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Nadkarni AN, Mukamal KJ, Zhu X, Siscovick D, Brach JS, Jacob M, Seshadri S, Abe T, Rosano C, Djousse L, Rosso AL. Associations of Neurological Biomarkers in Serum With Gait Measures: The Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae043. [PMID: 38334311 PMCID: PMC11005783 DOI: 10.1093/gerona/glae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Gait impairment leads to increased mobility decline and may have neurological contributions. This study explores how neurological biomarkers are related to gait in older adults. METHODS We studied participants in the Cardiovascular Health Study, a population-based cohort of older Americans, who underwent a serum biomarker assessment from samples collected in 1996-1997 for neurofilament light chain (NfL), glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, and total tau (n = 1 959, mean age = 78.0 years, 60.8% female). In a subsample (n = 380), cross-sectional associations with quantitative gait measures were explored. This subsample was assessed on a mat for gait speed, step length, double support time, step time, step length variability, and step time variability. Gait speed was also measured over a 15-ft walkway annually from 1996-1997 to 1998-1999 for longitudinal analyses. Linear regression models assessed cross-sectional associations of biomarkers with gait measures, whereas mixed effects models assessed longitudinal gait speed change from baseline to 1998-1999. RESULTS Neurofilament light chain was significantly associated with annual gait speed decline (standardized β = -0.64 m/s, 95% CI: [-1.23, -0.06]) after adjustment for demographic and health factors. Among gait mat-assessed phenotypes, NfL was also cross-sectionally associated with gait speed (β = 0.001 m/s [0.0003, 0.002]) but not with other gait measures. None of the remaining biomarkers were significantly related to gait in either longitudinal or cross-sectional analyses. CONCLUSIONS Higher NfL levels were related to greater annual gait speed decline. Gait speed decline may be related to axonal degeneration. The clinical utility of NfL should be explored.
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Affiliation(s)
- Abhijay N Nadkarni
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Xiaonan Zhu
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mini Jacob
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Sudha Seshadri
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Temidayo Abe
- Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Caterina Rosano
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luc Djousse
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Andrea L Rosso
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Oris C, Bouillon-Minois JB, Kahouadji S, Pereira B, Dhaiby G, Defrance VB, Durif J, Schmidt J, Moustafa F, Bouvier D, Sapin V. S100B vs. "GFAP and UCH-L1" assays in the management of mTBI patients. Clin Chem Lab Med 2024; 62:891-899. [PMID: 38033294 DOI: 10.1515/cclm-2023-1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES To compare for the first time the performance of "GFAP and UCH-L1" vs. S100B in a cohort of patients managed for mild traumatic brain injury (mTBI) according to actualized French guidelines. METHODS A prospective study was recently carried at the Emergency Department of Clermont-Ferrand University Hospital in France. Patients with mTBI presenting a medium risk of complications were enrolled. Blood S100B and "GFAP and UCHL-1" were sampled and measured according to French guidelines. S100B was measured in patients with samples within 3 h of trauma (Cobas®, Roche Diagnostics), while GFAP and UCHL-1 were measured in all patients (samples <3 h and 3-12 h) using another automated assay (i-STAT® Alinity, Abbott). RESULTS For sampling <3 h, serum S100B correctly identifies intracranial lesions with a specificity of 25.7 % (95 % CI; 19.5-32.6 %), a sensitivity of 100 % (95 % CI; 66.4-100 %), and a negative predictive value of 100 % (95 % CI; 92.5-100 %). For sampling <12 h, plasma "GFAP and UCH-L1" levels correctly identify intracranial lesions with a specificity of 31.7 % (95 % CI; 25.7-38.2 %), a sensitivity of 100 % (95 % CI; 73.5-100 %), and a negative predictive value of 100 % (95 % CI; 95-100 %). Comparison of specificities (25.7 vs. 31.7 %) did not reveal a statistically significant difference (p=0.16). CONCLUSIONS We highlight the usefulness of measuring plasma "GFAP and UCH-L1" levels to target mTBI patients (sampling within 12 h post-injury) and optimize the reduction of CT scans.
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Affiliation(s)
- Charlotte Oris
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | | | - Samy Kahouadji
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Gabriel Dhaiby
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Julie Durif
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jeannot Schmidt
- Adult Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Farès Moustafa
- Adult Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Damien Bouvier
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
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Werner JK, Albrecht J, Capaldi VF, Jain S, Sun X, Mukherjee P, Williams SG, Collen J, Diaz-Arrastia R, Manley GT, Krystal AD, Wickwire E. Association of Biomarkers of Neuronal Injury and Inflammation With Insomnia Trajectories After Traumatic Brain Injury: A TRACK-TBI Study. Neurology 2024; 102:e209269. [PMID: 38547447 DOI: 10.1212/wnl.0000000000209269] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/05/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Insomnia affects about one-third of patients with traumatic brain injury and is associated with worsened outcomes after injury. We hypothesized that higher levels of plasma neuroinflammation biomarkers at the time of TBI would be associated with worse 12-month insomnia trajectories. METHODS Participants were prospectively enrolled from 18 level-1 trauma centers participating in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study from February 26, 2014, to August 8, 2018. Plasma glial fibrillary acidic protein (GFAP), high-sensitivity C-reactive protein (hsCRP), S100b, neuron-specific enolase (NSE), and ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1) were collected on days 1 (D1) and 14 (D14) after TBI. The insomnia severity index was collected at 2 weeks, 3, 6, and 12 months postinjury. Participants were classified into insomnia trajectory classes based on a latent class model. We assessed the association of biomarkers with insomnia trajectories, controlling for medical and psychological comorbidities and demographics. RESULTS Two thousand twenty-two individuals with TBI were studied. Elevations in D1 hsCRP were associated with persistent insomnia (severe, odds ratio [OR] = 1.33 [1.11, 1.59], p = 0.002; mild, OR = 1.10 [1.02, 1.19], p = 0.011). Similarly, D14 hsCRP elevations were associated with persistent insomnia (severe, OR = 1.27 [1.02, 1.59], p = 0.03). Of interest, D1 GFAP was lower in persistent severe insomnia (median [Q1, Q3]: 154 [19, 445] pg/mL) compared with resolving mild (491 [154, 1,423], p < 0.001) and persistent mild (344 [79, 1,287], p < 0.001). D14 GFAP was similarly lower in persistent (11.8 [6.4, 19.4], p = 0.001) and resolving (13.9 [10.3, 20.7], p = 0.011) severe insomnia compared with resolving mild (20.6 [12.4, 39.6]. Accordingly, increases in D1 GFAP were associated with reduced likelihood of having persistent severe (OR = 0.76 [95% CI 0.63-0.92], p = 0.004) and persistent mild (OR = 0.88 [0.81, 0.96], p = 0.003) compared with mild resolving insomnia. No differences were found with other biomarkers. DISCUSSION Elevated plasma hsCRP and, surprisingly, lower GFAP were associated with adverse insomnia trajectories after TBI. Results support future prospective studies to examine their utility in guiding insomnia care after TBI. Further work is needed to explore potential mechanistic connections between GFAP levels and the adverse insomnia trajectories.
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Affiliation(s)
- J Kent Werner
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Jennifer Albrecht
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Vincent F Capaldi
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Sonia Jain
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Xiaoying Sun
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Pratik Mukherjee
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Scott G Williams
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Jacob Collen
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Ramon Diaz-Arrastia
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Geoffrey T Manley
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Andrew D Krystal
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Emerson Wickwire
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
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Korpela S, Sundblom J, Zetterberg H, Constantinescu R, Svenningsson P, Paucar M, Niemelä V. Cerebrospinal fluid glial fibrillary acidic protein, in contrast to amyloid beta protein, is associated with disease symptoms in Huntington's disease. J Neurol Sci 2024; 459:122979. [PMID: 38569376 DOI: 10.1016/j.jns.2024.122979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/07/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Huntington's disease (HD) is a hereditary neurodegenerative disease, currently lacking disease-modifying treatments. Biomarkers are needed for objective assessment of disease progression. Evidence supports both complex protein aggregation and astrocyte activation in HD. This study assesses the 42 amino acid long amyloid beta (Aβ42) and glial fibrillary acidic protein (GFAP) as potential biomarkers in the cerebrospinal fluid (CSF) of HD mutation carriers. METHODS CSF from participants was obtained from three sites in Sweden. Clinical symptoms were graded with the composite Unified Huntington's disease rating scale (cUHDRS). Protein concentrations were measured using ELISA. Pearson correlations were calculated to assess disease progression association. Results were adjusted for age and collection site. RESULTS The study enrolled 28 manifest HD patients (ManHD), 13 premanifest HD gene-expansion carriers (PreHD) and 20 controls. Aβ42 levels did not differ between groups and there was no correlation with measures of disease progression. GFAP concentration was higher in ManHD (424 ng/l, SD 253) compared with both PreHD (266 ng/l, SD 92.4) and controls (208 ng/l, SD 83.7). GFAP correlated with both cUHDRS (r = -0.77, p < 0.001), and 5-year risk of disease onset (r = 0.70, p = 0.008). CONCLUSION We provide evidence that indicates CSF Aβ42 has limited potential as a biomarker for HD. GFAP is a potential biomarker of progression in HD. Validation in larger cohorts measuring GFAP in blood and CSF would be of interest.
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Affiliation(s)
- Sara Korpela
- Department of Medicine, Neurology, Västerås Central Hospital, Västerås, Sweden
| | - Jimmy Sundblom
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Radu Constantinescu
- Institute of Neuroscience and Physiology, Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Paucar
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Valter Niemelä
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden.
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5
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Lee M, Rafiq Sayyed D, Kim H, Sanchez JC, Sik Hong S, Choi S, Kim H, Han E, Won Kang H, Min Kim J, Joan M, Kim H, Chae H, Park JM. A comprehensive Exdia TRF-LFIA for simultaneous quantification of GFAP and NT-proBNP in distinguishing ischemic and hemorrhagic stroke. Clin Chim Acta 2024; 557:117872. [PMID: 38471630 DOI: 10.1016/j.cca.2024.117872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/23/2024] [Accepted: 03/09/2024] [Indexed: 03/14/2024]
Abstract
The goal of this study is to create a highly sensitive time-resolved fluorescence lateral flow immunoassay (TRF-LFIA) capable of concurrently measuring glial fibrillary acidic protein (GFAP) and the N-terminal fragment of B-type natriuretic peptide precursor (NT-proBNP). This assay is designed as a diagnostic tool and aims to provide an algorithm for stroke management, specifically for distinguishing between Ischemic stroke (IS) and Hemorrhagic stroke (HS). However, LFIA to quantify simultaneous serum NT-proBNP and GFAP are not yet available. We have developed and validated a novel TRF-LFIA for the simultaneous quantitative detection of NT-proBNP and GFAP. The sensitivity and reproducibility of the immunoassay were significantly improved by employing specific monoclonal antibodies linked to europium nanoparticles (EuNPs) that specifically target NT-proBNP and GFAP. The detection area on the nitrocellulose membrane featured sandwich-style complexes containing two test lines for NT-proBNP and GFAP, and one Control line. The fluorescence intensity of these test lines and control line was measured using an in-house developed Exdia TRF-Plus analyzer. As proof-of-concept, we enrolled patients suspected of having a stroke who were admitted within a specific time frame (6 h). A small amount of clinical specimen (serum) was used. To optimize the LFIA, an EuNPs conjugated antibodies were investigated to improve the detection sensitivity and decrease the background signal as well shorten the detection time. The Exdia TRF-LFIA cartridge offers a wide linear dynamic detection range, rapid detection, high sensitivity, and specificity. The limit of detection was determined to be 98 pg/mL for NT-proBNP and 68 pg/mL for GFAP, with minimal cross-reactivity. There were 200 clinical human serum samples that were used to evaluate this platform with high correlation. By combining the results of NT-proBNP and GFAP, we formulated an algorithm for the clinical assessment of Ischemic Stroke (IS) and Hemorrhagic Stroke (HS). According to our proposed algorithm, the combination of GFAP and NT-proBNP emerged as the most effective biomarker combination for distinguishing between IS and HS. Exdia TRF-LFIA shows great potential as a supplemental method for in vitro diagnostics in the laboratory or in other point-of-care testing (POCT) applications. Its development substantially decreases the diagnosis time for IS and HS. The proposed algorithm not only minimizes treatment delays but also lowers medical costs for patients.
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Affiliation(s)
- Minki Lee
- Precision Biosensor, 306, Techno 2-ro, Yuseong-gu, Daejeon 34036, South Korea
| | | | - Hyejeong Kim
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | | | - Sung Sik Hong
- Precision Biosensor, 306, Techno 2-ro, Yuseong-gu, Daejeon 34036, South Korea
| | - Sehee Choi
- Precision Biosensor, 306, Techno 2-ro, Yuseong-gu, Daejeon 34036, South Korea
| | - Hyunghoon Kim
- Precision Biosensor, 306, Techno 2-ro, Yuseong-gu, Daejeon 34036, South Korea
| | - Eunhee Han
- Department of Laboratory Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hye Won Kang
- Precision Biosensor, 306, Techno 2-ro, Yuseong-gu, Daejeon 34036, South Korea
| | - Jeong Min Kim
- Precision Biosensor, 306, Techno 2-ro, Yuseong-gu, Daejeon 34036, South Korea
| | - Montaner Joan
- ABCDx, Avenue de Sécheron 15, 1202 Geneva, Switzerland
| | - Hanshin Kim
- Precision Biosensor, 306, Techno 2-ro, Yuseong-gu, Daejeon 34036, South Korea
| | - Hyojin Chae
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jong-Myeon Park
- Precision Biosensor, 306, Techno 2-ro, Yuseong-gu, Daejeon 34036, South Korea.
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6
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Fissolo N, Benkert P, Sastre-Garriga J, Mongay-Ochoa N, Vilaseca-Jolonch A, Llufriu S, Blanco Y, Hegen H, Berek K, Perez-Miralles F, Rejdak K, Villar LM, Monreal E, Alvarez-Lafuente R, Soylu OK, Abdelhak A, Bachhuber F, Tumani H, Martínez-Yélamos S, Sánchez-López AJ, García-Merino A, Gutiérrez L, Castillo-Trivino T, Lycke J, Rosenstein I, Furlan R, Filippi M, Téllez N, Ramió-Torrentà L, Lünemann JD, Wiendl H, Eichau S, Khalil M, Kuhle J, Montalban X, Comabella M. Serum biomarker levels predict disability progression in patients with primary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 2024; 95:410-418. [PMID: 37940409 DOI: 10.1136/jnnp-2023-332251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND We aimed to investigate the potential of serum biomarker levels to predict disability progression in a multicentric real-world cohort of patients with primary progressive multiple sclerosis (PPMS). METHODS A total of 141 patients with PPMS from 18 European MS centres were included. Disability progression was investigated using change in Expanded Disability Status Scale (EDSS) score over three time intervals: baseline to 2 years, 6 years and to the last follow-up. Serum levels of neurofilament light chain (sNfL), glial fibrillar acidic protein (sGFAP) and chitinase 3-like 1 (sCHI3L1) were measured using single-molecule array assays at baseline. Correlations between biomarker levels, and between biomarkers and age were quantified using Spearman's r. Univariable and multivariable linear models were performed to assess associations between biomarker levels and EDSS change over the different time periods. RESULTS Median (IQR) age of patients was 52.9 (46.4-58.5) years, and 58 (41.1%) were men. Median follow-up time was 9.1 (7.0-12.6) years. Only 8 (5.7%) patients received treatment during follow-up. sNfL and sGFAP levels were moderately correlated (r=0.43) and both weakly correlated with sCHI3L1 levels (r=0.19 and r=0.17, respectively). In multivariable analyses, levels of the three biomarkers were associated with EDSS changes across all time periods. However, when analysis was restricted to non-inflammatory patients according to clinical and radiological parameters (n=64), only sCHI3L1 levels remained associated with future EDSS change. CONCLUSIONS Levels of sNfL, sGFAP and sCHI3L1 are prognostic biomarkers associated with disability progression in patients with PPMS, being CHI3L1 findings less dependent on the inflammatory component associated with disease progression.
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Affiliation(s)
- Nicolás Fissolo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pascal Benkert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andreu Vilaseca-Jolonch
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sara Llufriu
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Yolanda Blanco
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Harald Hegen
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Klaus Berek
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | - Luisa M Villar
- Departments of Neurology and Immunology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal deInvestigacion Sanitaria (IRYCIS), Madrid, Spain
| | - Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, REEM, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Roberto Alvarez-Lafuente
- Environmental Factors in Degenerative Diseases Research Group, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico SanCarlos (IdISSC), Madrid, Spain
| | - Onder K Soylu
- Department of Neurology, Ulm University, Ulm, Germany
| | - Ahmed Abdelhak
- Department of Neurology, Ulm University, Ulm, Germany
- Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California San Francisco, San Francisco, California, USA
| | | | | | - Sergio Martínez-Yélamos
- Neurology Department, Multiple Sclerosis Unit, Hospital Universitari deBellvitge-IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Antonio J Sánchez-López
- Neuroimmunology Unit, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | - Antonio García-Merino
- Neuroimmunology Unit, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | - Lucía Gutiérrez
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Igal Rosenstein
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roberto Furlan
- Clinical Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Università Vita Salute San Raffaele, Milano, Italy
| | - Nieves Téllez
- Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Lluís Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department,Hospital Universitari Dr. Josep Trueta and Hospital Santa Caterina.Neurodegeneration and Neuroinflammation research group (IDIBGI). Department of Medical Sciences, University of Girona, Girona, Spain
| | - Jan D Lünemann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Munster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Munster, Germany
| | - Sara Eichau
- Multiple Sclerosis Unit, Neurology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron University Hospital, Barcelona, Spain
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7
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Arctaedius I, Levin H, Thorgeirsdóttir B, Moseby-Knappe M, Cronberg T, Annborn M, Nielsen N, Zetterberg H, Blennow K, Ashton NJ, Frigyesi A, Friberg H, Lybeck A, Mattsson-Carlgren N. Plasma glial fibrillary acidic protein and tau: predictors of neurological outcome after cardiac arrest. Crit Care 2024; 28:116. [PMID: 38594704 PMCID: PMC11003115 DOI: 10.1186/s13054-024-04889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/23/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The purpose was to evaluate glial fibrillary acidic protein (GFAP) and total-tau in plasma as predictors of poor neurological outcome after out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA), including comparisons with neurofilament light (NFL) and neuron-specific enolase (NSE). METHODS Retrospective multicentre observational study of patients admitted to an intensive care unit (ICU) in three hospitals in Sweden 2014-2018. Blood samples were collected at ICU admission, 12 h, and 48 h post-cardiac arrest. Poor neurological outcome was defined as Cerebral Performance Category 3-5 at 2-6 months after cardiac arrest. Plasma samples were retrospectively analysed for GFAP, tau, and NFL. Serum NSE was analysed in clinical care. Prognostic performances were tested with the area under the receiver operating characteristics curve (AUC). RESULTS Of the 428 included patients, 328 were OHCA, and 100 were IHCA. At ICU admission, 12 h and 48 h post-cardiac arrest, GFAP predicted neurological outcome after OHCA with AUC (95% CI) 0.76 (0.70-0.82), 0.86 (0.81-0.90) and 0.91 (0.87-0.96), and after IHCA with AUC (95% CI) 0.77 (0.66-0.87), 0.83 (0.74-0.92) and 0.83 (0.71-0.95). At the same time points, tau predicted outcome after OHCA with AUC (95% CI) 0.72 (0.66-0.79), 0.75 (0.69-0.81), and 0.93 (0.89-0.96) and after IHCA with AUC (95% CI) 0.61 (0.49-0.74), 0.68 (0.56-0.79), and 0.77 (0.65-0.90). Adding the change in biomarker levels between time points did not improve predictive accuracy compared to the last time point. In a subset of patients, GFAP at 12 h and 48 h, as well as tau at 48 h, offered similar predictive value as NSE at 48 h (the earliest time point NSE is recommended in guidelines) after both OHCA and IHCA. The predictive performance of NFL was similar or superior to GFAP and tau at all time points after OHCA and IHCA. CONCLUSION GFAP and tau are promising biomarkers for neuroprognostication, with the highest predictive performance at 48 h after OHCA, but not superior to NFL. The predictive ability of GFAP may be sufficiently high for clinical use at 12 h after cardiac arrest.
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Affiliation(s)
- Isabelle Arctaedius
- Department of Clinical Sciences, Anaesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden.
| | - Helena Levin
- Department of Research and Education, Skane University Hospital and Department of Clinical Sciences, Anaesthesia and Intensive Care, Lund University, Lund, Sweden
| | - Bergthóra Thorgeirsdóttir
- Department of Clinical Sciences, Anaesthesia and Intensive Care, Skane University Hospital, Lund University, Malmö, Sweden
| | - Marion Moseby-Knappe
- Neurology and Rehabilitation Medicine, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Skane University Hospital, Lund University, Lund, Sweden
| | - Martin Annborn
- Department of Clinical Sciences, Anaesthesia and Intensive Care, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| | - Niklas Nielsen
- Department of Clinical Sciences, Anaesthesia and Intensive Care, Helsingborg Hospital, Lund University, Helsingborg, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Centre, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Attila Frigyesi
- Department of Clinical Sciences, Anaesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care, Skane University Hospital, Lund University, Malmö, Sweden
| | - Anna Lybeck
- Department of Clinical Sciences, Anaesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
| | - Niklas Mattsson-Carlgren
- Department of Clinical Sciences, Neurology, Skane University Hospital, Lund University, Lund, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
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Bera KD, Tabak J, Ploeg RJ. No Evidence of Progressive Proinflammatory Cytokine Storm in Brain-dead Organ Donors-A Time-course Analysis Using Clinical Samples. Transplantation 2024; 108:923-929. [PMID: 38192028 PMCID: PMC10962432 DOI: 10.1097/tp.0000000000004900] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/04/2023] [Accepted: 10/25/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Solid organ transplantation is a cost-effective treatment for end-stage organ failure. Organ donation after brain death is an important source of transplanted organs. Data are limited on the effects of brain injury or donor management on grafts. The consensus view has been that brain death creates a progressively proinflammatory environment. We aimed to investigate time-course changes across a range of cytokines in a donation after brain death cohort of donors who died of intracranial hemorrhage without any other systemic source of inflammation. METHODS A donor cohort was defined using the UK Quality in Organ Donation biobank. Serum levels of proteins involved in proinflammatory and brain injury pathways (tumor necrosis factor-alpha, interleukin-6, complement C5a, neuron-specific enolase, and glial fibrillary acidic protein) were measured from admission to organ recovery. Moving median analysis was used to combine donor trajectories and delineate a time-course. RESULTS A cohort of 27 donors with brain death duration between 10 and 30 h was created, with 24 donors contributing to the time-course analysis. We observed no increase in tumor necrosis factor-alpha or interleukin-6 throughout the donor management period. Neuronal injury marker and complement C5a remain high from admission to organ recovery, whereas glial fibrillary acidic protein rises around the confirmation of brain death. CONCLUSIONS We found no evidence of a progressive rise of proinflammatory mediators with prolonged duration of brain death, questioning the hypothesis of a progressively proinflammatory environment. Furthermore, the proposed approach allows us to study chronological changes and identify biomarkers or target pathways when logistical or ethical considerations limit sample availability.
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Affiliation(s)
- Katarzyna D. Bera
- Nuffield Department of Surgical Sciences, Oxford Transplant Centre, Oxford, United Kingdom
- Oxford University NHS Foundation Trust, Oxford, United Kingdom
| | - Joel Tabak
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, United Kingdom
| | - Rutger J. Ploeg
- Nuffield Department of Surgical Sciences, Oxford Transplant Centre, Oxford, United Kingdom
- Oxford University NHS Foundation Trust, Oxford, United Kingdom
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Arroyo Pereiro P, Muñoz-Vendrell A, León Moreno I, Bau L, Matas E, Romero-Pinel L, Martínez Yélamos A, Martínez Yélamos S, Andrés-Benito P. Baseline serum neurofilament light chain levels differentiate aggressive from benign forms of relapsing-remitting multiple sclerosis: a 20-year follow-up cohort. J Neurol 2024; 271:1599-1609. [PMID: 38085343 PMCID: PMC10973070 DOI: 10.1007/s00415-023-12135-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVES Serum biomarkers are emerging as useful prognostic tools for multiple sclerosis (MS); however, long-term studies are lacking. We aimed to evaluate the long-term prognostic value of the serum levels of neurofilament light chain (NfL), total tau, glial fibrillary acidic protein (GFAP), and chitinase 3-like-1 (CHI3L1) measured close to the time of MS onset. METHODS In this retrospective, exploratory, observational, case and controls study, patients with relapsing-remitting MS (RRMS) with available baseline serum samples and prospectively follow-up in our MS unit for a long time were selected based on their clinical evolution to form two groups: (1) a benign RRMS (bRRMS) group, defined as patients with an Expanded Disability Status Scale (EDSS) score of ≤ 3 at ≥ 10 years of follow-up; (2) an aggressive RRMS (aRRMS) group, defined as patients with an EDSS score of ≥ 6 at ≤ 15 years of follow-up. An age-matched healthy control (HC) group was selected. NfL, total tau, and GFAP serum levels were quantified using a single-molecule array (SIMOA), and CHI3L1 was quantified using ELISA. RESULTS Thirty-one patients with bRRMS, 19 with aRRMS, and 10 HC were included. The median follow-up time from sample collection was 17.74 years (interquartile range, 14.60-20.37). Bivariate and multivariate analyses revealed significantly higher NfL and GFAP levels in the aRRMS group than in the bRRMS group. A receiver operating characteristic curve analysis identified serum NfL level as the most efficient marker for distinguishing aRRMS from bRRMS. DISCUSSION This proof-of-concept study comparing benign and aggressive RRMS groups reinforces the potential role of baseline NfL serum levels as a promising long-term disability prognostic marker. In contrast, serum GFAP, total tau, and CHI3L1 levels demonstrated a lower or no ability to differentiate between the long-term outcomes of RRMS.
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Affiliation(s)
- Pablo Arroyo Pereiro
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Albert Muñoz-Vendrell
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Isabel León Moreno
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Laura Bau
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Elisabet Matas
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Lucía Romero-Pinel
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Antonio Martínez Yélamos
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Sergio Martínez Yélamos
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Pol Andrés-Benito
- Neurologic Diseases and Neurogenetics Group, Institute of Biomedical Research (IDIBELL), Avinguda de la Gran Via de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
- Multiple Sclerosis Unit, Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
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10
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Zhao H, Song L, Gao S, Wu L, Huang D. Autoimmune glial fibrillary acidic protein astrocytopathy coexisting with multiple endocrine neoplasia: a case report. Acta Neurol Belg 2024; 124:715-718. [PMID: 37979124 DOI: 10.1007/s13760-023-02416-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023]
Affiliation(s)
- He Zhao
- Department of Neurology, First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lihong Song
- Department of Neurology, First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- Department of Medicine, Lulong County Hospital, Qinhuangdao, 066400, Hebei, China
| | - Sai Gao
- Department of Neurology, First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lei Wu
- Department of Neurology, First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Dehui Huang
- Department of Neurology, First Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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11
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Liu M, Zhu Y, Yuan Y, Wang Y, Liu X, Li L, Gao Y, Yan H, Liu R, Cheng L, Yuan J, Wang Q, Li S, Liu Y, Wang Y, Shi C, Xu Y, Yang J. Plasma neurofilament light as a promising biomarker in neuronal intranuclear inclusion disease. J Neurol 2024; 271:2042-2052. [PMID: 38189920 DOI: 10.1007/s00415-023-12160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/09/2024]
Abstract
Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disorder lacking reliable biomarkers. This study investigates plasma protein levels as potential biomarkers of disease severity and progression in NIID. In this study, we enrolled 30 NIID patients and 36 age- and sex-matched controls, following them for 1-2 years. Plasma neurofilament light (NfL), glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and tau were measured using ultrasensitive single molecule array (Simoa) assays. Disease severity was evaluated with the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Activities of Daily Living (ADL), and CNS symptom counts, in addition to neuroimaging data. Our study revealed that NIID patients has significantly higher plasma NfL (median, 35.2 vs. 8.61 pg/mL, p < 0.001) and GFAP (102 vs. 79.0 pg/mL, p = 0.010) levels compared to controls, with NfL emerging as a robust diagnostic marker (AUC = 0.956). NfL levels were notably higher in acute-onset NIID (77.5 vs. 28.8 pg/mL, p = 0.001). NfL correlated strongly with disease severity, including MMSE (ρ = - 0.687, p < 0.001), MoCA (ρ = - 0.670, p < 0.001), ADL (ρ = 0.587, p = 0.001), CNS symptoms (ρ = 0.369, p = 0.045), and white matter hyperintensity volume (ρ = 0.620, p = 0.004). Higher baseline NfL (≥ 35.2 pg/mL) associated with increased ADL scores, CNS symptoms, and white matter hyperintensity at follow-up. UCH-L1 and total tau levels showed no significant differences. Our results suggested the potential of NfL as a promising biomarker of disease severity and progression in NIID.
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Affiliation(s)
- Minglei Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yuru Zhu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yanpeng Yuan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Yangyang Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaojing Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Lanjun Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Huimin Yan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Ruoyu Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Lin Cheng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Jing Yuan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Qingzhi Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Shuo Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yutao Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Yanlin Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Changhe Shi
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China
| | - Jing Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, China.
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou University, Zhengzhou, Henan, China.
- Institute of Neuroscience, Zhengzhou University, Zhengzhou, Henan, China.
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12
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García-Rodrigo L, Ramos-López C, Sánchez-Tirado E, Agüí L, González-Cortés A, Yáñez-Sedeño P, Pingarrón JM. Label-free electrochemical immunosensing of glial fibrillary acidic protein (GFAP) at synthesized rGO/MoS2/AgNPs nanocomposite. Application to the determination in human cerebrospinal fluid. Talanta 2024; 270:125597. [PMID: 38150968 DOI: 10.1016/j.talanta.2023.125597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 12/29/2023]
Abstract
An electrochemical bioplatform involving screen-printed carbon electrodes modified with rGO/MoS2/AgNPs nanocomposites, the covalent immobilization of the specific capture antibody, and label-free detection has been developed for the determination of Glial Fibrillary Acidic Protein (GFAP). The resulting immunosensor profits the benefits of the rGO high conductivity, the pseudo-peroxidase activity of MoS2 and the electrocatalytic effect provided by AgNPs for improving the reduction current responses of hydrogen peroxide at the electrode surface. GFAP is a biomarker of central nervous system injuries has been proposed for the detection and monitoring of neurological diseases as epilepsy, encephalitis, or multiple sclerosis. For the first time, amperometric detection of the immunosensing event was performed by measuring the electrocatalytic response of hydrogen peroxide reduction at the modified electrode. Several techniques including scanning (SEM) and transmission (TEM) electron microscopies were used for the characterization of the synthesized composite whilst electrochemical impedance spectroscopy (EIS) using the redox probe Fe(CN)63-/4- was employed to evaluate the success of the steps implied in the fabrication of the immunosensor. After optimization of the involved experimental variables, a linear calibration plot for GFAP was constructed over the 0.6-100 ng mL-1 range, and a detection limit of 0.16 ng mL-1 was achieved. The developed immunosensor was successfully applied to the determination of GFAP in human cerebrospinal fluid (CSF) of patients diagnosed with encephalitis.
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Affiliation(s)
- Lorena García-Rodrigo
- Department of Analytical Chemistry, Faculty of Chemistry, University Complutense of Madrid, 28040, Madrid, Spain
| | - Claudia Ramos-López
- Department of Analytical Chemistry, Faculty of Chemistry, University Complutense of Madrid, 28040, Madrid, Spain
| | - Esther Sánchez-Tirado
- Department of Analytical Chemistry, Faculty of Chemistry, University Complutense of Madrid, 28040, Madrid, Spain
| | - Lourdes Agüí
- Department of Analytical Chemistry, Faculty of Chemistry, University Complutense of Madrid, 28040, Madrid, Spain
| | - Araceli González-Cortés
- Department of Analytical Chemistry, Faculty of Chemistry, University Complutense of Madrid, 28040, Madrid, Spain
| | - Paloma Yáñez-Sedeño
- Department of Analytical Chemistry, Faculty of Chemistry, University Complutense of Madrid, 28040, Madrid, Spain.
| | - José M Pingarrón
- Department of Analytical Chemistry, Faculty of Chemistry, University Complutense of Madrid, 28040, Madrid, Spain
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13
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Stukas S, Cooper J, Higgins V, Holmes D, Adeli K, Wellington CL. Pediatric reference intervals for serum neurofilament light and glial fibrillary acidic protein using the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. Clin Chem Lab Med 2024; 62:698-705. [PMID: 37882772 PMCID: PMC10895925 DOI: 10.1515/cclm-2023-0660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Blood biomarkers have the potential to transform diagnosis and prognosis for multiple neurological indications. Establishing normative data is a critical benchmark in the analytical validation process. Normative data are important in children as little is known about how brain development may impact potential biomarkers. The objective of this study is to generate pediatric reference intervals (RIs) for serum neurofilament light (NfL), an axonal marker, and glial fibrillary acidic protein (GFAP), an astrocytic marker. METHODS Serum from healthy children and adolescents aged 1 to <19 years were obtained from the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. Serum NfL (n=300) and GFAP (n=316) were quantified using Simoa technology, and discrete RI (2.5th and 97.5th percentiles) and continuous RI (5th and 95th percentiles) were generated. RESULTS While there was no association with sex, there was a statistically significant (p<0.0001) negative association between age and serum NfL (Rho -0.400) and GFAP (Rho -0.749). Two statistically significant age partitions were generated for NfL: age 1 to <10 years (lower, upper limit; 3.13, 20.6 pg/mL) and 10 to <19 years (1.82, 7.44 pg/mL). For GFAP, three statistically significant age partitions were generated: age 1 to <3.5 years (80.4, 601 pg/mL); 3.5 to <11 years (50.7, 224 pg/mL); and 11 to <19 years (26.2, 119 pg/mL). CONCLUSIONS Taken together with the literature on adults, NfL and GFAP display U-shaped curves with high levels in infants, decreasing levels during childhood, a plateau during adolescence and early adulthood and increasing levels in seniors. These normative data are expected to inform future pediatric studies on the importance of age on neurological blood biomarkers.
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Affiliation(s)
- Sophie Stukas
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Cooper
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Victoria Higgins
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Holmes
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, Providence Health, Vancouver, BC, Canada
| | - Khosrow Adeli
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cheryl L. Wellington
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering (SBME), University of British Columbia, Vancouver, BC, Canada
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14
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Zhao E, Yu Q, Wang M, Wang Z, Jiang B, Ma X, Zhou B, Dai Q, Li J, Wang S, Chen F, Yang X. Value of serum brain-derived neurotrophic factor and glial fibrillary acidic protein for detecting depression in patients with Helicobacter pylori infection. Neurosci Lett 2024; 825:137687. [PMID: 38403261 DOI: 10.1016/j.neulet.2024.137687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Infection with helicobacter pylori (H. pylori) is associated with depression, and depression can affect the outcome of H. pylori treatment. This study aimed to evaluate the value of serum brain-derived neurotrophic factor (BDNF) and glial fibrillary acidic protein (GFAP) for predicting depression in H. pylori-positive patients. METHOD A total of 82H. pylori-positive and 82H. pylori-negative patients were recruited for this study. All patients underwent neuropsychological and gastrointestinal assessments and blood sampling. BDNF and GFAP levels were measured in serum. The least absolute shrinkage and selection operator (LASSO) model was used to determine a composite marker. RESULTS H. pylori-positive patients showed significantly increased serum GFAP levels and significantly decreased serum BDNF levels compared to H. pylori-negative patients. Among H. pylori-positive patients, serum levels of gastrin 17 (G-17), pepsinogen (PG) I/PGII, BDNF, and GFAP, as well as Gastrointestinal Symptom Rating Scale (GSRS) scores, were significantly correlated with Hamilton Depression Scale (HAMD-24) overall scores and factor scores. Interactions between serum BDNF/GFAP and gastrointestinal serum indices or GSRS scores were significantly associated with HAMD-24 scores in H. pylori-positive patients. The LASSO model indicated that the combination of serum BDNF, GFAP, and G-17 and GSRS scores could identify H. pylori-positive patients with depression with an area under the curve of 0.879. CONCLUSION Circulating changes in BDNF and GFAP were associated with the occurrence of depression in H. pylori-positive patients. A composite marker including neural and gastrointestinal function-related indices may be of value for identifying depression among H. pylori-positive patients.
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Affiliation(s)
- En Zhao
- Department of Gastroenterology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China.
| | - Qian Yu
- Department of Gastroenterology, Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Meilei Wang
- Department of Neurology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China
| | - Zhengqiu Wang
- Department of Gastroenterology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China
| | - Bin Jiang
- Department of Gastroenterology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China
| | - Xiang Ma
- Department of Gastroenterology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China
| | - Bin Zhou
- Department of Gastroenterology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China
| | - Qingyong Dai
- Department of Neurology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China
| | - Jinyu Li
- Department of Gastroenterology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China
| | - Shiming Wang
- Department of Gastroenterology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China
| | - Fengjuan Chen
- Department of Gastroenterology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China.
| | - Xiaojun Yang
- Department of Gastroenterology, Xishan People's Hospital of Wuxi City, Wuxi 214105, China.
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15
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Kim S, Lee JJ, Park JS, Kang M, Seok HY. Neurofilament light chain as a biomarker in neuromyelitis optica spectrum disorder: a comprehensive review and integrated analysis with glial fibrillary acidic protein. Neurol Sci 2024; 45:1255-1261. [PMID: 38141119 DOI: 10.1007/s10072-023-07277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND In the context of neuromyelitis optica spectrum disorder (NMOSD), there are several measures that serve as a biomarker. However, each of the methods has the intrinsic limitations. While neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) have emerged as an additional biomarker for NMOSD, a thorough investigation of their role remains incomplete. Our aim is to provide a comprehensive review of the current literature regarding NfL and GFAP as a biomarker and explore their potential utility in NMOSD. METHODS We performed a comprehensive search using PubMed and Google Scholar to identify peer-reviewed articles investigating NfL and GFAP as a biomarker in NMOSD. RESULTS Our search identified 13 relevant studies. NfL consistently showed promise in distinguishing NMOSD patients from healthy individuals, although it had limited specificity in distinguishing NMOSD from other demyelinating diseases. NfL offered certain advantages over GFAP, notably its ability to predict disability worsening during attacks. In contrast, GFAP provided valuable insight, particularly in distinguishing NMOSD from multiple sclerosis and identifying clinical relapses. In addition, GFAP showed predictive potential for future attacks. Some studies even suggested that NfL may serve as an indicator of treatment response in NMOSD. CONCLUSIONS NfL and GFAP hold promise as biomarkers for NMOSD, demonstrating their usefulness in distinguishing patients from healthy individuals, assessing disease severity, and possibly reflecting treatment response. However, it is important to recognize that NfL and GFAP may, at some point, have different roles.
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Affiliation(s)
- Sohyeon Kim
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea
| | - Jae-Joon Lee
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Minsung Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hung Youl Seok
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea.
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16
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Mazzeo S, Ingannato A, Giacomucci G, Bagnoli S, Cavaliere A, Moschini V, Balestrini J, Morinelli C, Galdo G, Emiliani F, Piazzesi D, Crucitti C, Frigerio D, Polito C, Berti V, Padiglioni S, Sorbi S, Nacmias B, Bessi V. The role of plasma neurofilament light chain and glial fibrillary acidic protein in subjective cognitive decline and mild cognitive impairment. Neurol Sci 2024; 45:1031-1039. [PMID: 37723371 PMCID: PMC10857957 DOI: 10.1007/s10072-023-07065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION AND AIM NfL and GFAP are promising blood-based biomarkers for Alzheimer's disease. However, few studies have explored plasma GFAP in the prodromal and preclinical stages of AD. In our cross-sectional study, our aim is to investigate the role of these biomarkers in the earliest stages of AD. MATERIALS AND METHODS We enrolled 40 patients (11 SCD, 21 MCI, 8 AD dementia). All patients underwent neurological and neuropsychological examinations, analysis of CSF biomarkers (Aβ42, Aβ42/Aβ40, p-tau, t-tau), Apolipoprotein E (APOE) genotype analysis and measurement of plasma GFAP and NfL concentrations. Patients were categorized according to the ATN system as follows: normal AD biomarkers (NB), carriers of non-Alzheimer's pathology (non-AD), prodromal AD, or AD with dementia (AD-D). RESULTS GFAP was lower in NB compared to prodromal AD (p = 0.003, d = 1.463) and AD-D (p = 0.002, d = 1.695). NfL was lower in NB patients than in AD-D (p = 0.011, d = 1.474). NfL demonstrated fair accuracy (AUC = 0.718) in differentiating between NB and prodromal AD, with a cut-off value of 11.65 pg/mL. GFAP showed excellent accuracy in differentiating NB from prodromal AD (AUC = 0.901) with a cut-off level of 198.13 pg/mL. CONCLUSIONS GFAP exhibited excellent accuracy in distinguishing patients with normal CSF biomarkers from those with prodromal AD. Our results support the use of this peripheral biomarker for detecting AD in patients with subjective and objective cognitive decline.
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Affiliation(s)
- Salvatore Mazzeo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Assunta Ingannato
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Giulia Giacomucci
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Arianna Cavaliere
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Valentina Moschini
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Juri Balestrini
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Carmen Morinelli
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Galdo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Filippo Emiliani
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Diletta Piazzesi
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Crucitti
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Daniele Frigerio
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | | | - Valentina Berti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, 50134, Florence, Italy
| | - Sonia Padiglioni
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Regional Referral Centre for Relational Criticalities- 50139, Tuscany Region, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
| | - Valentina Bessi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Nonato DTT, Aragão GF, Craveiro RMCB, Pereira MG, Vasconcelos SMM, Wong DVT, Júnior RCPL, Soares PMG, Lima MADS, Assreuy AMS, Chaves EMC. Polysaccharide-rich extract of Genipa americana leaves protects seizures and oxidative stress in the mice model of pentylenetetrazole-induced epilepsy. Biomed Pharmacother 2024; 172:116212. [PMID: 38364734 DOI: 10.1016/j.biopha.2024.116212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/18/2024] Open
Abstract
Plant polysaccharides have biological activities in the brain and those obtained from Genipa americana leaves present antioxidant and anticonvulsant effects in the mice model of pentylenetetrazole (PTZ)-induced acute seizures. This study aimed to evaluate the polysaccharide-rich extract of Genipa americana leaves (PRE-Ga) in the models of acute seizures and chronic epilepsy (kindling) induced by PTZ. In the acute seizure model, male Swiss mice (25-35 g) received PRE-Ga (1 or 9 mg/kg; intraperitoneal- IP), alone or associated with diazepam (0.01 mg/kg), 30 min before induction of seizures with PTZ (70 mg/kg; IP). In the chronic epilepsy model, seizures were induced by PTZ (40 mg/kg) 30 min after treatment and in alternated days up to 30 days and evaluated by video. Brain areas (prefrontal cortex, hippocampus, striatum) were assessed for inflammatory and oxidative stress markers. Diazepam associated to PRE-Ga (9 mg/kg; i.p.) increased the latency of seizures in acute (222.4 ± 47.57 vs. saline: 62.00 ± 4.709 s) and chronic models (6.267 ± 0.502 vs. saline: 4.067 ± 0.407 s). In hippocampus, PRE-Ga (9 mg/kg) inhibited TNF-α (105.9 ± 5.38 vs. PTZ: 133.5 ± 7.62 pmol/g) and malondialdehyde (MDA) (473.6 ± 60.51) in the chronic model. PTZ increased glial fibrillar acid proteins (GFAP) and Iba-1 in hippocampus, which was reversed by PRE-Ga (GFAP: 1.9 ± 0.23 vs PTZ: 3.1 ± 1.3 and Iba-1: 2.2 ± 0.8 vs PTZ: 3.2 ± 1.4). PRE-Ga presents neuroprotector effect in the mice model of epilepsy induced by pentylenetetrazole reducing seizures, gliosis, inflammatory cytokines and oxidative stress.
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Affiliation(s)
| | - Gislei Frota Aragão
- Superior Institute of Biomedical Sciences, State University of Ceará, 60714-903 Fortaleza, Ceará, Brazil
| | | | - Maria Gonçalves Pereira
- Superior Institute of Biomedical Sciences, State University of Ceará, 60714-903 Fortaleza, Ceará, Brazil
| | | | - Deysi Viviana Tenazoa Wong
- Department of Physiology and Pharmacology, Federal University of Ceará, 60455-760 Fortaleza, Ceará, Brazil
| | | | - Pedro Marcos Gomes Soares
- Department of Physiology and Pharmacology, Federal University of Ceará, 60455-760 Fortaleza, Ceará, Brazil
| | | | - Ana Maria Sampaio Assreuy
- Superior Institute of Biomedical Sciences, State University of Ceará, 60714-903 Fortaleza, Ceará, Brazil
| | - Edna Maria Camelo Chaves
- Superior Institute of Biomedical Sciences, State University of Ceará, 60714-903 Fortaleza, Ceará, Brazil.
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Liu Y, Cui Y, Xiao H, Cai J, Zeng W, Lu Z. Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy With Visual Field Defect: A Case Report. J Neuroophthalmol 2024; 44:e82-e84. [PMID: 36729821 DOI: 10.1097/wno.0000000000001781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Yang Liu
- Department of Neurology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, PR China
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Wang J, Tang C, Luo S. Letter to the Editor: a case of autoimmune glial fibrillary acidic protein astrocytopathy with acute paralytic ileus as initial symptom. Neurol Sci 2024; 45:1291-1293. [PMID: 37955783 DOI: 10.1007/s10072-023-07136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Jianing Wang
- Department of Cerebrovascular Disease, The Fifth Affliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China
| | - Chaogang Tang
- Department of Cerebrovascular Disease, The Fifth Affliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China
| | - Shijian Luo
- Department of Cerebrovascular Disease, The Fifth Affliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China.
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20
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Chiperi LE, Hutanu A. Glial Fibrillary Acidic Protein: Diagnostic and Prognostic Role in Psychomotor Development Dynamics in Patients with Congenital Heart Defects after Cardiovascular Surgery. Balkan Med J 2024; 41:151-152. [PMID: 38173149 PMCID: PMC10913118 DOI: 10.4274/balkanmedj.galenos.2023.2023-11-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Lacramioara Eliza Chiperi
- Clinic of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Heart Transplant, Targu Mures, Romania
- George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Adina Hutanu
- Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
- Laboratory of Humoral Immunology, Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
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21
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Malhotra AK, Ide K, Salaheen Z, Mahood Q, Cunningham J, Hutchison J, Guerguerian AM. Acute Fluid Biomarkers for Diagnosis and Prognosis in Children with Mild Traumatic Brain Injury: A Systematic Review. Mol Diagn Ther 2024; 28:169-187. [PMID: 38133736 DOI: 10.1007/s40291-023-00685-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Fluid biomarkers have the potential to improve the accuracy of diagnosis and prognosis in children with mild traumatic brain injury. Our primary objective was to assess the diagnostic and prognostic utility of acute blood and fluid biomarkers in children with mild traumatic brain injury. METHODS We performed a systematic review of the published literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Fluid biomarker studies assessing pediatric mild traumatic brain injury diagnosis or prognosis were included if blood or fluids were sampled within 24 h of injury. RESULTS Thirty-two studies involving 4743 patients were included comprising 25 diagnostic studies and ten prognostic studies with three studies assessing both diagnosis and prognosis. Sixteen of the 25 diagnostic studies reported the area under the receiver operating characteristic curve (AUC) for predicting abnormal computed tomography scans of the head; S100 calcium binding protein B (S100B, N = 6 studies, AUC range 0.67-1.00), glial fibrillary acidic protein (N = 5, AUC range 0.41-0.85), ubiquitin C-terminal hydrolase (N = 3, AUC 0.59 and 0.83), neuron specific enolase (N = 1, AUC 0.99), total tau (N = 1, AUC 0.65), and interleukin-6 (N = 1, AUC 0.61). In four of the ten prognostic studies, increased acute serum S100B levels, tumor necrosis factor-α, or interleukin-8 were associated with post-concussive symptoms or fatigue from 3 to 12 months post-injury. CONCLUSIONS The largest amount of evidence supported the potential use of S100B, glial fibrillary acidic protein, and UCH-L1, but there was mixed accuracy for diagnosis and prognostication for all biomarkers in pediatric mTBI.
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Affiliation(s)
- Armaan K Malhotra
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Kentaro Ide
- Department of Critical Care and Anesthesia, The National Center for Child Health and Development, Tokyo, Japan
| | - Zaid Salaheen
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Quenby Mahood
- Reference Library, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jessie Cunningham
- Reference Library, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jamie Hutchison
- Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Anne-Marie Guerguerian
- Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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22
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Yin P, Niu X, Guan C, Zhang Z, Liu Y, Li J, Cui G, Zan K, Xu C. Relationship between increased serum neurofilament light chain and glial fibrillary acidic protein levels with non-motor symptoms in patients with Parkinson's disease. Psychogeriatrics 2024; 24:415-425. [PMID: 38339819 DOI: 10.1111/psyg.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/14/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND This study set out to investigate the relationship between serum neurofilament light chain (NFL), glial fibrillary acidic protein (GFAP), and various non-motor symptoms (NMSs) in patients with Parkinson's disease (PD). METHODS The study included 37 healthy controls (HCs) and 51 PD patients. Clinical assessments of PD symptoms were conducted for all PD patients. The NMSS was utilised to evaluate the NMS burden (NMSB) in individuals. Based on the severity of NMSB, we further categorised the PD group into two subgroups: mild-moderate NMSB group and severe-very severe NMSB group. The amounts of NFL and GFAP in the serum were measured using an extremely sensitive single molecule array (Simoa) method. Statistical analyses were performed on the collected data using SPSS 26.0 and R (version 3.6.3). RESULTS Serum GFAP and NFL levels in the PD group with severe-very severe NMSB were significantly higher than those in the mild-moderate NMSB group (GFAP: P < 0.007; NFL: P < 0.009). Serum NFL and GFAP levels had positive correlations with NMSS total scores (GFAP: r = 0.326, P = 0.020; NFL: r = 0.318, P = 0.023) and multiple subdomains. The relationship between the attention/memory domains of NMSS and NFL levels is significantly positive (r = 0.283, P = 0.044). Similarly, the mood/apathy domains of NMSS are also significantly positively correlated with GFAP levels (r = 0.441, P = 0.001). Patients with emotional problems or cognitive impairment had higher GFAP or NFL levels, respectively. Furthermore, it has been demonstrated that NMSs play a mediating role in the quality of life of patients with PD. Moreover, the combination of NFL and GFAP has proven to be more effective than using a single component in identifying PD patients with severe-very severe NMSB. CONCLUSIONS The severity of NMSs in PD patients, particularly cognitive and emotional symptoms, was found to be associated with the levels of serum NFL and GFAP. This study marks the first attempt to examine the connection between NMSs of PD and the simultaneous identification of NFL and GFAP levels.
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Affiliation(s)
- Peixiao Yin
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Xuebin Niu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Chenyang Guan
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Zixuan Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Yuning Liu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Jinyu Li
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Guiyun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Kun Zan
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, China
| | - Chuanying Xu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, China
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23
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Silvestro S, Raffaele I, Quartarone A, Mazzon E. Innovative Insights into Traumatic Brain Injuries: Biomarkers and New Pharmacological Targets. Int J Mol Sci 2024; 25:2372. [PMID: 38397046 PMCID: PMC10889179 DOI: 10.3390/ijms25042372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
A traumatic brain injury (TBI) is a major health issue affecting many people across the world, causing significant morbidity and mortality. TBIs often have long-lasting effects, disrupting daily life and functionality. They cause two types of damage to the brain: primary and secondary. Secondary damage is particularly critical as it involves complex processes unfolding after the initial injury. These processes can lead to cell damage and death in the brain. Understanding how these processes damage the brain is crucial for finding new treatments. This review examines a wide range of literature from 2021 to 2023, focusing on biomarkers and molecular mechanisms in TBIs to pinpoint therapeutic advancements. Baseline levels of biomarkers, including neurofilament light chain (NF-L), ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1), Tau, and glial fibrillary acidic protein (GFAP) in TBI, have demonstrated prognostic value for cognitive outcomes, laying the groundwork for personalized treatment strategies. In terms of pharmacological progress, the most promising approaches currently target neuroinflammation, oxidative stress, and apoptotic mechanisms. Agents that can modulate these pathways offer the potential to reduce a TBI's impact and aid in neurological rehabilitation. Future research is poised to refine these therapeutic approaches, potentially revolutionizing TBI treatment.
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Affiliation(s)
| | | | | | - Emanuela Mazzon
- IRCCS Centro Neurolesi Bonino Pulejo, Via Provinciale Palermo, SS 113, Contrada Casazza, 98124 Messina, Italy; (S.S.); (I.R.); (A.Q.)
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24
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Wu J, Guo K, Liu J. Partially Reversible FLAIR Hyperintensity Along the Brainstem Surface in Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy. Neurology 2024; 102:e208064. [PMID: 38165301 DOI: 10.1212/wnl.0000000000208064] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
A 41-year-old woman presented with headache, fever, irritability, and confusion. She developed a coma after admission. MRI of the brain revealed periventricular and deep white matter lesions. Fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging hyperintensity along the brainstem surface was observed (Figure 1), considered a rare but characteristic finding in leptomeningeal carcinomatosis from lung cancer.1,2 However, serum tumor markers, CSF cytopathology, contrast-enhanced high-resolution chest CT, and whole-body PET were negative. Antiglial fibrillary acidic protein antibodies (cell-based assay) were positive in serum and CSF. After receiving intravenous methylprednisolone and immunoglobulin, the symptoms improved significantly. Repeated MRI of the brain showed partial resolution of the lesions (Figure 2). The lesions were possibly induced by immune-mediated intramyelinic edema.
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Affiliation(s)
- Jiongxing Wu
- From the Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Kundian Guo
- From the Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Junfeng Liu
- From the Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Abdelhak A, Antweiler K, Kowarik MC, Senel M, Havla J, Zettl UK, Kleiter I, Skripuletz T, Haarmann A, Stahmann A, Huss A, Gingele S, Krumbholz M, Benkert P, Kuhle J, Friede T, Ludolph AC, Ziemann U, Kümpfel T, Tumani H. Serum glial fibrillary acidic protein and disability progression in progressive multiple sclerosis. Ann Clin Transl Neurol 2024; 11:477-485. [PMID: 38111972 PMCID: PMC10863922 DOI: 10.1002/acn3.51969] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/29/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE Progression prediction is a significant unmet need in people with progressive multiple sclerosis (pwPMS). Studies on glial fibrillary acidic protein (GFAP) have either been limited to single center with relapsing MS or were based solely on Expanded Disability Status Scale (EDSS), which limits its generalizability to state-of-the-art clinical settings and trials applying combined outcome parameters. METHODS Serum GFAP and NfL (neurofilament light chain) were investigated in EmBioProMS participants with primary (PP) or secondary progressive MS. Six months confirmed disability progression (CDP) was defined using combined outcome parameters (EDSS, timed-25-foot walk test (T25FW), and nine-hole-peg-test (9HPT)). RESULTS 243 subjects (135 PPMS, 108 SPMS, age 55.5, IQR [49.7-61.2], 135 female, median follow-up: 29.3 months [17.9-40.9]) were included. NfL (age-) and GFAP (age- and sex-) adjusted Z scores were higher in pwPMS compared to HC (p < 0.001 for both). 111 (32.8%) CDP events were diagnosed in participants with ≥3 visits (n = 169). GFAP Z score >3 was associated with higher risk for CDP in participants with low NfL Z score (i.e., ≤1.0) (HR: 2.38 [1.12-5.08], p = 0.025). In PPMS, GFAP Z score >3 was associated with higher risk for CDP (HR: 2.88 [1.21-6.84], p = 0.016). Risk was further increased in PPMS subjects with high GFAP when NfL is low (HR: 4.31 [1.53-12.13], p = 0.006). INTERPRETATION Blood GFAP may help identify pwPPMS at risk of progression. Combination of high GFAP and low NfL levels could distinguish non-active pwPMS with particularly high progression risk.
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Affiliation(s)
- Ahmed Abdelhak
- Department of NeurologyUniversity of California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Department of NeurologyUniversity Hospital of UlmUlmGermany
| | - Kai Antweiler
- Department of Medical StatisticsUniversity Medical Centre GöttingenGöttingenGermany
| | - Markus C. Kowarik
- Department of Neurology and StrokeUniversity Hospital of TübingenTübingenGermany
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Makbule Senel
- Department of NeurologyUniversity Hospital of UlmUlmGermany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU HospitalLudwig‐Maximilians UniversityMunichGermany
| | - Uwe K. Zettl
- Department of Neurology, Neuroimmunological SectionUniversity of RostockRostockGermany
| | - Ingo Kleiter
- Marianne‐Strauß‐KlinikBehandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbHBergGermany
| | | | - Axel Haarmann
- Department of NeurologyUniversity Hospital WürzburgWürzburgGermany
| | - Alexander Stahmann
- Forschungs‐ und Projektentwicklungs‐gGmbHMS‐Registry by the German MS‐SocietyHanoverGermany
| | - Andre Huss
- Department of NeurologyUniversity Hospital of UlmUlmGermany
| | - Stefan Gingele
- Department of NeurologyHannover Medical SchoolHanoverGermany
| | - Markus Krumbholz
- Department of Neurology and StrokeUniversity Hospital of TübingenTübingenGermany
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
- Department of Neurology and Pain Treatment, Multiple Sclerosis Center, Center for Translational Medicine, Immanuel Klinik RüdersdorfUniversity Hospital of the Brandenburg Medical School Theodor FontaneRüdersdorf bei BerlinGermany
- Faculty of Health Sciences BrandenburgBrandenburg Medical School Theodor FontaneRüdersdorf bei BerlinGermany
| | - Pascal Benkert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Department of BiomedicineUniversity Hospital and University of BaselBaselSwitzerland
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Department of Clinical ResearchUniversity Hospital and University of BaselBaselSwitzerland
- Department of NeurologyUniversity Hospital and University of BaselBaselSwitzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Department of BiomedicineUniversity Hospital and University of BaselBaselSwitzerland
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Department of Clinical ResearchUniversity Hospital and University of BaselBaselSwitzerland
- Department of NeurologyUniversity Hospital and University of BaselBaselSwitzerland
| | - Tim Friede
- Department of Medical StatisticsUniversity Medical Centre GöttingenGöttingenGermany
| | - Albert C. Ludolph
- Department of NeurologyUniversity Hospital of UlmUlmGermany
- German Center for Neurodegenerative DiseasesUlmGermany
| | - Ulf Ziemann
- Department of Neurology and StrokeUniversity Hospital of TübingenTübingenGermany
- Hertie Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU HospitalLudwig‐Maximilians UniversityMunichGermany
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Brum WS, Ashton NJ, Simrén J, di Molfetta G, Karikari TK, Benedet AL, Zimmer ER, Lantero-Rodriguez J, Montoliu-Gaya L, Jeromin A, Aarsand AK, Bartlett WA, Calle PF, Coşkun A, Díaz-Garzón J, Jonker N, Zetterberg H, Sandberg S, Carobene A, Blennow K. Biological variation estimates of Alzheimer's disease plasma biomarkers in healthy individuals. Alzheimers Dement 2024; 20:1284-1297. [PMID: 37985230 PMCID: PMC10916965 DOI: 10.1002/alz.13518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Blood biomarkers have proven useful in Alzheimer's disease (AD) research. However, little is known about their biological variation (BV), which improves the interpretation of individual-level data. METHODS We measured plasma amyloid beta (Aβ42, Aβ40), phosphorylated tau (p-tau181, p-tau217, p-tau231), glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL) in plasma samples collected weekly over 10 weeks from 20 participants aged 40 to 60 years from the European Biological Variation Study. We estimated within- (CVI ) and between-subject (CVG ) BV, analytical variation, and reference change values (RCV). RESULTS Biomarkers presented considerable variability in CVI and CVG . Aβ42/Aβ40 had the lowest CVI (≈ 3%) and p-tau181 the highest (≈ 16%), while others ranged from 6% to 10%. Most RCVs ranged from 20% to 30% (decrease) and 25% to 40% (increase). DISCUSSION BV estimates for AD plasma biomarkers can potentially refine their clinical and research interpretation. RCVs might be useful for detecting significant changes between serial measurements when monitoring early disease progression or interventions. Highlights Plasma amyloid beta (Aβ42/Aβ40) presents the lowest between- and within-subject biological variation, but also changes the least in Alzheimer's disease (AD) patients versus controls. Plasma phosphorylated tau variants significantly vary in their within-subject biological variation, but their substantial fold-changes in AD likely limits the impact of their variability. Plasma neurofilament light chain and glial fibrillary acidic protein demonstrate high between-subject variation, the impact of which will depend on clinical context. Reference change values can potentially be useful in monitoring early disease progression and the safety/efficacy of interventions on an individual level. Serial sampling revealed that unexpectedly high values in heathy individuals can be observed, which urges caution when interpreting AD plasma biomarkers based on a single test result.
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Affiliation(s)
- Wagner S Brum
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- King's College London, Institute of Psychiatry, Psychology and Neuroscience Maurice Wohl Institute Clinical Neuroscience Institute, London, UK
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Joel Simrén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Guiglielmo di Molfetta
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Thomas K Karikari
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Benedet
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Eduardo R Zimmer
- Department of Biochemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Pharmacology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Graduate Program in Biological Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- McGill Centre for Studies in Aging, McGill University, Verdun, Quebec, Canada
| | - Juan Lantero-Rodriguez
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Laia Montoliu-Gaya
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | | | - Aasne K Aarsand
- European Federation of Clinical Chemistry and Laboratory Medicine Working Group on Biological Variation, Milan, Italy
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - William A Bartlett
- European Federation of Clinical Chemistry and Laboratory Medicine Working Group on Biological Variation, Milan, Italy
- School of Science and Engineering, University of Dundee, Dundee, UK
| | - Pilar Fernández Calle
- European Federation of Clinical Chemistry and Laboratory Medicine Working Group on Biological Variation, Milan, Italy
- Department of Laboratory Medicine, La Paz University Hospital, Madrid, Spain
| | - Abdurrahman Coşkun
- European Federation of Clinical Chemistry and Laboratory Medicine Working Group on Biological Variation, Milan, Italy
- School of Medicine, Department of Medical Biochemistry, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Jorge Díaz-Garzón
- European Federation of Clinical Chemistry and Laboratory Medicine Working Group on Biological Variation, Milan, Italy
- Department of Laboratory Medicine, La Paz University Hospital, Madrid, Spain
| | - Niels Jonker
- European Federation of Clinical Chemistry and Laboratory Medicine Working Group on Biological Variation, Milan, Italy
- Certe, Wilhelmina Ziekenhuis Assen, Assen, the Netherlands
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sverre Sandberg
- European Federation of Clinical Chemistry and Laboratory Medicine Working Group on Biological Variation, Milan, Italy
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Anna Carobene
- European Federation of Clinical Chemistry and Laboratory Medicine Working Group on Biological Variation, Milan, Italy
- Laboratory Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
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Desai P, Krueger KR, Mendes de Leon C, Wilson RS, Evans DA, Rajan KB. Depressive Symptoms, Glial Fibrillary Acid Protein Concentrations, and Cognitive Decline in a Cohort Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad129. [PMID: 37209409 PMCID: PMC10799753 DOI: 10.1093/gerona/glad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Little is known about how depressive symptoms and glial fibrillary acid protein (GFAP) concentrations taken together may influence cognitive functioning. Understanding this relationship may inform strategies for screening and early intervention to decrease the rate of cognitive decline. METHODS This study sample includes 1 169 participants from the Chicago Health and Aging Project (CHAP), consisting of 60% Black participants and 40% White participants, and 63% female participants and 37% male participants. CHAP is a population-based cohort study of older adults with a mean age of 77 years. Linear mixed-effects regression models tested the main effects of depressive symptoms and GFAP concentrations and their interactions on baseline cognitive function and cognitive decline over time. Models included adjustments for age, race, sex, education, chronic medical conditions, body mass index, smoking status, alcohol use, and their interactions with time. RESULTS The interaction of depressive symptomology and GFAP (β = -0.105 [standard error = 0.038], p = .006) on global cognitive function was statistically significant. Participants with depressive symptoms including and above the cutoff and high log of GFAP concentrations had more cognitive decline over time, followed by participants with depressive symptoms below the cutoff and high log of GFAP concentrations, depressive symptom scores including and above the cutoff and low log of GFAP concentrations, and depressive symptom scores below the cutoff and low log of GFAP concentrations. CONCLUSIONS Depressive symptoms have an additive effect on the association between the log of GFAP and baseline global cognitive function.
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Affiliation(s)
- Pankaja Desai
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, USA
| | - Kristin R Krueger
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Robert S Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Denis A Evans
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, USA
| | - Kumar B Rajan
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurology, University of California at Davis, Davis, USA
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van Gennip ACE, Satizabal CL, Tracy RP, Sigurdsson S, Gudnason V, Launer LJ, van Sloten TT. Associations of plasma NfL, GFAP, and t-tau with cerebral small vessel disease and incident dementia: longitudinal data of the AGES-Reykjavik Study. GeroScience 2024; 46:505-516. [PMID: 37530894 PMCID: PMC10828267 DOI: 10.1007/s11357-023-00888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023] Open
Abstract
We investigated the associations of plasma neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and total tau (t-tau) with markers of cerebral small vessel disease (SVD) and with incident dementia. We also investigated whether associations of NfL, GFAP, and t-tau with incident dementia were explained by SVD. Data are from a random subsample (n = 1069) of the population-based AGES-Reykjavik Study who underwent brain MRI and in whom plasma NfL, GFAP, and t-tau were measured at baseline (76.1 ± 5.4 years/55.9% women/baseline 2002-2006/follow-up until 2015). A composite SVD burden score was calculated using white matter hyperintensity volume (WMHV), subcortical infarcts, cerebral microbleeds, and large perivascular spaces. Dementia was assessed in a 3-step process and adjudicated by specialists. Higher NfL was associated with a higher SVD burden score. Dementia occurred in 225 (21.0%) individuals. The SVD burden score significantly explained part of the association between NfL and incident dementia. WMHV mostly strongly contributed to the explained effect. GFAP was not associated with the SVD burden score, but was associated with WMHV, and WMHV significantly explained part of the association between GFAP and incident dementia. T-tau was associated with WMHV, but not with incident dementia. In conclusion, the marker most strongly related to SVD is plasma NfL, for which the association with WMHV appeared to explain part of its association with incident dementia. This study suggests that plasma NfL may reflect the contribution of co-morbid vascular disease to dementia. However, the magnitude of the explained effect was relatively small, and further research is required to investigate the clinical implications of this finding.
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Affiliation(s)
- April C E van Gennip
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
| | - Russell P Tracy
- Laboratory for Clinical Biochemistry Research, The Robert Larner M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Thomas T van Sloten
- Department of Vascular Medicine, Utrecht University Medical Center, Utrecht, The Netherlands.
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29
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Schneider R, Brand-Arzamendi K, Reynold Lim T, Lee LE, Guenette M, Suthiphosuwan S, Bharatha A, Oh J. Plasma glial fibrillary acidic protein levels correlate with paramagnetic rim lesions in people with radiologically isolated syndrome. Mult Scler 2024; 30:156-165. [PMID: 38145319 DOI: 10.1177/13524585231219131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND There are no specific, evidence-based recommendations for the management of individuals with radiologically isolated syndrome. Imaging and blood biomarkers may have prognostic utility. OBJECTIVE To determine whether plasma neurofilament light protein (NfL) or glial fibrillary acidic protein (GFAP) levels in people with radiologically isolated syndrome correlate with imaging measures that have been shown to be associated with negative clinical outcomes in people with multiple sclerosis. METHODS Cross-sectional analysis of people with radiologically isolated syndrome. Participants underwent magnetic resonance imaging (MRI) of the brain and cervical spinal cord, and plasma was collected. Plasma NfL and GFAP levels were measured with a single-molecule array, and correlations with MRI measures were assessed, including the number of: T1-black holes, white-matter lesions demonstrating the central vein sign, paramagnetic rim lesions, cervical spinal cord lesions and infratentorial lesions. RESULTS Plasma GFAP levels, but not NfL levels, showed correlations with the number of T1-black holes, white matter lesions demonstrating the central vein sign and paramagnetic rim lesions (all p < 0.05). CONCLUSION We found correlations between plasma GFAP levels and imaging measures associated with poor clinical outcomes and chronic inflammation in individuals with radiologically isolated syndrome. Plasma GFAP may have prognostic utility in clinical trials and clinical practice.
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Affiliation(s)
- Raphael Schneider
- Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- BARLO MS Centre, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Koroboshka Brand-Arzamendi
- Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Timothy Reynold Lim
- Department of Radiology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Lisa Eunyoung Lee
- Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Melanie Guenette
- Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Suradech Suthiphosuwan
- Department of Radiology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Aditya Bharatha
- Department of Radiology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jiwon Oh
- Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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30
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Trivedi D, Forssten MP, Cao Y, Ismail AM, Czeiter E, Amrein K, Kobeissy F, Wang KKW, DeSoucy E, Buki A, Mohseni S. Screening Performance of S100 Calcium-Binding Protein B, Glial Fibrillary Acidic Protein, and Ubiquitin C-Terminal Hydrolase L1 for Intracranial Injury Within Six Hours of Injury and Beyond. J Neurotrauma 2024; 41:349-358. [PMID: 38115670 DOI: 10.1089/neu.2023.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
The Scandinavian NeuroTrauma Committee (SNC) guidelines recommend S100 calcium-binding protein B (S100B) as a screening tool for early detection of Traumatic brain injury (TBI) in patients presenting with an initial Glasgow Coma Scale (GCS) of 14-15. The objective of the current study was to compare S100B's diagnostic performance within the recommended 6-h window after injury, compared with glial fibrillary acidic protein (GFAP) and UCH-L1. The secondary outcome of interest was the ability of these biomarkers in detecting traumatic intracranial pathology beyond the 6-h mark. The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core database (2014-2017) was queried for data pertaining to all TBI patients with an initial GCS of 14-15 who had a blood sample taken within 6 h of injury in which the levels of S100B, GFAP, and UCH-L1 were measured. As a subgroup analysis, data involving patients with blood samples taken within 6-9 h and 9-12 h were analyzed separately for diagnostic ability. The diagnostic ability of these biomarkers for detecting any intracranial injury was evaluated based on the area under the receiver operating characteristic curve (AUC). Each biomarker's sensitivity, specificity, and accuracy were also reported at the cutoff that maximized Youden's index. A total of 531 TBI patients with GCS 14-15 on admission had a blood sample taken within 6 h, of whom 24.9% (n = 132) had radiologically confirmed intracranial injury. The AUCs of GFAP (0.86, 95% confidence interval [CI]: 0.82-0.90) and UCH-L1 (0.81, 95% CI: 0.76-0.85) were statistically significantly higher than that of S100B (0.74, 95% CI: 0.69-0.79) during this time. There was no statistically significant difference in the predictive ability of S100B when sampled within 6 h, 6-9 h, and 9-12 h of injury, as the p values were >0.05 when comparing the AUCs. Overlapping AUC 95% CI suggests no benefit of a combined GFAP and UCH-L1 screening tool over GFAP during the time periods studied [0.87 (0.83-0.90) vs. 0.86 (0.82-0.90) when sampled within 6 h of injury, 0.83 (0.78-0.88) vs. 0.83 (0.78-0.89) within 6 to 9 h and 0.81 (0.73-0.88) vs. 0.79 (0.72-0.87) within 9-12 h]. Targeted analysis of the CENTER-TBI core database, with focus on the patient category for which biomarker testing is recommended by the SNC guidelines, revealed that GFAP and UCH-L1 perform superior to S100B in predicting CT-positive intracranial lesions within 6 h of injury. GFAP continued to exhibit superior predictive ability to S100B during the time periods studied. S100B displayed relatively unaltered screening performance beyond the diagnostic timeline provided by SNC guidelines. These findings suggest the need for a reevaluation of the current SNC TBI guidelines.
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Affiliation(s)
- Dhanisha Trivedi
- Department of Neurosurgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences , Orebro University Hospital, Orebro, Sweden
| | | | - Yang Cao
- Clinical Epidemiology and Biostatistics, Orebro University Hospital, Orebro, Sweden
| | | | - Endre Czeiter
- Department of Neurosurgery, University of Pecs, Pecs, Hungary
- Neurotrauma Research Group, Szentágothai Research Center, University of Pecs, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, University of Pecs, Pecs, Hungary
| | - Krisztina Amrein
- Department of Neurosurgery, University of Pecs, Pecs, Hungary
- Neurotrauma Research Group, Szentágothai Research Center, University of Pecs, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, University of Pecs, Pecs, Hungary
| | - Firas Kobeissy
- Center for Neurotrauma, Multiomics, and Biomarkers, Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Kevin K W Wang
- Center for Neurotrauma, Multiomics, and Biomarkers, Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Erik DeSoucy
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City-Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Andras Buki
- Department of Neurosurgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences , Orebro University Hospital, Orebro, Sweden
| | - Shahin Mohseni
- School of Medical Sciences , Orebro University Hospital, Orebro, Sweden
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31
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Zhang J, Liu D, Xiang J, Yang M. Combining Glial Fibrillary Acidic Protein and Neurofilament Light Chain for the Diagnosis of Major Depressive Disorder. Anal Chem 2024; 96:1693-1699. [PMID: 38231554 DOI: 10.1021/acs.analchem.3c04825] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Major depressive disorder (MDD) is a prevalent brain disorder affecting more than 2% of the world's population. Due to the lack of well-specific biomarkers, it is difficult to distinguish MDD from other diseases with similar clinical symptoms (such as Alzheimer's disease and cerebral thrombosis). In this work, we provided a strategy to address this issue by constructing a combinatorial biomarker of serum glial fibrillary acidic protein (GFAP) and neurofilament light chain (NFL). To achieve the convenient and sensitive detection of two proteins, we developed an electrochemical immunosandwich sensor using two metal-ion-doped carbon dots (Pb-CDs and Cu-CDs) as probes for signal output. Each probe contains approximately 300 Pb2+ or 200 Cu2+, providing excellent signal amplification. This method achieved detection limits of 0.3 pg mL-1 for GFAP and 0.2 pg mL-1 for NFL, lower than most of the reported detection limits. Analysis of real serum samples showed that the concentration ratio of GFAP to NFL, which is associated with the relative degree of brain inflammation and neurodegeneration, is suitable for not only distinguishing MDD from healthy individuals but also specifically distinguishing MDD from Alzheimer's disease and cerebral thrombosis. The good specificity gives the combinatorial GFAP/NFL biomarker broad application prospects in the screening, diagnosis, and treatment of MDD.
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Affiliation(s)
- JinXia Zhang
- College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, P. R. China
| | - Dan Liu
- Eye Center of Xiangya Hospital, Central South University, Changsha 410083, P. R. China
| | - Juan Xiang
- College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, P. R. China
| | - Minghui Yang
- College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, P. R. China
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32
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Li M, Liu H, Xu M, Yu B, Guo M, Wang X, Shi G, Zhou R. Glial Fibrillary Acidic Protein as a Potential Indicator for Symptomatic Intracranial Hemorrhage in Acute Ischemic Patients Undergoing Endovascular Thrombectomy. Clin Interv Aging 2024; 19:123-132. [PMID: 38283765 PMCID: PMC10813222 DOI: 10.2147/cia.s448180] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/04/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024] Open
Abstract
Background The correlation between glial fibrillary acidic protein (GFAP) and symptomatic intracranial hemorrhage (sICH) in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT) treatment remains uncertain. We aimed to assess the association between levels of GFAP in the bloodstream and the occurrence of sICH. Methods Between June 2019 and May 2023, 142 consecutive AIS patients undergoing EVT at Stroke Center and 35 controls from the Physical Examination Center were retrospectively included. The levels of GFAP in the bloodstream were quantified using enzyme-linked immunosorbent assay prior to endovascular treatment (T1) and 24 h after the procedure (T2). The identification of sICH was based on the Heidelberg Bleeding Classification. Results Serum GFAP levels at T1 in AIS patients were significantly higher than those in the controls (0.249 [0.150-0.576] versus 0.065 [0.041-0.110] ng/mL, p = 0.001), and there was a notably elevation in GFAP levels at T2 compared to T1 (3.813 [1.474, 5.876] versus 0.249 [0.150-0.576] ng/mL, p = 0.001). Of the 142 AIS patients, 18 (14.5%) had sICH after EVT. Serum GFAP levels at T2 showed significant associations with sICH in both the unadjusted model (OR 1.513, 95% CI 1.269-1.805, p = 0.001) and multivariable adjusted model (OR 1.518, 95% CI 1.153-2.000, p = 0.003). Furthermore, the addition of GFAP at T2 to conventional model resulted in a significant enhancement of risk reclassification for sICH (integrated discrimination improvement [IDI] 0.183, 95% CI 0.070-0.295, p = 0.001). Conclusion Serum GFAP levels were notably increased in AIS patients 24 h after EVT. Elevated GFAP levels were correlated to an elevated risk of sICH. GFAP could potentially serve as a dependable indicator for sICH in AIS individuals who treated with EVT.
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Affiliation(s)
- Minghao Li
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Vascular Surgery, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Hua Liu
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Mingyang Xu
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Baiyang Yu
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing Clinical College of Bengbu Medical College, Bengbu, Anhui, People’s Republic of China
| | - Minwang Guo
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Xiaorong Wang
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Guomei Shi
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Rujuan Zhou
- Stroke Center, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
- Department of Neurology, Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
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Tajiri M, Takasone K, Kodaira M, Kimura A, Shimohata T, Sekijima Y. Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy Following SARS-CoV-2 Infection. Intern Med 2024; 63:337-339. [PMID: 37952950 PMCID: PMC10864074 DOI: 10.2169/internalmedicine.2751-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/01/2023] [Indexed: 11/14/2023] Open
Abstract
We herein report the first case of autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy after coronavirus disease 2019 (COVID-19). A 23-year-old man experienced fatigue, a fever, and headache 14 days after the resolution of COVID-19. He was severely disoriented and admitted to our hospital. On admission, the patient exhibited disorientation, headache, neck stiffness, myoclonus of both upper limbs, dysuria, and pyramidal signs. A blood examination revealed hyponatremia, and a cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis. The CSF test results were positive for anti-GFAPα antibodies. The patient was treated with methylprednisolone pulse therapy, followed by oral prednisolone, which quickly ameliorated his neurological abnormalities.
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Affiliation(s)
- Masateru Tajiri
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Ken Takasone
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Minori Kodaira
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
| | | | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
- Institute for Biomedical Sciences, Shinshu University, Japan
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34
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Zheng X, Yang J, Hou Y, Shi X, Liu K. Prediction of clinical progression in nervous system diseases: plasma glial fibrillary acidic protein (GFAP). Eur J Med Res 2024; 29:51. [PMID: 38216970 PMCID: PMC10785482 DOI: 10.1186/s40001-023-01631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/29/2023] [Indexed: 01/14/2024] Open
Abstract
Glial fibrillary acidic protein (GFAP), an intracellular type III intermediate filament protein, provides structural support and maintains the mechanical integrity of astrocytes. It is predominantly found in the astrocytes which are the most abundant subtypes of glial cells in the brain and spinal cord. As a marker protein of astrocytes, GFAP may exert a variety of physiological effects in neurological diseases. For example, previous published literatures showed that autoimmune GFAP astrocytopathy is an inflammatory disease of the central nervous system (CNS). Moreover, the studies of GFAP in brain tumors mainly focus on the predictive value of tumor volume. Furthermore, using biomarkers in the early setting will lead to a simplified and standardized way to estimate the poor outcome in traumatic brain injury (TBI) and ischemic stroke. Recently, observational studies revealed that cerebrospinal fluid (CSF) GFAP, as a valuable potential diagnostic biomarker for neurosyphilis, had a sensitivity of 76.60% and specificity of 85.56%. The reason plasma GFAP could serve as a promising biomarker for diagnosis and prediction of Alzheimer's disease (AD) is that it effectively distinguished AD dementia from multiple neurodegenerative diseases and predicted the individual risk of AD progression. In addition, GFAP can be helpful in differentiating relapsing-remitting multiple sclerosis (RRMS) versus progressive MS (PMS). This review article aims to provide an overview of GFAP in the prediction of clinical progression in neuroinflammation, brain tumors, TBI, ischemic stroke, genetic disorders, neurodegeneration and other diseases in the CNS and to explore the potential therapeutic methods.
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Affiliation(s)
- Xiaoxiao Zheng
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 1#, Changchun, China
| | - Jingyao Yang
- Institute of Physiology, School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Yiwei Hou
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 1#, Changchun, China
| | - Xinye Shi
- Department of Cardiology, Shanxi Yingkang Yisheng General Hospital, Renmin North Road 5188#, Yuncheng, China
| | - Kangding Liu
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 1#, Changchun, China.
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Zvozilova A, Reichova A, Mach M, Bakos J, Koprdova R. Effect of a New Substance with Pyridoindole Structure on Adult Neurogenesis, Shape of Neurons, and Behavioral Outcomes in a Chronic Mild Stress Model in Rats. Int J Mol Sci 2024; 25:845. [PMID: 38255918 PMCID: PMC10815319 DOI: 10.3390/ijms25020845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Despite an accumulating number of studies, treatments for depression are currently insufficient. Therefore, the search for new substances with antidepressant potential is very important. In this study, we hypothesized that treatment with a newly synthesized pyridoindole derivative compound SMe1EC2M3 would result in protective and antidepressant-like effects on behavioral outcomes and reverse the impaired adult hippocampal neurogenesis caused by chronic mild stress (CMS). We found that chronic administration of 5 mg/kg and 25 mg/kg SMe1EC2M3 to adult Sprague Dawley rats ameliorated the consequences of CMS on immobility and swimming time in a forced swim test. A slight sedative effect of the highest dose of SMe1EC2M3 in the nonstress group was observed in the open field. SMe1EC2M3 in the highest dose ameliorated CMS-induced decreases in the sucrose preference test. Administration of SMe1EC2M3 significantly increased SOX2-positive cells in the hippocampal dentate gyrus (DG) in CMS compared to control animals. A significant reduction in glial fibrillary acid protein (GFAP)-positive cells in the DG of CMS compared to control animals was observed. Administration of both 5 and 25 mg/kg SMe1EC2M3 significantly increased signal of GFAP-positive cells in the DG of CMS animals. No such effects of SMe1EC2M3 were observed in the cornu ammonis hippocampal area. Additionally, we found that incubation of primary hippocampal neurons in the presence of 1.50 µM SMe1EC2M3 significantly stimulated the length of neurites. Overall, we found that the negative effects of CMS on depression-like behavior are partially reduced by the administration of SMe1EC2M3 and are associated with changes in hippocampal neurogenesis and neuronal differentiation. SMe1EC2M3 represents a potential drug candidate with positive neuroplastic effects and neurogenesis-associated effects in therapeutic approaches to depression.
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Affiliation(s)
- Alexandra Zvozilova
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia; (A.Z.); (R.K.)
| | - Alexandra Reichova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia;
| | - Mojmir Mach
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia; (A.Z.); (R.K.)
| | - Jan Bakos
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia;
- Institute of Physiology, Faculty of Medicine, Comenius University, 811 08 Bratislava, Slovakia
| | - Romana Koprdova
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia; (A.Z.); (R.K.)
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36
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Phillips KA, Lopez M, Bartling-John E, Meredith R, Buteau A, Alvarez A, Ross CN. Serum biomarkers associated with aging and neurodegeneration in common marmosets (Callithrix jacchus). Neurosci Lett 2024; 819:137569. [PMID: 38000775 PMCID: PMC10841648 DOI: 10.1016/j.neulet.2023.137569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
The common marmoset (Callithrix jacchus), a small South American monkey, is an important nonhuman primate model in the study of aging and age-related neurodegenerative disease, including Alzheimer's disease, Parkinson's disease, and related dementias. Thorough characterization of the wild type marmoset brain agingmodel, including biomarkers of aging and neural degeneration, will further the marmoset's utility in translational research. We measured serum concentration of four key biomarkers of neural degeneration [total tau (T-tau), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and ubiquitin C-terminal hydrolase-L1 (UCH-L1)] via single molecule array from 24 marmosets (female n = 13, male n = 11) ranging in age from 1.3 to 18.7 years. Aged marmosets (>7 years) had significantly higher GFAP, NfL, UCH-L1, and T-tau than adult marmosets. Sex differences were not detected for any of these biomarker concentrations. These data provide an important initial range of reference values for GFAP, NfL, T-tau, and UCH-L1 to evaluate aging and neural health in marmosets, as well as evaluation of therapeutics in clinical models of disease.
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Affiliation(s)
- Kimberley A Phillips
- Department of Psychology, Trinity University, San Antonio Texas 78212, USA; Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio Texas USA.
| | - Matthew Lopez
- Department of Psychology, Trinity University, San Antonio Texas 78212, USA; Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio Texas USA
| | | | | | - Anna Buteau
- Department of Psychology, Trinity University, San Antonio Texas 78212, USA
| | - Addaline Alvarez
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio Texas USA
| | - Corinna N Ross
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio Texas USA; Texas Biomedical Research Institute, San Antonio Texas USA
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Hsiung PY, Shih PY, Wu YL, Chen HT, Hsu HH, Lin MW, Cheng YJ, Wu CY. Effects of nonintubated thoracoscopic surgery on postoperative neurocognitive function: a randomized controlled trial. Eur J Cardiothorac Surg 2024; 65:ezad434. [PMID: 38175778 DOI: 10.1093/ejcts/ezad434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/11/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES Postoperative neurocognitive disorder following thoracoscopic surgery with general anaesthesia may be linked to reduced intraoperative cerebral oxygenation and perioperative inflammation, which can potentially be exacerbated by mechanical ventilation. However, nonintubated thoracoscopic surgery, which utilizes regional anaesthesia and maintains spontaneous breathing, provides a unique model for studying the potential benefits of avoiding mechanical ventilation. This approach allows investigation into the impact on perioperative neurocognitive profiles, inflammatory responses and intraoperative cerebral oxygen levels. METHODS In total, 110 patients undergoing thoracoscopic surgery were randomly equally assigned to the intubated group and the nonintubated group. Regional cerebral oxygenation was monitored during surgery. Serum neuroinflammatory biomarkers, including interleukin-6 and glial fibrillary acidic protein, were measured at baseline (before surgery) and 24 h after surgery. Postoperative complication severity was compared using the Comprehensive Complication Index. The primary outcome was perioperative changes in neurocognitive test score, which was assessed at baseline, 24 h and 6 months after surgery. RESULTS Patients in the nonintubated group had higher neurocognitive test scores at 24 h (69.9 ± 10.5 vs 65.3 ± 11.8; P = 0.03) and 6 months (70.6 ± 6.7 vs 65.4 ± 8.1; P < 0.01) after surgery and significantly higher regional cerebral oxygenation over time during one-lung ventilation (P = 0.03). Patients in the intubated group revealed a significantly higher postoperative serum interleukin-6 level (group by time interaction, P = 0.04) and a trend towards a significantly higher serum glial fibrillary acidic protein level (group by time interaction, P = 0.11). Furthermore, patients in the nonintubated group had a significantly lower Comprehensive Complication Index (9.0 ± 8.2 vs 6.1 ± 7.1; P < 0.05). CONCLUSIONS Nonintubated thoracoscopic surgery was associated with improved postoperative neurocognitive recovery, more stable intraoperative cerebral oxygenation, ameliorated perioperative inflammation and attenuated postoperative complication severity.
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Affiliation(s)
- Ping-Yan Hsiung
- Department of Anesthesiology, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Po-Yuan Shih
- Department of Anesthesiology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yi-Luen Wu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hsin-Ting Chen
- Department of Anesthesiology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University, Taipei City, Taiwan
| | - Mong-Wei Lin
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University, Taipei City, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chun-Yu Wu
- Department of Anesthesiology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
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LoBue C, Stopschinski BE, Calveras NS, Douglas PM, Huebinger R, Cullum CM, Hart J, Gonzales MM. Blood Markers in Relation to a History of Traumatic Brain Injury Across Stages of Cognitive Impairment in a Diverse Cohort. J Alzheimers Dis 2024; 97:345-358. [PMID: 38143366 PMCID: PMC10947497 DOI: 10.3233/jad-231027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) has been linked to multiple pathophysiological processes that could increase risk for Alzheimer's disease and related dementias (ADRD). However, the impact of prior TBI on blood biomarkers for ADRD remains unknown. OBJECTIVE Using cross-sectional data, we assessed whether a history of TBI influences serum biomarkers in a diverse cohort (approximately 50% Hispanic) with normal cognition, mild cognitive impairment, or dementia. METHODS Levels of glial fibrillary acidic protein (GFAP), neurofilament light (NFL), total tau (T-tau), and ubiquitin carboxy-terminal hydrolase-L1 (UCHL1) were measured for participants across the cognitive spectrum. Participants were categorized based on presence and absence of a history of TBI with loss of consciousness, and study samples were derived through case-control matching. Multivariable general linear models compared concentrations of biomarkers in relation to a history of TBI and smoothing splines modelled biomarkers non-linearly in the cognitively impaired groups as a function of time since symptom onset. RESULTS Each biomarker was higher across stages of cognitive impairment, characterized by clinical diagnosis and Mini-Mental State Examination performance, but these associations were not influenced by a history of TBI. However, modelling biomarkers in relation to duration of cognitive symptoms for ADRD showed differences by history of TBI, with only GFAP and UCHL1 being elevated. CONCLUSIONS Serum GFAP, NFL, T-tau, and UCHL1 were higher across stages of cognitive impairment in this diverse clinical cohort, regardless of TBI history, though longitudinal investigation of the timing, order, and trajectory of the biomarkers in relation to prior TBI is warranted.
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Affiliation(s)
- Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas,TX
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Barbara E. Stopschinski
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
- Center for Alzheimer’s and Neurodegenerative Diseases, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nil Saez Calveras
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
- Center for Alzheimer’s and Neurodegenerative Diseases, University of Texas Southwestern Medical Center, Dallas, TX
| | - Peter M. Douglas
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ryan Huebinger
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - C. Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas,TX
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas,TX
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mitzi M. Gonzales
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, San Antonio, TX
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Korhonen O, Mononen M, Mohammadian M, Tenovuo O, Blennow K, Hossain I, Hutchinson P, Maanpää HR, Menon DK, Newcombe VF, Sanchez JC, Takala RSK, Tallus J, van Gils M, Zetterberg H, Posti JP. Outlier Analysis for Acute Blood Biomarkers of Moderate and Severe Traumatic Brain Injury. J Neurotrauma 2024; 41:91-105. [PMID: 37725575 DOI: 10.1089/neu.2023.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Blood biomarkers have been studied to improve the clinical assessment and prognostication of patients with moderate-severe traumatic brain injury (mo/sTBI). To assess their clinical usability, one needs to know of potential factors that might cause outlier values and affect clinical decision making. In a prospective study, we recruited patients with mo/sTBI (n = 85) and measured the blood levels of eight protein brain pathophysiology biomarkers, including glial fibrillary acidic protein (GFAP), S100 calcium-binding protein B (S100B), neurofilament light (Nf-L), heart-type fatty acid-binding protein (H-FABP), interleukin-10 (IL-10), total tau (T-tau), amyloid β40 (Aβ40) and amyloid β42 (Aβ42), within 24 h of admission. Similar analyses were conducted for controls (n = 40) with an acute orthopedic injury without any head trauma. The patients with TBI were divided into subgroups of normal versus abnormal (n = 9/76) head computed tomography (CT) and favorable (Glasgow Outcome Scale Extended [GOSE] 5-8) versus unfavorable (GOSE <5) (n = 38/42, 5 missing) outcome. Outliers were sought individually from all subgroups from and the whole TBI patient population. Biomarker levels outside Q1 - 1.5 interquartile range (IQR) or Q3 + 1.5 IQR were considered as outliers. The medical records of each outlier patient were reviewed in a team meeting to determine possible reasons for outlier values. A total of 29 patients (34%) combined from all subgroups and 12 patients (30%) among the controls showed outlier values for one or more of the eight biomarkers. Nine patients with TBI and five control patients had outlier values in more than one biomarker (up to 4). All outlier values were > Q3 + 1.5 IQR. A logical explanation was found for almost all cases, except the amyloid proteins. Explanations for outlier values included extremely severe injury, especially for GFAP and S100B. In the case of H-FABP and IL-10, the explanation was extracranial injuries (thoracic injuries for H-FABP and multi-trauma for IL-10), in some cases these also were associated with abnormally high S100B. Timing of sampling and demographic factors such as age and pre-existing neurological conditions (especially for T-tau), explained some of the abnormally high values especially for Nf-L. Similar explanations also emerged in controls, where the outlier values were caused especially by pre-existing neurological diseases. To utilize blood-based biomarkers in clinical assessment of mo/sTBI, very severe or fatal TBIs, various extracranial injuries, timing of sampling, and demographic factors such as age and pre-existing systemic or neurological conditions must be taken into consideration. Very high levels seem to be often associated with poor prognosis and mortality (GFAP and S100B).
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Affiliation(s)
- Otto Korhonen
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, Turko, Finland
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
| | - Malla Mononen
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, Turko, Finland
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
| | - Mehrbod Mohammadian
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
| | - Olli Tenovuo
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Iftakher Hossain
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, Turko, Finland
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Peter Hutchinson
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Henna-Riikka Maanpää
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, Turko, Finland
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Virginia F Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jean-Charles Sanchez
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Finland
| | - Jussi Tallus
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
- Department of Radiology, Turku University Hospital and University of Turku, Finland
| | - Mark van Gils
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, Turko, Finland
- Turku Brain Injury Center, Turku University Hospital and University of Turku, Turko, Finland
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turko, Finland
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Robertson CS, Martinez FS, McQuillan LE, Williamson J, Lamb DG, Wang KKW, Rubenstein R, Wagner AK. Serial Measurements of Serum Glial Fibrillary Acidic Protein in Moderate-Severe Traumatic Brain Injury: Potential Utility in Providing Insights into Secondary Insults and Long-Term Outcome. J Neurotrauma 2024; 41:73-90. [PMID: 37489296 DOI: 10.1089/neu.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
In patients with traumatic brain injury (TBI), serum biomarkers may have utility in assessing the evolution of secondary brain injury. A panel of nine brain-injury- associated biomarkers was measured in archived serum samples over 10 days post-injury from 100 patients with moderate-severe TBI. Among the biomarkers evaluated, serum glial fibrillary acidic protein (GFAP) had the strongest associations with summary measures of acute pathophysiology, including intracranial pressure (ICP), cerebral perfusion pressure (CPP), and brain tissue pO2 (PbtO2). Group based trajectory (TRAJ) analysis was used to identify three distinct GFAP subgroups. The low TRAJ group (n = 23) had peak levels of 9.4 + 1.2 ng/mL that declined rapidly. The middle TRAJ group (n = 48) had higher peak values (31.5 + 5.0 ng/mL) and a slower decline over time. The high TRAJ group (n = 26) had very high, sustained peak values (59.6 + 12.5 ng/mL) that even rose among some patients over 10 days. Patients in the high TRAJ group had significantly higher mortality rate than patients in low and middle TRAJ groups (26.9% vs. 7.0%, p = 0.028). The frequency of poor neurological outcome (Glasgow Outcome Score Extended [GOS-E] 1-4) was 88.5% in the high TRAJ group, 54.2% in the middle TRAJ group, and 30.4% in the low TRAJ group (p < 0.001). ICP was highest in the high TRAJ group (median 17.6 mm Hg), compared with 14.4 mmHg in the low and 15.9 mm Hg in middle TRAJ groups (p = 0.002). High TRAJ patients spent the longest time with ICP >25 mm Hg, median 23 h, compared with 2 and 6 h in the low and middle TRAJ groups (p = 0.006), and the longest time with ICP >30 mm Hg, median 5 h, compared with 0 and 1 h in the low and middle TRAJ groups, respectively (p = 0.013). High TRAJ group patients more commonly required tier 2 or 3 treatment to control ICP. The high TRAJ group had the longest duration when CPP was <50 mm Hg (p = 0.007), and PbtO2 was <10 mm Hg (p = 0.002). Logistical regression was used to study the relationship between temporal serum GFAP patterns and 6-month GOS-E. Here, the low and middle TRAJ groups were combined to form a low-risk group, and the high TRAJ group was designated the high-risk group. High TRAJ group patients had a greater chance of a poor 6-month GOS-E (p < 0.0001). When adjusting for baseline injury characteristics, GFAP TRAJ group membership remained associated with GOS-E (p = 0.003). When an intensive care unit (ICU) injury burden score, developed to quantify physiological derangements, was added to the model, GFAP TRAJ group membership remained associated with GOS-E (p = 0.014). Mediation analysis suggested that ICU burden scores were in the causal pathway between TRAJ group and 6-month mortality or GOS-E. Our results suggest that GFAP may be useful to monitor serially in moderate-severe TBI patients. Future studies in larger cohorts are needed to confirm these results.
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Affiliation(s)
| | | | - Leah E McQuillan
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John Williamson
- Brain Rehabilitation Research Center, Malcolm Randall VA Medical Center, Gainesville, Florida, USA
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Damon G Lamb
- Brain Rehabilitation Research Center, Malcolm Randall VA Medical Center, Gainesville, Florida, USA
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin K W Wang
- Brain Rehabilitation Research Center, Malcolm Randall VA Medical Center, Gainesville, Florida, USA
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Richard Rubenstein
- Department of Neurology, State University of New York-Downstate Health Sciences University, Brooklyn, New York, USA
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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41
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Kobeissy F, Arja RD, Munoz JC, Shear DA, Gilsdorf J, Zhu J, Yadikar H, Haskins W, Tyndall JA, Wang KK. The game changer: UCH-L1 and GFAP-based blood test as the first marketed in vitro diagnostic test for mild traumatic brain injury. Expert Rev Mol Diagn 2024; 24:67-77. [PMID: 38275158 DOI: 10.1080/14737159.2024.2306876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Major organ-based in vitro diagnostic (IVD) tests like ALT/AST for the liver and cardiac troponins for the heart are established, but an approved IVD blood test for the brain has been missing, highlighting a gap in medical diagnostics. AREAS COVERED In response to this need, Abbott Diagnostics secured FDA clearance in 2021 for the i-STAT Alinity™, a point-of-care plasma blood test for mild traumatic brain injury (TBI). BioMerieux VIDAS, also approved in Europe, utilizes two brain-derived protein biomarkers: neuronal ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP). These biomarkers, which are typically present in minimal amounts in healthy individuals, are instrumental in diagnosing mild TBI with potential brain lesions. The study explores how UCH-L1 and GFAP levels increase significantly in the bloodstream following traumatic brain injury, aiding in early and accurate diagnosis. EXPERT OPINION The introduction of the i-STAT Alinity™ and the Biomerieux VIDAS TBI blood tests mark a groundbreaking development in TBI diagnosis. It paves the way for the integration of TBI biomarker tools into clinical practice and therapeutic trials, enhancing the precision medicine approach by generating valuable data. This advancement is a critical step in addressing the long-standing gap in brain-related diagnostics and promises to revolutionize the management and treatment of mild TBI.
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Affiliation(s)
- Firas Kobeissy
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Rawad Daniel Arja
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Jennifer C Munoz
- Department of Pediatric Critical Care, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah A Shear
- Brain Trauma Neuroprotection & Neurorestoration (BTNN) Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Janice Gilsdorf
- Brain Trauma Neuroprotection & Neurorestoration (BTNN) Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Jiepei Zhu
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Hamad Yadikar
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Biological Sciences, Kuwait University, Safat, Kuwait
| | | | | | - Kevin K Wang
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
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Halloway S, Evans DA, Desai P, Dhana K, Beck T, Rajan KB. Serum total tau, neurofilament light, and glial fibrillary acidic protein are associated with mortality in a population study. J Am Geriatr Soc 2024; 72:149-159. [PMID: 37818793 PMCID: PMC10842309 DOI: 10.1111/jgs.18632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/04/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Total tau (t-tau), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) are neuronal cytoskeletal biomarkers that may indicate greater risk of poor outcomes in age-related conditions, including mortality. Health disparities experienced by some racial minority subgroups may influence biomarker expression and effects on longevity. We aimed to examine (a) associations of serum t-tau, NfL, and GFAP with overall and cardiovascular mortality and (b) differences in associations by racial background. METHODS Data came from 1327 older participants from the Chicago Health and Aging Project (CHAP), a longitudinal population-based study. Cox proportional hazards regression models were used to examine associations between concentrations of serum t-tau, NfL, and GFAP biomarker(s) and mortality (overall/cardiovascular mortality based on age at death). Interaction terms were used to examine differences between African-American and European-American participants. Models were adjusted for age, sex, education, the APOE-ε4 allele, body mass index, chronic health conditions, and cognitive and physical functioning. RESULTS Models showed that fivefold higher concentrations of t-tau (HR = 1.46, 95% CI: 1.27, 1.68), NfL (HR = 2.13, 95% CI: 1.76, 2.58), and GFAP (HR = 1.43, 95% CI: 1.08, 1.90) were separately associated with increased risk of overall mortality, with higher risk in African Americans in t-tau or NfL. In models with all biomarkers, NfL (HR = 2.17, 95% CI: 1.65, 2.85) was associated with risk of overall mortality, with racial differences in t-tau. Higher concentrations of t-tau (HR = 1.32, 95% CI: 1.02, 1.70), NfL (HR = 1.95, 95% CI: 1.40, 2.72), and GFAP (HR = 1.87, 95% CI: 1.18, 2.98) were separately associated with risk of cardiovascular mortality, with racial differences in t-tau, NfL, or GFAP. In combined models, NfL (HR = 1.73, 95% CI: 1.08, 2.78) was associated with cardiovascular mortality. CONCLUSIONS Serum t-tau, NfL, and GFAP may be early indicators for mortality outcomes among older adults, with racial differences among associations.
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Affiliation(s)
- Shannon Halloway
- University of Illinois Chicago College of Nursing, University of Illinois Chicago, Chicago, IL
| | - Denis A. Evans
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - Pankaja Desai
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - Klodian Dhana
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - Todd Beck
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL
| | - Kumar B. Rajan
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL
- Department of Neurology, University of California at Davis, Davis, CA
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Bien CG, Büttner T, Reichen IC, Thomas A, Vlad B, Woermann F, Bien CI, Jelcic I. Glial Fibrillary Acidic Protein Autoimmunity After Aseptic Meningitis: A Report of 2 Cases. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200180. [PMID: 37949666 PMCID: PMC10691222 DOI: 10.1212/nxi.0000000000200180] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/21/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES We describe 2 patients with glial fibrillary acidic protein (GFAP) autoimmunity secondary to aseptic viral meningitis or meningoencephalomyelitis. METHODS This study involved a retrospective chart review. RESULTS Two female patients, 45 and 55 years of age, developed aseptic meningoencephalomyelitis or meningitis; in one patient, it was likely caused by herpes simplex virus 2. The patients were recovering from the infectious condition when they, 51 and 5 days after onset, had new symptoms with detection of GFAP antibodies in the CSF; CSF and serum samples from the initial lumbar punctures had been negative for GFAP antibodies. Both patients recovered with steroid treatment (in one case, plus rituximab; in the other, plus azathioprine) including resolution of MRI and CSF abnormalities. DISCUSSION These 2 patients had GFAP autoimmunity secondary to viral meningoencephalomyelitis or meningitis. This suggests that GFAP astrocytopathy might not always be a primary disease entity; it may follow another brain injury that triggers this autoimmune response.
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Affiliation(s)
- Christian G Bien
- From the Bielefeld University (C.G.B.); Klinikum Emden (T.B., A.T.), Germany; University Hospital Zurich and University of Zurich (I.C.R., B.V., I.J.), Switzerland; Laboratory Krone (C.I.B.), Bad Salzuflen; Krankenhaus Mara (F.W.), Bielefeld, Germany.
| | - Thomas Büttner
- From the Bielefeld University (C.G.B.); Klinikum Emden (T.B., A.T.), Germany; University Hospital Zurich and University of Zurich (I.C.R., B.V., I.J.), Switzerland; Laboratory Krone (C.I.B.), Bad Salzuflen; Krankenhaus Mara (F.W.), Bielefeld, Germany
| | - Ina C Reichen
- From the Bielefeld University (C.G.B.); Klinikum Emden (T.B., A.T.), Germany; University Hospital Zurich and University of Zurich (I.C.R., B.V., I.J.), Switzerland; Laboratory Krone (C.I.B.), Bad Salzuflen; Krankenhaus Mara (F.W.), Bielefeld, Germany
| | - Annette Thomas
- From the Bielefeld University (C.G.B.); Klinikum Emden (T.B., A.T.), Germany; University Hospital Zurich and University of Zurich (I.C.R., B.V., I.J.), Switzerland; Laboratory Krone (C.I.B.), Bad Salzuflen; Krankenhaus Mara (F.W.), Bielefeld, Germany
| | - Benjamin Vlad
- From the Bielefeld University (C.G.B.); Klinikum Emden (T.B., A.T.), Germany; University Hospital Zurich and University of Zurich (I.C.R., B.V., I.J.), Switzerland; Laboratory Krone (C.I.B.), Bad Salzuflen; Krankenhaus Mara (F.W.), Bielefeld, Germany
| | - Friedrich Woermann
- From the Bielefeld University (C.G.B.); Klinikum Emden (T.B., A.T.), Germany; University Hospital Zurich and University of Zurich (I.C.R., B.V., I.J.), Switzerland; Laboratory Krone (C.I.B.), Bad Salzuflen; Krankenhaus Mara (F.W.), Bielefeld, Germany
| | - Corinna I Bien
- From the Bielefeld University (C.G.B.); Klinikum Emden (T.B., A.T.), Germany; University Hospital Zurich and University of Zurich (I.C.R., B.V., I.J.), Switzerland; Laboratory Krone (C.I.B.), Bad Salzuflen; Krankenhaus Mara (F.W.), Bielefeld, Germany.
| | - Ilijas Jelcic
- From the Bielefeld University (C.G.B.); Klinikum Emden (T.B., A.T.), Germany; University Hospital Zurich and University of Zurich (I.C.R., B.V., I.J.), Switzerland; Laboratory Krone (C.I.B.), Bad Salzuflen; Krankenhaus Mara (F.W.), Bielefeld, Germany
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Åkerlund CAI, Holst A, Bhattacharyay S, Stocchetti N, Steyerberg E, Smielewski P, Menon DK, Ercole A, Nelson DW. Clinical descriptors of disease trajectories in patients with traumatic brain injury in the intensive care unit (CENTER-TBI): a multicentre observational cohort study. Lancet Neurol 2024; 23:71-80. [PMID: 37977157 DOI: 10.1016/s1474-4422(23)00358-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Patients with traumatic brain injury are a heterogeneous population, and the most severely injured individuals are often treated in an intensive care unit (ICU). The primary injury at impact, and the harmful secondary events that can occur during the first week of the ICU stay, will affect outcome in this vulnerable group of patients. We aimed to identify clinical variables that might distinguish disease trajectories among patients with traumatic brain injury admitted to the ICU. METHODS We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. We included patients aged 18 years or older with traumatic brain injury who were admitted to the ICU at one of the 65 CENTER-TBI participating centres, which range from large academic hospitals to small rural hospitals. For every patient, we obtained pre-injury data and injury features, clinical characteristics on admission, demographics, physiological parameters, laboratory features, brain biomarkers (ubiquitin carboxy-terminal hydrolase L1 [UCH-L1], S100 calcium-binding protein B [S100B], tau, neurofilament light [NFL], glial fibrillary acidic protein [GFAP], and neuron-specific enolase [NSE]), and information about intracranial pressure lowering treatments during the first 7 days of ICU stay. To identify clinical variables that might distinguish disease trajectories, we applied a novel clustering method to these data, which was based on a mixture of probabilistic graph models with a Markov chain extension. The relation of clusters to the extended Glasgow Outcome Scale (GOS-E) was investigated. FINDINGS Between Dec 19, 2014, and Dec 17, 2017, 4509 patients with traumatic brain injury were recruited into the CENTER-TBI core dataset, of whom 1728 were eligible for this analysis. Glucose variation (defined as the difference between daily maximum and minimum glucose concentrations) and brain biomarkers (S100B, NSE, NFL, tau, UCH-L1, and GFAP) were consistently found to be the main clinical descriptors of disease trajectories (ie, the leading variables contributing to the distinguishing clusters) in patients with traumatic brain injury in the ICU. The disease trajectory cluster to which a patient was assigned in a model was analysed as a predictor together with variables from the IMPACT model, and prediction of both mortality and unfavourable outcome (dichotomised GOS-E ≤4) was improved. INTERPRETATION First-day ICU admission data are not the only clinical descriptors of disease trajectories in patients with traumatic brain injury. By analysing temporal variables in our study, variation of glucose was identified as the most important clinical descriptor that might distinguish disease trajectories in the ICU, which should direct further research. Biomarkers of brain injury (S100B, NSE, NFL, tau, UCH-L1, and GFAP) were also top clinical descriptors over time, suggesting they might be important in future clinical practice. FUNDING European Union 7th Framework program, Hannelore Kohl Stiftung, OneMind, Integra LifeSciences Corporation, and NeuroTrauma Sciences.
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Affiliation(s)
- Cecilia A I Åkerlund
- Department of Physiology and Pharmacology, Section of Anaesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Anders Holst
- School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | | | - Nino Stocchetti
- Department of Physiopathology and Transplant, Milan University, Milan, Italy; Fondazione IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ewout Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | | | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Ari Ercole
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK; Centre for Artificial Intelligence in Medicine, University of Cambridge, Cambridge, UK
| | - David W Nelson
- Department of Physiology and Pharmacology, Section of Anaesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, Stockholm, Sweden.
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45
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Munoz Pareja JC, de Rivero Vaccari JP, Chavez MM, Kerrigan M, Pringle C, Guthrie K, Swaby K, Coto J, Kobeissy F, Avery KL, Ghosh S, Dhanashree R, Shanmugham P, Lautenslager LA, Faulkenberry S, Pareja Zabala MC, Al Fakhri N, Loor-Torres R, Governale LS, Blatt JE, Gober J, Perez PK, Solano J, McCrea H, Thorson C, O'Phelan KH, Keane RW, Dietrich WD, Wang KK. Prognostic and Diagnostic Utility of Serum Biomarkers in Pediatric Traumatic Brain Injury. J Neurotrauma 2024; 41:106-122. [PMID: 37646421 PMCID: PMC11071081 DOI: 10.1089/neu.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Traumatic brain injury (TBI) remains a major cause of morbidity and death among the pediatric population. Timely diagnosis, however, remains a complex task because of the lack of standardized methods that permit its accurate identification. The aim of this study was to determine whether serum levels of brain injury biomarkers can be used as a diagnostic and prognostic tool in this pathology. This prospective, observational study collected and analyzed the serum concentration of neuronal injury biomarkers at enrollment, 24h and 48h post-injury, in 34 children ages 0-18 with pTBI and 19 healthy controls (HC). Biomarkers included glial fibrillary acidic protein (GFAP), neurofilament protein L (NfL), ubiquitin-C-terminal hydrolase (UCH-L1), S-100B, tau and tau phosphorylated at threonine 181 (p-tau181). Subjects were stratified by admission Glasgow Coma Scale score into two categories: a combined mild/moderate (GCS 9-15) and severe (GCS 3-8). Glasgow Outcome Scale-Extended (GOS-E) Peds was dichotomized into favorable (≤4) and unfavorable (≥5) and outcomes. Data were analyzed utilizing Prism 9 and R statistical software. The findings were as follows: 15 patients were stratified as severe TBI and 19 as mild/moderate per GCS. All biomarkers measured at enrollment were elevated compared with HC. Serum levels for all biomarkers were significantly higher in the severe TBI group compared with HC at 0, 24, and 48h. The GFAP, tau S100B, and p-tau181 had the ability to differentiate TBI severity in the mild/moderate group when measured at 0h post-injury. Tau serum levels were increased in the mild/moderate group at 24h. In addition, NfL and p-tau181 showed increased serum levels at 48h in the aforementioned GCS category. Individual biomarker performance on predicting unfavorable outcomes was measured at 0, 24, and 48h across different GOS-E Peds time points, which was significant for p-tau181 at 0h at all time points, UCH-L1 at 0h at 6-9 months and 12 months, GFAP at 48h at 12 months, NfL at 0h at 12 months, tau at 0h at 12 months and S100B at 0h at 12 months. We concluded that TBI leads to increased serum neuronal injury biomarkers during the first 0-48h post-injury. A biomarker panel measuring these proteins could aid in the early diagnosis of mild to moderate pTBI and may predict neurological outcomes across the injury spectrum.
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Affiliation(s)
- Jennifer C. Munoz Pareja
- Department of Pediatric Critical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Juan Pablo de Rivero Vaccari
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maria Mateo Chavez
- Knowledge and Research Evaluation Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Kerrigan
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Charlene Pringle
- Department of Pediatric Critical Care, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kourtney Guthrie
- Department of Pediatric Critical Care, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kathryn Swaby
- Department of Pediatric Critical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jennifer Coto
- Department of University of Miami Concussion Program, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Firas Kobeissy
- Department of Emergency Medicine, Multiomics & Biomarkers (CNMB), Morehouse University, School of Medicine, Atlanta, Georgia, USA
- Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Morehouse University, School of Medicine, Atlanta, Georgia, USA
| | - K. Leslie Avery
- Department of Pediatric Critical Care, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Suman Ghosh
- Department of Pediatric Neurology, Downstate Health Science University, New York, New York, USA
| | - Rajderkar Dhanashree
- Department of Radiology, Division of Pediatric Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Prashanth Shanmugham
- Department of Pediatric Critical Care, UT Southwestern University, Dallas, Texas, USA
| | - Lauren A. Lautenslager
- Department of Plastic Surgery, Indiana University School of Medicine, Bloomington, Indiana, USA
| | - Shannon Faulkenberry
- Department of Pediatric Critical Care, Orlando Regional Medical Center, Orlando, Florida, USA
| | | | - Nora Al Fakhri
- Department of Pediatric Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ricardo Loor-Torres
- Knowledge and Research Evaluation Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Lance S. Governale
- Department of Pediatric Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jason E. Blatt
- Department of Pediatric Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Joslyn Gober
- Department of Pediatric Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paula Karina Perez
- Department of Pediatrics, Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Juan Solano
- Department of Pediatric Critical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Heather McCrea
- Department of Pediatric Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chad Thorson
- Department of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kristine H. O'Phelan
- Department of Neurology and Neurocritical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert W. Keane
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Physiology and Biophysics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - W. Dalton Dietrich
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kevin K. Wang
- Department of Emergency Medicine, Multiomics & Biomarkers (CNMB), Morehouse University, School of Medicine, Atlanta, Georgia, USA
- Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Morehouse University, School of Medicine, Atlanta, Georgia, USA
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Michael BD, Dunai C, Needham EJ, Tharmaratnam K, Williams R, Huang Y, Boardman SA, Clark JJ, Sharma P, Subramaniam K, Wood GK, Collie C, Digby R, Ren A, Norton E, Leibowitz M, Ebrahimi S, Fower A, Fox H, Tato E, Ellul MA, Sunderland G, Held M, Hetherington C, Egbe FN, Palmos A, Stirrups K, Grundmann A, Chiollaz AC, Sanchez JC, Stewart JP, Griffiths M, Solomon T, Breen G, Coles AJ, Kingston N, Bradley JR, Chinnery PF, Cavanagh J, Irani SR, Vincent A, Baillie JK, Openshaw PJ, Semple MG, Taams LS, Menon DK. Para-infectious brain injury in COVID-19 persists at follow-up despite attenuated cytokine and autoantibody responses. Nat Commun 2023; 14:8487. [PMID: 38135686 PMCID: PMC10746705 DOI: 10.1038/s41467-023-42320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/06/2023] [Indexed: 12/24/2023] Open
Abstract
To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1-11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, tTau, GFAP, NfL, and UCH-L1 are increased with COVID-19 infection at acute timepoints and NfL and GFAP are significantly higher in participants with neurological complications. Inflammatory mediators (IL-6, IL-12p40, HGF, M-CSF, CCL2, and IL-1RA) are associated with both altered consciousness and markers of brain injury. Autoantibodies are more common in COVID-19 than controls and some (including against MYL7, UCH-L1, and GRIN3B) are more frequent with altered consciousness. Additionally, convalescent participants with neurological complications show elevated GFAP and NfL, unrelated to attenuated systemic inflammatory mediators and to autoantibody responses. Overall, neurological complications of COVID-19 are associated with evidence of neuroglial injury in both acute and late disease and these correlate with dysregulated innate and adaptive immune responses acutely.
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Affiliation(s)
- Benedict D Michael
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK.
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, L69 7BE, UK.
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7BB, UK.
| | - Cordelia Dunai
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, L69 7BE, UK
| | - Edward J Needham
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Kukatharmini Tharmaratnam
- Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, L69 3GF, UK
| | - Robyn Williams
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Departments of Neurology and Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Yun Huang
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Sarah A Boardman
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Jordan J Clark
- University of Liverpool, Liverpool, L69 7BE, UK
- Department of Microbiology, Icahn School of Medicine, Mount Sinai, NY, 10029, USA
- Center for Vaccine Research and Pandemic Preparedness (C-VARPP), Icahn School of Medicine, Mount Sinai, NY, 10029, USA
| | - Parul Sharma
- Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L3 5RF, UK
| | - Krishanthi Subramaniam
- Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L3 5RF, UK
| | - Greta K Wood
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Ceryce Collie
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Richard Digby
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Alexander Ren
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Emma Norton
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Maya Leibowitz
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Soraya Ebrahimi
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Andrew Fower
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Hannah Fox
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Esteban Tato
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, SE5 8AF, UK
| | - Mark A Ellul
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7BB, UK
| | - Geraint Sunderland
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Marie Held
- Centre for Cell Imaging, Liverpool Shared Research Facilities, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 7ZB, UK
| | - Claire Hetherington
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Franklyn N Egbe
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Alish Palmos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, SE5 8AF, UK
| | - Kathy Stirrups
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge, CB2 0QQ, UK
- Department of Haematology, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Alexander Grundmann
- Clinical Neurosciences, Clinical and Experimental Science, Faculty of Medicine, University of Southampton, Southampton, SO17 1BF, UK
- Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Anne-Cecile Chiollaz
- Département de médecine interne des spécialités (DEMED), University of Geneva, Geneva, CH-1211, Switzerland
| | - Jean-Charles Sanchez
- Département de médecine interne des spécialités (DEMED), University of Geneva, Geneva, CH-1211, Switzerland
| | - James P Stewart
- Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L3 5RF, UK
| | - Michael Griffiths
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Tom Solomon
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, L69 7BE, UK
- The Walton Centre NHS Foundation Trust, Liverpool, L9 7BB, UK
- The Pandemic Institute, Liverpool, L7 3FA, UK
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- NIHR Maudsley Biomedical Research Centre, King's College London, London, SE5 8AF, UK
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Nathalie Kingston
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge, CB2 0QQ, UK
- University of Cambridge, Cambridge, CB2 0QQ, UK
| | - John R Bradley
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge, CB2 0QQ, UK
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Patrick F Chinnery
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge, CB2 0QQ, UK
| | - Jonathan Cavanagh
- Centre for Immunology, School of Infection & Immunity, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8TA, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Departments of Neurology and Neuroscience, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, EH25 9RG, UK
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, EH10 5HF, UK
| | - Peter J Openshaw
- National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UK
- Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Malcolm G Semple
- Clinical Infection, Microbiology, and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, L69 7BE, UK
- Respiratory Unit, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, L14 5AB, UK
| | - Leonie S Taams
- Centre for Inflammation Biology and Cancer Immunology, King's College London, London, SE1 9RT, UK
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK
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Tang M, Huang S, Guo W, Zhou J, Huang Z, Li W, Sun Q, Wang Z. Case report: Excessive daytime sleepiness as a presenting manifestation of autoimmune glial fibrillary acidic protein astrocytopathy. Front Immunol 2023; 14:1302514. [PMID: 38173730 PMCID: PMC10761546 DOI: 10.3389/fimmu.2023.1302514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) is a recently discovered autoimmune inflammatory disease of the central nervous system. It presents with a variety of clinical symptoms, including fever, seizures, psychiatric symptoms, limber weakness, and sensory symptoms. However, the symptoms of sleep disorders have not been sufficiently addressed. Here, we report a case of GFAP-A in which the patient complained of excessive daytime sleepiness and an excessive need for sleep. Our patient was a 58-year-old male who experienced excessive daytime sleepiness for 50 days following SARS-CoV-2 infection. He was diagnosed with coronavirus disease 2019 on June 1st. On the 7th of June, he experienced excessive daytime sleepiness, nausea, reduced food intake, lower limb weakness, and dysuria. Subsequently, his sleepiness significantly deteriorated on July 21st. Five months prior, the patient underwent laparoscopic partial right nephrectomy for clear-cell renal cell carcinoma. Brain MRI revealed abnormal hyperintense lesions in the pontine brain and around the mesencephalic aqueduct on T2 and T2-fluid attenuated inversion recovery (T2-FLAIR) sequences However, these lesions did not exhibit any pathological enhancement. Spinal cord MRI revealed lesions in the C6-C7 and T2-T3 segments on the T2 sequence. His Epworth Sleepiness Scale (ESS) score was 16 (reference range, <10), and 24-hour polysomnography supported the diagnosis of rapid-eye-movement sleep disorder and severe sleep apnea-hypopnea syndrome. Glial fibrillary acidic protein IgG antibodies were detected in the cerebrospinal fluid (1:32, cell-based assay) but not in the serum. The level of hypocretin in the cerebrospinal fluid was 29.92 pg/mL (reference range ≥110 pg/mL), suggesting narcolepsy type 1. After treatment with corticosteroids for approximately 1 month, the patient showed considerable clinical and radiological improvement, as well as an increase in hypocretin levels. Although repeated polysomnography and multiple sleep latency tests suggested narcolepsy, his ESS score decreased to 8. Our findings broaden the range of clinical manifestations associated with GFAP-A, thereby enhancing diagnostic and therapeutic strategies for this disease. Additionally, our results indicate a potential common autoimmune mechanism involving GFAP-A and orexin system dysregulation, warranting further investigation.
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Affiliation(s)
| | | | | | | | | | | | | | - Zan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
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Baran Aİ, Huyut Z, Öncü MR, Akbay Hİ, Akmeşe Ş, Karsen H, Alp HH, Hakseven Karaduman Z, Tarcan T. Evaluation of cerebrospinal fluid levels for ALOX5, S100B, DEFA1, and GFAP in infectious meningitis. Medicine (Baltimore) 2023; 102:e36463. [PMID: 38115295 PMCID: PMC10727538 DOI: 10.1097/md.0000000000036463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND The aim of this study was to determine how the levels of peptide and protein-based biomarkers in cerebrospinal fluid change in bacterial, tuberculous, and aseptic meningitis, and to determine the success of these agents in distinguishing between different types of infectious meningitis. METHODS The levels of arachidonate-5-lipoxygenase, S100 calcium-binding protein B, defensin-α 1, and glial fibrillary acidic protein in cerebrospinal fluid samples from 20 tuberculosis, 40 bacterial, 25 aseptic meningitis patients, and 55 control groups were measured and compared using an enzyme-linked immunosorbent assay. RESULTS The mean age of the patients was 37.9 ± 14.4 years. The parameter that contributed the most to the differential diagnosis of the infectious meningitis groups was S100 calcium-binding protein B. The S100 calcium-binding protein B levels were significantly higher in the tuberculous meningitis group than in the other groups, and arachidonate-5-lipoxygenase levels were significantly higher in the tuberculous meningitis and bacterial meningitis groups (P < .05). CONCLUSION This study showed that cerebrospinal fluid arachidonate-5-lipoxygenase, and S100 calcium-binding protein B levels may differ in bacterial, aseptic, and tuberculous meningitis, and the results obtained may be quite effective as important potential biomarkers in the differential diagnosis of different types of meningitis.
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Affiliation(s)
- Ali İrfan Baran
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Zübeyir Huyut
- Department of Biochemistry, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Mehmet Reşit Öncü
- Department of Emergency Medicine, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Halil İbrahim Akbay
- Department of Biochemistry, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Şükrü Akmeşe
- Departmant of Pharmacy Services Program, Vocational School of Health, Harran University, Sanliurfa, Turkey
| | - Hasan Karsen
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Hamit Hakan Alp
- Department of Biochemistry, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Zekiye Hakseven Karaduman
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
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49
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Lowe MC, Money KM, Matthews E, Pastula DM, Piquet AL. case of autoimmune GFAP astrocytopathy with eosinophils in the cerebrospinal fluid. J Neuroimmunol 2023; 385:578249. [PMID: 37992587 DOI: 10.1016/j.jneuroim.2023.578249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
Cerebrospinal fluid (CSF) eosinophilia is associated with a narrow differential, primarily including parasitic and fungal infections, neoplasm, and chemical meningitis. It has rarely been reported in neuroinflammatory conditions including as a finding of CSF cytology in two autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy cases. Here we describe a case of autoimmune GFAP astrocytopathy with classic clinical and radiographic features as well as presence of eosinophils in the CSF. This case highlights a potential association of eosinophils in the CSF with autoimmune GFAP astrocytopathy, which may suggest its inclusion in the differential diagnosis of eosinophilic meningitis, encephalitis, or myelitis.
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Affiliation(s)
- Mallory C Lowe
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Kelli M Money
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Elizabeth Matthews
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Daniel M Pastula
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America; Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States of America
| | - Amanda L Piquet
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America.
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50
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Xu T, Chen J, Xuan T, Cheng J, Li H. Autoimmune glial fibrillary acidic protein astrocytopathy complicated with low flow perimedullary arteriovenous fistula: a case report. Front Immunol 2023; 14:1293425. [PMID: 38111582 PMCID: PMC10726202 DOI: 10.3389/fimmu.2023.1293425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023] Open
Abstract
Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy and low-flow perimedullary arteriovenous fistulas (PMAVFs) may cause longitudinal widespread myelopathy. We report a middle-aged male patient with autoimmune GFAP astrocytopathy complicated with low flow PMAVFs disease, presenting with lower extremity weakness and dysuria. Magnetic resonance imaging (MRI) of the spinal cord revealed a significant longitudinal extent of T2 high signal from T11 to L1, with the lesion located proximal to the vascular territory supplied by the anterior spinal artery. Multiple patchy abnormal signals were seen adjacent to the anterior and posterior horns of the lateral ventricles bilaterally and at the centers of the semi-ovals on MRI of the cranial brain, with iso signal in T1Flair, the high signal in T2WI, and no high signal seen in Diffusion Weighted Imaging (DWI). Subsequently, the presence of anti-GFAP antibodies was detected in the cerebrospinal fluid (CSF), and the diagnosis of autoimmune GFAP astrocytopathy in conjunction with low-flow PMAVFs was confirmed through spinal digital subtraction angiography (DSA). This case report aims to increase neurologists' awareness of this disease and avoid missed or misdiagnosed cases that may lead to delayed treatment.
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Affiliation(s)
- Ting Xu
- Department of Neuroelectrophysiology, Cardiovascular and Cerebrovascular Disease Hospital Branch, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jingyun Chen
- Department of Neuroelectrophysiology, Cardiovascular and Cerebrovascular Disease Hospital Branch, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Tingting Xuan
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Jiang Cheng
- Diagnosis and Treatment Engineering Technology Research Center of Nevous System Disease of Ningxia Hui Autonomous Region, Yinchuan, China
- Department of Neurology, Cardiovascular and Cerebrovascular Disease Hospital Branch, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Haining Li
- Diagnosis and Treatment Engineering Technology Research Center of Nevous System Disease of Ningxia Hui Autonomous Region, Yinchuan, China
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, China
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