Cerebrospinal fluid approach on neuro-oncology

Hyperdiploid Precursor B-acute Lymphoblastic Leukemia Presenting as a Cavernous Sinus Mass in a 4-Year-old Male

Risk stratification and appropriate treatment selection for children with precursor B-acute lymphoblastic leukemia (B-ALL) have improved outcomes. We report the case of a 4-year-old male with a lymphomatous cavernous sinus mass, a previously undescribed presentation of newly diagnosed hyperdiploid B-ALL. Few case reports in the literature describe lymphomatous involvement in this region, but none are associated with pediatric B-ALL. This case presented unique treatment and risk assignment challenges given the intracranial location of this tumor and proximity to the central nervous system.

Liquid Biomarkers for Improved Diagnosis and Classification of CNS Tumors

Liquid biopsy, as a non-invasive technique for cancer diagnosis, has emerged as a major step forward in conquering tumors. Current practice in diagnosis of central nervous system (CNS) tumors involves invasive acquisition of tumor biopsy upon detection of tumor on neuroimaging. Liquid biopsy enables non-invasive, rapid, precise and, in particular, real-time cancer detection, prognosis and treatment monitoring, especially for CNS tumors. This approach can also uncover the heterogeneity of these tumors and will likely replace tissue biopsy in the future. Key components of liquid biopsy mainly include circulating tumor cells (CTC), circulating tumor nucleic acids (ctDNA, miRNA) and exosomes and samples can be obtained from the cerebrospinal fluid, plasma and serum of patients with CNS malignancies. This review covers current progress in application of liquid biopsies for diagnosis and monitoring of CNS malignancies.

Potential biomarkers of childhood brain tumor identified by proteomics of cerebrospinal fluid from extraventricular drainage (EVD)

Brain tumors are the most common solid tumors in childhood. There is the need for biomarkers of residual disease, therapy response and recurrence. Cerebrospinal fluid (CSF) is a source of brain tumor biomarkers. We analyzed the proteome of waste CSF from extraventricular drainage (EVD) from 29 children bearing different brain tumors and 17 controls needing EVD insertion for unrelated causes. 1598 and 1526 proteins were identified by liquid chromatography-coupled tandem mass spectrometry proteomics in CSF control and brain tumor patients, respectively, 263 and 191 proteins being exclusive of either condition. Bioinformatic analysis revealed promising protein biomarkers for the discrimination between control and tumor (TATA-binding protein-associated factor 15 and S100 protein B). Moreover, Thymosin beta-4 (TMSB4X) and CD109, and 14.3.3 and HSP90 alpha could discriminate among other brain tumors and low-grade gliomas plus glyoneuronal tumors/pilocytic astrocytoma, or embryonal tumors/medulloblastoma. Biomarkers were validated by ELISA assay. Our method was able to distinguish among brain tumor vs non-tumor/hemorrhagic conditions (controls) and to differentiate two large classes of brain tumors. Further prospective studies may assess whether the biomarkers proposed by our discovery approach can be identified in other bodily fluids, therefore less invasively, and are useful to guide therapy and predict recurrences.

Cerebrospinal fluid microRNAs as diagnostic biomarkers in brain tumors

Cerebrospinal fluid (CSF) is a body fluid that has many important functions and is in direct contact with the extracellular environment of the central nervous system (CNS). CSF serves as both the communication channel allowing the distribution of various substances among the CNS cells and the storage facility for the waste products these cells release. For these reasons, CSF is a potential source of diagnostic biomarkers of many CNS diseases, including brain tumors. Recent studies have revealed that CSF also contains circulating microRNAs (miRNAs), short non-coding RNAs that have been described as biomarkers in many cancers. However, CSF miRNAs are difficult to detect, which is why researchers face major challenges, including technological difficulties in its detection and its lack of standardization. Therefore, this review aims (i) to highlight the potential of CSF miRNAs as diagnostic, prognostic and predictive biomarkers in brain tumors, and (ii) to summarize technological approaches for detection of CSF miRNAs.

The role of cytokines and chemokines in the microenvironment of the blood-brain barrier in leukemia central nervous system metastasis

AIM

Central nervous system (CNS) metastasis is a major obstacle in the treatment of leukemia, and the underlying mechanisms of leukemia CNS metastasis are not fully understood. The present study is an investigation of the role of the CNS microenvironment in leukemia CNS metastasis.

METHODS

Analog blood-brain barrier (BBB) was set by coculturing human brain microvascular endothelial cells (HBMVECs) and leukemia cells (U937 and IL-60), as well as HBMVECs and sera from leukemia patients, in vitro. The permeability of the HBMVEC monolayer and the levels of tight junction proteins, cytokines and chemokines (C&Ckines) were measured.

RESULTS

The permeability of HBMVECs increased when cocultured with leukemia sera. The expression of C&Ckines was significantly upregulated in HBMVECs cocultured with leukemia sera or leukemia cells, compared to the normal sera (P<0.05, respectively). Specifically, significantly higher levels of vascular endothelial growth factor A (VEGF-A) and matrix metalloprotease 9 (MMP-9) were found in HBMVECs and leukemia cells/sera coculturing systems.

CONCLUSION

Both leukemia cells and the molecules in leukemia sera play an important role in leukemia CNS metastasis. VEGF-A and MMPs may be the main factors resulting in the degradation of the BBB and inducing the CNS migration of leukemia cells.

Influence of pneumatic tube system transport on routinely assessed and spectrophotometric cerebrospinal fluid parameters

BACKGROUND

Pneumatic tube systems (PTS) are widely used in many hospitals. Using PTS reduces turnaround time (TAT) and can improve patients' outcome.

METHODS

We investigated whether clinically significant differences could be observed in CSF samples transported by pneumatic tube in comparison with samples transported by hand. Two aliquots from one sample were sent by PTS and by hand from the department of neurology or neurosurgery and compared.

RESULTS

Routine cytological and biochemical assessment was compared in 27 cases. There were no statistically significant changes (transport by hand vs. PTS) in glucose levels [data are expressed as median (minimum-maximum)] at 3.7 (2.5-8.6) mmol/L vs. 3.6 (2.7-8.6) mmol/L, p=0.96 or lactate levels at 1.8 mmol/L (1.1-5.5) vs. 1.8 mmol/L (1.1-5.4). We observed a statistically significant decline in total protein levels in samples transported by PTS at 0.56 g/L (0.19-4.29) vs. 0.49 g/L (0.18-4.3), p=0.008. We observed no changes in erythrocyte count at 5/μL (0-40,000) vs. 5/μL (0-40,106), mononuclear cells at 2/μL (1-145) vs. 3/μL (1-152), or polynuclear cells at 0/μL (0-235) vs. 0/μL (0-352). Spectrophotometric examination was performed in 20 cases. There were no statistically significant differences (transport by hand vs. transport by PTS) in NOA at 0.002 (0.001-1.537) vs. 0.001 (0.001-1.528), p=0.95 or NBA at 0.001 (0.001-0.231) vs. 0.001 (0.001-0.276), p=0.675. Samples transported by PTS were delivered faster than samples transported by courier (transport by hand vs. PTS) at 25 min (10-153) vs. 15 min (4-110), p=0.002.

CONCLUSIONS

We found no significant changes in glucose, lactate levels and in any of the cytological parameters assessed, nor were statistically significant changes observed in the spectrophotometric parameters. We found a statistically significant decrease in total protein levels in samples transported by PTS. Transport by PTS can be faster than transport by hand.

Tumor-Associated CSF MicroRNAs for the Prediction and Evaluation of CNS Malignancies

Cerebrospinal fluid (CSF) is a readily reachable body fluid that is reflective of the underlying pathological state of the central nervous system (CNS). Hence it has been targeted for biomarker discovery for a variety of neurological disorders. CSF is also the major route for seeding metastases of CNS malignancies and its analysis could be informative for diagnosis and risk stratification of brain cancers. Recently, modern high-throughput, microRNAs (miRNAs) measuring technology has enabled sensitive detection of distinct miRNAs that are bio-chemicallystable in the CSF and can distinguish between different types of CNS cancers. Owing to the fact that a CSF specimen can be obtained with relative ease, analysis of CSF miRNAs could be a promising contribution to clinical practice. In this review, we examine the current scientific knowledge on tumor associated CSF miRNAs that could guide diagnosis of different brain cancer types, or could be helpful in predicting disease progression and therapy response. Finally, we highlight their potential applications clinically as biomarkers and discuss limitations.

Two cases of spuriously elevated cerebrospinal glucose concentration

We present two cases of spuriously high cerebrospinal fluid glucose concentration with approximately normal blood glucose concentrations. The cause of these abnormal findings was the use of inappropriate collection tubes during the pre-analytical phase. Whilst no patient harm was identified following this error, significant time and effort were expended by both laboratory and clinical staff to explain the cause of these findings.