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Kamalian A, Barough SS, Ho SG, Albert M, Luciano MG, Yasar S, Moghekar A. Molecular Signatures of Normal Pressure Hydrocephalus: A Largescale Proteomic Analysis of Cerebrospinal Fluid. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.01.583014. [PMID: 38496536 PMCID: PMC10942380 DOI: 10.1101/2024.03.01.583014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Given the persistent challenge of differentiating idiopathic Normal Pressure Hydrocephalus (iNPH) from similar clinical entities, we conducted an in-depth proteomic study of cerebrospinal fluid (CSF) in 28 shunt-responsive iNPH patients, 38 Mild Cognitive Impairment (MCI) due to Alzheimer's disease, and 49 healthy controls. Utilizing the Olink Explore 3072 panel, we identified distinct proteomic profiles in iNPH that highlight significant downregulation of synaptic markers and cell-cell adhesion proteins. Alongside vimentin and inflammatory markers upregulation, these results suggest ependymal layer and transependymal flow dysfunction. Moreover, downregulation of multiple proteins associated with congenital hydrocephalus (e.g., L1CAM, PCDH9, ISLR2, ADAMTSL2, and B4GAT1) points to a possible shared molecular foundation between congenital hydrocephalus and iNPH. Through orthogonal partial least squares discriminant analysis (OPLS-DA), a panel comprising 13 proteins has been identified as potential diagnostic biomarkers of iNPH, pending external validation. These findings offer novel insights into the pathophysiology of iNPH, with implications for improved diagnosis.
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Affiliation(s)
- Aida Kamalian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | | | - Sara G. Ho
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Mark G. Luciano
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Sevil Yasar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Braun M, Boström G, Ingelsson M, Kilander L, Löwenmark M, Nyholm D, Burman J, Niemelä V, Freyhult E, Kultima K, Virhammar J. Levels of inflammatory cytokines MCP-1, CCL4, and PD-L1 in CSF differentiate idiopathic normal pressure hydrocephalus from neurodegenerative diseases. Fluids Barriers CNS 2023; 20:72. [PMID: 37833765 PMCID: PMC10571396 DOI: 10.1186/s12987-023-00472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Neuroinflammatory processes have been suggested to play a role in the pathophysiology of neurodegenerative diseases and post-hemorrhagic hydrocephalus, but have rarely been investigated in patients with idiopathic normal pressure hydrocephalus (iNPH). The aim of this study was to investigate whether levels of inflammatory proteins in CSF are different in iNPH compared to healthy controls and patients with selected neurodegenerative disorders, and whether any of these markers can aid in the differential diagnosis of iNPH. METHODS Lumbar CSF was collected from 172 patients from a single center and represented iNPH (n = 74), Alzheimer's disease (AD) (n = 21), mild cognitive impairment (MCI) due to AD (n = 21), stable MCI (n = 22), frontotemporal dementia (n = 13), and healthy controls (HC) (n = 21). Levels of 92 inflammatory proteins were analyzed using a proximity extension assay. As a first step, differences between iNPH and HC were investigated, and proteins that differed between iNPH and HC were then compared with those from the other groups. The linear regressions were adjusted for age, sex, and plate number. RESULTS Three proteins showed higher (MCP-1, p = 0.0013; CCL4, p = 0.0008; CCL11, p = 0.0022) and one lower (PD-L1, p = 0.0051) levels in patients with iNPH compared to HC. MCP-1 was then found to be higher in iNPH than in all other groups. CCL4 was higher in iNPH than in all other groups, except in MCI due to AD. PD-L1 was lower in iNPH compared to all other groups, except in stable MCI. Levels of CCL11 did not differ between iNPH and the differential diagnoses. In a model based on the four proteins mentioned above, the mean area under the receiver operating characteristic curve used to discriminate between iNPH and the other disorders was 0.91. CONCLUSIONS The inflammatory cytokines MCP-1 and CCL4 are present at higher-and PD-L1 at lower-levels in iNPH than in the other investigated diagnoses. These three selected cytokines may have diagnostic potential in the work-up of patients with iNPH.
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Affiliation(s)
- Madelene Braun
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Gustaf Boström
- Department of Public Health and Caring Sciences, Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, Departments of Medicine and Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Malin Löwenmark
- Department of Public Health and Caring Sciences, Molecular Geriatrics, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Dag Nyholm
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Joachim Burman
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Valter Niemelä
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Eva Freyhult
- Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
| | - Kim Kultima
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Johan Virhammar
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden.
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Pedersen CC, Ushakova A, Skogseth RE, Alves G, Tysnes OB, Aarsland D, Lange J, Maple-Grødem J. Inflammatory Biomarkers in Newly Diagnosed Patients With Parkinson Disease and Related Neurodegenerative Disorders. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/4/e200132. [PMID: 37258413 DOI: 10.1212/nxi.0000000000200132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/19/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Neuroinflammation contributes to Parkinson disease (PD) pathology, and inflammatory biomarkers may aid in PD diagnosis. Proximity extension assay (PEA) technology is a promising method for multiplex analysis of inflammatory markers. Neuroinflammation also plays a role in related neurodegenerative diseases, such as dementia with Lewy bodies (DLB) and Alzheimer disease (AD). The aim of this work was to assess the value of inflammatory biomarkers in newly diagnosed patients with PD and in patients with DLB and AD. METHODS Patients from the Norwegian ParkWest and Dementia Study of Western Norway longitudinal cohorts (PD, n = 120; DLB, n = 15; AD, n = 27) and 44 normal controls were included in this study. A PEA inflammation panel of 92 biomarkers was measured in the CSF. Disease-associated biomarkers were identified using elastic net (EN) analysis. We assessed the discriminatory power of disease-associated biomarkers using receiver operating characteristic (ROC) curve analysis and estimated the optimism-adjusted area under the curve (AUC) using the bootstrapping method. RESULTS EN analysis identified 9 PEA inflammatory biomarkers (ADA, CCL23, CD5, CD8A, CDCP1, FGF-19, IL-18R1, IL-6, and MCP-2) associated with PD. Seven of the 9 biomarkers were included in a diagnostic panel, which was able to discriminate between those with PD and controls (optimism-adjusted AUC 0.82). Our 7-biomarker PD panel was also able to distinguish PD from DLB and from AD. In addition, 4 inflammatory biomarkers were associated with AD and included in a panel, which could distinguish those with AD from controls (optimism-adjusted AUC 0.87). Our 4-biomarker AD panel was also able to distinguish AD from DLB and from PD. DISCUSSION In our exploratory study, we identified a 7-biomarker panel for PD and a 4-biomarker panel for AD. Our findings indicate potential inflammation-related biomarker candidates that could contribute toward PD-specific and AD-specific diagnostic panels, which should be further explored in other larger cohorts.
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Affiliation(s)
- Camilla Christina Pedersen
- From the The Norwegian Centre for Movement Disorders (C.C.P., G.A., J.L., J.M.-G.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (C.C.P., G.A., J.L., J.M.-G.), University of Stavanger; Section of Biostatistics (A.U.), Department of Research, Stavanger University Hospital; Department of Geriatric Medicine (R.E.S.), Haraldsplass Deaconess Hospital, Bergen; Department of Clinical Medicine (R.E.S., O.-B.T.), University of Bergen; Department of Neurology (G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Centre for Age-Related Medicine (D.A.), Stavanger University Hospital, Norway; and Department of Old Age Psychiatry (D.A.), Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - Anastasia Ushakova
- From the The Norwegian Centre for Movement Disorders (C.C.P., G.A., J.L., J.M.-G.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (C.C.P., G.A., J.L., J.M.-G.), University of Stavanger; Section of Biostatistics (A.U.), Department of Research, Stavanger University Hospital; Department of Geriatric Medicine (R.E.S.), Haraldsplass Deaconess Hospital, Bergen; Department of Clinical Medicine (R.E.S., O.-B.T.), University of Bergen; Department of Neurology (G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Centre for Age-Related Medicine (D.A.), Stavanger University Hospital, Norway; and Department of Old Age Psychiatry (D.A.), Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - Ragnhild Eide Skogseth
- From the The Norwegian Centre for Movement Disorders (C.C.P., G.A., J.L., J.M.-G.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (C.C.P., G.A., J.L., J.M.-G.), University of Stavanger; Section of Biostatistics (A.U.), Department of Research, Stavanger University Hospital; Department of Geriatric Medicine (R.E.S.), Haraldsplass Deaconess Hospital, Bergen; Department of Clinical Medicine (R.E.S., O.-B.T.), University of Bergen; Department of Neurology (G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Centre for Age-Related Medicine (D.A.), Stavanger University Hospital, Norway; and Department of Old Age Psychiatry (D.A.), Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - Guido Alves
- From the The Norwegian Centre for Movement Disorders (C.C.P., G.A., J.L., J.M.-G.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (C.C.P., G.A., J.L., J.M.-G.), University of Stavanger; Section of Biostatistics (A.U.), Department of Research, Stavanger University Hospital; Department of Geriatric Medicine (R.E.S.), Haraldsplass Deaconess Hospital, Bergen; Department of Clinical Medicine (R.E.S., O.-B.T.), University of Bergen; Department of Neurology (G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Centre for Age-Related Medicine (D.A.), Stavanger University Hospital, Norway; and Department of Old Age Psychiatry (D.A.), Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - Ole-Bjørn Tysnes
- From the The Norwegian Centre for Movement Disorders (C.C.P., G.A., J.L., J.M.-G.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (C.C.P., G.A., J.L., J.M.-G.), University of Stavanger; Section of Biostatistics (A.U.), Department of Research, Stavanger University Hospital; Department of Geriatric Medicine (R.E.S.), Haraldsplass Deaconess Hospital, Bergen; Department of Clinical Medicine (R.E.S., O.-B.T.), University of Bergen; Department of Neurology (G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Centre for Age-Related Medicine (D.A.), Stavanger University Hospital, Norway; and Department of Old Age Psychiatry (D.A.), Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - Dag Aarsland
- From the The Norwegian Centre for Movement Disorders (C.C.P., G.A., J.L., J.M.-G.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (C.C.P., G.A., J.L., J.M.-G.), University of Stavanger; Section of Biostatistics (A.U.), Department of Research, Stavanger University Hospital; Department of Geriatric Medicine (R.E.S.), Haraldsplass Deaconess Hospital, Bergen; Department of Clinical Medicine (R.E.S., O.-B.T.), University of Bergen; Department of Neurology (G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Centre for Age-Related Medicine (D.A.), Stavanger University Hospital, Norway; and Department of Old Age Psychiatry (D.A.), Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - Johannes Lange
- From the The Norwegian Centre for Movement Disorders (C.C.P., G.A., J.L., J.M.-G.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (C.C.P., G.A., J.L., J.M.-G.), University of Stavanger; Section of Biostatistics (A.U.), Department of Research, Stavanger University Hospital; Department of Geriatric Medicine (R.E.S.), Haraldsplass Deaconess Hospital, Bergen; Department of Clinical Medicine (R.E.S., O.-B.T.), University of Bergen; Department of Neurology (G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Centre for Age-Related Medicine (D.A.), Stavanger University Hospital, Norway; and Department of Old Age Psychiatry (D.A.), Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - Jodi Maple-Grødem
- From the The Norwegian Centre for Movement Disorders (C.C.P., G.A., J.L., J.M.-G.), Stavanger University Hospital; Department of Chemistry, Bioscience and Environmental Engineering (C.C.P., G.A., J.L., J.M.-G.), University of Stavanger; Section of Biostatistics (A.U.), Department of Research, Stavanger University Hospital; Department of Geriatric Medicine (R.E.S.), Haraldsplass Deaconess Hospital, Bergen; Department of Clinical Medicine (R.E.S., O.-B.T.), University of Bergen; Department of Neurology (G.A.), Stavanger University Hospital; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; Centre for Age-Related Medicine (D.A.), Stavanger University Hospital, Norway; and Department of Old Age Psychiatry (D.A.), Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom.
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Toft-Bertelsen TL, Barbuskaite D, Heerfordt EK, Lolansen SD, Andreassen SN, Rostgaard N, Olsen MH, Norager NH, Capion T, Rath MF, Juhler M, MacAulay N. Lysophosphatidic acid as a CSF lipid in posthemorrhagic hydrocephalus that drives CSF accumulation via TRPV4-induced hyperactivation of NKCC1. Fluids Barriers CNS 2022; 19:69. [PMID: 36068581 PMCID: PMC9450297 DOI: 10.1186/s12987-022-00361-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background A range of neurological pathologies may lead to secondary hydrocephalus. Treatment has largely been limited to surgical cerebrospinal fluid (CSF) diversion, as specific and efficient pharmacological options are lacking, partly due to the elusive molecular nature of the CSF secretion apparatus and its regulatory properties in physiology and pathophysiology. Methods CSF obtained from patients with subarachnoid hemorrhage (SAH) and rats with experimentally inflicted intraventricular hemorrhage (IVH) was analyzed for lysophosphatidic acid (LPA) by alpha-LISA. We employed the in vivo rat model to determine the effect of LPA on ventricular size and brain water content, and to reveal the effect of activation and inhibition of the transient receptor potential vanilloid 4 (TRPV4) ion channel on intracranial pressure and CSF secretion rate. LPA-mediated modulation of TRPV4 was determined with electrophysiology and an ex vivo radio-isotope assay was employed to determine the effect of these modulators on choroid plexus transport. Results Elevated levels of LPA were observed in CSF obtained from patients with subarachnoid hemorrhage (SAH) and from rats with experimentally-inflicted intraventricular hemorrhage (IVH). Intraventricular administration of LPA caused elevated brain water content and ventriculomegaly in experimental rats, via its action as an agonist of the choroidal transient receptor potential vanilloid 4 (TRPV4) channel. TRPV4 was revealed as a novel regulator of ICP in experimental rats via its ability to modulate the CSF secretion rate through its direct activation of the Na+/K+/2Cl− cotransporter (NKCC1) implicated in CSF secretion. Conclusions Together, our data reveal that a serum lipid present in brain pathologies with hemorrhagic events promotes CSF hypersecretion and ensuing brain water accumulation via its direct action on TRPV4 and its downstream regulation of NKCC1. TRPV4 may therefore be a promising future pharmacological target for pathologies involving brain water accumulation. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-022-00361-9.
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Affiliation(s)
- Trine L Toft-Bertelsen
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark
| | - Dagne Barbuskaite
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark
| | - Eva Kjer Heerfordt
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark
| | - Sara Diana Lolansen
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark
| | - Søren Norge Andreassen
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark
| | - Nina Rostgaard
- Department of Neurosurgery, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Markus Harboe Olsen
- Department of Neuroanaesthesiology, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nicolas H Norager
- Department of Neurosurgery, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tenna Capion
- Department of Neurosurgery, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Fredensborg Rath
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nanna MacAulay
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark.
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