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

  • Original Article - Spine trauma
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Abstract

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.

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Acknowledgements

We sincerely thank all the patients who participated in this study and the staff at the Aarhus University Hospital for their support and assistance throughout the study period.

Funding

This research was supported by Lundbeckfonden, Aase og Ejnar Danielsens Fond, Grosserer L.F. Foghts Fond, Dagmar Marshalls Fond, A.P. Møller Fonden, Grosserer A.V. Lykfeldt og Hustrus Legat, Jascha Fonden, and UlykkesPatientForeningen.

Author information

Authors and Affiliations

  1. Dept. of Neurosurgery, Cense-Spine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark

    Thea Overgaard Wichmann & Mikkel Mylius Rasmussen

  2. Dept. of Neurology, Aarhus University Hospital, Aarhus, Denmark

    Helge Kasch

  3. Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Helge Kasch, Kristian Høy, Hans Jürgen Hoffmann & Mikkel Mylius Rasmussen

  4. Dept. of Intensive Care, Aarhus University Hospital, Aarhus, Denmark

    Stig Dyrskog

  5. Dept. of Orthopaedic Surgery–Spine section, Aarhus University Hospital, Aarhus, Denmark

    Kristian Høy

  6. Dept. of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark

    Bjarne Kuno Møller

  7. Dept. of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark

    Jan Krog

  8. Dept. of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark

    Hans Jürgen Hoffmann

  9. Dept. of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark

    Claus Vinter Bødker Hviid

  10. Dept. of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark

    Claus Vinter Bødker Hviid

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  1. Thea Overgaard Wichmann
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  9. Mikkel Mylius Rasmussen
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Corresponding author

Correspondence to Thea Overgaard Wichmann.

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Ethical approval

This research was approved by the Central Denmark Region Committees on Health Research Ethics (1-10-72-382-17) and the Danish Data Protection Agency (1-16-02-754-17) and registered on ClinicalTrials.gov (NCT03505463). Written informed consent was obtained from all patients.

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Some of the data has been published elsewhere, but the data is presented in new analyses in the current manuscript.

This article is part of the Topical Collection on Spine trauma

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Wichmann, T.O., Kasch, H., Dyrskog, S. et al. Glial fibrillary acidic protein is a robust biomarker in cerebrospinal fluid and peripheral blood after traumatic spinal cord injury: a prospective pilot study. Acta Neurochir 165, 1417–1425 (2023). https://doi.org/10.1007/s00701-023-05520-x

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