CSF proteome: a protein repository for potential biomarker identification

Proteomic analysis is not limited to the analysis of serum or tissues. Synovial, peritoneal, pericardial and cerebrospinal fluid represent unique proteomes for disease diagnosis and prognosis. In particular, cerebrospinal fluid serves as a rich source of putative biomarkers that are not solely limited to neurologic disorders. Peptides, proteolytic fragments and antibodies are capable of crossing the blood-brain barrier, thus providing a repository of pathologic information. Proteomic technologies such as immunoblotting, isoelectric focusing, 2D gel electrophoresis and mass spectrometry have proven useful for deciphering this unique proteome. Cerebrospinal fluid proteins are generally less abundant than their corresponding serum counterparts, necessitating the development and use of sensitive analytical techniques. This review highlights some of the promising areas of cerebrospinal fluid proteomic research and their clinical applications.     

Extractive acylation and mass spectrometric assay of 3-methoxytyramine, normetanephrine, and metanephrine in cerebrospinal fluid

The chemical analysis of 3-methoxytyramine, normetanephrine, and metanephrine in tissues, blood, and cerebrospinal fluid is complicated by the low levels in which they occur and the amphoteric nature of the functional groups, which hampers their isolation from aqueous media. In the present report, we describe a practical and simple method for the routine isolation and derivatization of 3-methoxytyramine, normetanephrine, and metanephrine in high yield from aqueous samples like cerebrospinal fluid. The metabolites are simultaneously derivatized with pentafluoropropionic anhydride and extracted into an organic solvent. After further treatment with pentafluoropropionic anhydride under anhydrous conditions, the samples are ready for GC/MS analysis. The method is able to exploit the theoretical maximal sensitivity available in the electron capture negative-ion chemical ionization mode without any apparent losses during extraction and derivatization, giving limits of detection in the low picogram range. Mean levels of free 3-methoxytyramine, normetanephrine, and metanephrine in human cerebrospinal fluid were 3.77, 5.20, and 0.40 pmol/ml. Assay of pools of squirrel monkey, human, and canine cerebrospinal fluid with and without previous enzymatic hydrolysis demonstrated that the three metabolites occur predominantly in a conjugated form.     

Pressure distribution in the cranial cavity

Values of interstitial fluid pressure in surface layers of the human brain and of the pressure of the cerebrospinal fluid "bathing" the brain are presented. The results show a difference in these pressures. The analysis with a spherical model shows that intratissue structural (biomechanical) connections, and those between the brain, its membranes and cranium are extremely important in significantly weakening the transmission of the cerebrospinal fluid pressure to the cortex and surface layers of the brain.     

Determination of catecholamines in tissue and body fluids using microbore HPLC with amperometric detection

Performance of microbore reverse phase HPLC coupled with amperometric detection is detailed for the analysis of catecholamines in small tissue samples and human blood plasma and cerebrospinal fluid. Extraction procedures for pre-concentration and clean-up of these samples are described. Marked signal enhancement is observed due to the smaller column volume as well as the increased coulometric yield which results from the lower flow rates used with this technique. Detection limits of 0.2 to 0.5 picograms are obtained allowing analysis of catecholamines in extremely small tissue samples or small volumes of cerebrospinal fluid or plasma.     

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.     

Chiral separation of amino acids in biological fluids by micellar electrokinetic chromatography with laser-induced fluorescence detection

A method is presented for the chiral analysis of amino acids in biological fluids using micellar electrokinetic chromatography (MEKC) and laser-induced fluorescence (LIF). The amino acids are derivatized with the chiral reagent (+/−)-1-(9-anthryl)-2-propyl chloroformate (APOC) and separated using a mixed micellar separation system. No tedious pre-purification of samples is required. The excellent separation efficiency and good detection capabilities of the MEKC-LIF system are exemplified in the analysis of urine and cerebrospinal fluid. This is the first time MEKC has been reported for chiral analysis of amino acids in biological fluids. The amino acids -alanine, -glutamine, and -aspartic acid have been observed in cerebrospinal fluid, and -alanine and -glutamic acid in urine. To the best of our knowledge no measurements of either -alanine in cerebrospinal fluid or -glutamic acid in urine have been presented in the literature before.     

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.     

Paper Chromatographic Techniques for the Determination of Cephalothin and Desacetylcephalothin in Body Fluids

Paper chromatographic procedures may be used to detect cephalothin and its metabolite desacetylcephalothin in urine, plasma, synovial fluid, and cerebrospinal fluid. Protein-bound antibiotics are released from plasma, cerebrospinal fluid, and synovial fluid by dilution with an equal volume of dimethylformamide. Data are presented on the sample preparation, paper chromatographic system, and other specific techniques.     

中枢神经系统疾病脑脊液中免疫球蛋白与IL-6的表达与意义

目的:检测中枢神经系统疾病患者脑脊液中免疫球蛋白与IL-6的表达情况并探讨其临床意义。方法:采用罗氏C6000仪器通过免疫发光法检测和比较本院收治的30例正常人、61例脑炎患者、51例头痛患者、30例肌无力患者以及35例脑梗死患者的脑脊液中IgAcsf、IgMcsf、IgGcsf、AIbcsf与IL-6的表达。结果:除头痛患者外,其他中枢神经系统疾病患者的脑脊液中IgAcsf、IgMcsf、IgGcsf、AIbcsf蛋白的表达量均高于正常人群,且脑炎患者与肌无力患者的脑脊液中IgAcsf、IgMcsf蛋白的表达量均高于头痛患者,脑梗死患者的脑脊液中IgMcsf、IgGcsf蛋白的表达量高于头痛患者,肌无力患者的脑脊液中IgGcsf蛋白的表达量高于头痛患者,脑梗死患者的脑脊液中IL-6蛋白的表达量明显高于脑炎、头痛和肌无力患者,差异均具有统计学意义(P0.05)。结论:脑脊液中免疫球蛋白、IL-6的表达异常与中枢神经系统感染性疾病的发生有关,且在不同种类的中枢神经系统疾病之间存在差异,可能有助于预防、治疗和诊断中枢神经系统疾病。     

一种Beagle犬腰椎穿刺置管术介绍

目的建立一种新的Beagle犬脑脊液连续留取的方法。方法通过氯胺酮麻醉进行腰椎穿刺后置管可连续留取脑脊液。结果腰椎穿刺置管后成功连续留取清亮脑脊液超过48h。结论腰椎穿刺置管连续留取脑脊液简单、有效。     

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.     

DSA技术在恒河猴脑脊液动态采集中应用

探索数字减影血管造影(digital subtraction angiography,DSA)插管技术在恒河猴(Macaca mulatta)脑脊液动态采集中的应用。将28只恒河猴作为实验动物,随机分为实验组和对照组,每组14只,经左前肢静脉推注3%戊巴比妥钠溶液全麻后,常规剔除背部脊柱周围体毛、消毒,实验组从穿刺开始就在DSA技术下行腰椎间隙穿刺,对照组直接行腰椎间隙穿刺,将硬膜外麻醉导管经腰椎蛛网膜下腔送至枕大池并埋置泵。对不同穿刺方法的结果数据进行χ2检验;神经功能参照改良Tarlov评分标准,切口采用改良的切口愈合等级评分标准。实验组经腰椎间隙穿刺蛛网膜下腔全部成功;对照组8只穿刺成功,6只穿刺失败;所有动物埋置泵均能从泵中采集到无色透明的脑脊液;术后恒河猴均于当天恢复正常。在DSA技术下经腰椎间隙穿刺蛛网膜下腔并埋置泵,成功率高,操作简便、安全性好,可行性强;通过埋置的泵采集脑脊液,快速省时,可实现在动物清醒时、全生理状态下对脑脊液进行动态多次采集,有助于提高非人灵长类实验动物的福利,由于采样导管置于枕大池,采集到的脑脊液样品质量有保证,可用于研究缺血性脑卒中发生机制,满足检验需要,具有一定的实用价值。     

实验用猴脑脊液采集技术方法的创新

脑脊液在艾滋病的研究中有着重要的意义。近年来脑脊液的检测逐步成为SIV/SHIV感染猴模型研究和应用中的重要指标。传统的采集方法不易学习和掌握。针对上述情况我们优化了脑脊液的采集方法,优化后的方法明显缩短穿刺时间,显著提高成功率。     

Cytomegalovirus associated transverse myelitis in an immunocompetent host with DNA detection in cerebrospinal fluid; a case report

ABSTRACT: BACKGROUND: Cytomegalovirus associated transverse myelitis among immunocompetent adults has been rarely reported. We report a patient presenting with clinical myelitis followed by previously unreported finding of cytomegalovirus deoxyribonucleic acid in cerebrospinal fluid. Case report A forty year old immunocompetent male presented with acute onset progressive bilateral lower limb weakness. His spinal magnetic resonance imaging findings, cerebrospinal fluid analysis and clinical picture were compatible with transverse myelitis. Polymerase chain reaction of the cerebrospinal fluid for cytomegalovirus was positive while other infectious agents were not detected by serology or polymerase chain reaction. He was treated with intravenous ganciclovir with partial clinical response. CONCLUSION: Viral genome detection in the cerebrospinal fluid was performed but negative in five out of ten reported cases of cytomegalovirus associated transverse myelitis in the immunocompetent host. In previous cases the inability to isolate the virus in cerebrospinal fluid was considered favouring an immunological mechanism leading to pathogenesis rather than direct viral toxicity but this case is against that theory. This case highlights the fact that Cytomegalovirus should be considered as an aetiological agent in patients with transverse myelitis and that the virus may cause serious infections in immunocompetent host. Therefore this report is of importance to neurologists and physicians in general.     

神经内镜与显微镜下经鼻蝶入路手术切除垂体腺瘤的临床疗效比较及术中出现脑脊液漏的危险因素分析

摘要 目的：对比垂体腺瘤患者采用显微镜或神经内镜下经鼻蝶入路手术切除后的临床疗效,分析术中出现脑脊液漏的危险因素。方法：回顾性分析2018年3月~2022年2月期间来我院接受手术治疗的178例垂体腺瘤患者的临床资料。根据采用手术器械的不同将178例患者分为A组（显微镜,n=91）和B组（神经内镜,n=87）。比较两组的肿瘤有效切除率、临床指标、术中脑脊液漏发生率及术后并发症发生率。根据术中是否发生脑脊液漏分为脑脊液漏组和无脑脊液漏组。经单因素和多因素Logistic回归分析患者术中发生脑脊液漏的危险因素。结果：B组的手术时间、住院时间短于A组,术中出血量少于A组（P<0.05）。A组、B组的肿瘤有效切除率组间对比,无统计学差异（P>0.05）。B组术中脑脊液漏发生率、术后并发症发生率低于A组（P<0.05）。垂体腺瘤患者术中发生脑脊液漏与再次手术、肿瘤大小、年龄、肿瘤质地、美国麻醉医师协会（ASA）分级有关（P<0.05）。肿瘤大小为巨大腺瘤、再次手术、肿瘤质地为韧是垂体腺瘤患者术中发生脑脊液漏的危险因素（P<0.05）。结论：显微镜与神经内镜下经鼻蝶入路手术切除垂体腺瘤,治疗效果相当,但神经内镜下手术可缩短手术时间、住院时间,减少术中出血量,降低术中脑脊液漏发生率、术后并发症发生率。此外,肿瘤大小为巨大腺瘤、再次手术、肿瘤质地为韧是垂体腺瘤患者术中发生脑脊液漏的危险因素。     

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。     

Gallbladder carcinoma cells in cerebrospinal fluid as the first manifestation of a tumor. A case report

BACKGROUND: Meningeal carcinomatosis (MC) rarely occurs as the first evidence of a tumor. In such cases cytology of the cerebrospinal fluid is crucial to the diagnosis. The most frequent primary MCs are lung and breast cancers. MC from a gallbladder carcinoma is uncommon. CASE: A 58-year-old woman presented with paroxysmal headaches, seizures and coma. Analysis of the cerebrospinal fluid revealed carcinoma cells and a low protein concentration. Only postmortem examination discovered gallbladder adenocarcinoma to be the source of the tumor cells. CONCLUSION: A case with the onset of MC secondary to rare mucinous adenocarcinoma of the gallbladder is presented. Cytology of the cerebrospinal fluid was the only examination that uncovered malignancy. Nine similar cases were found in the literature. Low cerebrospinal fluid protein seems to be of diagnostic value.     

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。     

Correlations between the cerebrospinal fluid surface tension value and 1. Concentration of total proteins 2. Number of cell elements

The contribution gives a survey about the problematics of surface tension in biomedical sciences. The paper presents results of a study devoted to the cerebrospinal fluid. The distribution of the surface tension values of this liquid in healthy individuals is presented (n = 33), and further, statistically significant correlations between the cerebrospinal fluid surface tension value and 1. concentration of total proteins expressed by Spearman's coefficient p(s) = (-0.995) and 2. number of cell elements expressed through Spearman's coefficient p(s) = (-0.965) in cerebrospinal fluid are described.