Rapid Diagnosis of Infection by Gas-Liquid Chromatography: Analysis of Sugars in Normal and Infected Cerebrospinal Fluid

A highly reproducible procedure was developed for gas-liquid chromatographic analysis of trimethylsilyl derivatives of normal human cerebrospinal fluid. Fourteen normal human cerebrospinal fluid samples tested with this procedure contained alpha- and beta-glucose as well as isomers of two unidentified sugars. Chromatographic changes in three cases of meningeal inflammation (two cryptococcosis and one thalamic astrocytoma) were limited to decreased concentrations of all sugars. In one case of early meningitis, the concentrations of the unknown sugars decreased before glucose. Now that a reproducible chromatogram of the trimethylsilyl derivatives of normal human cerebrospinal fluid has been established, more samples of abnormal cerebrospinal fluid should be prepared by these methods and examined by gas-liquid chromatography. It may be possible to identify unique products of infectious agents which will permit rapid diagnosis of central nervous system infection.     

Proteomics-based technologies in the discovery of biomarkers for multiple sclerosis in the cerebrospinal fluid

Multiple Sclerosis is the most common non-traumatic disorder of the central nervous system and is generally regarded as an immune-mediated disorder that occurs in young adults. Since cerebrospinal fluid is in close contact with the extracellular surface of the brain, it is of great interest to examine possible biomarkers for multiple sclerosis. Proteomic studies of cerebrospinal fluid samples represent an important step towards a better understanding of the disease and may lead to the identification of clinically useful markers. Methodological advances in proteomics allowed the comparison of the protein content in different cerebrospinal fluid samples, using gel or liquid-based approaches coupled with mass spectrometry. In this paper, we discuss the advantages and limitations of the strategies employed and the potential biomarkers for multiple sclerosis identified so far using proteomics-based approaches.     

中枢神经系统感染患儿血清和脑脊液CRP、PCT、TNF-α及MMP-9水平及其临床意义

目的:探讨中枢神经系统感染患儿血清和脑脊液C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)及基质金属蛋白酶-9(MMP-9)水平及其临床意义。方法:选择2017年1月~2018年6月期间南京市第二医院收治的中枢神经系统感染患儿93例作为研究对象,其中化脓性脑膜炎62例记为化脓性脑膜炎组,病毒性脑炎31例记为病毒性脑炎组,另选取同期于我院治疗的非中枢神经系统感染患儿40例作为对照组,比较各组血清、脑脊液CRP、PCT、TNF-α、MMP-9水平及阳性率,并计算血清和脑脊液CRP、PCT、TNF-α、MMP-9诊断中枢神经系统感染的灵敏度、特异度及准确度。结果:化脓性脑膜炎组患儿血清、脑脊液CRP、PCT、TNF-α及MMP-9水平及阳性率高于病毒性脑炎组和对照组,病毒性脑炎组患儿血清、脑脊液CRP、TNF-α及MMP-9水平及阳性率高于对照组(P<0.05),病毒性脑炎组与对照组血清、脑脊液PCT水平及阳性率比较无统计学差异(P>0.05)。血清或脑脊液CRP+PCT+TNF-α+MMP-9联合检验对中枢神经系统感染具有一定的诊断价值。结论:中枢神经系统感染患儿血清、脑脊液CRP、TNF-α、PCT及MMP-9水平明显升高,其中化脓性脑膜炎患儿血清、脑脊液PCT水平高于病毒性脑炎患儿,血清或脑脊液CRP、PCT、TNF-α及MMP-9联合检验对儿童中枢神经系统感染的鉴别诊断具有较高的价值。     

Effects of negatively charged aerosol on blood and cerebrospinal fluid parameters in rats

Adult male rats were exposed for 90 to 140 minutes to negatively charged tapwater aerosol. Blood and cerebrospinal fluid samples were collected to determine effects of the exposure on selected hematologic and serum chemistry parameters, and ionized calcium and pH in cerebrospinal fluid. Of the 27 variables assayed, 24 yielded sufficient data for statistical analysis. Two parameters, serum alkaline phosphatase and mean corpuscular hemoglobin concentration, were significantly different (p<0.05) from control values, probably representing chance occurrences. It appears that whatever biological effects may be exerted by electro-aerosols, they are not mediated by the parameters investigated in this study.     

Role of neuroproteomics in CNS drug discovery

Neuroproteomics is the application of proteomics to the study of the CNS and its disorders. Proteomic technologies can be applied to the discovery of targets for drugs to treat neurological disorders. Diseases that are particularly suitable for this approach are those with protein pathology, such as Alzheimer's disease. Important receptors for CNS drugs include proteins such as G-protein-coupled receptors, N-methyl-d-aspartate receptors and protein kinases. Molecular diagnostics can be based on proteins detected in the cerebrospinal fluid and these same proteins can serve as drug targets. Proteomics complements pharmacogenomics and will facilitate the development of personalized medicines for neurological disorders.     

Proteomics in Parkinson’s disease: current trends,translational snags and future possibilities

Proteomic technologies are widely used to understand the molecular mechanism of Parkinson’s disease (PD) and to develop biomarkers for its early diagnosis. The differential expression patterns of brain, cerebrospinal fluid and blood proteins of patients or chemically induced animal models are used to identify protein fingerprints for developing diagnostic and therapeutic strategies for PD. A number of differentially expressed proteins associated with energy metabolism, oxidative stress, signal transduction, electron transport and detoxification pathways are identified using proteomic strategies. Proteomics immensely contributed to the detection of qualitative and quantitative changes of expressed proteins and their post-translational modifications. An update on proteomics-driven research for developing early biomarkers and understanding the molecular aspects of PD, along with their translational snags, challenges and future possibilities, are discussed in this review.     

Characterization of the human ventricular cerebrospinal fluid proteome obtained from hydrocephalic patients

The continuing expansion of proteomic technology has been fueled by the potential for discovering novel biomarkers that may be used for the early detection of disease. It has been proposed that human cerebrospinal fluid (CSF), which surrounds and protects the brain and spinal cord from traumatic injury, may be a valuable target for the diagnosis of a variety of conditions such as Alzheimer's disease, traumatic brain injury, amyotrophic lateral sclerosis and Parkinson's disease. The immense complexity of biofluids, however, still requires that considerable development be made in the analytical techniques used so that comprehensive coverage of the proteins present in such samples is achieved. Using a simple separation strategy the protein complement of human ventricular cerebrospinal fluid obtained from patients with hydrocephalus was evaluated. The study resulted in the identification of over 1500 unique proteins that were found within all nine CSF samples that were analyzed. Comparison with the HUPO serum proteome database demonstrated that human ventricular CSF contains a large array of proteins that may be unique to CSF. This analysis greatly increases our knowledge of the protein content of this clinically important biofluid.     

脑脊液乳酸和血清降钙素原及C反应蛋白 对小儿细菌性脑膜炎的诊断价值

目的探讨脑脊液乳酸、血清降钙素原及C反应蛋白对小儿细菌性脑膜炎的诊断价值。方法选取我院2016年4月至2017年6月收治的50例细菌性脑膜炎患儿以及50例病毒性脑膜炎患儿进行作为研究对象,比较2类患儿脑脊液乳酸(LA)、血清降钙素原(PCT)及C反应蛋白(CRP)的水平,并分析其诊断价值。结果细菌性脑膜炎组患儿脑脊液LA、血清PCT及CRP水平显著高于病毒性脑膜炎患儿(均P0.05)。血清PCT诊断的灵敏度和特异度最高(96.4%、90.9%,P0.05)。3项指标联合检测的灵敏度(100.0%)和特异度(95.5%)明显高于任一单项指标(均P0.05)。经过Pearson相关性分析,脑脊液LA、血清PCT及CRP与小儿细菌性脑膜炎均呈显著正相关关系(均P0.05)。结论脑脊液乳酸、血清PCT及CRP对小儿细菌性脑膜炎的诊断和治疗效果监测有重要应用价值。     

Experience with a radioimmunoassay of luteinizing hormone-releasing hormone (LH-RH) in biological material of man.

A radioimmunoassay of LH-RH with a sensitivity of 7.8 pg/ml is described. Labelling and purification techniques, methods for extraction of LH-RH and separation techniques of bound and free labelled hormone are compared. Determination of LH-RH levels in serum after administration of synthetic LH-RH by different routes and measurements of endogenous LH-RH levels in serum of normal subjects and patients with different endocrine diseases as well as in cerebrospinal fluid of normal men are performed. The measurement of exogenously administered LH-RH in serum reflects the disappearance of synthetic LH-RH from peripheral circulation in dependence upon the kind of administration route. The level of endogenous LH-RH was found to be under the limit of the assay in all samples of cerebrospinal fluid and of serum of normal male subjects. The results obtained in the patient groups show that the radioimmunological estimation of endogenous LH-RH in peripheral body fluids does not reflect the hypophysiotrophic role of this hypothalamic peptide.     

The 1H NMR Profile of Healthy Dog Cerebrospinal Fluid

The availability of data for reference values in cerebrospinal fluid for healthy humans is limited due to obvious practical and ethical issues. The variability of reported values for metabolites in human cerebrospinal fluid is quite large. Dogs present great similarities with humans, including in cases of central nervous system pathologies. The paper presents the first study on healthy dog cerebrospinal fluid metabolomic profile using ¹H NMR spectroscopy. A number of 13 metabolites have been identified and quantified from cerebrospinal fluid collected from a group of 10 mix breed healthy dogs. The biological variability as resulting from the relative standard deviation of the physiological concentrations of the identified metabolites had a mean of 18.20% (range between 9.3% and 44.8%). The reported concentrations for metabolites may be used as normal reference values. The homogeneity of the obtained results and the low biologic variability show that the ¹H NMR analysis of the dog’s cerebrospinal fluid is reliable in designing and interpreting clinical and therapeutic trials in dogs with central nervous system pathologies.     

Autoantigen Microarray for High-throughput Autoantibody Profiling in Systemic Lupus Erythematosus

Systemic lupus erythematosus(SLE) is a complex autoimmune disease characterized by the production of autoantibodies to a broad range of self-antigens. Profiling the autoantibody repertoire using array-based technology has emerged as a powerful tool for the identification of biomarkers in SLE and other autoimmune diseases. Proteomic microarray has the capacity to hold large number of self-antigens on a solid surface and serve as a high-throughput screening method for the determination of autoantibody specificities. The autoantigen arrays carrying a wide variety of self-antigens, such as cell nuclear components(nucleic acids and associated proteins), cytoplasmic proteins, phospholipid proteins, cell matrix proteins, mucosal/secreted proteins, glomeruli, and other tissue-specific proteins, have been used for screening of autoantibody specificities associated with different manifestations of SLE. Arrays containing synthetic peptides and molecular modified proteins are also being utilized for identification of autoantibodies targeting to special antigenic epitopes. Different isotypes of autoantibodies, including Ig G, Ig M, Ig A, and Ig E, as well as other Ig subtypes, can be detected simultaneously with multi-color labeled secondary antibodies. Serum and plasma are the most common biologic materials for autoantibody detection, but other body fluids such as cerebrospinal fluid, synovial fluid, and saliva can also be a source of autoantibody detection.Proteomic microarray as a multiplexed high-throughput screening platform is playing an increasingly-important role in autoantibody diagnostics.In this article,we highlight the use of autoantigen microarrays for autoantibody exploration in SLE.     

Human body fluid proteome analysis

The focus of this article is to review the recent advances in proteome analysis of human body fluids, including plasma/serum, urine, cerebrospinal fluid, saliva, bronchoalveolar lavage fluid, synovial fluid, nipple aspirate fluid, tear fluid, and amniotic fluid, as well as its applications to human disease biomarker discovery. We aim to summarize the proteomics technologies currently used for global identification and quantification of body fluid proteins, and elaborate the putative biomarkers discovered for a variety of human diseases through human body fluid proteome (HBFP) analysis. Some critical concerns and perspectives in this emerging field are also discussed. With the advances made in proteomics technologies, the impact of HBFP analysis in the search for clinically relevant disease biomarkers would be realized in the future.     

Quantitative analysis of sulpiride in body fluids by high-performance liquid chromatography with fluorescence detection

A high-performance liquid chromatographic method for the analysis of sulpiride, N-ethyl-2-(2-methoxy-5-sulphonamido-benzamido-methyl)-pyrrolidine, in body fluids is described. A structurally related compound, N-ethyl-2-(2,4-dimethoxy-benzamido-methyl)-pyrrolidine, was used as internal standard.A fluorescence detector with excitation maximum at 299 nm and emission maximum at 342 nm was used for the quantitation. The detection limit was about 10 ng/ml in serum and cerebrospinal fluid and about 200 ng/ml in urine. The experimental error was 5–10% in the concentration range 25–100 ng/ml. Some preliminary data from a pharmacokinetic study in healthy volunteers are presented. The half-life for sulpiride in serum was about 8 h. Sulpiride was also measured in cerebrospinal fluid from five drug-treated psychotic patients.     

The Phage Proteomic Tree: a genome-based taxonomy for phage

There are approximately 10(31) phage in the biosphere, making them the most abundant biological entities on the planet. Despite their great numbers and ubiquitous presence, very little is known about phage biodiversity, biogeography, or phylogeny. Information is limited, in part, because the current ICTV taxonomical system is based on culturing phage and measuring physical parameters of the free virion. No sequence-based taxonomic systems have previously been established for phage. We present here the "Phage Proteomic Tree," which is based on the overall similarity of 105 completely sequenced phage genomes. The Phage Proteomic Tree places phage relative to both their near neighbors and all other phage included in the analysis. This method groups phage into taxa that predicts several aspects of phage biology and highlights genetic markers that can be used for monitoring phage biodiversity. We propose that the Phage Proteomic Tree be used as the basis of a genome-based taxonomical system for phage.     

Specific activation of B-cell clones within the central nervous system in course of herpes simplex encephalitis

Total and virus-specific immunoglobulin (Ig) G oligoclonal bands were studied in paired serum and cerebrospinal fluid (CSF) of four patients with herpes simplex virus type 1 (HSV-1) encephalitis. We used the isoelectric focusing in agarose gel, a sensitive technique for protein separation, followed by passive transfer of proteins on nitrocellulose paper and specific immunostaining. Oligoclonal bands were observed in serum and CSF of all patients. HSV-1-specific oligoclonal IgG bands were present in the CSF only during a limited period of the disease, having their counterpart in serum during the remaining periods. Our findings contribute to tackle the issue of B-cell activation within central nervous system and peripheral blood compartments in course of HSV-1 encephalitis.     

An approach to remove albumin for the proteomic analysis of low abundance biomarkers in human serum

Proteomic technologies are being used to discover and identify disease-associated biomarkers. The application of these technologies in the search for potential diagnostic/prognostic biomarkers in the serum of patients has been limited by the presence of highly abundant albumin and immunoglobulins that constitute approximately 60-97% of the total serum proteins. The purpose of the study was to evaluate whether treatment of human serum with Affi-Gel Blue alone or in combination with Protein A (Aurum serum protein mini kit, Bio-Rad) before two-dimensional gel electrophoresis (2-DE) analysis removed high abundance proteins to allow the visualization of low abundant proteins. Serum samples were treated with either Affi-Gel Blue or Aurum kit and then subjected to 2-DE using 11 cm, pH 4-7 isoelectric focussing strips for the first dimension and 10% sodium dodecyl sulfate-polyacrylamide gel electrophoresis for second dimension. Protein spots were visualized using a fluorescent protein dye (SYPRO Ruby, Bio-Rad). Comparison between treatment methods showed significant removal of albumin by both Affi-Gel Blue and Aurum kit and considerable differences in the protein profile of the gels after each treatment. Direct comparison between treatments revealed twenty-eight protein spots unique to Affi-Gel Blue while only two spots were unique after Aurum kit treatment. Unique spots in Affi-Gel Blue and Aurum kit treated serum were not visualized in untreated serum. Sixteen hours of Affi-Gel Blue treatment resulted in enhanced visualization of fifty-three protein spots by two-fold, thirty-one by five-fold, twelve by ten-fold and six by twenty-fold. In parallel after Aurum kit treatment two-, five-, ten- and twenty-fold enhancements of thirty, thirteen, eight and five protein spots, respectively, were observed. The pattern of increased visualization of protein spots with both treatment methods was similar. In conclusion, treatment of serum samples with Affi-Gel Blue or Aurum kit before 2-DE analysis can be used to remove high abundance proteins in order to increase the detection sensitivity of proteins present in low abundance.     

Invasive meningococcal disease and latex agglutination test — Is it still beneficial for diagnosis?

We showed current clinical usefulness of the latex agglutination (LA) test for confirmation of meningococcal etiology on 32 cerebrospinal fluid, 77 serum and 93 urine samples collected during the first week of hospitalization from 19 patients with laboratory confirmed invasive meningococcal disease. The positivity of the LA test in cerebrospinal fluid was 47%, in serum 42% and in urine 24%, while the PCR of cerebrospinal fluid and serum was positive in 95 and 47% cases, respectively. The latest positivity of the LA test was detected on day 2 in cerebrospinal fluid, on day 3 in serum and on day 4 in urine. In the group of patients who had received antibiotic therapy we found nonsignificant reduction of LA positivity and also statistically significant reduction of culture positivity in CSF (p = 0.04); the PCR positivity changed minimally. In blood samples, nonsignificant reduction of culture positivity and no difference in LA and PCR positivity was found. We did not find any statistically significant relationship between test results and clinical forms. The LA test can be therefore considered to be an auxiliary diagnostic method, rapid and easily practicable but less sensitive than PCR. It can be recommended especially for local laboratories where PCR is not available and the patient already received antibiotics before admission to the hospital.     

Pharmacokinetics and Bioavailability of a Therapeutic Enzyme (Idursulfase) in Cynomolgus Monkeys after Intrathecal and Intravenous Administration

Intravenous enzyme replacement therapy with iduronate-2-sulfatase is an approved treatment for Hunter syndrome, however, conventional intravenous delivery cannot treat the neurologic manifestations of the disease due to its limited central nervous system penetration. Intrathecal administration of iduronate-2-sulfatase for delivery to the central nervous system is currently under investigation. The objective of this study was to evaluate the pharmacokinetics of idursulfase in the central nervous system of cynomolgus monkeys (Macaca fasicularis) after intravenous and intrathecal administration. Twenty-seven monkeys, treatment-naïve to enzyme replacement therapy, were placed into 4 groups according to body weight: Group 1 was administered 0.5 mg/kg idursulfase intravenously, Groups 2–4 were administered an intrathecal formulation (1-, 10-, and 30-mg doses). Blood samples and cerebrospinal fluid (sampled at the cisterna magna or lumbar level) were collected at the same time points for 72 hours post dosing. Following intravenous administration, a high maximum serum concentration and rapid distribution of iduronate-2-sulfatase out of the central compartment were observed (elimination half-life: 4.3 hours). Iduronate-2-sulfatase exposure in the cerebrospinal fluid was limited, suggesting intravenous administration provided minimal penetration of the blood–brain barrier. Following intrathecal administration, a high maximum observed concentration was immediately noted and elimination half-life ranged between 7.8–10 hours and 5.9–6.7 hours (cisterna magna and lumbar sampling, respectively). Cerebrospinal fluid pharmacokinetic profiles at different doses of iduronate-2-sulfatase were similar and the dose/exposure relationship was proportional. After intrathecal administration, movement of iduronate-2-sulfatase from cerebrospinal fluid to serum was observed (systemic bioavailability was 40–83%). The clear penetration of iduronate-2-sulfatase into the cerebrospinal fluid and the dose response suggest that intrathecal delivery of iduronate-2-sulfatase may be suitable for treating the central nervous system manifestations associated with Hunter syndrome.     

两性霉素B联合氟康唑治疗艾滋病合并新型隐球菌性脑膜脑炎的疗效预测因素分析

目的:探讨两性霉素B联合氟康唑治疗艾滋病合并新型隐球菌性脑膜脑炎(简称"艾滋病合并隐脑")的疗效预测因素。方法:回顾性收集2010年1月1日-2016年12月31日58例在首都医科大学附属北京佑安医院住院治疗且接受两性霉素B联合氟康唑治疗的艾滋病合并隐脑患者的临床资料,分析其疗效预测因素及预测价值。结果:根据预后将患者分为好转组(38例)和死亡组(20例),单因素分析结果显示两组之间CD4+T细胞计数、脑脊液细胞计数比较有统计学差异(P分别为0.032,0.001)。Logistic回归多因素分析结果显示脑脊液细胞计数是两性霉素B联合氟康唑治疗艾滋病合并隐脑的疗效预测因素(P=0.023),Exp(B)=1.01,95%置信区间为1.00-1.03。ROC曲线对脑脊液细胞计数的预测价值进行分析,结果显示曲线下面积为0.889,预测阈值为261个/mm3,对应的敏感性=0.684,特异性=1.0。结论:脑脊液细胞计数是两性霉素B联合氟康唑治疗艾滋病合并新型隐球菌性脑膜脑炎良好的疗效预测参考因素。     

Neuron-specific enolase as a marker of neuronal lesions during various comas in man

The detection of neuron-specific enolase in biological fluids has been investigated as an indirect marker of neuronal damage in man. This protein was measured by a sandwich enzymoimmunoassay in serums and cerebrospinal fluids from patients with consciousness disorders of various aetiologies. Neuron-specific enolase level was significantly increased in sera from patients with comas resulting from anoxemia, head injury, septic state, cirrhosis and fulminant hepatitis. On the other hand, patients with meningitis (affection not normally accompanied with neuronal lesion) exhibited no change of this marker level. The statistical analysis of our results suggests that, in neurological disorders, the neuron-specific enolase levels in cerebrospinal fluid could have some prognostic value. The correlation between its level in cerebrospinal fluid and in serum was also demonstrated. Neuron-specific enolase increase in biological fluids thus represents a useful and promising marker to biochemically characterize various strokes possibly resulting in neuronal damage.