Comparative analysis of albumin quotient and total CSF protein in immune-mediated neuropathies: a multicenter study on diagnostic implications.

Autor: Seeliger T; Department of Neurology, Hannover Medical School, Hannover, Germany., Gingele S; Department of Neurology, Hannover Medical School, Hannover, Germany., Güzeloglu YE; Department of Neurology, Hannover Medical School, Hannover, Germany., Heitmann L; Department of Neurology, Hannover Medical School, Hannover, Germany., Lüling B; Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany., Kohle F; Department of Neurology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany., Preßler H; Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany.; Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany., Stascheit F; Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany.; Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany., Motte J; Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany., Fisse AL; Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany., Grüter T; Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany., Pitarokoili K; Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany., Skripuletz T; Department of Neurology, Hannover Medical School, Hannover, Germany.
Jazyk: angličtina
Zdroj: Frontiers in neurology [Front Neurol] 2024 Jan 09; Vol. 14, pp. 1330484. Date of Electronic Publication: 2024 Jan 09 (Print Publication: 2023).
DOI: 10.3389/fneur.2023.1330484
Abstrakt: Introduction: Blood-cerebrospinal fluid (CSF) barrier dysfunction is pivotal for diagnosing immune-mediated neuropathies, especially in spinal nerve root inflammation. Typically, either total CSF protein or the CSF to serum albumin ratio (Q Alb ) is measured. Total CSF protein measurements have limitations, notably its fixed reference value regardless of age, in contrast to the age-dependent reference for Q Alb . Our goal was to evaluate both markers in patients with immune-mediated neuropathies.
Methods: In our multicenter research, we collected retrospective CSF data from patients suffering from immune-mediated neuropathies across four German research centers. These parameters were analyzed in relation to their clinical characteristics.
Results: Out of 419 samples, 36 (8.6%) displayed a notable variation between total CSF protein and Q Alb values. A detailed analysis revealed that patients displaying elevated Q Alb but normal total CSF protein levels were significantly younger at disease onset ( p  = 0.01), at the time of diagnosis ( p  = 0.005), and when undergoing lumbar puncture ( p  = 0.001) compared to patients with elevated CSF protein and normal Q Alb levels. These effects were especially evident for the subgroup of samples derived by female patients.
Discussion: Our work confirms the crucial role of Q Alb in diagnosing immune-mediated neuropathies and particularly its efficacy as a marker for evaluating the blood-CSF barrier in patients with an earlier disease onset. Considering the significance of the albumin quotient, its assessment is especially advisable in younger patients of female sex to avoid missing a potential barrier dysfunction that might be falsely negative when using total protein.
Competing Interests: TSe reports support for attending meetings by Abbvie. SG reports research support from Alnylam Pharmaceuticals, CSL Behring, Else Kröner Fresenius Foundation, Deutsche Forschungsgemeinschaft and Hannover Biomedical Research School (HBRS) and consulting and/or speaker honoraria from Alexion, Alnylam Pharmaceuticals, AstraZeneca, GSK, Pfizer and Merck all outside the submitted work. JM reports research grants by Biogen and Deutsche Forschungsgemeinschaft, stock/stock options at Biontech and CureVac, as well as support for attending meetings and/or travel by Biogen, Novartis and Alnylam. JM also received honoraria or lectures/ manuscripts by Biogen. KP reports research grants by Biogen idec, Novartis, Celgene, CSL Behring, Grifols, honoraria for lectures from CSL Behring, Grifols, participation on an Advisory Board 2021 by Celgene and non-paid consultant activity for patients organizations POTS and Dysautonomie e.V. TSk reports honoraria for lectures and travel expenses for attending meetings from Alexion, Alnylam Pharmaceuticals, argenx, Bayer Vital, Biogen, Celgene, Centogene, CSL Behring, Euroimmun, Janssen-Cilag, Merck Serono, Novartis, Pfizer, Roche, Sanofi, Siemens, Swedish Orphan Biovitrum, Teva, Viatris. His research is supported by the German Ministry for Education and Research (BMBF), Bristol-Myers Squibb Foundation for Immuno-Oncology, Claudia von Schilling Foundation for Breast Cancer Research, Else Kröner Fresenius Foundation, Hannover Biomedical Research School (HBRS), Alnylam Pharmaceuticals, CSL Behring, Novartis, Sanofi Genzyme, VHV Foundation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2024 Seeliger, Gingele, Güzeloglu, Heitmann, Lüling, Kohle, Preßler, Stascheit, Motte, Fisse, Grüter, Pitarokoili and Skripuletz.)
Databáze: MEDLINE
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