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Lewczuk P, Łukaszewicz-Zając M, Mroczko P, Kornhuber J. Clinical significance of fluid biomarkers in Alzheimer's Disease. Pharmacol Rep 2020; 72:528-542. [PMID: 32385624 PMCID: PMC7329803 DOI: 10.1007/s43440-020-00107-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022]
Abstract
The number of patients with Alzheimer's Disease (AD) and other types of dementia disorders has drastically increased over the last decades. AD is a complex progressive neurodegenerative disease affecting about 14 million patients in Europe and the United States. The hallmarks of this disease are neurotic plaques consist of the Amyloid-β peptide (Aβ) and neurofibrillary tangles (NFTs) formed of hyperphosphorylated Tau protein (pTau). Currently, four CSF biomarkers: Amyloid beta 42 (Aβ42), Aβ42/40 ratio, Tau protein, and Tau phosphorylated at threonine 181 (pTau181) have been indicated as core neurochemical AD biomarkers. However, the identification of additional fluid biomarkers, useful in the prognosis, risk stratification, and monitoring of drug response is sorely needed to better understand the complex heterogeneity of AD pathology as well as to improve diagnosis of patients with the disease. Several novel biomarkers have been extensively investigated, and their utility must be proved and eventually integrated into guidelines for use in clinical practice. This paper presents the research and development of CSF and blood biomarkers for AD as well as their potential clinical significance. Upper panel: Aβ peptides are released from transmembrane Amyloid Precursor Protein (APP) under physiological conditions (blue arrow). In AD, however, pathologic accumulation of Aβ monomers leads to their accumulation in plaques (red arrow). This is reflected in decreased concentration of Aβ1-42 and decreased Aβ42/40 concentration ratio in the CSF. Lower panel: Phosphorylated Tau molecules maintain axonal structures; hyperphosphorylation of Tau (red arrow) in AD leads to degeneration of axons, and release of pTau molecules, which then accumulate in neurofibrillary tangles. This process is reflected by increased concentrations of Tau and pTau in the CSF.
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Affiliation(s)
- Piotr Lewczuk
- Lab for Clinical Neurochemistry and Neurochemical Dementia Diagnostics, Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
- Department of Neurodegeneration Diagnostics, Medical University of Białystok, Białystok, Poland.
| | | | - Piotr Mroczko
- Department of Criminal Law and Criminology, Faculty of Law, University of Białystok, Białystok, Poland
| | - Johannes Kornhuber
- Lab for Clinical Neurochemistry and Neurochemical Dementia Diagnostics, Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
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Tomescu-Baciu A, Vartdal F, Holmøy T, Vedeler CA, Lossius A. G1m1 predominance of intrathecal virus-specific antibodies in multiple sclerosis. Ann Clin Transl Neurol 2018; 5:1303-1309. [PMID: 30349866 PMCID: PMC6186941 DOI: 10.1002/acn3.642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 12/05/2022] Open
Abstract
We have previously shown that plasmablasts of the G1m1 allotype of IgG1 are selectively enriched in the cerebrospinal fluid of G1m1/G1m3 heterozygous patients with multiple sclerosis, whereas both allotypes are equally used in neuroborreliosis. Here, we demonstrate a strong preference for the G1m1 allotype in the intrathecal humoral immune responses against measles, rubella, and varicella zoster virus in G1m1/G1m3 heterozygous multiple sclerosis patients. Conversely, intrathecally synthesized varicella zoster virus‐specific IgG1 in varicella zoster virus meningoencephalitis comprised both allotypes. This implies that G1m1 B cells are selected to the central nervous system of multiple sclerosis patients regardless of specificity and suggests that an antigen‐independent mechanism could drive the intrathecal humoral immune response.
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Affiliation(s)
- Alina Tomescu-Baciu
- Department of Immunology and Transfusion Medicine Faculty of Medicine University of Oslo Oslo University Hospital Rikshospitalet Oslo Norway
| | - Frode Vartdal
- Department of Immunology and Transfusion Medicine Faculty of Medicine University of Oslo Oslo University Hospital Rikshospitalet Oslo Norway
| | - Trygve Holmøy
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway.,Department of Neurology Akershus University Hospital Lørenskog Norway
| | - Christian A Vedeler
- Department of Clinical Medicine University of Bergen Bergen Norway.,Department of Neurology Haukeland University Hospital Bergen Norway
| | - Andreas Lossius
- Department of Immunology and Transfusion Medicine Faculty of Medicine University of Oslo Oslo University Hospital Rikshospitalet Oslo Norway.,Department of Neurology Akershus University Hospital Lørenskog Norway
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Hottenrott T, Schorb E, Fritsch K, Dersch R, Berger B, Huzly D, Rauer S, Tebartz van Elst L, Endres D, Stich O. The MRZ reaction and a quantitative intrathecal IgG synthesis may be helpful to differentiate between primary central nervous system lymphoma and multiple sclerosis. J Neurol 2018; 265:1106-1114. [DOI: 10.1007/s00415-018-8779-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 01/04/2023]
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Hottenrott T, Dersch R, Berger B, Endres D, Huzly D, Thiel J, Rauer S, Stich O, Salzer U, Venhoff N. The MRZ reaction helps to distinguish rheumatologic disorders with central nervous involvement from multiple sclerosis. BMC Neurol 2018; 18:14. [PMID: 29386006 PMCID: PMC5793342 DOI: 10.1186/s12883-018-1018-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 01/18/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Some rheumatologic disorders may initially manifest with central nervous system (CNS) affection, mimicking the clinical, magnetic resonance imaging, and cerebrospinal fluid findings of multiple sclerosis (MS). The MRZ reaction (MRZR), composed of the three respective antibody indices (AIs) against measles, rubella, and varicella zoster virus, has been found positive frequently in MS patients. However, it is unclear whether the MRZR is helpful to distinguish rheumatologic disorders with CNS involvement (RDwCNS) from MS. METHODS The MRZR was evaluated in patients with RDwCNS (n = 23), MS (n = 46; age and sex matched to patients with RDwCNS), and other inflammatory autoimmune neurological diseases affecting the CNS (OIND; n = 48). Both the stringency levels that have been used in previous MRZR studies, MRZR-1 (≥ 1 of 3 AIs positive) and MRZR-2 (≥ 2 of 3 AIs positive), were applied. RESULTS There was no statistically significant difference in the prevalence of positive MRZR between patients with RDwCNS (MRZR-1: 13.0% and MRZR-2: 8.7%, respectively) and OIND (MRZR-1: 22.9% and MRZR-2: 8.3%, respectively). Compared to these two study cohorts, the MS group exhibited significantly higher prevalences of positive MRZR (MRZR-1: 82.6%, MRZR-2: 63.0%; p < 0.005 each). CONCLUSIONS Considering the high specificity of MRZR-2 for MS found in this study, MRZR-2 can be a useful diagnostic tool for distinguishing MS from RDwCNS or OIND.
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Affiliation(s)
- Tilman Hottenrott
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany.
| | - Rick Dersch
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Benjamin Berger
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Hauptstraße 5, D-79104, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, University Medical Center Freiburg, Hermann-Herder-Strasse 11, D-79104, Freiburg, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany
| | - Sebastian Rauer
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Oliver Stich
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany
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Hottenrott T, Dersch R, Berger B, Rauer S, Huzly D, Stich O. The MRZ reaction in primary progressive multiple sclerosis. Fluids Barriers CNS 2017; 14:2. [PMID: 28166789 PMCID: PMC5294835 DOI: 10.1186/s12987-016-0049-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/29/2016] [Indexed: 11/17/2022] Open
Abstract
Background The MRZ reaction (MRZR), composed of the three antibody indices (AI) against measles, rubella and varicella zoster virus and found positive in the majority of relapsing-remitting multiple sclerosis (RRMS) patients, is absent in other inflammatory neurological diseases (OIND). So far, it has been uncertain whether its differential diagnostic promise extends to patients with primary-progressive multiple sclerosis (PPMS). Objective To investigate the prevalence of MRZR in PPMS compared to RRMS and OIND patients. Methods MRZR was assessed in patients with PPMS (n = 103), RRMS (n = 100) and OIND (n = 48). Both stringency levels for MRZR testing, MRZR-1 (≥1 AI positive) and MRZR-2 (≥2 AI positive), were applied. Results Prevalence of positive MRZR-1 was 83.5% in PPMS and 67.8% in RRMS (p < 0.05). A positive MRZR-2 was found in 54.4% of PPMS and in 43.0% of RRMS patients (not significant). Compared to both MS subgroups, OIND patients exhibit lower frequencies of positive MRZR (MRZR-1: 22.9%, MRZR-2: 8.3%; p < 0.0001 each). Conclusion Positive MRZR was at least as frequent in PPMS as in RRMS and much less frequent in OIND, confirming its promise as a potentially useful diagnostic tool for distinguishing both MS course types from OIND.
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Affiliation(s)
- Tilman Hottenrott
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.
| | - Rick Dersch
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
| | - Benjamin Berger
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
| | - Sebastian Rauer
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.,Ravo Diagnostika GmbH, Oltmannsstrasse 5, 79100, Freiburg, Germany
| | - Daniela Huzly
- University Medical Center Freiburg, Institute of Virology, Hermann-Herder-Strasse 11, 79104, Freiburg, Germany
| | - Oliver Stich
- Department of Neurology and Neurophysiology, University Medical Center Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany
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Huss A, Buttmann M, Brecht I, Weishaupt A, Otto M, Tumani H. Validation of a multiplexing technique to determine the intrathecal, polyspecific antiviral immune response in multiple sclerosis. Expert Rev Mol Diagn 2016; 16:1353-1356. [PMID: 27759441 DOI: 10.1080/14737159.2016.1249468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Beside the determination of oligoclonal bands (OCBs) as a diagnostic biomarker in multiple sclerosis (MS), the presence of an intrathecal production of antibodies against the neurotropic viruses measles (M), rubella (R) and Varicella-Zoster (Z), the so called MRZ reaction (MRZR) is an even more specific diagnostic biomarker in MS. METHODS We compared and validated the determination of the MRZR in 97 cerebrospinal fluid (CSF) and serum sample pairs of a bead-based multiplexing technique and a classical enzyme-linked immunosorbent assay (ELISA). RESULTS Conformity of 94% (M), 94% (R), 94% (Z), 96% (H) and 97% for the interpretation of the MRZR was obtained. CONCLUSION Based on our findings of high conformity between the multiplex technique and classical ELISA, as well as the time and cost savings multiplexing allows, we conclude that the multiplexing technique is applicable as a diagnostic tool for the determination of the MRZR.
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Affiliation(s)
- André Huss
- a Department of Neurology , University of Ulm , Ulm , Germany
| | - Mathias Buttmann
- b Department of Neurology , University of Würzburg , Würzburg , Germany
| | - Isabel Brecht
- b Department of Neurology , University of Würzburg , Würzburg , Germany
| | - Andreas Weishaupt
- b Department of Neurology , University of Würzburg , Würzburg , Germany
| | - Markus Otto
- a Department of Neurology , University of Ulm , Ulm , Germany
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Persson L, Longhi S, Enarsson J, Andersen O, Haghigi S, Nilsson S, Lagging M, Johansson M, Bergström T. Elevated antibody reactivity to measles virus NCORE protein among patients with multiple sclerosis and their healthy siblings with intrathecal oligoclonal immunoglobulin G production. J Clin Virol 2014; 61:107-12. [PMID: 25022622 DOI: 10.1016/j.jcv.2014.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/07/2014] [Accepted: 06/11/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) and their healthy siblings with the MS oligoclonal bands (OCB) trait, (a hyperimmune condition in form of two or more CSF enriched OCBs) harbor in cerebrospinal fluid (CSF) and serum elevated immunoglobulin G (IgG) titers against measles crude whole-cell antigen. The underlying mechanism resulting in the increased IgG antibody reactivity to measles remains unclear. The response may represent specific IgG reactivity to measles antigens or unspecific auto-antibodies targeting cellular components in the crude whole virus antigens commonly used in detection assays. OBJECTIVE To determine the specificity of the measles IgG antibody reactivity by using a purified single nucleoprotein as antigen, thereby minimizing the contribution from auto-antibodies. STUDY DESIGN The conserved N-terminal portion of the measles nucleocapsid protein (NCORE) was expressed as a specific antigen devoid of human or primate components. Serological analyses were performed on CSF and sera from MS patients, their clinically healthy siblings and healthy unrelated controls. RESULTS MS patients demonstrated higher IgG reactivity compared to healthy controls in both CSF (P<0.001) and serum (P<0.001), and compared to siblings in CSF (P<0.001) and serum (P=0.2). Siblings with MS OCB trait showed higher IgG reactivity than healthy controls in CSF (P=0.002) and serum (P=0.01). Comparison between siblings with MS OCB trait and siblings without MS OCB trait showed (P=0.04) for CSF and (P=0.08) for serum. CONCLUSION These findings suggest a measles-specific component in the antibody reactivity demonstrated by MS patients and their siblings with the MS OCB trait.
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Affiliation(s)
- Linn Persson
- Section for Clinical Virology, Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10 B, 41264 Gothenburg, Sweden
| | - Sonia Longhi
- Architecture et Fonction des Macromolécules Biologiques (AFMB), UMR 7257, CNRS et Université Aix-Marseille, 13288 Marseille, France
| | - Johanna Enarsson
- Section for Clinical Virology, Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10 B, 41264 Gothenburg, Sweden
| | - Oluf Andersen
- Section of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sara Haghigi
- Section of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Staffan Nilsson
- Department of Mathematical Statistics, Chalmers University of Technology, Gothenburg, Sweden
| | - Martin Lagging
- Section for Clinical Virology, Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10 B, 41264 Gothenburg, Sweden
| | - Maria Johansson
- Section for Clinical Virology, Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10 B, 41264 Gothenburg, Sweden
| | - Tomas Bergström
- Section for Clinical Virology, Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10 B, 41264 Gothenburg, Sweden.
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The participation of varicella zoster virus in relapses of multiple sclerosis. Clin Neurol Neurosurg 2014; 119:44-8. [PMID: 24635924 DOI: 10.1016/j.clineuro.2013.12.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 12/18/2013] [Accepted: 12/25/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Recent studies have documented the apparent participation of varicella zoster virus (VZV) in the etiopathogenesis of multiple sclerosis (MS). The present study aimed to corroborate the possible presence of VZV during exacerbations of MS. DESIGN Fifty-three patients with definite MS were included; of them, 31 were studied during the first week of a clinical relapse, whereas 16 were studied during remission; 6 patients with progressive MS were also studied. Genes from 5 herpes viruses: varicella zoster, herpes simplex 1 and 2, Epstein-Barr and herpes 6 were studied by polymerase chain reaction in cerebrospinal fluid and in peripheral blood mononuclear cells (PBMC). As controls 21 patients with inflammatory or functional neurological disorders were included. RESULTS DNA from varicella zoster virus was found in the CSF from all MS patients studied during relapse (100%) and in the PBMC from 28 of them (90%). However, VZV DNA was found in the CSF only in 5 MS patients studied during remission (31%) and in the PBMC from 3 of them (19%). VZV DNA was also found, but in lower amounts, in the CSF (83%) and PBMC (33%) from patients with progressive MS. In contrast, VZV was not found either in CSF or in PBMC from controls. Results from the other herpes viruses tested were similar in MS patients and in controls. CONCLUSIONS Our results corroborate the conspicuous, but ephemeral presence of VZV during relapses of MS and support the idea of VZV involvement in the etiopathogenesis of MS. Recent epidemiological and molecular studies as well as reports of severe VZV infections triggered by specifically induced immunosuppression during therapy of MS give additional support to this potential association.
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Hvaring C, Vujicic S, Aasly JO, Feinstein DL, White LR, Boullerne AI. IgM to S-nitrosylated protein is found intrathecally in relapsing–remitting multiple sclerosis. J Neuroimmunol 2013; 256:77-83. [DOI: 10.1016/j.jneuroim.2012.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 12/13/2012] [Accepted: 12/28/2012] [Indexed: 12/20/2022]
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The pros and cons of multiplexing: a guest-editor's introduction. Methods 2012; 56:461-3. [PMID: 22691822 DOI: 10.1016/j.ymeth.2012.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 05/31/2012] [Indexed: 01/01/2023] Open
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