RESUMEN
BACKGROUND: Multiple sclerosis (MS) is an immune-mediated demyelinating disorder of the central nervous system. The glycosphingolipid sulfatide, a lipid particularly enriched in the myelin sheath, has been shown to be involved the maintenance of this specific membrane structure. Sulfatide in cerebrospinal fluid (CSF) may reflect demyelination, a dominating feature of MS. We investigated the diagnostic utility of CSF sulfatide isoform levels to separate different courses or phenotypes of MS disease. MATERIAL AND METHODS: This was a mono-center, cross-sectional study of relapsing-remitting MS (RRMS) (n = 45) and progressive MS (PMS) (n = 42) patients (consisting of primary PMS (n = 17) and secondary PMS (n = 25)) and healthy controls (n = 19). In total, 20 sulfatide isoforms were measured in CSF by liquid chromatography-mass spectrometry. RESULTS: CSF total sulfatide concentrations, as well as CSF sulfatide isoform distribution, did not differ across the study groups, and their levels were independent of disease course/phenotype, disease duration, time to conversion to secondary PMS, age, and disability in MS patients. CONCLUSION: CSF sulfatide isoforms lack diagnostic and prognostic utility as a biomarker for progressive MS.
Asunto(s)
Esclerosis Múltiple Crónica Progresiva , Esclerosis Múltiple Recurrente-Remitente , Esclerosis Múltiple , Humanos , Esclerosis Múltiple Recurrente-Remitente/diagnóstico , Esclerosis Múltiple Recurrente-Remitente/líquido cefalorraquídeo , Esclerosis Múltiple/diagnóstico , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Sulfoglicoesfingolípidos/química , Estudios Transversales , Esclerosis Múltiple Crónica Progresiva/diagnóstico , Esclerosis Múltiple Crónica Progresiva/líquido cefalorraquídeo , Biomarcadores/líquido cefalorraquídeo , Isoformas de ProteínasRESUMEN
BACKGROUND: Sulfatides (STs) in cerebrospinal fluid (CSF), as well as magnetic resonance imaging (MRI)-detected white matter hyperintensities (WMHs), may reflect demyelination. Here, we investigated the diagnostic utility of CSF ST levels in the subcortical small vessel type of dementia (SSVD), which is characterized by the presence of brain WMHs. OBJECTIVE: To study the diagnostic utility of CSF ST levels in SSVD. METHODS: This was a mono-center, cross-sectional study of SSVD (nâ=â16), Alzheimer's disease (nâ=â40), mixed dementia (nâ=â27), and healthy controls (nâ=â33). Totally, 20 ST species were measured in CSF by liquid chromatography-mass spectrometry (LC-MS/MS). RESULTS: CSF total ST levels, as well as CSF levels of hydroxylated and nonhydroxylated ST species, did not differ across the study groups. In contrast, CSF neurofilament light chain (NFL) levels separated the patient groups from the controls. CSF total ST level correlated with CSF/serum albumin ratio in the total study population (râ=â0.64, pâ<â0.001) and in all individual study groups. Furthermore, CSF total ST level correlated positively with MRI-estimated WMH volume in the total study population (râ=â0.30, pâ<â0.05), but it did not correlate with CSF NFL level. CONCLUSION: Although there was some relation between CSF total ST level and WMH volume, CSF ST levels were unaltered in all dementia groups compared to the controls. This suggests that CSF total ST level is a poor biomarker of demyelination in SSVD. Further studies are needed to investigate the mechanisms underlying the marked correlation between CSF total ST level and CSF/serum albumin ratio.
Asunto(s)
Enfermedad de Alzheimer , Demencia Vascular , Enfermedades Desmielinizantes , Imagen por Resonancia Magnética/métodos , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Sustancia Blanca/diagnóstico por imagen , Anciano , Enfermedad de Alzheimer/líquido cefalorraquídeo , Enfermedad de Alzheimer/diagnóstico , Cromatografía Liquida/métodos , Estudios Transversales , Demencia Vascular/líquido cefalorraquídeo , Demencia Vascular/diagnóstico , Demencia Vascular/fisiopatología , Enfermedades Desmielinizantes/líquido cefalorraquídeo , Enfermedades Desmielinizantes/diagnóstico , Diagnóstico Diferencial , Técnicas de Diagnóstico Neurológico , Femenino , Humanos , Masculino , Proteínas de Neurofilamentos/líquido cefalorraquídeo , Utilización de Procedimientos y Técnicas , Reproducibilidad de los Resultados , Sustancia Blanca/patologíaRESUMEN
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). Several biomarkers including proteins and lipids have been reported in MS cerebrospinal fluid (CSF), reflecting different aspects of the pathophysiology particularly of relapsing-remitting MS (RRMS). Sulfatide, abundant in the myelin sheath and a proposed target for autoimmune attack in MS, has been reported altered in MS CSF. Here, we investigated the potential of CSF sulfatide and its isoforms as biomarkers in MS. A highly sensitive and quantitative mass spectrometry method was employed to determine levels of sulfatide isoforms in CSF from RRMS and progressive MS (PMS) patients, and healthy donors (HD). We demonstrate that levels of total CSF sulfatide and C24:1, C26:1, and C26:1-OH isoforms were significantly increased in PMS compared with RRMS patients and HD, while C23:0-OH was significantly decreased in CSF from PMS patients compared to the other two groups. Multivariate discriminant analysis showed that CSF sulfatide isoform pattern in PMS patients was distinct and non-overlapping with that of RRMS patients and HD. Sulfatide levels did not correlate with tested biomarkers or clinical parameters. The results suggest that CSF sulfatide isoform levels may be used to discriminate the phenotype of MS and might play a role in the progression of the disease.
Asunto(s)
Esclerosis Múltiple Recurrente-Remitente/líquido cefalorraquídeo , Esclerosis Múltiple Recurrente-Remitente/diagnóstico , Esclerosis Múltiple/líquido cefalorraquídeo , Esclerosis Múltiple/diagnóstico , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Adulto , Estudios de Casos y Controles , Citocinas/líquido cefalorraquídeo , Progresión de la Enfermedad , Femenino , Proteína Ácida Fibrilar de la Glía/líquido cefalorraquídeo , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Proteínas de Neurofilamentos/líquido cefalorraquídeo , Análisis de Componente Principal , Isoformas de Proteínas/líquido cefalorraquídeo , Curva ROC , Sulfoglicoesfingolípidos/química , Linfocitos T/metabolismo , Adulto JovenRESUMEN
Sulfatides (STs) are a group of glycosphingolipids that are highly expressed in brain. Due to their importance for normal brain function and their potential involvement in neurological diseases, development of accurate and sensitive methods for their determination is needed. Here we describe a high-throughput oriented and quantitative method for the determination of STs in cerebrospinal fluid (CSF). The STs were extracted using a fully automated liquid/liquid extraction method and quantified using ultra-performance liquid chromatography coupled to tandem mass spectrometry. With the high sensitivity of the developed method, quantification of 20 ST species from only 100 µl of CSF was performed. Validation of the method showed that the STs were extracted with high recovery (90%) and could be determined with low inter- and intra-day variation. Our method was applied to a patient cohort of subjects with an Alzheimer's disease biomarker profile. Although the total ST levels were unaltered compared with an age-matched control group, we show that the ratio of hydroxylated/nonhydroxylated STs was increased in the patient cohort. In conclusion, we believe that the fast, sensitive, and accurate method described in this study is a powerful new tool for the determination of STs in clinical as well as preclinical settings.
Asunto(s)
Fraccionamiento Químico/métodos , Cromatografía Líquida de Alta Presión/métodos , Pruebas de Química Clínica/métodos , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Sulfoglicoesfingolípidos/aislamiento & purificación , Espectrometría de Masas en Tándem/métodos , Adulto , Anciano , Automatización , Humanos , Persona de Mediana EdadRESUMEN
A proportion of healthy siblings of multiple sclerosis (MS) patients have an oligoclonal immunological reaction in their cerebrospinal fluid (CSF) termed the "MS oligoclonal trait". The CSF levels of the major myelin glycosphingolipid sulfatide and serum antibodies against the glycosphingolipids sulfatide and galactosylceramide were recently reported to be increased in MS patients. We studied the levels of these substances in pairs of 46 patients and their 46 healthy siblings and 50 unrelated healthy blood donors (HBD). The sulfatide concentration in CSF was assayed by thin layer chromatography and immunostaining, and the concentration of galactosylceramide by densitometry after thin layer chromatography. Anti-glycosphingolipid antibody levels were assayed by ELISA. In the healthy siblings, the CSF sulfatide concentrations were markedly increased (p<0.001, age adjusted p=0.025), and the serum IgM anti-GalCer antibodies were increased in healthy siblings compared with HBD (p=0.02). The increased sulfatide or antibody levels did not co-segregate with the "MS oligoclonal trait" or the HLA-DR15 phenotype. In conclusion, a proportion of healthy siblings of MS patients have increased CSF sulfatide and anti-glycosphingolipid antibody levels, which may, analogous to the "MS oligoclonal trait", constitute an "MS glycosphingolipid endophenotype". Endophenotypes could potentially simplify the genetics of complex disorders.
Asunto(s)
Autoanticuerpos/biosíntesis , Glicoesfingolípidos/sangre , Esclerosis Múltiple/sangre , Esclerosis Múltiple/líquido cefalorraquídeo , Hermanos , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Adolescente , Adulto , Anciano , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Femenino , Estudios de Seguimiento , Glicoesfingolípidos/inmunología , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/inmunología , Regulación hacia Arriba/inmunología , Adulto JovenRESUMEN
BACKGROUND/AIMS: Demyelination and axonal degeneration are the hallmarks of established white matter lesions (WML). The neurochemistry of ongoing WML is only partially known. We explored cerebrospinal fluid (CSF) substances as markers of brain tissue damage in relation to progression of WML rated on magnetic resonance imaging. METHODS: CSF from elderly individuals with WML was analyzed for amyloid markers, total τ, hyperphosphorylated τ, neurofilament protein light subunit, sulfatide and CSF/serum-albumin ratio. After 3 years, a follow-up magnetic resonance imaging was performed. Progression of WML was rated using the Rotterdam Progression Scale (RPS). RESULTS: 37 subjects (age 73.6 ± 4.6 years) were included. Subjects with more pronounced progression (RPS > 2; n = 15) had lower mean sulfatide concentration at baseline as compared to subjects with no or minimal progression (RPS 0-2; n = 22) according to univariate analyses (p = 0.009). Sulfatide was the only biomarker that predicted the RPS score according to regression analysis, explaining 18.9% of the total variance (r = 0.38, p = 0.015). CONCLUSION: The correlation of CSF sulfatide levels and RPS scores may reflect a remyelination response to the demyelination process associated with WML. Furthermore, the results strengthen the notion that WML pathology is different from that of Alzheimer's disease.
Asunto(s)
Encéfalo/patología , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/líquido cefalorraquídeo , Enfermedad de Alzheimer/psicología , Péptidos beta-Amiloides/líquido cefalorraquídeo , Biomarcadores , Demencia Vascular/líquido cefalorraquídeo , Demencia Vascular/psicología , Enfermedades Desmielinizantes/patología , Enfermedades Desmielinizantes/psicología , Progresión de la Enfermedad , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Leucoaraiosis/líquido cefalorraquídeo , Leucoaraiosis/psicología , Modelos Lineales , Imagen por Resonancia Magnética , Masculino , Degeneración Nerviosa/patología , Degeneración Nerviosa/psicología , Países Bajos/epidemiología , Pruebas Neuropsicológicas , Valor Predictivo de las Pruebas , Factores Socioeconómicos , Proteínas tau/líquido cefalorraquídeoRESUMEN
BACKGROUND AND PURPOSE: White matter lesions (WMLs) caused by small vessel disease are common in elderly people and contribute to cognitive impairment. There are no established biochemical markers for WMLs. We aimed to study the relation between degree of WMLs rated on magnetic resonance imaging of the brain and cerebrospinal fluid (CSF) levels of structural biomarkers associated with Alzheimer's disease (AD) and subcortical vascular dementia. METHODS: Fifty-three non-demented elderly individuals with WMLs were subjected to lumbar puncture. Degree of WMLs was rated using the Fazekas scale. Volumetric assessment of WMLs was performed. CSF samples were analyzed for the 40 and 42 amino acid fragments of amyloid beta, alpha- and beta-cleaved soluble amyloid precursor protein, total tau (T-tau), hyperphosphorylated tau (P-tau(181)), neurofilament light protein (NFL), sulfatide and CSF/Serum-albumin ratio. RESULTS: Fifteen subjects had mild, 23 had moderate and 15 had severe degree of WMLs. CSF-NFL levels differed between the groups (P < 0.001) and correlated with the volume of WMLs (r = 0.477, P < 0.001). CSF sulfatide concentration displayed similar changes but less strongly. T-tau, P-tau(181) and the different amyloid markers as well as CSF/S-albumin ratio did not differ significantly between the groups. CONCLUSIONS: The association of increased CSF-NFL levels with increasing severity of WMLs in non-demented subjects suggests that NFL is a marker for axonal damage in response to small vessel disease in the brain. This manifestation may be distinct from or earlier than the neurodegenerative process seen in AD, as reflected by the lack of association between WMLs and AD biomarkers.
Asunto(s)
Encefalopatías/líquido cefalorraquídeo , Anciano , Anciano de 80 o más Años , Albúminas/líquido cefalorraquídeo , Precursor de Proteína beta-Amiloide/líquido cefalorraquídeo , Biomarcadores/líquido cefalorraquídeo , Encéfalo/patología , Encefalopatías/patología , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Fibras Nerviosas Mielínicas/patología , Proteínas de Neurofilamentos/líquido cefalorraquídeo , Fosforilación , Nexinas de Proteasas , Receptores de Superficie Celular , Índice de Severidad de la Enfermedad , Punción Espinal , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Proteínas tau/líquido cefalorraquídeo , Proteínas tau/metabolismoRESUMEN
A girl with Hurler disease (MPS IH) underwent allogeneic stem cell transplantation at 13 months of age with her one HLA-B antigen mismatch mother as donor. The procedure was complicated by cerebral hemorrhage and a ventricular-peritoneal shunt device was inserted. Mild GVH reactions were rapidly reversed. One year after transplantation ventriculitis was suspected and the shunt was replaced by a ventricular drainage catheter. Antibiotics had no effect and graft-versus-host disease (GVHD) was diagnosed. All symptoms were reversed by prednisolone and cyclosporine. Increased albumin and pleocytosis in the cerebrospinal fluid (CSF) normalized concomitantly. Electron microscopy of the CSF sediment showed debris consisting of numerous complex aggregates of thin lamellae and electron dense fragments with a tight lamellar texture. Biochemical analysis of the CSF sediment proved that the debris contained galactosylceramide and sulfatide. The electron microscopic and biochemical findings were interpreted to represent stripping of central myelin as a result of subacute GVHD in the central nervous system and its desquamation from the brain parenchyma into the ventricular CSF through the post-hemorrhage defect. From reversal of the GVHD at 2 years of age until follow-up at 10 years of age the clinical condition remained stable with no recurrence or deterioration.
Asunto(s)
Trasplante de Médula Ósea , Encefalopatías/diagnóstico , Enfermedades Desmielinizantes/diagnóstico , Enfermedad Injerto contra Huésped/diagnóstico , Mucopolisacaridosis I/terapia , Encéfalo/patología , Encefalopatías/patología , Encefalopatías/terapia , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/patología , Hemorragia Cerebral/terapia , Líquido Cefalorraquídeo/citología , Niño , Enfermedades Desmielinizantes/patología , Enfermedades Desmielinizantes/terapia , Femenino , Estudios de Seguimiento , Galactosilceramidas/líquido cefalorraquídeo , Enfermedad Injerto contra Huésped/patología , Enfermedad Injerto contra Huésped/terapia , Humanos , Inmunosupresores/uso terapéutico , Microscopía Electrónica , Mucopolisacaridosis I/diagnóstico , Mucopolisacaridosis I/patología , Vaina de Mielina/ultraestructura , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Derivación VentriculoperitonealRESUMEN
BACKGROUND - To evaluate cerebrospinal fluid (CSF) markers for neuronal degeneration and demyelination in idiopathic normal pressure hydrocephalus (INPH), subcortical arteriosclerotic encephalopathy (SAE), and neurologically healthy subjects. METHODS - Lumbar CSF concentrations of sulfatide, neurofilament protein light (NFL), total-tau (T-tau), hyperphosphorylated tau (P-tau), and beta-amyloid(1-42) (Abeta42) were analyzed in 62 INPH patients, 26 SAE patients, and 23 neurologically healthy controls. In INPH patients, samples before and after shunt surgery were analysed. RESULTS - The CSF concentration of NFL was elevated in INPH and SAE compared with the controls, and levels of T-tau, P-tau, and Abeta42 were lower in INPH compared with SAE and controls. No difference was seen for sulfatide. All markers except Abeta42 were significantly elevated after shunt surgery. CONCLUSIONS - The most striking finding was the power of the combined pattern of NFL, P-tau, and Abeta42 in distinguishing between the clinical diagnoses of INPH, SAE, and neurologically healthy elderly.
Asunto(s)
Líquido Cefalorraquídeo/química , Hidrocéfalo Normotenso/líquido cefalorraquídeo , Hidrocéfalo Normotenso/diagnóstico , Degeneración Nerviosa/líquido cefalorraquídeo , Degeneración Nerviosa/diagnóstico , Factores de Edad , Anciano , Anciano de 80 o más Años , Péptidos beta-Amiloides/análisis , Péptidos beta-Amiloides/líquido cefalorraquídeo , Biomarcadores/análisis , Biomarcadores/líquido cefalorraquídeo , Presión del Líquido Cefalorraquídeo/fisiología , Derivaciones del Líquido Cefalorraquídeo , Diagnóstico Diferencial , Femenino , Humanos , Hidrocéfalo Normotenso/fisiopatología , Arteriosclerosis Intracraneal/líquido cefalorraquídeo , Arteriosclerosis Intracraneal/diagnóstico , Arteriosclerosis Intracraneal/fisiopatología , Hipertensión Intracraneal/líquido cefalorraquídeo , Hipertensión Intracraneal/diagnóstico , Hipertensión Intracraneal/fisiopatología , Masculino , Persona de Mediana Edad , Degeneración Nerviosa/etiología , Proteínas de Neurofilamentos/análisis , Proteínas de Neurofilamentos/líquido cefalorraquídeo , Fragmentos de Péptidos/análisis , Fragmentos de Péptidos/líquido cefalorraquídeo , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Sulfoglicoesfingolípidos/análisis , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Regulación hacia Arriba/fisiología , Proteínas tau/análisis , Proteínas tau/líquido cefalorraquídeoRESUMEN
HIV establishes a latent infection in resting CD4(+) T-lymphocytes. A possible strategy to eliminate cellular reservoirs in long-lived, HIV-1-infected quiescent CD4(+) T-lymphocytes might be to add T-cell-activating agents to potent antiretroviral therapy. In this report we describe a patient with Guillain-Barré syndrome treated with high dose intravenous immunoglobulin (IVIG) in addition to antiretroviral therapy. A transiently increased viral load and immunoactivation during the IVIG treatment suggest activation of latently infected cells and increased turnover rate of the latent viral reservoir. HIV replication was controlled with plasma viral load <20 copies/ml, for at least 3 months after antiretroviral treatment interruption. CSF neural markers reflecting degenerative processes in the brain during the symptomatic period and follow-up were also analysed. Very high CSF sulfatide concentrations were found indicating that the pathology involves severe demyelination.We hypothesize that IVIG in this case contributed to an activation of latently infected cells, which led to a transient increase in plasma HIV-1 RNA during the IVIG treatment and a long period of undetectable viral load after antiretroviral treatment interruption. Further, this is the first time, to our knowledge, that detailed CSF findings are described in HIV-1 associated GBS.
Asunto(s)
Síndrome de Guillain-Barré/complicaciones , Síndrome de Guillain-Barré/terapia , Infecciones por VIH/complicaciones , Infecciones por VIH/terapia , VIH-1 , Inmunoglobulinas Intravenosas/uso terapéutico , Adulto , Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/virología , Síndrome de Guillain-Barré/líquido cefalorraquídeo , Infecciones por VIH/inmunología , Infecciones por VIH/virología , VIH-1/fisiología , Humanos , Activación de Linfocitos , Masculino , ARN Viral/sangre , ARN Viral/líquido cefalorraquídeo , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Replicación ViralAsunto(s)
Enfermedad de Alzheimer/metabolismo , Sulfoglicoesfingolípidos/metabolismo , Enfermedad de Alzheimer/diagnóstico , Péptidos beta-Amiloides/metabolismo , Apolipoproteínas E/metabolismo , Biomarcadores/líquido cefalorraquídeo , Encéfalo/metabolismo , Ceramidas/metabolismo , Genotipo , Humanos , Fosfatidilinositoles/líquido cefalorraquídeo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Sulfoglicoesfingolípidos/líquido cefalorraquídeoRESUMEN
We recently noted a profound decline in brain sulfatides (ST) in subjects who died with incipient dementia due to Alzheimer's disease. Herein, we measured ST levels in cerebrospinal fluid in cognitively normal elderly and in subjects with mild cognitive impairment due to incipient demenia of the Alzheimer type. There was a significant decrease in cerebrospinal fluid ST and in the ST to phosphatidylinositol ratio in MCI subjects. The ST to phosphatidylinositol ratio accurately differentiated very mildly impaired subjects from controls on an individual basis. The cerebrospinal fluid ST to phosphatidylinositol ratio may be a very useful biomarker for the earliest clinical stage of Alzheimer's disease.
Asunto(s)
Enfermedad de Alzheimer/líquido cefalorraquídeo , Encéfalo/metabolismo , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Anciano , Anciano de 80 o más Años , Trastornos del Conocimiento/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Fosfatidilinositoles/líquido cefalorraquídeo , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
Normal pressure hydrocephalus (NPH) is associated with periventricular white matter lesions and demyelination. The aim of the present study was to examine the cerebrospinal fluid (CSF) levels of tumor necrosis factor-alpha (TNF-alpha), a proinflammatory cytokine mediating myelin damage, in patients with NPH. TNF-alpha levels were analyzed by ELISA and measured before and after shunt operation in 35 patients with NPH. The levels of this cytokine were related to the symptomatology and to magnetic resonance imaging (MRI) verified white matter lesions. They were also related to intrathecal levels of sulfatide, a marker for white matter degradation and to levels of neurofilament, a marker for neuronal degeneration. The preoperative levels of TNF-alpha were increased in the CSF of NPH patients compared to controls, and correlated to the levels of sulfatide. The intrathecal TNF-alpha levels were higher in NPH patients with impairment of wakefulness than in those without this symptom. The preoperative TNF-alpha levels were significantly correlated to the improvement of psychometrical test scores, and of wakefulness and to the overall improvement of the patients following shunt operation. Importantly, shunt operation led to complete disappearance of intrathecal TNF-alpha. We conclude that NPH is correlated with intrathecal TNF-alpha production being reversed following shunt operation in parallel with the clinical improvement. The positive correlation between preoperative TNF-alpha and sulfatide levels in the CSF suggest that intrathecal TNF-alpha may contribute to the damage of the white matter known to occur in patients with NPH.
Asunto(s)
Hidrocéfalo Normotenso/líquido cefalorraquídeo , Factor de Necrosis Tumoral alfa/líquido cefalorraquídeo , Adulto , Anciano , Anciano de 80 o más Años , Encéfalo/patología , Encéfalo/fisiopatología , Mapeo Encefálico , Estudios de Casos y Controles , Derivaciones del Líquido Cefalorraquídeo , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Marcha , Humanos , Hidrocéfalo Normotenso/metabolismo , Hidrocéfalo Normotenso/cirugía , Imagen por Resonancia Magnética/instrumentación , Imagen por Resonancia Magnética/métodos , Masculino , Escala del Estado Mental , Persona de Mediana Edad , Psicometría/métodos , Desempeño Psicomotor , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
OBJECTIVES: Subcortical vascular dementia (SVD) is associated with white matter lesions and demyelination. The aim of the present study was to examine the cerebrospinal fluid (CSF) levels of TNF-alpha, a proinflammatory cytokine mediating myelin damage, in SVD patients. The intrathecal TNF-alpha levels were related to the clinical symptoms of dementia, as well as to intrathecal levels of sulfatide, a marker of white matter degradation, and of neurofilament, a marker of neuronal degeneration. METHODS: CSF levels of TNF-a, sulfatide and neurofilament were all analyzed by immunoenzymatic procedures in 17 patients with SVD and in 26 healthy controls. RESULTS: The intrathecal concentration of TNF-alpha was significantly increased in SVD patients compared to healthy controls (p = 0.0001). The intrathecal levels of TNF-alpha were significantly correlated (r = 0.6, p = 0.02) to the levels of sulfatide, but not to the levels of neurofilament, (r = 0.08, NS). CONCLUSIONS: We have demonstrated intrathecal production of TNF-alpha in SVD patients. The correlation between TNF-a and sulfatide levels in the CSF suggests that this apoptosis-inducing cytokine leads to the death of oligodendrocytes, thereby contributing to white matter degeneration, a hallmark of SVD.
Asunto(s)
Encéfalo/metabolismo , Demencia Vascular/líquido cefalorraquídeo , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Factor de Necrosis Tumoral alfa/líquido cefalorraquídeo , Anciano , Anciano de 80 o más Años , Apoptosis , Encéfalo/patología , Estudios de Casos y Controles , Demencia Vascular/inmunología , Demencia Vascular/patología , Femenino , Humanos , Masculino , Neuronas/patologíaRESUMEN
OBJECTIVES: To analyse the diagnostic and prognostic value of periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) magnetic resonance imaging (MRI) changes and their relation to symptoms and cerebrospinal fluid (CSF) markers of demyelination (sulphatide) and axonal degeneration [neurofilament triplet protein (NFL)] in a large series of patients with normal pressure hydrocephalus (NPH) and Binswanger disease (BD). MATERIALS AND METHODS: PVH and DWMH were determined by a semi-automatic segmentation method on T2-weighted images in 29 patients with NPH and 17 patients with BD. CSF analyses, psychometric testing and quantification of balance, gait and continence were performed in all patients and also postoperatively in NPH patients. RESULTS: No MRI variable could identify NPH or BD patients. Abundant PVH and DWMH preoperatively correlated with improvement in gait, balance and psychometric performance after shunt surgery (P < 0.05). CSF sulphatide correlated positively with the amount of DWMH (P < 0.05) while NFL was correlated to both PVH and DWMH (P < 0.05). Abundant PVH correlated with poor psychometric performance while DWMH correlated with gait disturbance (P < 0.05). Postoperative reduction in PVH correlated with improvement in gait, balance and psychometric performance. CONCLUSION: In spite of a refined quantification method, NPH and BD patients exhibited similar MRI changes. MRI had a predictive value in NPH patients. DWMH might relate to demyelination and PVH to neuronal axonal dysfunction. NPH and BD share the major part of symptoms and MRI changes, indicating a common pathophysiological pattern, and we raise the question of how to treat BD patients.
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Axones/patología , Demencia Vascular/patología , Enfermedades Desmielinizantes/patología , Hidrocéfalo Normotenso/patología , Anciano , Anciano de 80 o más Años , Demencia Vascular/líquido cefalorraquídeo , Enfermedades Desmielinizantes/líquido cefalorraquídeo , Femenino , Humanos , Hidrocéfalo Normotenso/líquido cefalorraquídeo , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sulfoglicoesfingolípidos/líquido cefalorraquídeoRESUMEN
Disorders of the cerebral white matter in children constitute a heterogeneous group and the diagnostic work is often complicated. Clinical and radiological characteristics can provide diagnostic clues but there is a need for further diagnostic methods. This study focused on assessing neurochemical "markers" in the cerebrospinal fluid considered to reflect damage to white matter components such as myelin and glial cells as well as neurones with their axons and synapses. The aim was to evaluate whether they contributed to the elucidation of pathogenic processes and the direction of further diagnostic efforts. Seventeen of the 26 cases had increased levels of the glial cell marker ganglioside GD3, indicating gliosis, or of the CNS myelin marker sulfatide, indicating myelin disturbance. As signs of disturbed maturation or sustenance, the nerve cell markers GD1 b, GT1 b and total gangliosides were reduced, as was the synapse marker GD1a. Increased 5-HIAA indicated increased serotonergic turnover. Children with an increased level of the axonal marker Tau protein had a progressive disease whereas GD1a was reduced in the progressive group (n = 11). In contrast, GD3 and HVA were increased in the non-progressive group (n = 15). The chemical profiles were found to be useful, in combination with clinical and radiological findings, when investigating children with white matter abnormalities.
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Monoaminas Biogénicas/líquido cefalorraquídeo , Encefalopatías/líquido cefalorraquídeo , Encefalopatías/diagnóstico , Encéfalo/patología , Líquido Cefalorraquídeo/química , Gangliósidos/líquido cefalorraquídeo , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Adolescente , Biomarcadores/líquido cefalorraquídeo , Química Encefálica , Encefalopatías/patología , Niño , Preescolar , Diagnóstico Diferencial , Progresión de la Enfermedad , Femenino , Humanos , Lactante , MasculinoRESUMEN
OBJECTIVES: To examine the CSF concentrations of molecules reflecting demyelination, neuronal and axonal degeneration, gliosis, monoaminergic neuronal function, and aminergic and peptidergic neurotransmission in a large series of patients with normal pressure hydrocephalus (NPH) or subcortical arteriosclerotic encephalopathy (SAE), to elucidate pathogenic, diagnostic, and prognostic features. METHODS: CSF concentrations of glycosphingolipid (sulfatide), proteins (neurofilament triplet protein (NFL), glial fibrillary acidic protein (GFAP)), neuropeptides (vasoactive intestinal peptide (VIP), 4-aminobutyric acid (GABA)), and monoamines (homovanillic acid (HVA), 5-hydroxy-indoleacetic acid (5-HIAA), 4-hydroxy-3-methoxyphenylglycol (HMPG)) were analysed in 43 patients with NPH and 19 patients with SAE. The diagnoses of NPH and SAE were based on strict criteria and patients with NPH were subsequently operated on. Twelve clinical variables, psychometric tests measuring perceptual speed, accuracy, learning, and memory and a psychiatric evaluation were performed in all patients and before and after a shunt operation in patients with NPH. RESULTS: The CSF sulfatide concentration was markedly increased in patients with SAE (mean 766, range 300-3800 nmol/l) compared with patients with NPH (mean 206, range 50-400 nmol/l) (p<0.001). 5-HIAA, GABA, and VIP in CSF were higher in patients with SAE than in patients with NPH. The patients with NPH with cerebrovascular aetiology had higher sulfatide concentrations and a poorer outcome after shunt surgery than patients with NPH with other aetiologies. CONCLUSIONS: The pathogenesis of the white matter changes in NPH and SAE is different and ischaemic white matter changes can be a part of the NPH state. The markedly increased CSF sulfatide concentrations in patients with SAE indicate ongoing demyelination as an important pathophysiological feature of SAE. The CSF sulfatide concentration distinguished between patients with SAE and those with NPH with a sensitivity of 74% and a specificity of 94%, making it an important diagnostic marker.
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Demencia Vascular/diagnóstico , Hidrocéfalo Normotenso/diagnóstico , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Adulto , Anciano , Anciano de 80 o más Años , Encéfalo/patología , Demencia Vascular/líquido cefalorraquídeo , Diagnóstico Diferencial , Femenino , Humanos , Hidrocéfalo Normotenso/líquido cefalorraquídeo , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Proteínas del Tejido Nervioso/líquido cefalorraquídeo , Pruebas Neuropsicológicas , Pronóstico , Valores de ReferenciaRESUMEN
There is a need for improvement of the diagnosis of vascular dementia (VaD). Today, the clinician has to rely on clinical examination, history, and, possibly, brain imaging to identify cerebrovascular damage and other signs of VaD. The clinical diagnosis of subcortical VaD may be difficult because the clinical manifestation of this disorder is often similar to that of Alzheimer disease. There are also mixed forms of the two disorders. Biochemical diagnostic markers, which reflect the pathogenetic processes in the brain, would add to the accuracy of the diagnosis. There are some interesting candidate markers: the cerebrospinal fluid (CSF)/serum albumin ratio could be used to identify blood-brain barrier damage to the small intracerebral vessels, CSF sulfatide to identify ongoing demyelination of the white matter, CSF neuron-specific enolase to identify ongoing neuronal degeneration, and CSF tau protein and CSF neurofilament light protein to identify ongoing axonal degeneration. None of these potential markers is specific to subcortical VaD, but together and used in conjunction with the conventional diagnostic workup, they may be of diagnostic value.
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Corteza Cerebral/irrigación sanguínea , Demencia Vascular/líquido cefalorraquídeo , Demencia Vascular/etiología , Enfermedad de Alzheimer/líquido cefalorraquídeo , Biomarcadores/líquido cefalorraquídeo , Humanos , Proteínas de Neurofilamentos/líquido cefalorraquídeo , Fosfopiruvato Hidratasa/líquido cefalorraquídeo , Sulfoglicoesfingolípidos/líquido cefalorraquídeo , Proteínas tau/líquido cefalorraquídeoRESUMEN
Myelin degeneration is commonly found in the central nervous system (CNS) of individuals infected with human immunodeficiency virus type 1 (HIV-1), especially in patients with HIV-1-associated dementia. We analysed cerebrospinal fluid (CSF) and serum samples from 25 HIV-1 infected individuals for the presence of antibodies directed against sulfatide, the major acidic glycosphingolipid in myelin. Nine of the patients had CNS complications, including 3 with HIV-1-associated dementia, and 16 had no neurological symptoms. Elevated titres of anti-sulfatide antibodies were found in serum from 24/25 HIV-1-infected individuals but in none of them in the CSF. Although the vast majority of HIV-1-infected individuals harbour autoantibodies directed against sulfatide in serum, the lack of detectable intrathecal production indicates that anti-sulfatide antibodies are not a major component in the pathogenesis of CNS myelin damage in HIV-1 infection.
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Complejo SIDA Demencia/inmunología , VIH-1/inmunología , Sulfoglicoesfingolípidos/inmunología , Complejo SIDA Demencia/sangre , Complejo SIDA Demencia/líquido cefalorraquídeo , Adulto , Autoanticuerpos/sangre , Autoanticuerpos/líquido cefalorraquídeo , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/líquido cefalorraquídeo , Persona de Mediana Edad , Vaina de Mielina/química , Vaina de Mielina/inmunología , Vaina de Mielina/virología , Sulfoglicoesfingolípidos/líquido cefalorraquídeoRESUMEN
Increased amounts of ganglioside GD3 [II3 (NeuAc)2-LacCer], associated with reactive gliosis, have been documented in a variety of neurodegenerative disorders. GD3 expression has also been reported in microglial cells, not only during development but also in reactive states, where the glial activation is considered to be part of the repair process. It is important to find markers in cerebrospinal fluid that will enable us to identify damage and register changes in pathological processes within the brain. A sensitive and practically applicable method for determination of GD3 ganglioside in cerebrospinal fluid has been developed. The procedure, which includes extraction, purification on silica gel and thin-layer enzyme-linked immunostaining, also allows determination of sulphatide, a marker of demyelinating processes, in the same portion of CSF. The method has been applied to CSF samples from 101 normal individuals aged 2-83 years. The GD3 concentration was found to be significantly correlated to age and reflecting the concentrations within the brain. GD3 ganglioside analysis by means of this method might be useful for studying glial changes during brain maturation as well as in brain disorders.