Combination of neurofilament heavy chain and complement C3 as CSF biomarkers for ALS.

Combination of neurofilament heavy chain and complement C3 as CSF biomarkers for ALS.
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DOI:
10.1111/j.1471-4159.2011.07224.x
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发表时间:
2011-05
影响因子:
4.7
通讯作者:
Bowser R
Bowser R
中科院分区:
医学2区
文献类型:
--
作者:
Ganesalingam J;An J;Shaw CE;Shaw G;Lacomis D;Bowser R

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肌萎缩侧索硬化症(ALS)是一种进展迅速且最终致命的神经退行性疾病,从症状出现起平均生存期为3年。若旨在改变疾病进程的治疗干预要取得成功,快速且确切的早期诊断至关重要。已知在ALS的发病机制中会出现细胞骨架改变和炎症反应。我们测量了ALS患者、疾病对照组以及健康受试者脑脊液(CSF)中的细胞骨架蛋白和炎症标志物水平。通过受试者工作特征(ROC)分析,我们在一个训练集中确定了每种蛋白的阈值,这些阈值为ALS诊断提供了最佳的敏感性和特异性。有趣的是,最佳检测指标是磷酸化神经丝重链与补体C3的水平比值(pNFH/C3)。接下来,我们将该检测方法应用于另一组独立的脑脊液样本测试集以验证我们的结果。总体而言,在总共71名ALS患者、52名疾病对照受试者和40名健康受试者中,预测性的pNFH/C3比值识别ALS的敏感性为87.3%,特异性为94.6%。此外,脑脊液中pNFH的水平与ALS患者的生存期相关。我们还在ALS患者血浆中检测到pNFH升高,并观察到同一受试者脑脊液和血浆中pNFH水平之间存在相关性。这些发现为大规模前瞻性生物标志物研究提供了支持,以确定ALS诊断和预后标志物的临床效用。
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive and ultimately fatal neurodegenerative disease with an average survival of 3 years from symptom onset. Rapid and conclusive early diagnosis is essential if interventions with disease-modifying therapies are to be successful. Cytoskeletal modification and inflammation are known to occur during the pathogenesis of ALS. We measured levels of cytoskeletal proteins and inflammatory markers in the cerebrospinal fluid (CSF) of ALS, disease controls and healthy subjects. We determined threshold values for each protein that provided the optimal sensitivity and specificity for ALS within a training set, as determined by receiver operating characteristic (ROC) analysis. Interestingly, the optimal assay was a ratio of the levels for phosphorylated neurofilament heavy chain and complement C3 (pNFH/C3). We next applied this assay to a separate test set of CSF samples to verify our results. Overall, the predictive pNFH/C3 ratio identified ALS with 87.3% sensitivity and 94.6% specificity in a total of 71 ALS subjects, 52 disease control subjects and 40 healthy subjects. In addition, the level of CSF pNFH correlated with survival of ALS patients. We also detected increased pNFH in the plasma of ALS patients and observed a correlation between CSF and plasma pNFH levels within the same subjects. These findings support large-scale prospective biomarker studies to determine the clinical utility of diagnostic and prognostic signatures in ALS.
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