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Reinhold D, Farztdinov V, Yan Y, Meisel C, Sadlowski H, Kühn J, Perschel FH, Endres M, Düzel E, Vielhaber S, Guttek K, Goihl A, Venø M, Teegen B, Stöcker W, Stubbemann P, Kurth F, Sander LE, Ralser M, Otto C, Streit S, Jarius S, Ruprecht K, Radbruch H, Kjems J, Mülleder M, Heppner F, Körtvelyessy P. The brain reacting to COVID-19: analysis of the cerebrospinal fluid proteome, RNA and inflammation. J Neuroinflammation 2023; 20:30. [PMID: 36759861 PMCID: PMC9909638 DOI: 10.1186/s12974-023-02711-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Patients with COVID-19 can have a variety of neurological symptoms, but the active involvement of central nervous system (CNS) in COVID-19 remains unclear. While routine cerebrospinal fluid (CSF) analyses in patients with neurological manifestations of COVID-19 generally show no or only mild inflammation, more detailed data on inflammatory mediators in the CSF of patients with COVID-19 are scarce. We studied the inflammatory response in paired CSF and serum samples of patients with COVID-19 (n = 38). Patients with herpes simplex virus encephalitis (HSVE, n = 10) and patients with non-inflammatory, non-neurodegenerative neurological diseases (n = 28) served as controls. We used proteomics, enzyme-linked immunoassays, and semiquantitative cytokine arrays to characterize inflammatory proteins. Autoantibody screening was performed with cell-based assays and native tissue staining. RNA sequencing of long-non-coding RNA and circular RNA was done to study the transcriptome. Proteomics on single protein level and subsequent pathway analysis showed similar yet strongly attenuated inflammatory changes in the CSF of COVID-19 patients compared to HSVE patients with, e.g., downregulation of the apolipoproteins and extracellular matrix proteins. Protein upregulation of the complement system, the serpin proteins pathways, and other proteins including glycoproteins alpha-2 and alpha-1 acid. Importantly, calculation of interleukin-6, interleukin-16, and CXCL10 CSF/serum indices suggest that these inflammatory mediators reach the CSF from the systemic circulation, rather than being produced within the CNS. Antibody screening revealed no pathological levels of known neuronal autoantibodies. When stratifying COVID-19 patients into those with and without bacterial superinfection as indicated by elevated procalcitonin levels, inflammatory markers were significantly (p < 0.01) higher in those with bacterial superinfection. RNA sequencing in the CSF revealed 101 linear RNAs comprising messenger RNAs, and two circRNAs being significantly differentially expressed in COVID-19 than in non-neuroinflammatory controls and neurodegenerative patients. Our findings may explain the absence of signs of intrathecal inflammation upon routine CSF testing despite the presence of SARS-CoV2 infection-associated neurological symptoms. The relevance of blood-derived mediators of inflammation in the CSF for neurological COVID-19 and post-COVID-19 symptoms deserves further investigation.
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Affiliation(s)
- Dirk Reinhold
- grid.5807.a0000 0001 1018 4307Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-Von-Guericke-University, Magdeburg, Germany ,grid.5807.a0000 0001 1018 4307Health Campus Immunology, Infectiology and Inflammation (GC-I3), Medical Faculty, Otto-Von-Guericke-University, Magdeburg, Germany
| | - Vadim Farztdinov
- grid.6363.00000 0001 2218 4662Core Facility, High-Throughput Mass Spectrometry, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Yan Yan
- grid.7048.b0000 0001 1956 2722Interdisciplinary Nanoscience Center, Aarhus University, 8000 Aarhus C, Denmark ,Omiics ApS, 8200 Aarhus N, Denmark
| | | | | | - Joachim Kühn
- Labor Berlin Charité Vivantes GmbH, 13353 Berlin, Germany
| | | | - Matthias Endres
- grid.6363.00000 0001 2218 4662Department of Neurology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE) in Berlin, 10117 Berlin, Germany
| | - Emrah Düzel
- grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE) in Magdeburg, 39120 Magdeburg, Germany
| | - Stefan Vielhaber
- grid.5807.a0000 0001 1018 4307Department of Neurology, University Hospital Magdeburg, Otto-Von Guericke University, 39120 Magdeburg, Germany
| | - Karina Guttek
- grid.5807.a0000 0001 1018 4307Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-Von-Guericke-University, Magdeburg, Germany
| | - Alexander Goihl
- grid.5807.a0000 0001 1018 4307Institute of Molecular and Clinical Immunology, Medical Faculty, Otto-Von-Guericke-University, Magdeburg, Germany
| | | | - Bianca Teegen
- Clinical-Immunological Laboratory Prof. Dr. Stöcker, 23627 Groß Grönau, Germany
| | - Winfried Stöcker
- Clinical-Immunological Laboratory Prof. Dr. Stöcker, 23627 Groß Grönau, Germany
| | - Paula Stubbemann
- grid.6363.00000 0001 2218 4662Department of Infectious Diseases and Respiratory Medicine, German Center for Lung Research (DZL), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Florian Kurth
- grid.6363.00000 0001 2218 4662Department of Infectious Diseases and Respiratory Medicine, German Center for Lung Research (DZL), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Leif E. Sander
- grid.6363.00000 0001 2218 4662Department of Infectious Diseases and Respiratory Medicine, German Center for Lung Research (DZL), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Markus Ralser
- grid.6363.00000 0001 2218 4662Core Facility, High-Throughput Mass Spectrometry, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Institute for Biochemistry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Carolin Otto
- grid.6363.00000 0001 2218 4662Department of Neurology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Simon Streit
- grid.6363.00000 0001 2218 4662Department of Neuropathology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sven Jarius
- grid.7700.00000 0001 2190 4373Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Klemens Ruprecht
- grid.6363.00000 0001 2218 4662Department of Neurology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Helena Radbruch
- grid.6363.00000 0001 2218 4662Department of Neuropathology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jørgen Kjems
- grid.7048.b0000 0001 1956 2722Interdisciplinary Nanoscience Center, Aarhus University, 8000 Aarhus C, Denmark
| | - Michael Mülleder
- grid.6363.00000 0001 2218 4662Core Facility, High-Throughput Mass Spectrometry, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Frank Heppner
- grid.6363.00000 0001 2218 4662Department of Neuropathology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Körtvelyessy
- Department of Neurology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany. .,German Center for Neurodegenerative Diseases (DZNE) in Magdeburg, 39120, Magdeburg, Germany. .,Department of Neuropathology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Sadlowski H, Schmidt V, Hiss J, Kuehn JA, Schneider CG, Zulu G, Hachangu A, Sikasunge CS, Mwape KE, Winkler AS, Schuelke M. Diagnosis of Taenia solium infections based on "mail order" RNA-sequencing of single tapeworm egg isolates from stool samples. PLoS Negl Trop Dis 2021; 15:e0009787. [PMID: 34890398 PMCID: PMC8694474 DOI: 10.1371/journal.pntd.0009787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/22/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Combined community health programs aiming at health education, preventive anti-parasitic chemotherapy, and vaccination of pigs have proven their potential to regionally reduce and even eliminate Taenia solium infections that are associated with a high risk of neurological disease through ingestion of T. solium eggs. Yet it remains challenging to target T. solium endemic regions precisely or to make exact diagnoses in individual patients. One major reason is that the widely available stool microscopy may identify Taenia ssp. eggs in stool samples as such, but fails to distinguish between invasive (T. solium) and less invasive Taenia (T. saginata, T. asiatica, and T. hydatigena) species. The identification of Taenia ssp. eggs in routine stool samples often prompts a time-consuming and frequently unsuccessful epidemiologic workup in remote villages far away from a diagnostic laboratory. Here we present "mail order" single egg RNA-sequencing, a new method allowing the identification of the exact Taenia ssp. based on a few eggs found in routine diagnostic stool samples. We provide first T. solium transcriptome data, which show extremely high mitochondrial DNA (mtDNA) transcript counts that can be used for subspecies classification. "Mail order" RNA-sequencing can be administered by health personnel equipped with basic laboratory tools such as a microscope, a Bunsen burner, and access to an international post office for shipment of samples to a next generation sequencing facility. Our suggested workflow combines traditional stool microscopy, RNA-extraction from single Taenia eggs with mitochondrial RNA-sequencing, followed by bioinformatic processing with a basic laptop computer. The workflow could help to better target preventive healthcare measures and improve diagnostic specificity in individual patients based on incidental findings of Taenia ssp. eggs in diagnostic laboratories with limited resources.
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Affiliation(s)
- Henrik Sadlowski
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
| | - Veronika Schmidt
- Department of Neurology, Centre for Global Health, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jonathan Hiss
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
| | - Johannes A. Kuehn
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
| | - Christian G. Schneider
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
| | - Gideon Zulu
- School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Alex Hachangu
- School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | | | - Kabemba E. Mwape
- School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Andrea S. Winkler
- Department of Neurology, Centre for Global Health, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
- Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Markus Schuelke
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neuropediatrics, Berlin, Germany
- * E-mail:
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Muench P, Jochum S, Wenderoth V, Ofenloch-Haehnle B, Hombach M, Strobl M, Sadlowski H, Sachse C, Torriani G, Eckerle I, Riedel A. Development and Validation of the Elecsys Anti-SARS-CoV-2 Immunoassay as a Highly Specific Tool for Determining Past Exposure to SARS-CoV-2. J Clin Microbiol 2020; 58:e01694-20. [PMID: 32747400 PMCID: PMC7512151 DOI: 10.1128/jcm.01694-20] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022] Open
Abstract
The Elecsys Anti-SARS-CoV-2 immunoassay (Roche Diagnostics) was developed to provide accurate, reliable detection of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated sensitivity, specificity, cross-reactivity, and agreement with a vesicular stomatitis virus-based pseudoneutralization assay for the Elecsys Anti-SARS-CoV-2 immunoassay. Sensitivity and agreement between Elecsys Anti-SARS-CoV-2 immunoassay and pseudoneutralization assay measurements were evaluated using samples from patients with PCR-confirmed SARS-CoV-2 infection, a majority of whom were hospitalized. Specificity was evaluated using samples from routine diagnostic testing/blood donors collected before December 2019 and thus deemed negative for SARS-CoV-2-specific antibodies. Cross-reactivity was evaluated using samples containing a wide range of potentially cross-reacting analytes, purchased from commercial vendors. For sensitivity and specificity, point estimates and 95% confidence intervals (CIs) were calculated. Agreement between the Elecsys Anti-SARS-CoV-2 immunoassay and the pseudoneutralization assay was calculated. The sensitivity of the Elecsys Anti-SARS-CoV-2 immunoassay in patients with prior PCR-confirmed SARS-CoV-2 infection was 99.5% (95% CI, 97.0 to 100.0%) at ≥14 days post-PCR confirmation. Overall specificity (n = 10,453) was 99.80% (95% CI, 99.69 to 99.88%). Only 4/792 samples containing potential cross-reacting analytes were reactive with the Elecsys Anti-SARS-CoV-2 immunoassay, resulting in an overall specificity in this cohort of 99.5% (95% CI, 98.6 to 99.9%). Positive, negative, and overall agreement (n = 46) between the Elecsys Anti-SARS-CoV-2 immunoassay and the pseudoneutralization assay were 86.4% (95% CI, 73.3 to 93.6%), 100% (95% CI, 34.2 to 100%), and 87.0% (95% CI, 74.3 to 93.9%), respectively. The Elecsys Anti-SARS-CoV-2 immunoassay demonstrated high sensitivity (99.5% at ≥14 days post-PCR confirmation) and specificity (99.80%), supporting its use as a tool for identification of past SARS-CoV-2 infection, including use in populations with low disease prevalence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Giulia Torriani
- Department of Molecular Medicine and Microbiology, Faculty of Medicine, Université de Genève, Geneva, Switzerland
| | - Isabella Eckerle
- Department of Molecular Medicine and Microbiology, Faculty of Medicine, Université de Genève, Geneva, Switzerland
- Hôpitaux Universitaires Genève, Geneva, Switzerland
- Division of Infectious Diseases, Department of Medicine, Université de Genève, Geneva, Switzerland
- Laboratory of Virology, Division of Laboratory Medicine, Université de Genève, Geneva, Switzerland
- Center for Emerging Viral Diseases, Université de Genève, Geneva, Switzerland
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