Empirical assessment of biases in cerebrospinal fluid biomarkers of Alzheimer's disease: an umbrella review and re-analysis of data from meta-analyses

OBJECTIVE

Alzheimer's disease (AD) is a leading cause of years lived with disability in older age, and several cerebrospinal fluid (CSF) markers have been proposed in individual meta-analyses to be associated with AD but field-wide evaluation and scrutiny of the literature is not available.

MATERIALS AND METHODS

We performed an umbrella review for the reported associations between CSF biomarkers and AD. Data from available meta-analyses were reanalyzed using both random and fixed effects models. We also estimated between-study heterogeneity, small-study effects, excess significance, and prediction interval.

RESULTS

A total of 38 meta-analyses on CSF markers from 11 eligible articles were identified and reanalyzed. In 14 (36%) of the meta-analyses, the summary estimate and the results of the largest study showed non-concordant results in terms of statistical significance. Large heterogeneity (I2≥75%) was observed in 73% and small-study effects under Egger's test were shown in 28% of CSF biomarkers.

CONCLUSIONS

Our results suggest that there is an excess of statistically significant results and significant biases in the literature of CSF biomarkers for AD. Therefore, the results of CSF biomarkers should be interpreted with caution.

Evolution of the domain topology in a ferroelectric

Topological materials, including topological insulators, magnets with Skyrmions and ferroelectrics with topological vortices, have recently attracted phenomenal attention in the materials science community. Complex patterns of ferroelectric domains in hexagonal REMnO(3) (RE: rare earths) turn out to be associated with the macroscopic emergence of Z(2)×Z(3) symmetry. The results of our depth profiling of crystals with a self-poling tendency near surfaces reveal that the partial dislocation (i.e., wall-wall) interaction, not the interaction between vortices and antivortices, is primarily responsible for topological condensation through the macroscopic breaking of the Z(2) symmetry.

Self-organization, condensation, and annihilation of topological vortices and antivortices in a multiferroic

The interaction among topological defects can induce novel phenomena such as disclination pairs in liquid crystals and superconducting vortex lattices. Nanoscale topological vortices with swirling ferroelectric, magnetic, and structural antiphase relationships were found in multiferroic h-YMnO(3). Herein, we report the discovery of intriguing, but seemingly irregular configurations of a zoo of topological vortices and antivortices. These configurations can be neatly analyzed in terms of graph theory and reflect the nature of self-organized criticality in complexity phenomena. External stimuli such as chemistry-driven or electric poling can induce the condensation and eventual annihilation of topological vortex-antivortex pairs.

NMDA recepter-mediated neuroprotection by essential oils from the rhizomes of Acorus gramineus

Acori graminei Rhizoma (AGR) is shown to exhibit a number of pharmacological actions including sedation and anticonvulsive action. To further characterize its actions in the CNS, the present study evaluated the effects of essential oils (EO) from AGR on the excitotoxic neuronal cell death induced in primary rat cortical cell cultures. EO inhibited the glutamate-induced excitotoxicity in a concentration-dependent manner, with the IC50 of 0.241 mg/ml. EO exerted more potent neuroprotection against the toxicity induced by NMDA (IC50 = 0.139 mg/ml). In contrast, the AMPA-induced toxicity was not inhibited by EO. Receptor-ligand binding studies were performed to investigate the neuroprotective action mechanism. EO dramatically inhibited the specific bindings of a use-dependent NMDA receptorion channel blocker [3H]MK-801, indicating an NMDA receptor antagonist-like action. However, the bindings of [3H]MDL 105,519, a ligand selective for the glycine binding site of NMDA receptor, were not considerably inhibited. These results demonstrated that EO extracted from AGR exhibited neuroprotective effects on cultured cortical neurons through the blockade of NMDA receptor activity, and that the glycine binding site appeared not to be the major site of action.

Inhibition of excitotoxic neuronal death by methanol extract of Acori graminei rhizoma in cultured rat cortical neurons

Acori graminei rhizoma (AGR) are reported to exhibit a number of pharmacological actions in the central nervous system. The effects of the methanol extract of AGR on excitotoxic neuronal death were evaluated in the present study using cultured rat cortical neurons. Based on the phase-contrast microscopic examinations of cultures and lactate dehydrogenase activities measured in the culture media, the glutamate-induced excitotoxicity was significantly inhibited by the extract. The inhibitory action of the extract was more potent and selective for the N-methyl-D-aspartate (NMDA) receptor-mediated toxicity. The AGR extract competed with [3H]MDL 105,519 for the specific binding to the glycine site of the NMDA receptor with the IC(50) value of 164.7 microg/ml. Modulation of the NMDA receptor activity by the extract was determined using [3H]MK-801 binding studies. The reduction of the binding in the presence of the extract indicated the receptor inactivation by AGR. These results demonstrated that the methanol extract of AGR exhibited protective action against excitotoxic neuronal death, and that the neuroprotective action was primarily due to the blockade of NMDA receptor function by the interaction with the glycine binding site of the receptor.

A tetrodotoxin-producing Vibrio strain, LM-1, from the puffer fish Fugu vermicularis radiatus

Identification of tetrodotoxin (TTX) and its derivatives produced from a Vibrio strain in the intestine of the puffer fish Fugu vermicularis radiatus was performed by thin-layer chromatography, electrophoresis, high-performance liquid chromatography, and gas chromatography-mass spectrometry, together with a mouse bioassay for toxicity. It was demonstrated that the isolated bacterium produced TTX, 4-epi-TTX, and anhTTX during cultivation, suggesting that Vibrio strains are responsible for the toxification of the puffer fish.

Development of a custom designed TAH using rapid prototyping

The failure of the orthotopic implantation of a totally implantable artificial heart (TAH) was due mainly to anatomic mismatches in the conduits of the conventional TAH system. To overcome this anatomic incompatibility, a custom design and fabrication process was designed using the rapid prototyping (RP) technique. After three dimensional reconstruction of magnetic resonance imaging of the thoracic cavity and vascular remnants of the recipient, study of anatomic fit was done using the reconstructed thoracic model and three dimensional computer aided design (CAD) model. The direction of the inflow and outflow conduits of the blood sac was changed with a Unigraphics CAD. The RP model of the designed chamber was fabricated and examined for anatomic compatibility. Through this approach, the minute directional mismatch of the inflow and outflow conduits was improved. Thus, a new custom designed moving actuator Korean TAH with CAD and RP techniques was developed.