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Iacono S, Piccoli T, Aridon P, Schirò G, Blandino V, Tarantino D, Agnello L, Ciaccio M, Ragonese P, Salemi G. Evaluation of serum and cerebrospinal fluid biomarkers after vaccination against SARS-CoV-2. Ann Clin Transl Neurol 2023; 10:1025-1034. [PMID: 37139906 PMCID: PMC10270270 DOI: 10.1002/acn3.51785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE Vaccines are a major achievement of science, and new vaccines against SARS-CoV-2 are protecting the entire population from a life-threatening infection. Although several neurological complications or worsening of pre-existing neurological conditions after vaccination have been observed, whether a biological plausibility exist between new vaccines against-SARS-CoV-2 and neurological consequences is unclear. The aim of this study is to evaluate whether vaccines against SARS-CoV-2 induce systemic or cerebrospinal fluid alterations in patients with neurological disorders. METHODS Patients who underwent lumbar puncture (LP) between February 2021 and October 2022 were enrolled. Serum C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), cerebrospinal fluid total protein content (CSF-TPc), glucose CSF/serum ratio, number of CSF cells per cubic millimeter, and CSF neurofilament light chain (CSF-NfL) were compared between unvaccinated and vaccinated patients. RESULTS A total of 110 patients were included and fitted into three groups according firstly to vaccination status (vaccinated and unvaccinated) and then to time from last dose of vaccine to LP (within or after 3 months). TPc, CSF/SGlu ratio, number of cells per cubic millimeter, CSF-NfL, CRP, and NLR were not different between groups (all p > 0.05), and also, they did not differ neither according to age nor diagnosis. No relevant differences between groups were also noticed when the at-risk time window was set to 6 weeks. INTERPRETATION No signs of neuroinflammation, axonal loss and systemic inflammation were found in patients with neurological disorders after anti-SARS-CoV-2 vaccination compared with unvaccinated ones.
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Affiliation(s)
- Salvatore Iacono
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND)University of PalermoPalermoItaly
| | - Tommaso Piccoli
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND)University of PalermoPalermoItaly
| | - Paolo Aridon
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND)University of PalermoPalermoItaly
| | - Giuseppe Schirò
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND)University of PalermoPalermoItaly
| | - Valeria Blandino
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND)University of PalermoPalermoItaly
| | - Domenico Tarantino
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND)University of PalermoPalermoItaly
| | - Luisa Agnello
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory MedicineUniversity Hospital “P. Giaccone”PalermoItaly
| | - Marcello Ciaccio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory MedicineUniversity Hospital “P. Giaccone”PalermoItaly
| | - Paolo Ragonese
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND)University of PalermoPalermoItaly
| | - Giuseppe Salemi
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND)University of PalermoPalermoItaly
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Castellazzi M, Ferri C, Tecilla G, Huss A, Crociani P, Desina G, Barbella G, Piola A, Permunian S, Senel M, Leone M, Tumani H, Pugliatti M. The Sexual Dimorphism in Cerebrospinal Fluid Protein Content Does Not Affect Intrathecal IgG Synthesis in Multiple Sclerosis. J Pers Med 2022; 12:jpm12060977. [PMID: 35743761 PMCID: PMC9224729 DOI: 10.3390/jpm12060977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS) that mainly affects young adults and females more than males. The detection of intrathecal IgG synthesis (IIS) on cerebrospinal fluid (CSF) analysis supports the diagnosis of MS. A sexual dimorphism has recently been described in CSF protein content. (2) Methods: Clinical and laboratory data from 340 MS patients (F = 231, M = 99) and 89 people with clinically isolated syndrome (CIS) (F = 57, M = 32) were retrospectively analyzed to assess the presence of variables affected by sex and age. (3) Results: In MS, the albumin quotient (QAlb), reflecting the blood–CSF barrier (BCSFB) function, was higher in males (5.6 vs. 4.34) and correlated to age with a constant difference between sexes (F = 41.71). In CIS patients, QAlb increased with age only in males (r = 0.3567). Age was positively correlated to disease duration and severity in MS (r = 0.3502, r = 0.2986, respectively). No differences emerged for quantitative and qualitative IIS determinations. (4) Discussion: Although the main difference between males and females concerns the function of BCSFB assessed by QAlb, this sexual dimorphism does not affect the determination of the IIS evaluated both by quantitative and qualitative methods.
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Affiliation(s)
- Massimiliano Castellazzi
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
- Correspondence: ; Tel.: +39-0532-236388
| | - Caterina Ferri
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
| | - Ginevra Tecilla
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
| | - André Huss
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.H.); (M.S.); (H.T.)
| | - Paola Crociani
- Neurology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (P.C.); (G.D.); (M.L.)
| | - Gaetano Desina
- Neurology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (P.C.); (G.D.); (M.L.)
| | - Gianvito Barbella
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
| | - Alice Piola
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
| | - Samantha Permunian
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
| | - Makbule Senel
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.H.); (M.S.); (H.T.)
| | - Maurizio Leone
- Neurology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (P.C.); (G.D.); (M.L.)
| | - Hayrettin Tumani
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.H.); (M.S.); (H.T.)
| | - Maura Pugliatti
- Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (G.T.); (G.B.); (A.P.); (S.P.); (M.P.)
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, 44121 Ferrara, Italy
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Neilson LE, Hollen C, Hiller A, Wooliscroft L. Oligoclonal Bands in Multiple System Atrophy: Case Report and Proposed Mechanisms of Immunogenicity. Front Neurosci 2022; 16:852939. [PMID: 35295090 PMCID: PMC8919426 DOI: 10.3389/fnins.2022.852939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple System Atrophy (MSA) is a neurodegenerative disease with heterogeneous manifestations and is therefore difficult to diagnose definitively. Because of this, oftentimes an extensive workup for mimickers is undertaken. We herein report a case where the history and cerebrospinal fluid (CSF) findings of oligoclonal bands suggested an inflammatory disorder. Immunomodulatory therapy failed to ameliorate symptoms or alter the trajectory of continued physical decline, prompting re-visitation of the diagnosis. Oligoclonal bands, while generally viewed as specific to multiple sclerosis or other inflammatory conditions, may be seen in other disease processes. Therefore, this finding should not exclude consideration of neurodegenerative disease.
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Affiliation(s)
- Lee E Neilson
- Department of Neurology, Veterans Affairs Medical Center, Portland, OR, United States.,Department of Neurology, Oregon Health and Sciences University, Portland, OR, United States
| | - Christopher Hollen
- Department of Neurology, Veterans Affairs Medical Center, Portland, OR, United States.,Department of Neurology, Oregon Health and Sciences University, Portland, OR, United States
| | - Amie Hiller
- Department of Neurology, Veterans Affairs Medical Center, Portland, OR, United States.,Department of Neurology, Oregon Health and Sciences University, Portland, OR, United States
| | - Lindsey Wooliscroft
- Department of Neurology, Veterans Affairs Medical Center, Portland, OR, United States.,Department of Neurology, Oregon Health and Sciences University, Portland, OR, United States
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Castellazzi M, Pizzicotti S, Lombardo I, Alfiero S, Morotti A, Pellegatti P, Negri G, Natali L, Ferri C, Fainardi E, Bellini T, Pugliatti M. Sexual dimorphism in the cerebrospinal fluid total protein content. Clin Chem Lab Med 2021; 58:1885-1890. [PMID: 32598300 DOI: 10.1515/cclm-2020-0419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/18/2020] [Indexed: 11/15/2022]
Abstract
Objectives Cerebrospinal fluid (CSF) is a clear, colorless body fluid filling the central nervous system. The determination of the CSF total protein (TP) content represents an important screening test of various pathologies. We aimed to address the effect of sex and age on CSF-TP content and the use of the current upper reference limits (URLs). Methods CSF-TP content was analysed in a selected population of 1,252 patients (648 women and 604 men; age 18-89 years) who underwent lumbar puncture as a part of the diagnostic work-up. Samples presenting (i) more than 5 white blood cells (WBC)/µL, (ii) discolorations and (iii) reduced glucose were not included. Results The CSF-TP content median values were significantly higher in men than in women (46 vs. 37 mg/dL) even after adjusting for age and different hospital inpatients. CSF-TP content positively correlated with age both in men and in women with a constant difference between sexes of 8.5 mg/dL. Applying the most used URLs (mainly 45 and 50 mg/dL, but also 60 mg/dL), men received a laboratory report suggestive of altered CSF-TP content more frequently than women. The use of age- and sex-calibrated CSF-TP URLs reduced, but not eliminated, this sex-gap. Conclusions Using the current URLs, a condition of "elevated CSF-TP content" may be overestimated in men or, conversely, underestimated in women, regardless of the age and of the diagnosis. These results highlighted the need to apply CSF-TP URLs values normalized for both sex and age.
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Affiliation(s)
- Massimiliano Castellazzi
- Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, Ferrara, Italy
| | - Stefano Pizzicotti
- Chemical-Clinical Analysis Laboratory, "S. Anna" University Hospital, Ferrara, Italy
| | - Ilenia Lombardo
- Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Sarah Alfiero
- Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Patrizia Pellegatti
- Chemical-Clinical Analysis Laboratory, "S. Anna" University Hospital, Ferrara, Italy
| | - Giovanna Negri
- Chemical-Clinical Analysis Laboratory, "S. Anna" University Hospital, Ferrara, Italy
| | - Lara Natali
- Chemical-Clinical Analysis Laboratory, "S. Anna" University Hospital, Ferrara, Italy
| | - Caterina Ferri
- Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Enrico Fainardi
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, Ferrara, Italy
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Tiziana Bellini
- Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Maura Pugliatti
- Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, Ferrara, Italy
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Castellazzi M, Ferri C, Alfiero S, Lombardo I, Laudisi M, Tecilla G, Boni M, Pizzicotti S, Fainardi E, Bellini T, Pugliatti M. Sex-Related Differences in Cerebrospinal Fluid Plasma-Derived Proteins of Neurological Patients. Diagnostics (Basel) 2021; 11:diagnostics11050884. [PMID: 34065720 PMCID: PMC8156001 DOI: 10.3390/diagnostics11050884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background and aims: Cerebrospinal fluid (CSF) protein content presents a sexual dimorphism in humans. We investigated sex-related differences in CSF IgG levels and in the quantification of intrathecal IgG synthesis (IIS). Methods: CSF, serum albumin and IgG were measured in 1519 neurological patients and both linear and hyperbolic formulas were used for the quantification of IIS. CSF-restricted oligoclonal IgG bands (OCBs) were used as “gold standard”. Results: The linear IgG Index showed a weak agreement with OCBs in males and females (k = 0.559, k = 0.587, respectively), while the hyperbolic Reiber’s formulas had a moderate agreement with OCBs in females (k = 0.635) and a weak agreement in males (k = 0.565). Higher CSF albumin and IgG levels were found in men than in women in the whole population and in subjects without IIS after adjusting for age and for serum concentrations of albumin and IgG, respectively (Quade statistics, p < 0.000001). CSF and serum albumin and IgG levels positively correlated to age in both sexes. CSF total protein content did not correlate with CSF leukocyte numbers but was higher in patients with marked pleocytosis. Conclusions: In neurological patients, men have higher levels of CSF serum-derived proteins, such as albumin and IgG.
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Affiliation(s)
- Massimiliano Castellazzi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, 44121 Ferrara, Italy
- Correspondence: ; Tel.: +39-0532-236388
| | - Caterina Ferri
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
| | - Sarah Alfiero
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
| | - Ilenia Lombardo
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
| | - Michele Laudisi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
| | - Ginevra Tecilla
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
| | - Michela Boni
- Chemical-Clinical Analysis Laboratory, “S. Anna” University Hospital, 44124 Ferrara, Italy; (M.B.); (S.P.)
| | - Stefano Pizzicotti
- Chemical-Clinical Analysis Laboratory, “S. Anna” University Hospital, 44124 Ferrara, Italy; (M.B.); (S.P.)
| | - Enrico Fainardi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy;
| | - Tiziana Bellini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, 44121 Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (S.A.); (I.L.); (M.L.); (G.T.); (T.B.); (M.P.)
- Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, 44121 Ferrara, Italy
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Vitale F, Ortolan J, Volpe BT, Marambaud P, Giliberto L, d'Abramo C. Intramuscular injection of vectorized-scFvMC1 reduces pathological tau in two different tau transgenic models. Acta Neuropathol Commun 2020; 8:126. [PMID: 32762731 PMCID: PMC7409655 DOI: 10.1186/s40478-020-01003-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
With evidence supporting the prion-like spreading of extracellular tau as a mechanism for the initiation and progression of Alzheimer's disease (AD), immunotherapy has emerged as a potential disease-modifying strategy to target tau. Many studies have proven effective to clear pathological tau species in animal models of AD, and several clinical trials using conventional immunotherapy with anti-tau native antibodies are currently active. We have previously generated a vectorized scFv derived from the conformation-dependent anti-tau antibody MC1, scFvMC1, and demonstrated that its intracranial injection was able to prevent tau pathology in adult tau mice. Here, we show that, in a prevention paradigm and in two different tau transgenic models (JNPL3 and P301S), a one-time intramuscular injection of AAV1-scFvMC1 generated a long-lasting peripheral source of anti-tau scFvMC1 and significantly reduced insoluble and soluble tau species in the brain. Moreover, our data showed that scFvMC1 was internalized by the microglia, in the absence of overt inflammation. This study demonstrates the efficacy of intramuscular delivery of vectorized scFv to target tau, and suggests a new potential application to treat AD and the other tauopathies.
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Affiliation(s)
- Francesca Vitale
- Institute of Molecular Medicine, The Litwin-Zucker Center for Alzheimer's Disease & Memory Disorder, The Feintein Institutes for Medical Research, Manhasset, NY, USA
| | - Jasmin Ortolan
- Institute of Molecular Medicine, The Litwin-Zucker Center for Alzheimer's Disease & Memory Disorder, The Feintein Institutes for Medical Research, Manhasset, NY, USA
| | - Bruce T Volpe
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Molecular Medicine, Center for Autoimmune and Musculoskeletal Disease, The Feinstein Institutes for Medical Research, Manhasset, USA
| | - Philippe Marambaud
- Institute of Molecular Medicine, The Litwin-Zucker Center for Alzheimer's Disease & Memory Disorder, The Feintein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Luca Giliberto
- Institute of Molecular Medicine, The Litwin-Zucker Center for Alzheimer's Disease & Memory Disorder, The Feintein Institutes for Medical Research, Manhasset, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Northwell Health Neuroscience Institute, Northwell Health System, Manhasset, NY, USA.
| | - Cristina d'Abramo
- Institute of Molecular Medicine, The Litwin-Zucker Center for Alzheimer's Disease & Memory Disorder, The Feintein Institutes for Medical Research, Manhasset, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Lassmann H. Pathogenic Mechanisms Associated With Different Clinical Courses of Multiple Sclerosis. Front Immunol 2019; 9:3116. [PMID: 30687321 PMCID: PMC6335289 DOI: 10.3389/fimmu.2018.03116] [Citation(s) in RCA: 364] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/17/2018] [Indexed: 01/02/2023] Open
Abstract
In the majority of patients multiple sclerosis starts with a relapsing remitting course (RRMS), which may at later times transform into secondary progressive disease (SPMS). In a minority of patients the relapsing remitting disease is skipped and the patients show progression from the onset (primary progressive MS, PPMS). Evidence obtained so far indicate major differences between RRMS and progressive MS, but no essential differences between SPMS and PPMS, with the exception of a lower incidence in the global load of focal white matter lesions and in particular in the presence of classical active plaques in PPMS. We suggest that in MS patients two types of inflammation occur, which develop in parallel but partially independent from each other. The first is the focal bulk invasion of T- and B-lymphocytes with profound blood brain barrier leakage, which predominately affects the white matter, and which gives rise to classical active demyelinated plaques. The other type of inflammation is a slow accumulation of T-cells and B-cells in the absence of major blood brain barrier damage in the connective tissue spaces of the brain, such as the meninges and the large perivascular Virchow Robin spaces, where they may form aggregates or in most severe cases structures in part resembling tertiary lymph follicles. This type of inflammation is associated with the formation of subpial demyelinated lesions in the cerebral and cerebellar cortex, with slow expansion of pre-existing lesions in the white matter and with diffuse neurodegeneration in the normal appearing white or gray matter. The first type of inflammation dominates in acute and relapsing MS. The second type of inflammation is already present in early stages of MS, but gradually increases with disease duration and patient age. It is suggested that CD8+ T-lymphocytes remain in the brain and spinal cord as tissue resident cells, which may focally propagate neuroinflammation, when they re-encounter their cognate antigen. B-lymphocytes may propagate demyelination and neurodegeneration, most likely by producing soluble neurotoxic factors. Whether lymphocytes within the brain tissue of MS lesions have also regulatory functions is presently unknown. Key open questions in MS research are the identification of the target antigen recognized by tissue resident CD8+ T-cells and B-cells and the molecular nature of the soluble inflammatory mediators, which may trigger tissue damage.
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Affiliation(s)
- Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Al Shweiki MHDR, Oeckl P, Steinacker P, Hengerer B, Schönfeldt-Lecuona C, Otto M. Major depressive disorder: insight into candidate cerebrospinal fluid protein biomarkers from proteomics studies. Expert Rev Proteomics 2017; 14:499-514. [DOI: 10.1080/14789450.2017.1336435] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Patrick Oeckl
- Department of Neurology, Ulm University, Ulm, Germany
| | | | - Bastian Hengerer
- CNS Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | | | - Markus Otto
- Department of Neurology, Ulm University, Ulm, Germany
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9
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Morell-Garcia D, Bauça JM, Sastre MP, Yañez A, Llompart I. Sample-dependent diagnostic accuracy of prostaglandin D synthase in cerebrospinal fluid leak. Clin Biochem 2016; 50:27-31. [PMID: 27614217 DOI: 10.1016/j.clinbiochem.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/01/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prostaglandin D2 synthase, commonly known as β-trace protein (βTP), is an excellent biomarker for the assessment of cerebrospinal fluid (CSF) leaks. Despite being widely used, the limits for the diagnostic values of βTP are not well established to date, and currently suggested cut-off values in literature range from 0.25 to 6.0mg/L. Sample-specific and more accurate thresholds are a current need. METHODS A retrospective observational study, performed in a tertiary-care hospital, between January 2006 and January 2014. A total of 74 patients were included, with a definitive diagnosis after initial leak suspicion and at least one determination of βTP using a nephelometry-based assay. A total of 46 CSF samples were included in the control group. Samples were obtained from nasal secretions, ear secretions or spinal surgical injury, directly using sterile Eppendorf tubes. The analysis of 3 different cut-off values was performed and the receiver operating curve (ROC) analyses were calculated. RESULTS Initial diagnostic suspicion was confirmed in 51% of cases, most of which were of postoperative origin (51%) and traumatic (26%). The βTP median concentration in different samples was significantly higher in the presence of cerebrospinal fluid fistula, regardless of sample type (22.0mg/L vs. 0.24mg/L, 95% confidence interval: 19.0-30.8 vs. 0.08-0.40; p<0.001). Data from contingency tables show 100% sensitivity and specificity, depending on sample type and the cut-off value used: for rhinorrhea and otorrhea samples, the most appropriate it was 0.7mg/L, while values >2.0mg/L could be used for spine postoperative fluid leakage samples. CONCLUSIONS The cut off value for βTP in the diagnosis and follow-up of cerebrospinal fluid leaks should be modified depending on the type of secretion (sample type), for a better diagnostic accuracy.
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Affiliation(s)
- Daniel Morell-Garcia
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Institut d'Investigació Sanitària de Palma (IdISPa), Palma de Mallorca, Balearic Islands, Spain.
| | - Josep Miquel Bauça
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Institut d'Investigació Sanitària de Palma (IdISPa), Palma de Mallorca, Balearic Islands, Spain
| | - M Pilar Sastre
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Aina Yañez
- Institut d'Investigació Sanitària de Palma (IdISPa), Palma de Mallorca, Balearic Islands, Spain
| | - Isabel Llompart
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
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Mitragotri S, Burke PA, Langer R. Overcoming the challenges in administering biopharmaceuticals: formulation and delivery strategies. Nat Rev Drug Discov 2014; 13:655-72. [PMID: 25103255 PMCID: PMC4455970 DOI: 10.1038/nrd4363] [Citation(s) in RCA: 1073] [Impact Index Per Article: 107.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The formulation and delivery of biopharmaceutical drugs, such as monoclonal antibodies and recombinant proteins, poses substantial challenges owing to their large size and susceptibility to degradation. In this Review we highlight recent advances in formulation and delivery strategies--such as the use of microsphere-based controlled-release technologies, protein modification methods that make use of polyethylene glycol and other polymers, and genetic manipulation of biopharmaceutical drugs--and discuss their advantages and limitations. We also highlight current and emerging delivery routes that provide an alternative to injection, including transdermal, oral and pulmonary delivery routes. In addition, the potential of targeted and intracellular protein delivery is discussed.
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Affiliation(s)
- Samir Mitragotri
- Department of Chemical Engineering, Center for Bioengineering, University of California, Santa Barbara, California 92106, USA
| | - Paul A Burke
- Burke Bioventures LLC, 277 Broadway, Cambridge, Massachusetts 02139, USA
| | - Robert Langer
- Department of Chemical Engineering, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, USA
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11
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Birch K, Burrows G, Cruickshank A, Egner W, Holbrook I, Lewis E, McNeilly J, Patel D, Worthington V. Cerebrospinal fluid total protein cannot reliably distinguish true subarachnoid haemorrhage from other causes of raised cerebrospinal fluid net bilirubin and net oxyhaemoglobin absorbances. Ann Clin Biochem 2014; 51:657-61. [DOI: 10.1177/0004563214538949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In cerebrospinal fluid (CSF) spectrophotometry, if the net bilirubin absorbance (NBA) and net oxyhaemoglobin absorbance (NOA) are both raised with a visible oxyhaemoglobin peak, the revised national guidelines for analysis of CSF bilirubin advise interpreting the results as ‘Consistent with subarachnoid haemorrhage (SAH)’ regardless of the CSF total protein concentration of the specimen. We wanted to study the range of CSF total protein concentrations found in confirmed SAH to establish if the CSF total protein value can give further guidance on the likelihood of SAH. Methods Consecutive cases from five different hospital sites were included if the CSF NBA was greater than 0.007 AU and the NOA was greater than 0.02 AU with a visible oxyhaemoglobin peak. For the cases identified, the laboratory information management system and patient records were interrogated to identify the total protein concentration of the CSF specimen and whether SAH had ultimately been confirmed or excluded by other methods and supporting evidence. Results Results from 132 patients were included. The CSF total protein range in confirmed SAH was 0.23–3.08 g/L with a median concentration of 0.7 g/L (n = 51). In the SAH excluded group, the CSF total protein range was 0.43–29 g/L with a median concentration of 1.9 g/L (n = 81). Conclusions Although confirmed SAH was not associated with the very highest concentrations of CSF total protein, a definite CSF protein cut-off concentration above which SAH could reliably be excluded cannot be recommended.
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Affiliation(s)
- Katherine Birch
- Department of Neurobiochemistry and Neuroimmunology, The Walton Centre, Liverpool, UK
| | - Gillian Burrows
- Department of Blood Sciences, Stepping Hill Hospital, Stockport, UK
| | - Anne Cruickshank
- Department of Biochemistry, Southern General Hospital, Glasgow, UK
| | - William Egner
- UK NEQAS for Immunology, Immunochemistry & Allergy, Northern General Hospital, Sheffield, UK
| | - Ian Holbrook
- Department of Clinical Biochemistry, York Hospital, York, UK
| | - Emma Lewis
- Department of Blood Sciences, Countess of Chester Hospital, Chester, UK
| | - Jane McNeilly
- Department of Biochemistry, Southern General Hospital, Glasgow, UK
| | - Dina Patel
- UK NEQAS for Immunology, Immunochemistry & Allergy, Northern General Hospital, Sheffield, UK
| | - Viki Worthington
- Department of Neuroimmunology, National Hospital for Neurology & Neurosurgery, London, UK
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12
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Samuel N, Remke M, Rutka JT, Raught B, Malkin D. Proteomic analyses of CSF aimed at biomarker development for pediatric brain tumors. J Neurooncol 2014; 118:225-238. [PMID: 24771250 DOI: 10.1007/s11060-014-1432-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 03/31/2014] [Indexed: 11/29/2022]
Abstract
Primary brain tumors cumulatively represent the most common solid tumors of childhood and are the leading cause of cancer related death in this age group. Traditionally, molecular findings and histological analyses from biopsies of resected tumor tissue have been used for diagnosis and classification of these diseases. However, there is a dearth of useful biomarkers that have been validated and clinically implemented for pediatric brain tumors. Notably, diseases of the central nervous system (CNS) can be assayed through analysis of cerebrospinal fluid (CSF) and as such, CSF represents an appropriate medium to obtain liquid biopsies that can be informative for diagnosis, disease classification and risk stratification. Proteomic profiling of pediatric CNS malignancies has identified putative protein markers of disease, yet few effective biomarkers have been clinically validated or implemented. Advances in protein quantification techniques have made it possible to conduct such investigations rapidly and accurately through proteome-wide analyses. This review summarizes the current literature on proteomics in pediatric neuro-oncology and discusses the implications for clinical applications of proteomics research. We also outline strategies for translating effective CSF proteomic studies into clinical applications to optimize the care of this patient population.
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Affiliation(s)
- Nardin Samuel
- MD/PhD Program, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Marc Remke
- The Hospital for Sick Children, Toronto, ON, Canada
| | - James T Rutka
- The Hospital for Sick Children, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Brian Raught
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - David Malkin
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada. .,The Hospital for Sick Children, Toronto, ON, Canada. .,Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
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13
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Paganetti P, Reichwald J, Bleckmann D, Abramowski D, Ammaturo D, Barske C, Danner S, Molinari M, Müller M, Papin S, Rabe S, Schmid P, Staufenbiel M. Transgenic expression of β1 antibody in brain neurons impairs age-dependent amyloid deposition in APP23 mice. Neurobiol Aging 2013; 34:2866-78. [PMID: 23870837 DOI: 10.1016/j.neurobiolaging.2013.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/22/2013] [Accepted: 06/18/2013] [Indexed: 11/19/2022]
Abstract
Heterologous expression of the functional amyloid beta (Aβ) antibody β1 in the central nervous system was engineered to maximize antibody exposure in the brain and assess the effects on Aβ production and accumulation in these conditions. A single open reading frame encoding the heavy and light chains of β1 linked by the mouth and foot virus peptide 2A was expressed in brain neurons of transgenic mice. Two of the resulting BIN66 transgenic lines were crossed with APP23 mice, which develop severe central amyloidosis. Brain concentrations at steady-state 5 times greater than those found after peripheral β1 administration were obtained. Similar brain and plasma β1 concentrations indicated robust antibody efflux from the brain. In preplaque mice, β1 formed a complex with Aβ that caused a modest Aβ increase in brain and plasma. At 11 months of age, β1 expression reduced amyloid by 97% compared with age-matched APP23 mice. Interference of β1 with β-secretase cleavage of amyloid precursor protein was relatively small. Our data suggest that severely impaired amyloid formation was primarily mediated by a complex of β1 with soluble Aβ, which might have prevented Aβ aggregation or favored transport out of the brain.
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Affiliation(s)
- Paolo Paganetti
- Novartis Institutes for Biomedical Research, Basel, Switzerland.
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14
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Protein markers for the differential diagnosis of vascular dementia and Alzheimer's disease. INTERNATIONAL JOURNAL OF PROTEOMICS 2012; 2012:824024. [PMID: 22701795 PMCID: PMC3373063 DOI: 10.1155/2012/824024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/11/2012] [Accepted: 04/03/2012] [Indexed: 11/17/2022]
Abstract
Alzheimer's disease (AD) is the most common form of dementia found in all human populations worldwide, while vascular dementia (VaD) is the second most common form of dementia. New biomarkers for early and specific diagnosis of AD and VaD are needed to achieve greater insight into changes occurring in the brain and direct therapeutic strategies. The objective of this explorative study was to discover candidate protein biomarkers for the differential diagnosis between VaD and AD. Surface-enhanced laser desorption/ionization (SELDI) TOF-MS was used to differentially profile proteins and peptides in CSF samples from 28 AD patients and 21 patients with VaD. A combination of univariate (Kruskal-Wallis) and multivariate (independent component analysis) statistical approaches produced a list of 27 proteins and peptides that could differentiate between VaD and AD. These markers represent various physiological processes, such as protein degradation (ubiquitin), protease inhibition (cystatin C and alpha-1-antichymoptrypsin), and inflammation (C3a and C4a) that are known to be represented in neurodegenerative diseases.
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Abstract
The pathogenic fungus Cryptococcus neoformans exhibits a striking propensity to cause central nervous system (CNS) disease in people with HIV/AIDS. Given that cryptococcal infections are generally initiated by pulmonary colonization, dissemination requires that the fungus withstand phagocytic killing, cross the alveolar-capillary interface in the lung, survive in the circulatory system and breach the blood-brain barrier. We know little about the molecular mechanisms underlying dissemination, but there is a rapidly growing list of mutants that fail to cause CNS disease. These mutants reveal a remarkable diversity of functions and therefore illustrate the complexity of the cryptococcal-host interaction. The challenge now is to extend the analysis of these mutants to acquire a detailed understanding of each step in dissemination.
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16
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Clarke NA, Hartmann T, Jones EL, Ballard CG, Francis PT. Antipsychotic medication is associated with selective alterations in ventricular cerebrospinal fluid Aβ 40 and tau in patients with intractable unipolar depression. Int J Geriatr Psychiatry 2011; 26:1283-91. [PMID: 21308788 DOI: 10.1002/gps.2678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/29/2010] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Alterations in plasma and in lumbar cerebrospinal fluid amyloid-B peptide (Aβ) levels have been reported in Alzheimer's disease. Studies have also suggested similar changes in depressed patients. No information is available on the impact of psychotropic drugs on this in patients with depression. We therefore quantified Aβ in ventricular cerebrospinal fluid (CSF) in a population of patients with treatment-resistant depression, with and without antipsychotic medication. METHOD A cross-sectional study of 32 patients undergoing subcaudate tractotomy for major (unipolar) depressive disorder. Ventricular CSF concentrations of Aβ peptide 1-40 and 1-42, also p-tau and total tau were determined by Western blotting or enzyme-linked immunosorbent assay. RESULTS Patients taking antipsychotic medication in the 2 weeks prior to surgery demonstrated significantly higher levels of Aβ 1-40 (mean ± SD: 727.3 ± 382.3 vs. 440.9 ± 337.2 pg/ml; p = 0.032, Student's t-test) but unaltered Aβ 1-42 (mean 72.1 ± 67.5 vs. 60.0 ± 56.7 pg/ml; p = 0.587) compared to a matched sample not treated with antipsychotic drugs. The same group demonstrated elevated total tau (mean 945.0 ± 422.2 vs. 534.3 ± 388.3 pg/ml; p = 0.010) but not p-tau (mean 98.6 ± 71.5 vs. 88.1 ± 70.5 pg/ml; p = 0.694). No similar effect was found with lithium, antidepressants, carbamazepine or benzodiazepines. CONCLUSIONS This preliminary study suggests antipsychotic drugs, widely used in patients with severe depression across all age ranges, may be associated with alteration of Aβ 1-40 and total tau, indices strongly linked with progressive organic brain disease. Further confirmatory work is needed.
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Affiliation(s)
- Nicholas A Clarke
- King's College London, Wolfson Centre for Age-Related Diseases, London, UK
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17
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Diagnostic strategy used to establish etiologies of encephalitis in a prospective cohort of patients in England. J Clin Microbiol 2011; 49:3576-83. [PMID: 21865429 DOI: 10.1128/jcm.00862-11] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The laboratory diagnostic strategy used to determine the etiology of encephalitis in 203 patients is reported. An etiological diagnosis was made by first-line laboratory testing for 111 (55%) patients. Subsequent testing, based on individual case reviews, resulted in 17 (8%) further diagnoses, of which 12 (71%) were immune-mediated and 5 (29%) were due to infection. Seventy-five cases were of unknown etiology. Sixteen (8%) of 203 samples were found to be associated with either N-methyl-d-aspartate receptor or voltage-gated potassium channel complex antibodies. The most common viral causes identified were herpes simplex virus (HSV) (19%) and varicella-zoster virus (5%), while the most important bacterial cause was Mycobacterium tuberculosis (5%). The diagnostic value of testing cerebrospinal fluid (CSF) for antibody was assessed using 139 samples from 99 patients, and antibody was detected in 46 samples from 37 patients. Samples collected at 14 to 28 days were more likely to be positive than samples taken 0 to 6 days postadmission. Three PCR-negative HSV cases were diagnosed by the presence of virus-specific antibody in the central nervous system (CNS). It was not possible to make an etiological diagnosis for one-third of the cases; these were therefore considered to be due to unknown causes. Delayed sampling did not contribute to these cases. Twenty percent of the patients with infections with an unknown etiology showed evidence of localized immune activation within the CNS, but no novel viral DNA or RNA sequences were found. We conclude that a good standard of clinical investigation and thorough first-line laboratory testing allows the diagnosis of most cases of infectious encephalitis; testing for CSF antibodies allows further cases to be diagnosed. It is important that testing for immune-mediated causes also be included in a diagnostic algorithm.
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Chai X, Wu S, Murray TK, Kinley R, Cella CV, Sims H, Buckner N, Hanmer J, Davies P, O'Neill MJ, Hutton ML, Citron M. Passive immunization with anti-Tau antibodies in two transgenic models: reduction of Tau pathology and delay of disease progression. J Biol Chem 2011; 286:34457-67. [PMID: 21841002 DOI: 10.1074/jbc.m111.229633] [Citation(s) in RCA: 260] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The microtubule-associated protein Tau plays a critical role in the pathogenesis of Alzheimer disease and several related disorders (tauopathies). In the disease Tau aggregates and becomes hyperphosphorylated forming paired helical and straight filaments, which can further condense into higher order neurofibrillary tangles in neurons. The development of this pathology is consistently associated with progressive neuronal loss and cognitive decline. The identification of tractable therapeutic targets in this pathway has been challenging, and consequently very few clinical studies addressing Tau pathology are underway. Recent active immunization studies have raised the possibility of modulating Tau pathology by activating the immune system. Here we report for the first time on passive immunotherapy for Tau in two well established transgenic models of Tau pathogenesis. We show that peripheral administration of two antibodies against pathological Tau forms significantly reduces biochemical Tau pathology in the JNPL3 mouse model. We further demonstrate that peripheral administration of the same antibodies in the more rapidly progressive P301S tauopathy model not only reduces Tau pathology quantitated by biochemical assays and immunohistochemistry, but also significantly delays the onset of motor function decline and weight loss. This is accompanied by a reduction in neurospheroids, providing direct evidence of reduced neurodegeneration. Thus, passive immunotherapy is effective at preventing the buildup of intracellular Tau pathology, neurospheroids, and associated symptoms, although the exact mechanism remains uncertain. Tau immunotherapy should therefore be considered as a therapeutic approach for the treatment of Alzheimer disease and other tauopathies.
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Affiliation(s)
- Xiyun Chai
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana 46285, USA
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19
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Zougman A, Pilch B, Podtelejnikov A, Kiehntopf M, Schnabel C, Kumar C, Mann M. Integrated Analysis of the Cerebrospinal Fluid Peptidome and Proteome. J Proteome Res 2008; 7:386-99. [DOI: 10.1021/pr070501k] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Perez LF, Prieto JM, Tutor JC. A thermodynamic study of beta-N-acetylhexosaminidase enzyme heterogeneity in cerebrospinal fluid from patients with multiple sclerosis. Ups J Med Sci 2007; 112:296-302. [PMID: 18484071 DOI: 10.3109/2000-1967-202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND ss-N-acetylhexosaminidase (Hex) is a lysosomal hydrolase, whose determination in the cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS) has provided discordant results. METHODS Total Hex and its isoenzymes Hex A and Hex B were determined using a thermodynamic procedure in the CSF of 27 patients with definitive MS, 8 with possible MS, 9 with meningitis, 14 with other neurological diseases, and in 10 controls without any neurological disease. RESULTS In the group of patients with definitive MS, the total Hex and Hex A were significantly higher than in the control group (p<0.001), with a possible association of greater enzymatic activities with the presence of oligoclonal bands and recent relapse; however, an overlap was detected for the activities of total Hex and its isoenzymes between the groups of patients with different neurological diseases. A significant correlation was obtained for neuron-specific enolase (NSE) with total Hex and Hex A and Hex B isoenzymes (p<0.001); however, in the partial correlation statistical significance was only obtained between NSE and Hex A (p<0.001) which is the most abundant Hex isoenzyme in the brain. CONCLUSIONS Although the inflammatory process in MS mainly takes place in the perivascular zone, with little activity in the cerebral parenchyma, the significant increase of NSE and Hex A isoenzyme in CSF reveals a neuronal damage. The disease status may have effect on the CSF Hex activity.
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Affiliation(s)
- Luis F Perez
- Laboratorio Central Hospital Clínico Universitario, Santiago de Compostela, Spain
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21
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Pedemonte E, Mancardi G, Giunti D, Corcione A, Benvenuto F, Pistoia V, Uccelli A. Mechanisms of the adaptive immune response inside the central nervous system during inflammatory and autoimmune diseases. Pharmacol Ther 2006; 111:555-66. [PMID: 16442633 DOI: 10.1016/j.pharmthera.2005.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Accepted: 11/18/2005] [Indexed: 12/25/2022]
Abstract
In this review we will discuss the unique features that make the central nervous system (CNS) a specialized microenvironment where immune responses are tightly regulated in order to properly face pathogens without damaging the neural cells. We will show how every paradigm of this theoretical model has been addressed by the scientific literature over the past decades providing new insights on the immune response within the CNS. In particular, new light has been shed on the trafficking of the immune cells inside and outside the CNS. Dendritic cells (DCs) have been described in the context of structures in direct contact with the cerebrospinal fluid (CSF) and their migration, upon antigen encounter, outside the CNS into deep cervical lymph nodes (DCLNs) has been further clarified. T-cells, B-cells, and antibody-secreting cells (ASCs) have been found in the CSF and CNS parenchymal lesions of inflammatory disorders and their phenotype depicted. Moreover, in chronically inflamed CNS, ectopic lymphoid structures have been observed and a germinal center reaction similar to the one found in peripheral lymph nodes has been described. These structures may play a role in the maintenance and expansion of the local autoimmune response. Although the complex interactions between immune and neural cells still remain far to be elucidated, the data discussed here suggest that the physiopathology of the adaptive immune response inside the CNS mimics, although in a mitigated fashion, what occurs in other organs and tissues.
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Affiliation(s)
- Enrico Pedemonte
- Neuroimmunology Unit, Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Italy
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Mayringer I, Timeltaler B, Deisenhammer F. Correlation between the IgG index, oligoclonal bands in CSF, and the diagnosis of demyelinating diseases. Eur J Neurol 2005; 12:527-30. [PMID: 15958092 DOI: 10.1111/j.1468-1331.2005.00997.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Intrathecal immunoglobulin synthesis can be assessed by different approaches. It can be measured quantitatively by the IgG index or qualitatively by isoelectric focusing (IEF) to detect oligoclonal bands (OCB). In this study we investigated if there is a correlation between the frequency of OCB and the IgG index and if the IgG index predicts the diagnosis of a demyelinating CNS disease (DMD). We found a positive correlation between the IgG index and the frequency of OCB as well as the probability of DMD. We conclude that quantitative assessment of CSF-IgG can be useful because it is easier and quicker to perform than IEF but cannot replace IEF in general because this is the most sensitive method to detect abnormal IgG in CSF.
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Affiliation(s)
- I Mayringer
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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Caudie C, Birouk AM, Bancel J, Claudy D, Gignoux L, Vukusic S, Confavreux C. Le profil cytoimmunologique du LCR lors du diagnostic précoce de la sclérose en plaques. ACTA ACUST UNITED AC 2005; 53:68-74. [PMID: 15708649 DOI: 10.1016/j.patbio.2004.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2003] [Accepted: 04/01/2004] [Indexed: 10/26/2022]
Abstract
The purpose of this paper is to report cerebrospinal fluid (CSF) findings in multiple sclerosis (MS) from our laboratory, to discuss the implications of CSF abnormalities in terms of diagnosis. Paired CSF-serum samples from of 1533 on 3893 patients with suspected neurological diseases over a 10 year period were analysed by routine laboratory microscopy and assays of immunoglobulin G by isoelectric focusing for the detection of intrathecal oligoclonal IgG. Patients were grouped further into four headings according to their disorders: MS (625 cases), definite (246 cases) probable (123 cases) and possible (256 cases) according to Poser, others inflammatory neurological diseases (91 cases), various non-inflammatory neurological disorders (732 cases) and uncertain neurological disorders (85 cases). Definite MS group (16%) was compared to non-inflammatory neurological disorders (48%). Important signs for activity of multiple sclerosis are observed. Cell counts were 10/microl in 71% (N < or =2/microl). Inflammatory cytology is observed after concentration and cytocentrifugation on slides with activated B-lymphocytes, lymphoplasmocytes and/or plasmocytes (76%), total protein concentration is increased in 37% (N < 0.40g/l), CSF/serum albumin quotient with age dependent references for the blood-CSF barrier dysfunction is increased in 26% (N < 0.65 x 10(-2)), IgG index for intrathecal synthesis of IgG is increased in 69% (N < 0.70), sensitive detection of oligoclonal IgG restricted to CSF by isoelectric focusing is positive in 91% (86-96%) with a specificity of 96% (93-99%).
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Affiliation(s)
- Christiane Caudie
- Fédération de biologie, service d'immunologie et de neuro-immunologie, hôpital neurologique et neurochirurgical Pierre-Wertheimer, 59 boulevard Pinel, 69677 Lyon Bron, France.
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Kay AD, Petzold A, Kerr M, Keir G, Thompson E, Nicoll JAR. Alterations in cerebrospinal fluid apolipoprotein E and amyloid beta-protein after traumatic brain injury. J Neurotrauma 2004; 20:943-52. [PMID: 14588111 DOI: 10.1089/089771503770195795] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is evidence that apolipoprotein E (apoE) and amyloid beta-protein (Abeta), which are implicated in the pathology of chronic neurodegenerative disorders, are involved in the response of the brain to acute injury; however, human in vivo evidence is sparse. We conducted a prospective observational study to determine the magnitude and time-course of alterations in cerebrospinal fluid (CSF) apoE and Abeta concentrations after traumatic brain injury (TBI), and the relationship of these changes to severity of injury and clinical outcome. Enzyme linked immunosorbant assay (ELISA) was used to assay apoE, Abeta(1-40) and Abeta(1-42) in serial CSF samples from 13 patients with TBI and 13 controls. CSF S100B and tau were assayed as surrogate markers of brain injury. There was a significant decrease in CSF apoE (p < 0.001) and Abeta (p< 0.001) after TBI contrasting the observed elevation in CSF S100B (p < 0.001) and tau (p < 0.001) concentration. There was significant correlation (r = 0.67, p = 0.01) between injury severity and the decrease in Abeta(1-40) concentration after TBI. In vivo, changes in apoE and Abeta concentration occur after TBI and may be important in the response of the human brain to injury.
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Affiliation(s)
- Andrew D Kay
- Department of Neurosurgery, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, Glasgow, United Kingdom.
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25
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Kleine TO, Damm T. Distinct heterogeneity of IgG immune response in cerebrospinal fluid (CSF) detected by isoelectric focusing (IEF) with extended immunofixation. Brain Res Bull 2003; 61:309-20. [PMID: 12909301 DOI: 10.1016/s0361-9230(03)00094-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An optimized automated IEF procedure in polyacrylamide micro gels and immunofixation with 10 monospecific antibodies against some fragments of the IgG molecule and against the whole IgG isotypes IgG(1), IgG(2), IgG(3), IgG(4), respectively, detected oligoclonal bands (OBs) within acid, neutral, and alkaline ranges of the gels. Accuracy and reliability of the OB assay for detection of an intrathecal IgG synthesis proved to be higher with immunofixation than with silver staining of bands precipitated by trichloroacetic acid. CSF OBs were specified as lambda or kappa IgG subfractions, respectively, duplex IgGs precipitated with anti-lambda, anti-kappa, and anti-Fc antibodies at the same pI. Most of OBs were classified as belonging to either IgG(1), IgG(2), IgG(3), or IgG(4) isotypes in CSF. The IEF procedure additionally allowed the discrimination of both free light chains and possible "free" heavy gamma chain fragments in CSF, when immunofixation was done with monospecific antibodies against both light chains and gamma chain fragments (e.g. anti-F(ab')(2), anti-Fd, anti-Fc, anti-C(H)2). The results pointed out a distinct heterogeneity of the IgG immune response in human CSF. The IEF procedure with extended immunofixation is recommended for completion of the basic laboratory procedures used in neuroimmunology in order to discriminate inflammatory processes in human CNS.
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Affiliation(s)
- Tilmann O Kleine
- Department of Clinical Chemistry and Molecular Diagnostics, Clinicum of the University Marburg, D-35033 Marburg, Germany
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Kleine TO, Zwerenz P, Zöfel P, Shiratori K. New and old diagnostic markers of meningitis in cerebrospinal fluid (CSF). Brain Res Bull 2003; 61:287-97. [PMID: 12909299 DOI: 10.1016/s0361-9230(03)00092-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Five new markers (tumor necrosis factor TNF-alpha, interleukin IL-1 beta, IL-6, IL-8, lipopolysaccharide binding protein (LBP)) and 11 old classical markers were evaluated in 180 cerebrospinal fluid (CSF) and serum pairs to discriminate acute bacterial meningitis (BM) on admission from aseptic (viral) meningitis (AM), bacterial meningitis treated with antibiotics (TM) from AM, and AM from multiple sclerosis (MS). Statistical tests were computed which classified correctly > or =90% of the patients with BM, TM, AM at a sum minimum of false positive plus false negative results, and which reached additionally > or =90% sensitivity and specificity. To discriminate BM from AM, CSF IL-6 test > or =500 ng/l and CSF IL-1 beta test > or =8 ng/l besides CSF lactate test > or =3.5mM/l and CSF granulocyte test > or =150 M/l were revealed. CSF lactate test > or =3.2 mmol/l discriminated TM from AM. CSF leukocyte test > or =35 M/l discriminated AM from MS. Tests with the new markers were more laborious, expensive, and time consuming compared to CSF lactate test. Test candidates, detecting > or =80% of patients with > or =80% sensitivity and specificity, were evaluated with CSF TNF-alpha, IL-8 and LBP, serum IL-6, CSF leukocytes, lymphocytes and monocytes, Qglucose, CSF total protein, albumin, and Qalbumin. All tests should be reviewed in context of clinical findings to diagnose BM reliably.
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Affiliation(s)
- Tilmann O Kleine
- Neurochemistry Department, Centre of Nervous Diseases, Clinicum of the University, D-35033 Marburg, Germany
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Kleine TO, Damm T. Molecular heterogeneity, detected by two electrophoretic micro procedures, of IgG in human cerebrospinal fluid (CSF). Anal Bioanal Chem 2003; 375:1000-5. [PMID: 12733010 DOI: 10.1007/s00216-003-1809-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2002] [Accepted: 01/23/2003] [Indexed: 10/20/2022]
Abstract
Semi-automated electrophoretic procedures in the PhastSystem (Amersham Pharmacia Biotech) with micro polyacrylamide gels (PAGs) and SDS-PAG gradients were modified to analyze IgG in human cerebrospinal fluid (CSF) and matched serum samples with respect to the molecular IgG structure L-H-H-L. Isoelectric focusing (IEF) with specific immunofixation detected discrete IgG bands in CSF standing out against a polyclonal and monoclonal background pattern in CSF and serum; they were denoted oligoclonal bands (IgG OBs) (OB assay positive) indicating IgG synthesis in the central nervous system (CNS) of patients with subacute and chronic processes of inflammatory CNS disorders; assay was negative with identical (mirror) bands in CSF and serum for other CNS processes. IgG OBs were specified as lambda (kappa) IgG subfractions, precipitated with the anti-light (L) chains lambda (kappa) and anti-heavy (H) chain fragments (Fd, Fc, C(H)2) as well as with anti-F(ab')(2), and as duplex IgGs with kappa and lambda OBs at the same pI. With SDS-PAG gradient electrophoresis and specific immunofixation more than six IgG fractions were detected and classed according to apparent molecular weights of a S-sulfonated human IgG standard; they were characterized with the monospecific antibodies against the L and H chain fragments as 25, 50, 75, 100, 125 and 150 kD fractions containing combinations of L and H chains as well as mixtures of both L and H chain fragments of varying dimensions. Generally, this molecular IgG heterogeneity could not be connected with the IgG OB heterogeneity revealed by IEF; but single OBs in the strongly alkaline pH region of PAG may correspond to H fragments with basic pI. Nevertheless, evidence for the existence of both free L chains and the free H chain were revealed as specific OBs with IEF and with the anti-L and anti-H antibodies in the 25 kD and 50 kD fractions, respectively, of CSF samples of six patients with diverse CNS diseases. Further experiments are needed to elicit the origin of the molecular IgG heterogeneity during the immune response of subacute and chronic inflammatory processes in human CNS.
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Affiliation(s)
- T O Kleine
- Referenzlabor für Liquordiagnostik, Abteilung Klinische Chemie und Molekulare Diagnostik, Deutschhausstrasse 12, 35033, Marburg, Germany.
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Kay AD, Petzold A, Kerr M, Keir G, Thompson EJ, Nicoll JAR. Cerebrospinal fluid apolipoprotein E concentration decreases after traumatic brain injury. J Neurotrauma 2003; 20:243-50. [PMID: 12820678 DOI: 10.1089/089771503321532824] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The APOE epsilon4 allele has been associated with unfavorable outcome after several types of acute brain injury, yet the biological mechanisms underlying this observation are poorly understood. Postmortem and experimental brain injury studies suggest the presence of increased amounts of apolipoprotein E (apoE) within the neuropil after acute brain injury. We assayed the concentration of apolipoprotein E in the cerebrospinal fluid (CSF) of non-injured controls and patients with traumatic brain injury (TBI) to determine whether differences exist, and if these differences correlate with injury severity and clinical outcome. CSF apoE and S100B, a marker of injury severity, were measured by enzyme linked immunosorbant assay. CSF was sampled from 27 traumatic brain injury patients (mean age 32, median 25, range 16-65 years) within 3 days of injury, and 28 controls (mean age 40, median 37, range 19-73 years). The TBI patients all had a Glasgow Coma Score (GCS) of less than eight (i.e., severe head injury). Clinical outcome was determined using the Glasgow Outcome Score (GOS). The average concentration of apoE in the CSF of controls was 12.4 mg/L (95% CI: 10.5-14.3 mg/L) and in TBI patients was 3.7 mg/L (95% CI: 2.1-4.1 mg/L; Mann-Whitney: p < 0.0001). In contrast, the concentration of S100B in the CSF of TBI patients was significantly higher than that of controls (Mann-Whitney: p < 0.0001). We speculate that apoE is retained within the parenchyma of the central nervous system in response to injury where in view of previous data, it may have a protective role.
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Affiliation(s)
- Andrew D Kay
- Department of Neurosurgery, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, Glasgow, United Kingdom.
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Kay A, Petzold A, Kerr M, Keir G, Thompson E, Nicoll J. Decreased cerebrospinal fluid apolipoprotein E after subarachnoid hemorrhage: correlation with injury severity and clinical outcome. Stroke 2003; 34:637-42. [PMID: 12624284 DOI: 10.1161/01.str.0000057579.25430.16] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The apolipoprotein E (APOE) epsilon4 allele has been associated with unfavorable outcome after subarachnoid hemorrhage (SAH), suggesting that apoE plays an important role in the response of the brain to SAH. We determined the concentration of apoE in the cerebrospinal fluid (CSF) of patients with SAH and a control group to test the hypothesis that alterations in CSF apoE reflect the response of the brain to SAH and are correlated with the severity of injury and outcome. METHODS ApoE and S100B (a marker of brain injury) were measured by ELISA in CSF from a non-brain-injured control group and patients with SAH. The severity of SAH was determined from the Glasgow Coma Scale, and the clinical outcome was determined from the Glasgow Outcome Scale. RESULTS In contrast to increased CSF concentration of S100B, CSF apoE concentration was significantly lower in patients after SAH than in control subjects (Mann-Whitney test, P<0.0001). SAH patients with more severe injury and less favorable outcome had lower CSF apoE concentration than did patients with milder injury and better clinical outcome (Fisher exact test, P=0.02). CONCLUSIONS The concentration of apoE in the CSF decreases after SAH, despite the likely leakage of plasma apoE into the CSF. We speculate that apoE is retained within the parenchyma of the central nervous system in response to injury, where, in view of previous data, it may have a protective role.
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Affiliation(s)
- Andrew Kay
- Department of Neurosurgery, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, UK.
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Trip SA, Wroe SJ. Primary orthostatic tremor associated with a persistent cerebrospinal fluid monoclonal IgG band. Mov Disord 2003; 18:345-346. [PMID: 12621643 DOI: 10.1002/mds.10328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Primary orthostatic tremor is of unknown aetiology and is believed to be a distinct entity rather than a subtype of essential tremor. We describe the first patient with a typical phenotype of primary orthostatic tremor who has a persistent isolated monoclonal immunoglobulin G band in the cerebrospinal fluid.
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Affiliation(s)
- S Anand Trip
- Department of Clinical Neurology, Ipswich Hospital, Ipswich, United Kingdom
| | - Stephen J Wroe
- Department of Clinical Neurology, Ipswich Hospital, Ipswich, United Kingdom
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Wetterhall M, Palmblad M, Håkansson P, Markides KE, Bergquist J. Rapid analysis of tryptically digested cerebrospinal fluid using capillary electrophoresis-electrospray ionization-Fourier transform ion cyclotron resonance-mass spectrometry. J Proteome Res 2002; 1:361-6. [PMID: 12645892 DOI: 10.1021/pr025526s] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mass spectrometry has in recent years been established as the method of choice for protein identification and characterization in proteomics. Capillary electrophoresis (CE) is a fast and efficient method for the separation of peptides and proteins. The on-line combination of CE with Fourier transform ion cyclotron resonance (FTICR) mass spectrometry (MS) has been shown to be a powerful tool in the analysis of complex mixtures of proteins. This paper presents the first results from a proteomic analysis of human cerebrospinal fluid proteins by tryptic digestion and CE-FTICR-MS, where 30 proteins could be identified on a 95% confidence level with mass measurement errors less than 5 ppm.
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Affiliation(s)
- Magnus Wetterhall
- Institute of Chemistry, Department of Analytical Chemistry, Uppsala University, PO Box 531, SE-751 21 Uppsala, Sweden
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Izquierdo G, Angulo S, Garcia-Moreno JM, Gamero MA, Navarro G, Gata JM, Ruiz-Peña JL, Páramo MD. Intrathecal IgG synthesis: marker of progression in multiple sclerosis patients. Acta Neurol Scand 2002; 105:158-63. [PMID: 11886357 DOI: 10.1034/j.1600-0404.2002.1o009.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We study the power of IgG synthesis value as a marker of disease activity in multiple sclerosis (MS). MATERIAL AND METHODS Link index was calculated in 202 MS patients. Time between first, second and third attack and progression index (PI) were compared in patient with normal (NLI) high (HL) or very high Link index (VHLI). RESULTS Secondary progressive (SP) patients had a higher LI than relapsing-remitting (RR) and primary progressive (PP) courses (1.10 +/- 0.5 for SP vs 0.86 +/- 0.5 for RR and 0.81 +/- 0.5 for PP, P=0.01 and 0.03, respectively). Having a HLI in MS RR and SP patients has no time effect in the development of the second and third attack. PI was higher in patients with VHIL (0.67 +/- 0.7) vs patients with NLI (0.42 +/- 0.4, P=0.008) and with HLI (0.39 +/- 0.3, P=0.001). CONCLUSIONS This study confirmed that LI is a good marker of subsequent progression of MS.
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Affiliation(s)
- G Izquierdo
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain.
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Bergquist J, Palmblad M, Wetterhall M, Håkansson P, Markides KE. Peptide mapping of proteins in human body fluids using electrospray ionization Fourier transform ion cyclotron resonance mass spectrometry. MASS SPECTROMETRY REVIEWS 2002; 21:2-15. [PMID: 12210611 DOI: 10.1002/mas.10016] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Human body fluids have been rediscovered in the post-genomic era as great sources of biological markers and perhaps particularly as sources of potential protein biomarkers of disease. Analytical tools that allow rapid screening, low sample consumption, and accurate protein identification are of great importance in studies of complex biological samples and clinical diagnosis. Mass spectrometry is today one of the most important analytical tools with applications in a wide variety of fields. One of the fastest growing applications is in proteomics, or the study of protein expression in an organism. Mass spectrometry has been used to find post-translational modifications and to identify key functions of proteins in the human body. In this study, we review the use of human body fluids as sources for clinical markers and present new data that show the ability of Fourier transform ion cyclotron resonance (FTICR) mass spectrometry (MS) to identify and characterize proteins in four human body fluids: plasma, cerebrospinal fluid (CSF), saliva, and urine. The body fluids were tryptically digested without any prior separation, purification, or selection, and the digest was introduced into a 9.4 T FTICR mass spectrometer by direct-infusion electrospray ionization (ESI). Even though these samples represent complex biological mixtures, the described method provides information that is comparable with traditional 2D-PAGE data. The sample consumption is extremely low, a few microliters, and the analysis time is only a few minutes. It is, however, evident that the separation of proteins and/or peptides must be included in the methodology, in order to detect low-abundance proteins and other proteins of biological relevance.
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Affiliation(s)
- Jonas Bergquist
- Department of Analytical Chemistry, Institute of Chemistry, Uppsala University, P.O. Box 531, SE-751 21 Uppsala, Sweden.
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Bard F, Cannon C, Barbour R, Burke RL, Games D, Grajeda H, Guido T, Hu K, Huang J, Johnson-Wood K, Khan K, Kholodenko D, Lee M, Lieberburg I, Motter R, Nguyen M, Soriano F, Vasquez N, Weiss K, Welch B, Seubert P, Schenk D, Yednock T. Peripherally administered antibodies against amyloid beta-peptide enter the central nervous system and reduce pathology in a mouse model of Alzheimer disease. Nat Med 2000; 6:916-9. [PMID: 10932230 DOI: 10.1038/78682] [Citation(s) in RCA: 1466] [Impact Index Per Article: 61.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One hallmark of Alzheimer disease is the accumulation of amyloid beta-peptide in the brain and its deposition as plaques. Mice transgenic for an amyloid beta precursor protein (APP) mini-gene driven by a platelet-derived (PD) growth factor promoter (PDAPP mice), which overexpress one of the disease-linked mutant forms of the human amyloid precursor protein, show many of the pathological features of Alzheimer disease, including extensive deposition of extracellular amyloid plaques, astrocytosis and neuritic dystrophy. Active immunization of PDAPP mice with human amyloid beta-peptide reduces plaque burden and its associated pathologies. Several hypotheses have been proposed regarding the mechanism of this response. Here we report that peripheral administration of antibodies against amyloid beta-peptide, was sufficient to reduce amyloid burden. Despite their relatively modest serum levels, the passively administered antibodies were able to enter the central nervous system, decorate plaques and induce clearance of preexisting amyloid. When examined in an ex vivo assay with sections of PDAPP or Alzheimer disease brain tissue, antibodies against amyloid beta-peptide triggered microglial cells to clear plaques through Fc receptor-mediated phagocytosis and subsequent peptide degradation. These results indicate that antibodies can cross the blood-brain barrier to act directly in the central nervous system and should be considered as a therapeutic approach for the treatment of Alzheimer disease and other neurological disorders.
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Affiliation(s)
- F Bard
- Elan Pharmaceuticals, 800 Gateway Boulevard, South San Francisco, California 94080, USA.
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Legorreta AP, Leung KM, Berkbigler D, Evans R, Liu X. Outcomes of a population-based asthma management program: quality of life, absenteeism, and utilization. Ann Allergy Asthma Immunol 2000; 85:28-34. [PMID: 10923601 DOI: 10.1016/s1081-1206(10)62430-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite the availability of the National Asthma Education Program (NAEP) guidelines since 1991, asthma remains inadequately managed. To improve quality of life, functional status, and self-management behavior of asthma patients, a large health maintenance organization (HMO) in California implemented an asthma management program in 1996. OBJECTIVE To evaluate the effectiveness of an asthma management program in an HMO setting. DESIGN AND SETTING Prospective study. Survey data from members who participated in the intervention program and data from members who received usual care were analyzed using propensity score technique. RESULTS A total of 1,043 asthma patients who responded both baseline and follow-up survey were included in the analysis. From baseline to followup, participants in the in-home intervention program reported significant improvement in functional status (improvements range from 0.2 to 7.2), daily use of steroid inhaler (+4.1%), daily peak flow meter use (+6.4%), self-reported knowledge of what to do for an asthma attack (+12.4%), and feeling that their asthma was under control (+10.8%). Absenteeism (-11.8%) and hospitalization due to asthma (-3.5%) were significantly reduced from baseline to follow-up. Participants did not report significant changes in overuse of beta2-agonists and emergency room visits due to asthma. In comparison with the asthmatic patients who received usual care (non-participants), participants had significantly greater improvement on daily use of steroid inhaler (+4.0% versus -6.0%), daily use of home peak flow meter (+6.4% versus 1.9%) and self-reported knowledge on what to do for an asthma attack (+12.4% versus +5.4%). CONCLUSION These findings suggest that population-based programs can improve functional status, increase self-monitoring and knowledge about asthma, and decrease absenteeism and hospitalization for asthma by directly providing asthmatic patients with educational materials and self-monitoring tools. Such "direct-to-consumer" outreach programs may help bridge the gap between NAEPs 1991 practice guidelines and the reality of current asthma management.
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Affiliation(s)
- A P Legorreta
- Health Benchmarks, Inc., Woodland Hills, California 91367, USA
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Affiliation(s)
- E Ruiz-Huidobro
- Department of Internal Medicine, The University of Texas, Southwestern Medical Center at Dallas, 752335-8859, USA
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Sajanti J, Majamaa K. Detection of meningeal fibrosis after subarachnoid haemorrhage by assaying procollagen propeptides in cerebrospinal fluid. J Neurol Neurosurg Psychiatry 1999; 67:185-8. [PMID: 10406986 PMCID: PMC1736496 DOI: 10.1136/jnnp.67.2.185] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study whether meningeal collagen synthesis under normal conditions is reflected in the CSF and whether a meningeal fibroproliferative reaction or fibrosis after subarachnoid haemorrhage can be detected by measuring markers of collagen synthesis in the CSF. METHODS Serum samples and CSF were collected from 56 patients with various neurological symptoms and from nine patients with a recent subarachnoid haemorrhage. The concentrations of the carboxyterminal propeptide of type I procollagen (PICP) and the aminoterminal propeptide of type III procollagen (PIIINP) were measured using radioimmunoassays. RESULTS The mean(SD) concentration of PICP was 75.2 (SD 13.6) microgram/l and that of PIIINP 3.56 (SD 0.91) microgram/l in the CSF of the controls, and the CSF/serum ratios were 0.74 (SD 0.24) for PICP and 1.34 (SD 0.48) for PIIINP. A 1.4-fold increase in both the PICP (p=0.001) and the PIIINP (p=0.001) concentration was found in patients with a neurological disease and with an abnormal CSF leucocyte count or protein concentration. In eight patients with a recent subarachnoid haemorrhage the PICP was 5.9-fold higher (p<0.001) and the PIIINP concentration 7.7-fold higher (p<0.001) than that in the controls, whereas no difference was found in the serum values. Similar high concentrations were also found in a patient from whom the CSF sample was obtained before operation for aneurysm. CONCLUSIONS The intrathecal compartment is a site for active collagen synthesis under normal conditions. The synthesis rate is markedly increased in patients with a recent subarachnoid haemorrhage, suggesting a fibroproliferative reaction or fibrosis. Assays of procollagen propeptides may be useful in the clinical diagnosis of meningeal fibrosis and their use may enable the identification of diseases and symptoms aetiologically related to meningeal fibrosis.
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Affiliation(s)
- J Sajanti
- Department of Neurology and Department of Medical Biochemistry, University of Oulu, Oulu, Finland
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Marchetti P, Gutierrez J, Velia P, Faucompré JL, Onraed B, Formstecher P, Hennache B. Identification of IgG-specific oligoclonal banding in serum and cerebrospinal fluid by isoelectric focusing: description of a simplified method for the diagnosis of neurological disorders. Clin Chem Lab Med 1999; 37:735-8. [PMID: 10510731 DOI: 10.1515/cclm.1999.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Clinical laboratory procedures using cerebrospinal fluid (CSF) to assist in the diagnosis of multiple sclerosis (MS) are based essentially on the determination of oligoclonal bands (OB) in CSF and not in serum. To date, the techniques using isoelectric focusing (IEF) have represented one of the most efficient methods for detecting supernumerary bands in CSF but unfortunately were not always compatible with a routine use. Here, we describe a revised method of IEF suitable for the diagnosis of neurological disorders. The kit-based technique was simplified and the present procedure allowed an easier execution, reduced the overall analysis time and permitted an uncomplicated intepretation of oligoclonal profiles. Moreover, the technique developed was very sensitive and specific for the diagnosis of MS diagnosis. In conclusion, the IEF protocol described in this report is suitable for OB detection in any laboratory.
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Affiliation(s)
- P Marchetti
- Laboratoire de Biochimie, Hôpital cardiologique Lille, France
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Roelandse FW, Amons R, ter Braak EP, Nieuwland R, van Loon J, Souverijn JH. The high alkaline fraction on isoelectric focusing of cerebrospinal fluid is cystatin C. J Neurol Sci 1998; 157:105-8. [PMID: 9600685 DOI: 10.1016/s0022-510x(98)00055-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A high alkaline fraction with a pI of 9.2 is sometimes seen on isoelectric focusing patterns of cerebrospinal fluid. The appearance of this fraction mainly depends on the type of concentrators used to prepare the cerebrospinal fluid samples, prior to isoelectric focusing. The amino acid sequence of the high alkaline fraction showed sequence identity to cystatin C, a cysteine protease inhibitor with a pI of 9.2-9.3 and a molecular mass of 13.4 kDa. In addition, on Western blot the high alkaline fraction was recognized by an antibody, directed against cystatin C. Taken together, the present findings demonstrate that the high alkaline fraction is cystatin C.
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Affiliation(s)
- F W Roelandse
- Department of Clinical Chemistry, Leiden University Medical Centre, Netherlands.
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Affiliation(s)
- A O Olukoga
- Department of Clinical Biochemistry, Hope Hospital, Salford, Manchester
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Differences between Ventricular and Lumbar Cerebrospinal Fluid in Hydrocephalus Secondary to Cysticercosis. Neurosurgery 1995. [DOI: 10.1097/00006123-199510000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rubalcava MA, Sotelo J. Differences between ventricular and lumbar cerebrospinal fluid in hydrocephalus secondary to cysticercosis. Neurosurgery 1995; 37:668-71; discussion 671-2. [PMID: 8559294 DOI: 10.1227/00006123-199510000-00009] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We studied ventricular and lumbar cerebrospinal fluid (CSF) in 16 patients with hydrocephalus secondary to meningeal cysticercosis, and samples were taken at the time of the surgical implantation of a ventricular shunt. All lumbar CSF samples revealed raised cell counts (mean, 72 +/- 28/mm3) and protein counts (mean, 78 +/- 12 mg/dl), as well as positive immune reactions to cysticerci antigens. In contrast, 50% of the ventricular CSF samples exhibited cell and protein counts within normal limits and five showed negative immune reactions to cysticerci antigens. Ample differences between ventricular and lumbar CSF were also observed in the contents of glucose and immunoglobulins G, A, and M. The biochemical and immunological composition of the CSF varied greatly along the cerebrospinal axis in patients with chronic arachnoiditis caused by cysticercosis. Our findings further support the premise of the subarachnoid space as an immunologically active substratum and provide information to explain the frequent occlusion of ventricular shunts in patients with hydrocephalus secondary to inflammatory disorders of the subarachnoid space.
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Affiliation(s)
- M A Rubalcava
- National Institute of Neurology and Neurosurgery of Mexico, Mexico City
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Knowles WA, Luxton RW, Hand JF, Gardner SD, Brown DW. The JC virus antibody response in serum and cerebrospinal fluid in progressive multifocal leucoencephalopathy. ACTA ACUST UNITED AC 1995; 4:183-94. [PMID: 15566839 DOI: 10.1016/0928-0197(95)00012-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/1994] [Accepted: 03/20/1995] [Indexed: 11/23/2022]
Abstract
BACKGROUND A clinical diagnosis of progressive multifocal leucoencephalopathy (PML) can be confirmed by histological or virological examination of brain material. Whilst a less invasive method is provided by the detection of JC DNA in cerebrospinal fluid (CSF), very few studies have been done to assess the value of JC virus (JCV) serology in PML diagnosis. OBJECTIVES To study the JCV antibody response in the serum and CSF of PML patients. STUDY DESIGN A retrospective study was done using haemagglutination inhibition (HI), M-antibody capture radioimmunoassay (MACRIA) and JC-specific oligoclonal IgG banding on one or more sera and/or CSFs from 28 confirmed PML patients. Seventy-one serum and CSF samples were tested from patients with memory loss or dementia as a control group. RESULTS Twenty-seven PML patients (96%) had detectable JCV HI antibody in the serum, with titres ranging from 1 : 10 to > 1 : 20480, compared to 48 (68%) of the controls (P = <0.005). JCV IgM antibody was detected in the serum of 12/22 (55%) PML patients. JCV HI antibody was detected in the CSF in 12 of 18 (67%) PML patients, antibody index measurements being used to control for a possible breakdown of the blood-brain barrier. Intrathecal JCV antibody was not found in any control patient. Locally produced JCV-specific IgG bands were detected in the CSF of 7 PML patients tested, confirming the intrathecal origin and specificity of the HI antibody. CONCLUSIONS The presence of intrathecal JCV antibody indicates active central nervous system infection with JC virus, and provides a useful diagnostic test for PML, with a sensitivity of 67% and a specificity of 100%. The absence of serum JCV antibody nearly always excludes a diagnosis of PML, but the titre of antibody, IgG or IgM, correlates with the underlying condition rather than the development of neurological symptoms.
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Affiliation(s)
- W A Knowles
- Virus Reference Division, Central Public Health Laboratory, Colindale Avenue, London NW9 5HT, UK
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Hashim IA, Walsh A, Hart CA, Shenkin A. Cerebrospinal fluid interleukin-6 and its diagnostic value in the investigation of meningitis. Ann Clin Biochem 1995; 32 ( Pt 3):289-96. [PMID: 7632033 DOI: 10.1177/000456329503200305] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We examined the measurement and the diagnostic value of cerebrospinal fluid interleukin-6 (CSF IL-6) in meningitis. The cytokine was measured by bioassay (B9 hybridoma cell line) and by immunoassay (in-house radioimmunoassay). We compared the diagnostic value of CSF IL-6 determination with that of other biochemical markers of meningitis. Although there was significant correlation between bioactive and immunoactive IL-6 (r = 0.724, P < 0.001), results were frequently different with biological/immunological ratios ranging from 0.2 to 24.3 (mean 4.6). Gel permeation chromatography suggested that the discrepancy in biological and immunological activities was not due to molecular heterogeneity, but may be explained by the presence of a synergistic factor. Interleukin-6 concentration was markedly elevated in CSF from most patients with bacterial meningitis compared to patients with viral meningitis and those without evidence of infection. However, low IL-6 levels by radioimmunoassay did not exclude bacterial meningitis (sensitivity 86%). CSF total protein and CSF glucose were significantly different between all three groups, but there was no significant difference in lactate concentration between virally infected and normal CSF, both of which had lower lactate concentrations than those in bacterial infection. CSF IL-6 measurement had greater sensitivity, specificity and predictive value than these other biochemical markers, and hence a rapid assay for IL-6 in CSF may contribute to the early diagnosis of bacterial infection.
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Affiliation(s)
- I A Hashim
- Department of Clinical Chemistry, Royal Liverpool University Hospital, UK
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Silberring J, Brostedt P, Neiman J, Hellman U, Liljequist S, Terenius L. Proteinergic profiles in cerebrospinal fluid from alcoholic subjects. Biomed Chromatogr 1994; 8:137-41. [PMID: 8075523 DOI: 10.1002/bmc.1130080309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Minute amounts of cerebrospinal fluid samples from alcoholics were subjected to separation by HPLC-molecular sieving, combined with multispectral UV analysis of the acquired data. A significant difference in the protein/polypeptide pattern within the molecular weight range of 7-10 kDa has been observed between samples, taken directly after detoxification and 2 weeks later. Spectral analysis of the results suggests that the components are of peptidergic nature. On the other hand, albumin content did not differ significantly, suggesting that the blood-brain barrier was not affected. An enzyme marker, dynorphin converting enzyme, remained unchanged in both groups.
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Affiliation(s)
- J Silberring
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Cowdrey GN, Tasker PJ, Gould BJ, Rice-Oxley M, Firth GB. Isoelectric focusing in an immobilized pH gradient for the detection of intrathecal IgG in cerebrospinal fluid: sensitivity and specificity for the diagnosis of multiple sclerosis. Ann Clin Biochem 1993; 30 ( Pt 5):463-8. [PMID: 8250498 DOI: 10.1177/000456329303000509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cerebrospinal fluid and serum from 192 patients was analysed for the presence of intrathecally synthesized oligoclonal IgG bands using isoelectric focusing in an immobilized pH gradient pH 7-10. The sensitivity of this method for the diagnosis of multiple sclerosis (MS) was 95% (21 of 22), or 75% if patients with suspected MS were included. The specificity for the diagnosis of MS was 98%, or 96% if the suspected MS patients were included. The very high specificity may be because the intrathecally synthesized oligoclonal IgG associated with MS is more alkaline than IgG from serum and is better detected in an immobilized alkaline pH gradient.
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Affiliation(s)
- G N Cowdrey
- Department of Biochemistry, Hurstwood Park Neurological Centre, Princess Royal Hospital, Haywards Heath, West Sussex, UK
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Fredman P. Detection of oligoclonal IgG bands in cerebrospinal fluid by immunofixation after isoelectric focusing on polyacrylamide gels with the PhastSystem. Electrophoresis 1992; 13:158-61. [PMID: 1592046 DOI: 10.1002/elps.1150130132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This paper describes the detection of oligoclonal bands of IgG immunoglobulins in cerebrospinal fluids (CSF) using isoelectric focusing (IEF) and immunofixation with the PhastSystem equipment. The proteins were separated by IEF on polyacrylamide gels, pH 3-9. The IgG immunoglobulins were then fixed by overlaying the gel with antihuman IgG antiserum. Fixed immunoglobulins were detected with silver staining in the PhastSystem Development Unit. One microliter of serum or CSF containing 15 mg/L of IgG was found to be optimal. The procedure had good reproducibility both with regard to IEF and silver staining of the fixed immunoglobulins. The manpower need was reduced, and the procedure has been found to be useful in the clinical laboratory.
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Affiliation(s)
- P Fredman
- Department of Psychiatry and Neurochemistry, University of Göteborg, Mölndal Hospital, Sweden
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Wiederkehr F. Analysis of cerebrospinal fluid proteins by electrophoresis. JOURNAL OF CHROMATOGRAPHY 1991; 569:281-96. [PMID: 1939490 DOI: 10.1016/0378-4347(91)80234-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The cerebrospinal fluid (CSF) is a specific ultrafiltrate of plasma, which surrounds the brain and spinal cord. The study of its proteins and their alteration may yield useful information on several neurological diseases. By using various electrophoretic separation techniques, several CSF proteins have been identified derived from plasma or from brain. Different one-dimensional methods, such as agarose gel electrophoresis and isoelectric focusing, are of similar value in identifying the non-specific oligoclonal bands, which are mainly helpful in the diagnosis of multiple sclerosis and other inflammatory diseases. Isoelectric focusing has a greater resolution than other one-dimensional methods, and it yields additional data about disease-associated proteins occurring in Alzheimer's disease, Huntington's chorea and amyotrophic lateral sclerosis. Silver-stained two-dimensional gels provide more information about the complex protein composition of CSF, particularly about proteins produced in the brain, such as apolipoprotein E and neuron-specific enolase. For the detection of oligoclonal antibodies, the investigation of protein changes revealed by Parkinson's disease, schizophrenia and Creutzfeldt-Jakob disease, and the analysis of CSF immune complexes, two-dimensional electrophoresis has a greater sensitivity.
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Affiliation(s)
- F Wiederkehr
- Institute of Clinical Chemistry, University Hospital Zürich, Switzerland
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Keir G, Luxton RW, Thompson EJ. Isoelectric focusing of cerebrospinal fluid immunoglobulin G: an annotated update. Ann Clin Biochem 1990; 27 ( Pt 5):436-43. [PMID: 2281923 DOI: 10.1177/000456329002700504] [Citation(s) in RCA: 96] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A revised agarose isoelectric focusing method for detecting oligoclonal IgG in unconcentrated cerebrospinal fluid is presented. The technique is shown to be robust and reproducible and suitable for the detection of intrathecal IgG synthesis.
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Affiliation(s)
- G Keir
- Department of Special Chemical Pathology, National Hospital for Nervous Diseases, Queen Square, London, UK
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