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Biomarkers for diagnosis and prognosis in amyotrophic lateral sclerosis
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.ORCID iD: 0000-0002-9347-0364
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by loss of upper and lower motor neurons, leading to paresis, muscle atrophy, and respiratory failure. ALS can be difficult to diagnose and prognosticate early.

Aim: To investigate the diagnostic and prognostic characteristics of biomarkers in cerebrospinal fluid (CSF), plasma, and skeletal muscle tissue in patients with ALS.

Paper I: Neurofilament light chain (NFL) and phosphorylated neurofilament heavy chain (pNFH) were analyzed in CSF using enzyme-linked immunosorbent assay (ELISA), and NFL in plasma was analyzed using single-molecule array (SIMOA). CSF NFL, CSF pNFH, and plasma NFL concentrations can differentiate ALS patients from ALS mimics, and were significantly negatively correlated with the disease duration in ALS patients.

Paper II: Myosin heavy chain (MyHC) isoforms in extraocular muscles were investigated using immunofluorescence. Control donors had significantly higher proportion of myofibers containing MyHCIIa and significantly lower proportion of myofibers containing MyHCeom in the global layer compared to spinal-onset ALS and bulbar-onset ALS donors. Disease duration in the spinal-onset ALS donors was significantly correlated with the proportion of myofibers containing MyHCIIa in the global layer and MyHCeom in the orbital layer.

Paper III: The study combined the neurofilament concentrations from Paper I, with cytokines previously analyzed in CSF and plasma using SIMOA, to investigate distinct molecular phenotypes in ALS. Patients with bulbar-onset ALS had significantly higher concentrations of CSF tumor necrosis factor α (TNF-α) compared to ALS mimics. TNF-α and NFL were significantly correlated with each other in both CSF and plasma in ALS patients. Combined analysis of NFL and IL-6 in plasma identified molecular prognostic subgroups in ALS patients.

Paper IV: Creatine kinase (CK), high-sensitivity cardiac troponin T (hs-cTnT), hs-cTnI, and cystatin C (CysC) were analyzed in plasma in a fully accredited laboratory. CK and hs-cTnT concentrations were significantly elevated in limb-onset ALS compared to controls and bulbar-onset ALS. hs-cTnT concentrations were significantly elevated in truncal-onset ALS compared to controls and bulbar-onset ALS. Multivariable Cox proportional hazards models indicated elevated concentrations of CysC as a significant marker for worse prognosis in ALS.

Conclusions: The papers report diagnostic and prognostic characteristics of biomarkers in CSF, plasma, and muscle tissue in ALS patients. The significant findings for biomarkers in plasma could be of value since plasma sampling does not involve a lumbar puncture.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. , p. 91
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2290
Keywords [en]
amyotrophic lateral sclerosis, biomarkers, neurofilaments, cytokines, troponin, cystatin C
National Category
Neurology
Research subject
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-222636ISBN: 978-91-8070-312-3 (print)ISBN: 978-91-8070-313-0 (electronic)OAI: oai:DiVA.org:umu-222636DiVA, id: diva2:1846645
Public defence
2024-04-19, Hörsal B, byggnad 1D, 9 trappor, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2024-03-28 Created: 2024-03-25 Last updated: 2024-03-25Bibliographically approved
List of papers
1. Neurofilaments can differentiate ALS subgroups and ALS from common diagnostic mimics
Open this publication in new window or tab >>Neurofilaments can differentiate ALS subgroups and ALS from common diagnostic mimics
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2021 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 22128Article in journal (Refereed) Published
Abstract [en]

Delayed diagnosis and misdiagnosis are frequent in people with amyotrophic lateral sclerosis (ALS), the most common form of motor neuron disease (MND). Neurofilament light chain (NFL) and phosphorylated neurofilament heavy chain (pNFH) are elevated in ALS patients. We retrospectively quantified cerebrospinal fluid (CSF) NFL, CSF pNFH and plasma NFL in stored samples that were collected at the diagnostic work-up of ALS patients (n = 234), ALS mimics (n = 44) and controls (n = 9). We assessed the diagnostic performance, prognostication value and relationship to the site of onset and genotype. CSF NFL, CSF pNFH and plasma NFL levels were significantly increased in ALS patients compared to patients with neuropathies & myelopathies, patients with myopathies and controls. Furthermore, CSF pNFH and plasma NFL levels were significantly higher in ALS patients than in patients with other MNDs. Bulbar onset ALS patients had significantly higher plasma NFL levels than spinal onset ALS patients. ALS patients with C9orf72HRE mutations had significantly higher plasma NFL levels than patients with SOD1 mutations. Survival was negatively correlated with all three biomarkers. Receiver operating characteristics showed the highest area under the curve for CSF pNFH for differentiating ALS from ALS mimics and for plasma NFL for estimating ALS short and long survival. All three biomarkers have diagnostic value in differentiating ALS from clinically relevant ALS mimics. Plasma NFL levels can be used to differentiate between clinical and genetic ALS subgroups.

Place, publisher, year, edition, pages
Nature Publishing Group, 2021
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-189808 (URN)10.1038/s41598-021-01499-6 (DOI)000717747400105 ()2-s2.0-85118949353 (Scopus ID)
Available from: 2021-11-22 Created: 2021-11-22 Last updated: 2024-03-25Bibliographically approved
2. Myofiber type shift in extraocular muscles in amyotrophic lateral sclerosis
Open this publication in new window or tab >>Myofiber type shift in extraocular muscles in amyotrophic lateral sclerosis
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2023 (English)In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 64, no 5, article id 15Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate changes in myofiber composition in the global layer (GL) and orbital layer (OL) of extraocular muscles (EOMs) from terminal amyotrophic lateral sclerosis (ALS) donors.

Methods: Medial recti muscles collected postmortem from spinal-onset ALS, bulbar-onset ALS, and healthy control donors were processed for immunofluorescence with antibodies against myosin heavy chain (MyHC) IIa, MyHCI, MyHCeom, laminin, neurofilaments, synaptophysin, acetylcholine receptor γ-subunit, and α-bungarotoxin.

Results: The proportion of myofibers containing MyHCIIa was significantly smaller and MyHCeom was significantly larger in the GL of spinal-onset ALS and bulbar-onset ALS donors compared to control donors. Changes in the GL were more prominent in the bulbar-onset ALS donors, with a significantly larger proportion of myofibers containing MyHCeom being present compared to spinal-onset ALS donors. There were no significant differences in the myofiber composition in the OL. In the spinal-onset ALS donors, the proportions of myofibers containing MyHCIIa in the GL and MyHCeom in the OL were significantly correlated with the disease duration. Neurofilament and synaptophysin were present at motor endplates of myofibers containing MyHCeom in ALS donors.

Conclusions: The EOMs of terminal ALS donors displayed changes in the fast-type myofiber composition in the GL, with a more pronounced alteration in bulbar-onset ALS donors. Our results align with the worse prognosis and subclinical changes in eye movement function previously observed in bulbar-onset ALS patients and suggest that the myofibers in the OL might be more resistant to the pathological process in ALS.

Place, publisher, year, edition, pages
Association for Research in Vision and Ophthalmology (ARVO), 2023
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-210285 (URN)10.1167/iovs.64.5.15 (DOI)37200039 (PubMedID)2-s2.0-85159762499 (Scopus ID)
Available from: 2023-06-21 Created: 2023-06-21 Last updated: 2024-03-26Bibliographically approved
3. Combined analysis of neurofilament light chain and interleukin 6 in plasma reveals distinct molecular phenotypes in ALS and can differentiate ALS patients into prognostic subgroups
Open this publication in new window or tab >>Combined analysis of neurofilament light chain and interleukin 6 in plasma reveals distinct molecular phenotypes in ALS and can differentiate ALS patients into prognostic subgroups
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(English)Manuscript (preprint) (Other academic)
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-222633 (URN)
Available from: 2024-03-24 Created: 2024-03-24 Last updated: 2024-03-25
4. Cardiac troponin T, cystatin C and creatine kinase as biomarkers in clinical phenotypes, genotypes and prognostication in amyotrophic lateral sclerosis
Open this publication in new window or tab >>Cardiac troponin T, cystatin C and creatine kinase as biomarkers in clinical phenotypes, genotypes and prognostication in amyotrophic lateral sclerosis
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(English)Manuscript (preprint) (Other academic)
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-222634 (URN)
Available from: 2024-03-24 Created: 2024-03-24 Last updated: 2024-03-25

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