Glial fibrillary acidic protein is a robust biomarker in cerebrospinal fluid and peripheral blood after traumatic spinal cord injury: a prospective pilot study

• Published in: Acta neurochirurgica Vol. 165; no. 6; pp. 1417 - 1425
• Main Authors: Wichmann, Thea Overgaard, Kasch, Helge, Dyrskog, Stig, Høy, Kristian, Møller, Bjarne Kuno, Krog, Jan, Hoffmann, Hans Jürgen, Hviid, Claus Vinter Bødker, Rasmussen, Mikkel Mylius
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01-06-2023; Springer Nature B.V
• Subjects: Biomarkers; Cerebrospinal fluid; Glial fibrillary acidic protein; Glial Fibrillary Acidic Protein - cerebrospinal fluid; Humans; Interleukin 10; Interleukin 12; Interleukin 13; Interleukin 2; Interleukin 4; Interleukin 6; Interleukin 8; Intermediate Filaments; Interventional Radiology; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurology; Neuronal-glial interactions; Neuroradiology; Neurosurgery; Original Article - Spine trauma; Peripheral blood; Phosphopyruvate hydratase; Pilot Projects; Prospective Studies; Recovery of function; Spinal cord injuries; Spinal Cord Injuries - cerebrospinal fluid; Spinal Cord Injuries - diagnosis; Spinal Injuries; Spine trauma; Surgical Orthopedics; Tumor necrosis factor-TNF; Tumor necrosis factor-α; γ-Interferon; Traumatic spinal cord injury; Biomarkers; Inflammation; Cerebrospinal fluid; Blood
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-023-05520-x

Purpose
Biochemical biomarkers to determine the injury severity and the potential for functional recovery of traumatic spinal cord injury (TSCI) are highly warranted; however, it remains to be clarified whether cerebrospinal fluid (CSF) or peripheral blood (PB) is the ideal sample media. This study aims to measure and compare biomarker concentrations in CSF and PB and to explore associations between biomarker concentrations and injury severity, i.e., American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade, and biomarker concentrations and clinical outcome, i.e., AIS grade improvement and Spinal Cord Independent Measure version III (SCIM-III) score.
Methods
From 2018 to 2020, we conducted a single-center prospective pilot study of TSCI patients (
n
=15) and healthy controls (
n
=15). Sample collection and clinical outcome assessment were performed at median 13 h [IQR: 19], 9 days [IQR: 2], and 148 days [IQR: 49] after TSCI. Concentrations of neuron-specific enolase (NSE); glial fibrillary acid protein (GFAP); neurofilament light chain (NfL); interferon-γ (IFN-γ); interleukin (IL)-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, and IL-13; and tumor necrosis factor α (TNF-α) were measured and associated to clinical outcomes.
Results
The biomarker concentrations were higher in CSF than PB. CSF concentrations of GFAP, NSE, IFN-y, TNF-a, IL-2, IL-12p70, IL-4, IL-10, and IL-13 and PB concentrations of GFAP and IFN-y were significantly associated with AIS grade, but not with AIS grade improvement or SCIM-III score.
Conclusions
Our results support GFAP as a potential diagnostic biomarker that may be measured in CSF as well as PB.