Neurofilament Medium Polypeptide (NFM) Protein Concentration Is
Total Page:16
File Type:pdf, Size:1020Kb
Neurofilament medium polypeptide (NFM) protein concentration is increased in CSF and serum samples from patients with brain injury MARTÍNEZ-MORILLO, Eduardo, CHILDS, Charmaine <http://orcid.org/0000- 0002-1558-5633>, GARCÍA, Belén Prieto, ÁLVAREZ MENÉNDEZ, Francisco V., ROMASCHIN, Alexander D., CERVELLIN, Gianfranco, LIPPI, Giuseppe and DIAMANDIS, Eleftherios P. Available from Sheffield Hallam University Research Archive (SHURA) at: http://shura.shu.ac.uk/9484/ This document is the author deposited version. You are advised to consult the publisher's version if you wish to cite from it. Published version MARTÍNEZ-MORILLO, Eduardo, CHILDS, Charmaine, GARCÍA, Belén Prieto, ÁLVAREZ MENÉNDEZ, Francisco V., ROMASCHIN, Alexander D., CERVELLIN, Gianfranco, LIPPI, Giuseppe and DIAMANDIS, Eleftherios P. (2015). Neurofilament medium polypeptide (NFM) protein concentration is increased in CSF and serum samples from patients with brain injury. Clinical Chemistry and Laboratory Medicine, 53 (10), 1575-1584. Copyright and re-use policy See http://shura.shu.ac.uk/information.html Sheffield Hallam University Research Archive http://shura.shu.ac.uk Clin Chem Lab Med 2015; aop Eduardo Mart í nez-Morillo , Charmaine Childs , Bel é n Prieto Garc í a , Francisco V. Á lvarez Men é ndez , Alexander D. Romaschin , Gianfranco Cervellin , Giuseppe Lippi and Eleftherios P. Diamandis * Neurofilament medium polypeptide (NFM) protein concentration is increased in CSF and serum samples from patients with brain injury DOI 10.1515/cclm-2014-0908 Methods: An ELISA from Elabscience was used. The selec- Received September 14 , 2014 ; accepted January 6 , 2015 tivity was evaluated using size-exclusion chromatography and mass spectrometry. Intra- and inter-batch coefficients of variation (CV) were also studied. Fifty-one CSF samples Abstract from 36 age-matched patients with hemorrhagic stroke (HS) (n = 30), ischemic stroke (IS) (n = 11) and healthy indi- Background: Brain injury is a medical emergency that viduals (n = 10) were assayed. In addition, serum samples needs to be diagnosed and treated promptly. Several pro- from healthy volunteers (n = 47), 68 serum samples from teins have been studied as biomarkers of this medical seven patients with HS, 106 serum samples from 12 condition. The aims of this study were to: 1) evaluate the patients with traumatic brain injury (TBI) and 68 serum selectivity and precision of a commercial ELISA kit for samples from 68 patients with mild traumatic brain injury neurofilament medium polypeptide (NFM) protein; and (mTBI) were also analyzed. 2) evaluate the concentration in cerebrospinal fluid (CSF) Results: NFM was identified in the chromatographic and serum of healthy individuals and patients with brain fraction with highest immunoreactivity. The intra- and damage. inter-batch CVs were ≤ 10% and ≤ 13%, respectively. The CSF-NFM concentration in HS was significantly higher (p < 0.0001) than in IS and controls. Serum NFM con- *Corresponding author: Eleftherios P. Diamandis, MD, PhD, FRCPC, centration ranged from 0.26 to 8.57 ng/mL in healthy FRSC, Pathology and Laboratory Medicine Department, Mount Sinai = Hospital, Suite 6-201, Box 32, 60 Murray Street, Toronto, ON M5T individuals (median 2.29), from 0.97 to 42.4 ng/mL in 3L9, Canada, Phone: + 1 416 586 8443, Fax: + 1 416 619 5521, HS (median = 10.8) and from 3.48 to 45.4 ng/mL in TBI E-mail: [email protected] ; Department of Clinical (median = 14.7). Finally, 44% of patients with mTBI had Biochemistry, University Health Network, Toronto, ON, Canada ; increased NFM concentration, with significantly higher and Department of Pathology and Laboratory Medicine, Mount Sinai levels (p = 0.01) in patients with polytrauma. Hospital, Toronto, ON, Canada Eduardo Mart í nez-Morillo: Lunenfeld-Tanenbaum Research Conclusions: To our knowledge this is the first study Institute, Joseph and Wolf Lebovic Health Complex, Mount Sinai describing increased NFM levels in CSF and serum from Hospital, Toronto, ON, Canada ; and Department of Clinical patients with brain damage. Biochemistry, Laboratory of Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain Keywords: biomarker; brain injury; cerebrospinal fluid; Charmaine Childs: Centre for Health and Social Care Research, neurofilament; serum; stroke. Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK Bel é n Prieto Garc í a and Francisco V. Á lvarez Men é ndez: Department of Clinical Biochemistry, Laboratory of Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain Introduction Alexander D. Romaschin: Li Ka Shing Knowledge Institute, St. Michael ’ s Hospital, Department of Laboratory Medicine and The term “ brain injury ” refers to a potentially lethal Pathobiology, University of Toronto, Toronto, ON, Canada medical condition that includes two major types of brain Gianfranco Cervellin: Emergency Department, Academic Hospital of damage: 1) spontaneous, non-traumatic brain injury; and Parma, Parma, Italy Giuseppe Lippi: Laboratory of Clinical Chemistry and Hematology, 2) traumatic brain injury (TBI). The most common cause of Academic Hospital of Parma, Parma, Italy. http://orcid.org/0000- brain injury is by accidental injury to the head. Approxi- 0001-9523-9054 mately 1.7 million Americans suffer a TBI each year, and Brought to you by | Complejo Asistencial de Salamanca Authenticated Download Date | 8/7/15 10:00 AM 2 Mart í nez-Morillo et al.: NFM concentration is increased in brain injury 75% – 90% of those are classified as mild traumatic brain Materials and methods injury (mTBI) [1] . However, stroke is the most common form of non-traumatic brain injury, with 795,000 people ELISA kit for NFM protein in the US suffering a new or recurrent stroke each year. Ischemic stroke (IS) represents 87% of all stroke cases A commercial ELISA kit [Human Neurofi lament 3 (NEF3); Catalog No: whereas hemorrhagic stroke (HS) accounts for 13% of E-EL-H0740; from Elabscience Biotechnology Co., Ltd] was used to cases [2] . measure NFM protein in various biological fl uids. The ELISA kit uses capture and secondary monoclonal antibodies from rat and whole pro- A brain injury is usually a medical emergency that tein (natural, purifi ed protein) as standard material, according to the needs to be diagnosed and treated promptly, in order to information provided by the manufacturer. The reported limit of detec- improve the likelihood of patient survival and reduce the tion is 9.4 pg/mL; with an analytical measurement range from 15.6 to consequences of brain damage. For this purpose, several 1000 pg/mL. The intra-batch coeffi cient of variation (CV) is below 10%. proteins such as S100 calcium-binding protein B (S100B), The assay was performed according to the manufacturer ’ s instructions. neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP) have been proposed as diagnostic and Size exclusion high-performance liquid chromatography prognostic biomarkers of TBI and stroke [3 – 6] . However, (SE-HPLC) given the complexity and heterogeneity of brain injury eti- ology, none of these proteins seem to be useful in these The SE-HPLC was performed using 0.1 M NaH2 PO4 /Na2 HPO4 , 0.15 M patients as single biomarkers. Therefore, it has been sug- NaCl (pH 7.0) buff er at a fl ow rate of 0.5 mL/min for 60 min with a gel gested that integrated panels of biomarkers with specific fi ltration column TSKgel G3000SW, 7.5 mm (ID) x 60 cm (L), 10 μ m and complementary characteristics may assist in the diag- (Tosoh Bioscience, King of Prussia, PA, USA). Liquid chromatogra- phy was performed in a HPLC 1100 series (Agilent Technologies) with nosis, risk assessment, treatment selection and prediction diode array detector (DAD), set at 254 nm (UV lamp). The system was of clinical outcomes of patients with brain damage. controlled with ChemStation soft ware (Agilent Technologies). One In our previous study [7] , we identified three novel hundred microliters of each sample (100 μ L loop) were loaded into biomarkers of brain injury: neurofilament medium pol- the column. Proteins contained in four diff erent samples (NFM stand- ypeptide (NFM), α -internexin ( α -Inx) and β -synuclein ard from ELISA kit, brain tissue extract from previous study [7] , CSF sample from patient with HS and no blood contamination and serum ( β -Syn) in the cerebrospinal fluid (CSF) of patients with sample from healthy individual) were subjected to chromatographic HS, by using a mass spectrometry-based assay. The aim separation. Fractions (0.5 mL) were collected every minute, from 18 of the current work was to perform a verification study of to 58 min, aft er the isocratic fl ow was started. The same volume of a one of these biomarkers using a more sensitive analytical Gel Filtration Standard (Catalog 151-1901, Bio-Rad Laboratories) was assay. The protein selected was NFM for three reasons: loaded before samples. 1) given its novelty (to our knowledge this is the first study evaluating NFM as biomarker of brain injury); 2) Mass spectrometry identifi cation the other two members of its family, neurofilament light and heavy polypeptides (NFL and NFH), have also been Three SE-HPLC fractions from brain tissue extract were analyzed in studied and identified as potential biomarkers of HS [8 – an LTQ Orbitrap XL (Thermo Scientifi c). Samples volume was reduced 11] ; and 3) there was a commercial ELISA kit available, from 400 to 50 μ L using a SpeedVac concentrator (Savant SC250EXP, with enough sensitivity (low pg/mL level) to detect this Thermo Scientifi c) and then processed as described previously [7] . protein in CSF and blood samples of patients with brain Briefl y, proteins were denatured, reduced, alkylated and trypsin digested. Peptides were analyzed by liquid chromatography coupled damage. to tandem mass spectrometry (LC-MS/MS), and the resulting spectra Before we assayed NFM protein in biological samples were searched separately against the Human UniprotKB-SwissProt from patients with brain injury, the commercial ELISA kit Database 2013_10 (containing 88266 forward protein sequences) by was validated, since we and others have drawn attention Mascot soft ware (version 2.2, Matrix Science).