesmacher A, Würzner R, Marksteiner J, Fuchs D. Cognitive deterioration in Alzheimer's disease is accompanied by increase of plasma neopterin. J Psychiatr Res 2007; 41:694-701. [PMID: 16542679 DOI: 10.1016/j.jpsychires.2006.02.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 01/30/2006] [Accepted: 02/01/2006] [Indexed: 01/18/2023]
Abstract
The pro-inflammatory reaction of the immune system is a feature of healthy aging and might influence the progression of Alzheimer's disease (AD). Neopterin is a pteridine derivative, released from macrophages upon stimulation with pro-inflammatory cytokine interferon-gamma. Forty-three probable AD patients were investigated at baseline and follow up (14.5+/-0.5 months; mean+/-s.e.m.). We assessed the clinical progression by the Consortium to Establish a Registry for Alzheimer's disease (CERAD) battery and compared cognitive changes to serum concentrations of neopterin, C-reactive protein (CRP) and antibody to cytomegalovirus (CMV). The mean neopterin concentrations increased significantly from 9.8+/-1.0 to 13.6+/-2.1 nM (p=0.04). In contrast, mean CRP concentrations at baseline was 0.46+/-0.1 and non-significantly decreased to 0.28+/-0.04 mg/dl. Of AD patients 70% were CMV IgG-seropositive at baseline and CMV-antibody concentrations correlated with levels of neopterin (Spearman r=0.386, p=0.016). CERAD scores did not correlate with any of immune parameters at baseline. At follow up, the increase of neopterin correlated significantly with the decrease in the total CERAD and MMSE scores, according to the clinical progression (r=-0.353, p<0.05 and r=-0.401, p<0.01, respectively). Subdividing the sample with respect to baseline MMSE scores, neopterin concentrations significantly increased only in the group of MMSE<20. In the multiple testing covariated for age, gender, Apolipoprotein E-epsilon4 allele, time difference between both measurements, neopterin remained significantly associated with cognitive decline. In summary, neopterin concentrations correlated with cognitive decline in AD patients, which might be due to high CMV seropositivity in that population.
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Affiliation(s)
- Imrich Blasko
- Department of Psychiatry, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Tyrol, Austria.
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Coppus AW, Fekkes D, Verhoeven WMA, Tuinier S, Egger JIM, van Duijn CM. Plasma amino acids and neopterin in healthy persons with Down's syndrome. J Neural Transm (Vienna) 2007; 114:1041-5. [PMID: 17401539 PMCID: PMC2794348 DOI: 10.1007/s00702-007-0656-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Accepted: 02/04/2007] [Indexed: 12/14/2022]
Abstract
In persons with Down's syndrome (DS) immunological abnormalities as well as hypothyroidism and Alzheimer type dementia are frequently observed. In addition, the activity of the enzyme cystathionine beta-synthase (CBS) is over-expressed which results in an altered homocysteine metabolism. In the present study, 48 older healthy DS persons without signs of dementia, psychiatric or somatic comorbidity and free of medication were analyzed for plasma levels of amino acids, neopterin and monoaminergic metabolites. Data were compared with those obtained from age and sex matched healthy controls. It was found that the spectrum of amino acids showed widespread differences in that levels of nearly all essential amino acids were lower in DS patients as compared to healthy controls. In addition, a significantly lower methionine and higher taurine concentration were observed which is in accordance with a disturbed homocysteine metabolism. With respect to the monoamine metabolites, the concentration of 5-hydroxyindoleacetic acid was not altered whereas that of homovanillic acid was significantly increased. Finally, the concentration of the immune activation marker neopterin was increased in persons with DS. It is concluded that healthy DS persons of older age show extensive biochemical abnormalities suggesting a compromised homocysteine metabolism, an activated cell-mediated immune response and an enhanced turnover of dopamine.
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Affiliation(s)
- A W Coppus
- Centre for Intellectual Disabilities Dichterbij, Gennep, The Netherlands
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Mehta PD, Capone G, Jewell A, Freedland RL. Increased amyloid beta protein levels in children and adolescents with Down syndrome. J Neurol Sci 2007; 254:22-7. [PMID: 17275850 DOI: 10.1016/j.jns.2006.12.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 12/01/2006] [Accepted: 12/04/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Persons with Down syndrome (DS) (40 years and older) have neuropathological changes characteristic of Alzheimer disease (AD). Soluble forms of amyloid beta (Abeta) peptide generated from amyloid precursor protein (APP) end at C-terminal residues 40 and 42. The presence of the apolipoprotein E (ApoE) epsilon4 allele is a significant risk factor for the development of sporadic AD. Although preliminary studies have shown an association of plasma Abeta42 and ApoE epsilon4 allele in older persons with DS who have dementia, the relationship between plasma Abeta40 and Abeta42 levels and ApoE phenotypes in children with DS has not been examined. Inflammation might play a role in the growth of DS brains. Neopterin is an immune activation marker for the cell-mediated immune response. OBJECTIVE To examine the levels of plasma Abeta40, Abeta42, and neopterin in children or adolescents with DS or controls. MATERIALS AND METHODS Blood was collected from DS (N=35; 7+/-3.8 years old) and their siblings (N=34; 10+/-4.5). Plasma Abeta40 and Abeta42, and neopterin levels were quantitated by sandwich ELISA. RESULTS Abeta40 and Abeta42 levels were higher in DS than controls. The ratio of Abeta42/Abeta40 was lower in DS than in controls. There were significant negative correlations between age and Abeta40 in DS and controls, and between age and Abeta42 levels in DS but not in controls. There was no association of Abeta40 or Abeta42 levels with Apo E in either group. Neopterin levels were higher in DS than controls, and the levels were not correlated with Abeta40 and Abeta42 levels in DS or controls. CONCLUSIONS The over expression of APP gene in DS leads to increases in plasma Abeta40 and Abeta42 levels before plaque formation in DS brain. Higher neopterin concentrations in DS reflect inflammatory cell activation. Further studies are needed to determine whether DS children with lower plasma Abeta42/Abeta40 ratios are at increased risk of developing AD during aging than those with higher ratios.
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Affiliation(s)
- Pankaj D Mehta
- Department of Developmental Neurobiology, Department of Infant Development, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY 10314-6399, United States.
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