Immunoreactive LHRH in cerebrospinal fluid: the clinical significance in intracranial diseases

Cerebrospinal fluid (CSF) and plasma levels of luteinizing hormone-releasing hormone (LHRH) were measured by RIA in 46 patients with acute intracranial diseases, ie, cerebral bleeding (group A), cerebral thrombosis (B), head injury (C) and meningitis (D), and the results were compared to those obtained in 21 patients with non-intracranial diseases (group E; control). Immunoreactive LHRH concentrations in CSF (CSF IR-LHRH) of 8 postmenopausal women in group E ranged 1.3 to 6.1 (mean +/- SE: 3.1 +/- 0.6) pg/ml, and those of 5 other women and 8 men with group E ranged 1.0 to 5.6 (3.6 +/- 0.4)pg/ml. In 7 out of 15 patients in group A(7/15), CSF IR-LHRH were above the levels seen in group E. In group B, C and D, CSF IR-LHRH were above the control levels in 9/15, 1/9, 3/7, respectively. The changes in plasma LHRH were not clear in postmenopausal patients in groups A and B. Plasma IR-LHRH in other women and men in group A were above the control levels in 2 out of 9 patients (2/9). Those in groups B, C and D were above the control levels in 3/8, 1/9, 2/7, respectively. Moreover, both plasma and CSF IR-LHRH of 13 patients in group A or B in chronic stage were within the control ranges. In cases observed following the time course, the occasionally increased IR-LHRH in plasma and CSF tended to decrease following the abatement of the diseases.(ABSTRACT TRUNCATED AT 250 WORDS)     

The preferential release of beta-endorphin from the anterior pituitary lobe by corticotropin releasing factor (CRF)

Although a number of investigators have shown that release of ACTH is accompanied by the release of Beta-endorphin (beta-End) and Beta-lipotropin (beta-LPH), the proportion of the latter two peptides released with stress or by CRF is unclear. To evaluate directly the release of beta-End versus beta-LPH from the anterior lobe, we used molecular sieving of plasma and subsequent radioimmunoassay to measure release of both beta-End and beta-LPH into plasma after thirty minutes of inescapable intermittent footshock. We found a substantial increase in circulating beta-End which appears to be of anterior lobe origin. The beta-End does not appear to represent peripheral conversion of beta-LPH to beta-End since the ratio of beta-LPH:beta-End released remained constant between five and thirty minutes of stress, and the rate of disappearance of beta-LPH is slower than the rate of disappearance of beta-End following the termination of stress. Further confirmation of these findings was obtained by examining the POMC derived peptides released by pituitary cell suspensions in the presence and absence of oCRF. While unstimulated release consisted of equal proportions of beta-End and beta-LPH, stimulation of the anterior lobe cell suspensions with oCRF resulted in the release of two-fold more beta-End than beta-LPH.     

TIMPs and MMPs expression in CSF from patients with TSP/HAM

The tropical spastic paraparesis or human T-cell lymphotropic virus associated myelopathy (TSP/HAM), has been related with an overexpression of matrix metalloproteinases (MMPs), especially MMP-9. Initial studies of reverse zymography with cerebrospinal fluid (CSF) from TSP/HAM patients, and controls showed the presence of TIMPs, endogenous MMP inhibitors. We determined in CSF the levels of TIMPs by immunoanalysis in 25 patients with TSP/HAM, and compared with two groups: controls and patients with acute and subacute inflammatory neurological diseases. We found that TIMP-2, TIMP-3 and TIMP-4 levels were significantly higher than in controls in both TSP/HAM and inflammatory patients, while TIMP-1 was increased only in the inflammatory group. Levels of MMP-3 and MMP-9 from the two groups of patients showed a significant upregulation in CSF. In the CSF of around the 70% of TSP-HAM and inflammatory patients the presence MMP-9 was detected by zymography, but not in controls. MMP-2 was only overexpressed in the acute inflammatory group. The active form of MMP-2 was observed in both groups of patients with a similar high frequency (60%). MMPs overexpressions are independent of the evolution time of the disease in TSP/HAM. The chronic overexpression of these extracelullar matrix proteins detected in CSF of TSP/HAM should be indirectly produced by secreted viral proteins being responsible for the progression of this disease, accounting for the observed differences with acute inflammatory patients. Our results support the existence of an imbalance between MMPs and their endogenous tissue inhibitors, which could be a pathogenic factor in the chronicity of TSP/HAM.     

Beta endorphin-like immunoreactivity in human aqueous humor and crystalline lens

We measured the concentration of beta-endorphin (beta-End) in plasma, as well as in aqueous humor and crystalline lens removed during cataract surgery. beta-End was detected both in the aqueous humor and in the crystalline lens. The concentration of beta-End in the aqueous humor corresponded to almost the half of the plasma level (2.18 fmol/l and 4.55 fmol/l). Endogenous beta-End is presumed to enter the intraocular structures by passive diffusion.     

Tumor necrosis factor-alpha and its soluble receptors in plasma and cerebrospinal fluid of multiple sclerosis patients treated with methylprednisolone.

Demyelination is the main pathological feature of multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system. Tumor necrosis factor-alpha (TNF-alpha) can cause myelin damage and contribute to MS pathogenesis. We measured plasma and cerebrospinal fluid (CSF) levels of TNF-alpha and its soluble receptors, TNF-sRp55 and TNF-sRp75, in 18 patients with active MS, and in neurological and healthy controls. The same determinations were repeated on plasma and on CSF samples that were collected after the MS patients had ended a six-day treatment with high-dose methylprednisolone (MP). Pre- and post-treatment plasma and CSF TNF-alpha levels, when detectable, and those of TNF-sRp75, did not vary, and were similar to those of controls. CSF TNF-sRp55 levels were higher in acute MS patients than in controls. Post-treatment CSF TNF-sRp55 levels were higher than in the active phase of the disease. The MS patients, who clinically improved, tended to have the highest CSF TNF-sRp55 levels. The increase was due to intrathecal TNF-sRp55 synthesis. Although it is involved in MS pathogenesis, TNF-alpha is not detectable in plasma or in CSF samples from MS patients in various phases of the disease. A better marker of disease activity seems to be CSF TNF-sRp55 levels. The increased CSF levels of TNF-sRp55 in response to MP circumstantially suggest that this receptor could partially account for the beneficial effects of MP in acute MS.     

Plasma and Urinary 11-Hydroxycorticosteroids in Differential Diagnosis of Cushing's Syndrome

Morning plasma 11-hydroxycorticoids, urinary 11-hydroxycorticoids, and urinary 17-oxogenic steroids were measured before and during a dexamethasone suppression test. This consisted in the administration by mouth of 2 mg of dexamethasone daily for 48 hours, followed by 8 mg daily for 48 hours. In addition midnight plasma 11-hydroxycorticoids were measured before the start of the test. The subjects investigated were 21 patients with Cushing''s syndrome, 27 obese female patients, 10 female patients with the Stein-Leventhal syndrome, and 8 female patients with idiopathic hirsutism.The results showed that the clearest distinction between the groups was made by measurement of the basal urinary 11-hydroxycorticoid excretion, where, in the group of patients with Cushing''s syndrome, all the levels were well above the upper limit of normal. In addition raised midnight plasma 11-hydroxycorticoid levels were of great diagnostic value. By using these results together with those of the dexamethasone suppression tests it was possible to make a firm preoperative diagnosis of pituitary-dependent Cushing''s syndrome in 90% of patients in this series.     

Cerebrospinal fluid S-100 protein levels in neurological pathologies

The aim of this paper was to evaluate S-100 concentration in cerebrospinal fluid (CSF) from patients with different neurological disorders, and in subjects with no proven neurological pathology, in order to study possible differences in their protein concentrations. The total number of patient-samples examined was 119 (58 males and 61 females; mean age 35 yrs, 1-79 yrs). Based on the final diagnoses, nine patient groups were studied: a control group, meningitis, acute lymphatic leukemia (ALL), dementia, hydrocephalia, polyneuropathy-motor neuron disease, acute cerebral infarction (ACI), and patients diagnosed with multiple sclerosis. S-100 protein concentrations were measured by the Sangtec 100 two-site immunoradiometric assay. The highest S-100 levels in CSF were found in the dementia group, ACI group, bacterial-fungal and lymphocytic meningitis groups (Kruskal-Wallis test). The S-100 concentrations in these groups were significantly higher compared with the control group (Mann-Whitney U test, p<0.05, p<0.01) and the multiple sclerosis group (p<0.05, p<0.01). No other significant differences were found between groups. Our results suggest that the high protein levels in CSF found in these pathologies may reflect the presence of brain damage. However, the levels need to be considered individually, as they depend on several factors, such as age, severity of brain damage or interval between the onset of brain damage and the taking of the sample.     

Diurnal beta-endorphin changes in human cerebrospinal fluid

Plasma and cerebrospinal fluid (CSF) beta-endorphin levels were determined by a RIA method in seven hydrocephalic male patients. The samples were simultaneously collected every two hours from 8 AM to 12 midnight and every hour from 1 AM to 7 AM. In both plasma and CSF beta-endorphin levels showed significant time-related variations during the 24 hour period. These results suggest the existence of diurnal CSF beta-endorphin variations analogous to those observed in plasma.     

A Multiplex Protein Panel Applied to Cerebrospinal Fluid Reveals Three New Biomarker Candidates in ALS but None in Neuropathic Pain Patients

The objective of this study was to develop and apply a novel multiplex panel of solid-phase proximity ligation assays (SP-PLA) requiring only 20 μL of samples, as a tool for discovering protein biomarkers for neurological disease and treatment thereof in cerebrospinal fluid (CSF). We applied the SP-PLA to samples from two sets of patients with poorly understood nervous system pathologies amyotrophic lateral sclerosis (ALS) and neuropathic pain, where patients were treated with spinal cord stimulation (SCS). Forty-seven inflammatory and neurotrophic proteins were measured in samples from 20 ALS patients and 15 neuropathic pain patients, and compared to normal concentrations in CSF from control individuals. Nineteen of the 47 proteins were detectable in more than 95% of the 72 controls. None of the 21 proteins detectable in CSF from neuropathic pain patients were significantly altered by SCS. The levels of the three proteins, follistatin, interleukin-1 alpha, and kallikrein-5 were all significantly reduced in the ALS group compared to age-matched controls. These results demonstrate the utility of purpose designed multiplex SP-PLA panels in CSF biomarker research for understanding neuropathological and neurotherapeutic mechanisms. The protein changes found in the CSF of ALS patients may be of diagnostic interest.     

Proopiomelanocortin opioids in brain, CSF, and plasma of piglets during hypoxia

beta-Endorphin-like immunoreactivity (BELI), containing the biologically active beta-endorphin, its precursor beta-lipotropin (BLP), and deactivated product N-acetyl-beta-endorphin (ABE), were measured by radioimmunoassay in plasma, cerebrospinal fluid (CSF), and in a dorsal medullary slice containing the respiratory-related nucleus tractus solitarius (dmscNTS) of young and older piglets in normoxia and hypoxia. Significant increase with hypoxia occurred in the levels of BLP in the plasma and CSF and of BELI and ABE in the plasma of the young group. In the older group, such increases occurred in ABE levels of the dmscNTS, in BLP and ABE levels of the CSF, and in plasma BELI. Estimated levels of pure beta-endorphin were higher in the CSF of young piglets during both control and hypoxia. With hypoxia, these estimated levels increased significantly in the plasma of the young age group but showed only a borderline increase in the old group. It is possible that higher opioid levels in the CSF of young as compared with older neonates, enhanced by a greater opioid increase in their plasma during hypoxia, may help explain the suppressed respiratory response to hypoxia of the newborn.     

In vivo influences on cerebrospinal fluid amino acid levels

The concentration of 19 amino acids and ethanolamine in two independent groups (n = 36, n = 19) of normal human cerebrospinal fluid (CSF) samples were measured by high performance liquid chromatography. Age, sex, time of lumbar puncture, position during lumbar puncture, protein and glucose content of the CSF were monitored and the influence of these parameters on CSF amino acid levels was determined. Hypotheses formulated after observing measurements from the first group of CSF samples were tested against the second group of CSF samples using conservative statistics. The main finding was a positive correlation between CSF glucose and CSF glutamate levels.     

Analgesic responses to intrathecal morphine in relation to CSF concentrations of morphine-3,beta-glucuronide and morphine-6,beta-glucuronide.

This study was performed to determine whether variations in analgesic responses to intrathecal morphine could be explained by cerebrospinal fluid (CSF) concentrations of morphine metabolites. Twenty-four CSF samples were collected at the beginning, middle and end of treatment periods in seven cancer patients with pain of malignant origin. CSF concentrations of morphine-3,beta-glucuronide (M3G) and morphine-6,beta-glucuronide (M6G) metabolites were measured by gas chromatography/mass spectrometry. Analgesic responses to morphine were estimated concurrent with CSF collection using a visual analog scale representing percentages of pain relief. Effective analgesia was defined as > or = 75% pain relief. CSF concentration of M3G and M6G in the 24 samples were 722 +/- 116 ng/ml and 699 +/- 158 ng/ml, respectively. CSF samples were categorized into two groups: (1) those collected during effective analgesia (N=14), and (2) those collected during ineffective analgesia (N=10). M6G levels detected in group 1 samples (effective analgesia) were significantly greater than those found in group 2 samples (ineffective analgesia) (978 +/- 243 ng/ml vs 309 +/- 68 ng/ml, P<0.05). Intergroup differences in CSF M3G concentrations and M3G/M6G ratios were not significant. It is concluded that CSF M6G may be indicative of effectiveness of analgesia in cancer patients subjected to intrathecal morphine.     

围术期应用肼苯哒嗪预防疝修补术后慢性疼痛的研究

目的：探讨肼苯哒嗪对疝修补术后患者慢性疼痛发生率的影响。方法：选择单侧腹股沟疝患者48人,随机分为实验组（T组）和对照组（c组）各24例,在术前3天至术后4天共7天内接受药物或安慰荆治疗。其中T组每日两次,每次10mg肼苯哒嗪,C组同样方式给予安慰剂。测量患者术后4天内的平均动脉）Z（MAP）、心率（HR）、NRS急性疼痛评分以及术后3月、6月S—LANSS慢性疼痛评分。结果：T组患者术后MAP明显低于C组（P〈0．05）,HR两组相比无差异（P〉0．05）;两组患者术后急性疼痛程度相比无统计学差别（P〉0．05）;T组患者在术后3月和6月慢性疼痛发生率明显低于C组（P〈0．05）。结论：常规剂量肼苯哒嗪可以用于术后患者,对疝修补术后急性疼痛无影响,但可以明显降低术后慢性疼痛的发生率。     

Interleukin-6 in neuro-Behçet’s disease: Association with disease subsets and long-term outcome

Increased cerebrospinal fluid (CSF) IL-6 has been reported in patients with Behçet’s disease (BD) and neurological involvement. To elucidate the value of IL-6 as a marker of disease activity, serum and CSF IL-6 levels of 68 BD patients with acute (26) or chronic progressive (14) parenchymal involvement (pNB), dural sinus thrombosis (10), ischemic stroke (5) or headache (13) were measured by ELISA. Samples from multiple sclerosis, subacute sclerosing panencephalitis, and noninflammatory neurological disorders were used as controls. CSF but not serum samples of neuro-BD patients with acute pNB displayed significantly increased IL-6 levels as compared to other groups. Chronic progressive pNB patients also showed increased CSF IL-6 levels, albeit less prominent. Patients with increased CSF IL-6 levels were more likely to have increased CSF cell counts and total protein levels and these three parameters were correlated with long-term (3 years) disease outcome. In four chronic progressive patients, IL-6 was elevated despite otherwise normal CSF. CSF IL-6 seems to be a marker of disease activity and long-term outcome for pNB along with CSF cell count and protein levels. CSF IL-6 could be used in chronic progressive patients who have normal CSF cell, or protein levels to detect disease activity.     

Plasma and Cerebrospinal Fluid Amino Acids in Epileptic Patients

Altered plasma and cerebrospinal fluid amino acid levels may be associated with human epilepsy. We studied three groups of patients, those with a generalized epileptic syndrome, juvenile myoclonic epilepsy, patients with refractory localization-related epilepsies, and patients with acute seizures (within 24 h). Plasma levels of amino acids were studied in all patient groups, as were those in the cerebrospinal fluid (CSF) of patients with acute seizures. After acute seizures, the amino acid changes in the CSF were limited to a reduction in the level of taurine, whereas the levels of most amino acids in plasma were decreased. On the other hand, levels of the excitatory amino acids glutamate and aspartate were increased. The most notable finding in the juvenile myoclonic epilepsy patients was an increase in glutamate level in the plasma. Our study supports the conception of an altered metabolism of glutamate in generalized epilepsies.     

Decrease in Plasma Levels of α-Synuclein Is Evident in Patients with Parkinson’s Disease after Elimination of Heterophilic Antibody Interference

There is substantial biochemical, pathological, and genetic evidence that α-synuclein (A-syn) is a principal molecule in the pathogenesis of Parkinson disease (PD). We previously reported that total A-syn levels in cerebrospinal fluid (CSF), measured with the specific enzyme-linked immunosorbent assay (ELISA) developed by ourselves, were decreased in patients with PD, and suggested the usefulness of A-syn in CSF and plasma as a biomarker for the diagnosis of PD. After our report, a considerable number of studies have investigated the levels A-syn in CSF and in blood, but have reported inconclusive results. Such discrepancies have often been attributed not only to the use of different antibodies in the ELISAs but also to interference from hemolysis. In this study we measured the levels of A-syn in CSF and plasma by using our own sandwich ELISA with or without heterophilic antibody (HA) inhibitor in 30 patients with PD and 58 age-matched controls. We thereby revealed that HA interfered with ELISA measurements of A-syn and are accordingly considered to be an important confounder in A-syn ELISAs. HA produced falsely exaggerated signals in A-syn ELISAs more prominently in plasma samples than in CSF samples. After elimination of HA interference, it was found that hemolysis did not have a significant effect on the signals obtained using our A-syn ELISA. Furthermore, plasma levels of A-syn were significantly lower in the PD group compared with the control group following elimination of HA interference with an HA inhibitor. Our results demonstrate that HA was a major confounder that should be controlled in A-syn ELISAs, and that plasma A-syn could be a useful biomarker for the diagnosis of PD if adequately quantified following elimination of HA interference.     

Insignificant role of the N-terminal cobalt-binding site of albumin in the assessment of acute coronary syndrome: discrepancy between the albumin cobalt-binding assay and N-terminal-targeted immunoassay

The aim of this study was to evaluate whether the N-terminus of human serum albumin (HSA) has a role in the cobalt binding detected using albumin cobalt-binding (ACB) assay. We compared the results obtained using an enzyme-linked immunosorbent assay (ELISA) for N-terminal-modified HSA with those of a conventional ACB assay in two groups: acute coronary syndrome (n?=?43) and non-ischemic chest pain (n = 39). ACB and cardiac troponin-I levels were higher in the acute coronary syndrome group. No significant correlation between ACB assay and ELISA results was observed in either of the two patient groups. In acute chest pain patients, the N-terminal site of HSA has a negligible or limited role in cobalt binding in the ACB assay.     

Gonadal steroid and chronic morphine treatment do not change the posttranslational processing of beta-endorphin in the rat brain

The present study examines whether two treatments known to induce refractoriness to exogenous morphine produce this desensitization through a change in the posttranslational processing of brain beta-endorphin (beta-End). The first experiment examined whether an ovarian steroid regimen which produces a transient desensitization of brain opiate receptor mechanisms alters beta-End processing in the preoptic area (POA), medial basal hypothalamus (MBH), and brainstem (BS). The second experiment monitored the effects of morphine pellet treatment, known to produce morphine dependency, on immunoreactive beta-End forms in the hypothalamus and periaquaductal gray area of the midbrain (PAG). The individual molecular forms of beta-End were separated using ion exchange chromatography and collection fractions were quantitated for beta-End immunoreactivity by RIA. The results show that regional differences occur in the posttranslational processing of beta-End. In the hypothalamus, MBH and POA, beta-End-(1-31) and its non-acetylated C-terminal cleavage products, beta-End-(1-27) and beta-End-(1-16) were the predominant forms of beta-End. The PAG pools produced a beta-End peptide elution profile similar to the hypothalamus, although small amounts of N-acetyl-beta-End-(1-31) were also identified. The BS exhibited the least posttranslational processing of beta-End; beta-End-(1-31) was the primary product with smaller amounts of beta-End-(1-27) and beta-End-(1-26) observed. However, neither ovarian steroid treatment nor chronic morphine produced any changes in posttranslational processing of beta-End or in total beta-End concentration in any of the brain regions examined in these experiments. These data indicate that the refractoriness or tolerance to exogenous morphine associated with steroid or chronic morphine treatment cannot be explained by alterations in the biological activity of beta-End resulting from the differential regulation of its posttranslational processing products.     

High viral load in the cerebrospinal fluid and brain correlates with severity of simian immunodeficiency virus encephalitis

AIDS dementia and encephalitis are complications of AIDS occurring most frequently in patients who are immunosuppressed. The simian immunodeficiency virus (SIV) model used in this study was designed to reproducibly induce AIDS in macaques in order to examine the effects of a neurovirulent virus in this context. Pigtailed macaques (Macaca nemestrina) were coinoculated with an immunosuppressive virus (SIV/DeltaB670) and a neurovirulent molecularly cloned virus (SIV/17E-Fr), and more than 90% of the animals developed moderate to severe encephalitis within 6 months of inoculation. Viral load in plasma and cerebrospinal fluid (CSF) was examined longitudinally to onset of AIDS, and viral load was measured in brain tissue at necropsy to examine the relationship of systemic and central nervous system (CNS) viral replication to the development of encephalitis. In all animals, plasma viral load peaked at 10 to 14 days postinfection and remained high throughout infection with no correlation found between plasma viremia and SIV encephalitis. In contrast, persistent high levels of CSF viral RNA after the acute phase of infection correlated with the development of encephalitis. Although high levels of viral RNA were found in the CSF of all macaques (six of six) during the acute phase, this high level was maintained only in macaques developing SIV encephalitis (five of six). Furthermore, the level of both viral RNA and antigen in the brain correlated with the severity of the CNS lesions. The single animal in this group that did not have CNS lesions had no detectable viral RNA in any of the regions of the brain. The results substantiate the use of CSF viral load measurements in the postacute phase of SIV infection as a marker for encephalitis and CNS viral replication.