The analysis of cerebrospinal fluid (CSF) is used in biomarker discovery studies for various neurodegenerative central nervous system (CNS) disorders. However, little is known about variation of CSF proteins and metabolites between patients without neurological disorders. A baseline for a large number of CSF compounds appears to be lacking. To analyze the variation in CSF protein and metabolite abundances in a number of well-defined individual samples of patients undergoing routine, non-neurological surgical procedures, we determined the variation of various proteins and metabolites by multiple analytical platforms. A total of 126 common proteins were assessed for biological variations between individuals by ESI-Orbitrap. A large spread in inter-individual variation was observed (relative standard deviations [RSDs] ranged from 18 to 148%) for proteins with both high abundance and low abundance. Technical variation was between 15 and 30% for all 126 proteins. Metabolomics analysis was performed by means of GC-MS and nuclear magnetic resonance (NMR) imaging and amino acids were specifically analyzed by LC-MS/MS, resulting in the detection of more than 100 metabolites. The variation in the metabolome appears to be much more limited compared with the proteome: the observed RSDs ranged from 12 to 70%. Technical variation was less than 20% for almost all metabolites. Consequently, an understanding of the biological variation of proteins and metabolites in CSF of neurologically normal individuals appears to be essential for reliable interpretation of biomarker discovery studies for CNS disorders because such results may be influenced by natural inter-individual variations. Therefore, proteins and metabolites with high variation between individuals ought to be assessed with caution as candidate biomarkers because at least part of the difference observed between the diseased individuals and the controls will not be caused by the disease, but rather by the natural biological variation between individuals.The analysis of CSF
1 is indispensable in the diagnosis and understanding of various neurodegenerative CNS disorders (
1–
3). CSF is a fluid that has different functions, such as the protection of the brain from outside forces, transport of biological substances, and excretion of toxic and waste substances. It is in close contact with the extracellular fluid of the brain. Therefore, the composition of CSF can reflect biological processes of the brain (
4). By discovering the characterization of the proteome and metabolome of CSF we may gain better insight on the pathogenesis of CNS disorders. This would be significant because, for many of these disorders, the etiology is still unclear.CSF is produced in the ventricles of the brain and in the subarachnoidal spaces. Humans normally produce around 500 mL of CSF each day, and the total volume of CSF at a given time is approximately 150 mL. CSF reflects the composition of blood plasma, although the concentrations of most proteins and metabolites in CSF are lower. However, individual proteins and metabolites can act differently. Active transport from blood and secretion from the brain contribute to the specific composition of CSF. This composition can be disturbed in neurological disorders (
5–
6). Since CNS-specific proteins and metabolites are typically low in abundance compared with their levels in blood, this change in composition is more likely to be found in CSF because in blood the more abundant plasma proteins can completely mask the signal of the less abundant proteins. Also, if the disease markers do not cross the blood-brain-barrier, then the CSF is the only viable biofluid source. Therefore, CSF might be an excellent source for biomarker discovery for CNS disorders if we follow the hypothesis that neurological diseases induce alterations in CSF protein and metabolite levels.Analysis of metabolites in CSF has been common practice in clinical chemistry for decades to analyze biomarkers for inborn errors of metabolism. The approaches used are either metabolite profiling of CSF using NMR (
7), or targeted analysis of one or a few metabolites using specific analytical methods (
8). Metabolomics includes the analysis of metabolites in biofluids by NMR or MS-based approaches,
i.e. LC-MS or GC-MS. Several metabolite profiling studies were performed on CSF using NMR, some of which were published only recently (
9,
10). Surprisingly, very few metabolomics studies using MS-based methods have been performed on CSF to date (
11,
12). One of the reasons is the fact that the human CSF metabolome has not yet been characterized very well. Many CSF metabolites remain unidentified, and for those that have been identified there is not much known about normal concentration ranges. A systematic categorization of the CSF metabolome is necessary and expected to be beneficial for future biomarker discoveries. Recently, Wishart
et al. made a good start in exploring the human CSF metabolome with their computer-aided literature survey that resulted in 308 detectable metabolites in human CSF (
13).The CSF proteome has been characterized to a much larger extent than the CSF metabolome and is currently the topic of investigations in several research groups worldwide. Recently, studies have been published with numerous identities and quantities of CSF proteins. Pan and co-workers were able to identify 2,594 proteins in well-characterized pooled human CSF samples using strict proteomics criteria with a combination of linear trap quadrupole LTQ-FT (Thermo Fisher Scientific, Bremen, Germany) and MALDI TOF/TOF equipment (
14). They were also able to quantify several proteins using a targeted LC MALDI TOF/TOF approach (
15). Hu
et al. have studied the intra- and inter-individual variation in human CSF and found large variations in protein concentrations in six patients by means of two dimensional–gel electrophoresis (
16), focusing mainly on the variations within individuals at two different time-points. Although only a limited number of proteins was analyzed, the variation between the time-points was profound, exceeding 200% for seven proteins.Unique CSF biomarkers may contribute to a deeper understanding of the mechanisms of CNS disorders. However, for this assumption to come true, there are still challenges ahead. Although CSF is not as complex as blood (almost missing the cellular part and the clotting system present in blood), it is expected to consist of thousands of organic- and non-organic salts, sugars, lipids, and proteins. A large part of the CSF consists of a few highly abundant metabolites and proteins, which hamper, if no precautions are undertaken, the identification and quantification of metabolites and proteins that occur in lower amounts. The analysis of the CSF metabolome is complicated because of the diverse chemical nature of metabolites and the lower concentration of metabolites compared with blood. Analytical method development is still required because it is not possible to identify the entire range of CSF metabolites with one single analytical method. Although in proteome research efforts have been made to quantify proteins, metabolomics studies up to now either do not provide quantitative information or they only give information for the most abundant metabolites.Another challenge is the sample amount obtained by lumbar puncture to collect CSF. Lumbar puncture is an invasive method that is not performed as frequently as blood sampling. However, often after the analysis of various clinical parameters, only a limited amount of CSF sample is available for biomarker discovery. Metabolomics studies are hampered by limited CSF sample amount. Therefore, analytical methods are required that are suitable to handle relatively small sample volumes.The main objectives of this study were (
1) to analyze the variation in CSF protein and metabolite abundances in a number of well-defined individual samples by multiple analytical platforms; and (
2) to integrate metabolomics and proteomics to present biological variations in metabolite and protein abundances and compare these with technical variations with the currently used analytical methods. The results will facilitate and increase the application of CSF for future biomarker discovery studies in the field of neurodegenerative diseases and neuro-oncology.
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