Metabolomika cerebrospinálneho likvoru pomocou magnetickej rezonančnej spektroskopie u pacientov so sclerosis multiplex, s klinicky izolovaným syndrómom, inými zápalovými ochoreniami mozgu a u zdravých kontrol

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Authors: E. Baranovičová ¹; D. Čierny ²; P. Hnilicova ¹; J. Lehotský ^1,3; R. Murín ³; Š. Sivák ⁴; E. Kurča ⁴; L. Plicová ²; E. Kantorová ⁴
Authors‘ workplace: BioMedical Center BioMed, Division, of Neurosciences, Jessenius Faculty, of Medicine, Comenius University in, Bratislava, Martin, Slovakia ¹; Department of Clinical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava and, University Hospital Martin, Slovakia ²; Department of Medical Biochemistry, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia ³; Clinic of Neurology, Jessenius Faculty, of Medicine, Comenius University, in Bratislava and University Hospital, Martin, Slovakia ⁴
Published in: Cesk Slov Neurol N 2020; 83/116(3): 315-322
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2020315

Overview

Cieľ: Včasné rozpoznanie sclerosis multiplex (SM) pomáha začať liečbu pacientov skôr, a tak oddialiť progresiu ochorenia. Urobili sme analýzu metabolitov cerebro-spinálneho likvoru (cerebrospinal fluid; CSF), s cieľom zistiť prediktory včas, a tak oddialiť SM.

Metódy: Do štúdie bolo zaradených 56 jedincov s podozrením na SM, pred začatím akejkoľvek liečby. Z nich bolo 28 diagnostikovaných ako definitívna SM, u 17 pacientov sme zistili klinicky izolovaný syndróm (clinically isolated syndrome; CIS) podľa McDonaldových kritérií z roku 2010, v 11 prípadoch sa jednalo o iné demyelinizačné ochorenie CNS (DEM). Kontrolnú skupinu (CON) tvorili 29 jedinci, ktorí nemali dokázané žiadne ochorenie CNS. Na meranie metabolitov CSF bola použitá protonová nukleárna magnetická rezonančná spektroskopia.

Výsledky: Glutamín, ktorý koreloval s Expanded Disability Status Scale (EDSS), bol jediným metabolitom, ktorý dokázal odlíšiť CIS, SM, DEM a CON. Valín, leucín, isoleucín, znížené u CIS a SM v porovnaní s CON, sa neodlišovali od DEM. Hladiny citrátu v CSF špecifikovali SM a CIS oproti DEM, ale nepomohli v rozlíšení CIS a SM. Citrát ukazoval signifikantné korelácie s vekom, dľžkou trvania ochorenia a EDSS u SM pacientov. Acetát, aceton, pyruvát, formát, histidin v CSF neboli signifikantnými prediktormi SM alebo CIS, hoci korelovali s niektorými vybranými premennými.

Záver: Táto práca ukazuje prediktívnu úlohu glutamínu v CSF v stanovení diagnózy SM od jej včasných štádií, vypichujúc tak dôležitú úlohu glutamát/glutamínového cyklu v patogenéze SM. Ďalší potenciálny prediktor SM bol citrát. Ďalšie metabolity neboli identifikované ako senzitívne CSF markery SM.

Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů.

Klíčová slova:

cerebro-spinálny likvor – metabolomika – jednoprotonová nukleárna magnetická rezonančná spektroskopia (1H-NMRS) – sclerosis multiplex – klinicky izolovaný syndrom – zápalové demyelizačné ochorenia mozgu

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