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Diagnostic utility of fluid biomarkers in multiple system atrophy: a systematic review and meta-analysis

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Abstract

Background

Multiple system atrophy (MSA) is an adult onset, fatal neurodegenerative disease. However, no reliable biomarker is currently available to guide clinical diagnosis and help to determine the prognosis. Thus, a comprehensive meta-analysis is warranted to determine effective biomarkers for MSA and provide useful guidance for clinical diagnosis.

Methods

A comprehensive literature search was made of the PubMed, Embase, Cochrane and Web of Science databases for relevant clinical trial articles for 1984–2019. Two review authors examined the full-text records, respectively, and determined which studies met the inclusion criteria. We estimated the mean difference, standard deviation and 95% confidence intervals.

Results

A total of 28 studies and 11 biomarkers were included in our analysis. Several biomarkers were found to be useful to distinguish MSA patients from healthy controls, including the reduction of phosphorylated tau, α-synuclein (α-syn), 42-amino-acid form of Aβ and total tau (t-tau), the elevation of neurofilament light-chain protein (NFL) in cerebrospinal fluid, the elevation of uric acid and reduction of homocysteine and coenzyme Q10 in plasma. Importantly, α-syn, NFL and t-tau could be used to distinguish MSA from Parkinson’s disease (PD), indicating that these three biomarkers could be useful biomarkers in MSA diagnosis.

Conclusion

The findings of our meta-analysis demonstrated diagnostic biomarkers for MSA. Moreover, three biomarkers could be used in differential diagnosis of MSA and PD. The results could be helpful for the early diagnosis of MSA and the accuracy of MSA diagnosis.

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Funding

This study was funded by the “Liaoning BaiQianWan Talents Program” and was also sponsored by Shenyang Science and technology plan project (19-112-4-045) and 345 Talent Project of Shengjing Hospital of China Medical University.

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Author notes

  1. Shengri Cong and Chunchen Xiang contributed equally.

Authors and Affiliations

  1. Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China

    Shengri Cong, Chunchen Xiang & Shuyan Cong

  2. Department of Clinical Epidemiology and Evidence-Based Medicine, First Hospital of China Medical University, Shenyang, China

    Hailong Wang

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  1. Shengri Cong
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Correspondence to Shuyan Cong.

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Cong, S., Xiang, C., Wang, H. et al. Diagnostic utility of fluid biomarkers in multiple system atrophy: a systematic review and meta-analysis. J Neurol 268, 2703–2712 (2021). https://doi.org/10.1007/s00415-020-09781-9

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  • DOI: https://doi.org/10.1007/s00415-020-09781-9

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