Association between ventricular CSF biomarkers and outcome after shunt surgery in idiopathic normal pressure hydrocephalus
Abstract Introduction The relationship between neurochemical changes and outcome after shunt surgery in idiopathic normal pressure hydrocephalus (iNPH), a treatable dementia and gait disorder, is unclear. We used baseline ventricular CSF to explore associations to outcome, after shunting, of biomark...
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | Fluids and Barriers of the CNS |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12987-023-00475-8 |
| _version_ | 1827708882956320768 |
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| author | Rebecca Grønning Anna Jeppsson Per Hellström Katarina Laurell Dan Farahmand Henrik Zetterberg Kaj Blennow Carsten Wikkelsø Mats Tullberg |
| author_facet | Rebecca Grønning Anna Jeppsson Per Hellström Katarina Laurell Dan Farahmand Henrik Zetterberg Kaj Blennow Carsten Wikkelsø Mats Tullberg |
| author_sort | Rebecca Grønning |
| collection | DOAJ |
| description | Abstract Introduction The relationship between neurochemical changes and outcome after shunt surgery in idiopathic normal pressure hydrocephalus (iNPH), a treatable dementia and gait disorder, is unclear. We used baseline ventricular CSF to explore associations to outcome, after shunting, of biomarkers selected to reflect a range of pathophysiological processes. Methods In 119 consecutive patients with iNPH, the iNPH scale was used before and after shunt surgery to quantify outcome. Ventricular CSF was collected perioperatively and analyzed for biomarkers of astrogliosis, axonal, amyloid and tau pathology, and synaptic dysfunction: glial fibrillary acidic protein (GFAP), chitinase-3-like protein 1 (YKL40/CHI3L1), monocyte chemoattractant protein-1 (MCP-1) neurofilament light (NfL), amyloid beta 38 (Aβ38), Aβ40, Aβ42, amyloid beta 42/40 ratio (Aβ42/40), soluble amyloid precursor protein alfa (sAPPα), sAPPβ, total tau (T-tau), phosphorylated tau (P-tau), growth-associated protein 43 (GAP43), and neurogranin. Results The neurogranin concentration was higher in improved (68%) compared to unimproved patients (median 365 ng/L (IQR 186–544) vs 330 (205–456); p = 0.046). A linear regression model controlled for age, sex and vascular risk factors including neurogranin, T-tau, and GFAP, resulted in adjusted R2 = 0.06, p = 0.047. The Aβ42/40 ratio was bimodally distributed across all samples, as well as in the subgroups of improved and unimproved patients but did not contribute to outcome prediction. The preoperative MMSE score was lower within the low Aβ ratio group (median 25, IQR 23–28) compared to the high subgroup (26, 24–29) (p = 0.028). The T-Tau x Aβ40/42 ratio and P-tau x Aβ40/42 ratio did not contribute to shunt response prediction. The prevalence of vascular risk factors did not affect shunt response. Discussion A higher preoperative ventricular CSF level of neurogranin, which is a postsynaptic marker, may signal a favorable postoperative outcome. Concentrations of a panel of ventricular CSF biomarkers explained only 6% of the variability in outcome. Evidence of amyloid or tau pathology did not affect the outcome. |
| first_indexed | 2024-03-10T17:12:01Z |
| format | Article |
| id | doaj.art-5caa8c263ff540328ca9cbca268d1cba |
| institution | Directory Open Access Journal |
| issn | 2045-8118 |
| language | English |
| last_indexed | 2024-03-10T17:12:01Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Fluids and Barriers of the CNS |
| spelling | doaj.art-5caa8c263ff540328ca9cbca268d1cba2023-11-20T10:36:59ZengBMCFluids and Barriers of the CNS2045-81182023-10-012011910.1186/s12987-023-00475-8Association between ventricular CSF biomarkers and outcome after shunt surgery in idiopathic normal pressure hydrocephalusRebecca Grønning0Anna Jeppsson1Per Hellström2Katarina Laurell3Dan Farahmand4Henrik Zetterberg5Kaj Blennow6Carsten Wikkelsø7Mats Tullberg8Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgHydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgHydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgDepartment of Medical Sciences, Neurology, Uppsala UniversityHydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgClinical Neurochemistry Laboratory, Sahlgrenska University HospitalClinical Neurochemistry Laboratory, Sahlgrenska University HospitalHydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgHydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgAbstract Introduction The relationship between neurochemical changes and outcome after shunt surgery in idiopathic normal pressure hydrocephalus (iNPH), a treatable dementia and gait disorder, is unclear. We used baseline ventricular CSF to explore associations to outcome, after shunting, of biomarkers selected to reflect a range of pathophysiological processes. Methods In 119 consecutive patients with iNPH, the iNPH scale was used before and after shunt surgery to quantify outcome. Ventricular CSF was collected perioperatively and analyzed for biomarkers of astrogliosis, axonal, amyloid and tau pathology, and synaptic dysfunction: glial fibrillary acidic protein (GFAP), chitinase-3-like protein 1 (YKL40/CHI3L1), monocyte chemoattractant protein-1 (MCP-1) neurofilament light (NfL), amyloid beta 38 (Aβ38), Aβ40, Aβ42, amyloid beta 42/40 ratio (Aβ42/40), soluble amyloid precursor protein alfa (sAPPα), sAPPβ, total tau (T-tau), phosphorylated tau (P-tau), growth-associated protein 43 (GAP43), and neurogranin. Results The neurogranin concentration was higher in improved (68%) compared to unimproved patients (median 365 ng/L (IQR 186–544) vs 330 (205–456); p = 0.046). A linear regression model controlled for age, sex and vascular risk factors including neurogranin, T-tau, and GFAP, resulted in adjusted R2 = 0.06, p = 0.047. The Aβ42/40 ratio was bimodally distributed across all samples, as well as in the subgroups of improved and unimproved patients but did not contribute to outcome prediction. The preoperative MMSE score was lower within the low Aβ ratio group (median 25, IQR 23–28) compared to the high subgroup (26, 24–29) (p = 0.028). The T-Tau x Aβ40/42 ratio and P-tau x Aβ40/42 ratio did not contribute to shunt response prediction. The prevalence of vascular risk factors did not affect shunt response. Discussion A higher preoperative ventricular CSF level of neurogranin, which is a postsynaptic marker, may signal a favorable postoperative outcome. Concentrations of a panel of ventricular CSF biomarkers explained only 6% of the variability in outcome. Evidence of amyloid or tau pathology did not affect the outcome.https://doi.org/10.1186/s12987-023-00475-8Normal pressure hydrocephalusCerebrospinal fluidPredictionNeurodegenerationAmyloidVentricular catheter |
| spellingShingle | Rebecca Grønning Anna Jeppsson Per Hellström Katarina Laurell Dan Farahmand Henrik Zetterberg Kaj Blennow Carsten Wikkelsø Mats Tullberg Association between ventricular CSF biomarkers and outcome after shunt surgery in idiopathic normal pressure hydrocephalus Fluids and Barriers of the CNS Normal pressure hydrocephalus Cerebrospinal fluid Prediction Neurodegeneration Amyloid Ventricular catheter |
| title | Association between ventricular CSF biomarkers and outcome after shunt surgery in idiopathic normal pressure hydrocephalus |
| title_full | Association between ventricular CSF biomarkers and outcome after shunt surgery in idiopathic normal pressure hydrocephalus |
| title_fullStr | Association between ventricular CSF biomarkers and outcome after shunt surgery in idiopathic normal pressure hydrocephalus |
| title_full_unstemmed | Association between ventricular CSF biomarkers and outcome after shunt surgery in idiopathic normal pressure hydrocephalus |
| title_short | Association between ventricular CSF biomarkers and outcome after shunt surgery in idiopathic normal pressure hydrocephalus |
| title_sort | association between ventricular csf biomarkers and outcome after shunt surgery in idiopathic normal pressure hydrocephalus |
| topic | Normal pressure hydrocephalus Cerebrospinal fluid Prediction Neurodegeneration Amyloid Ventricular catheter |
| url | https://doi.org/10.1186/s12987-023-00475-8 |
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