CSF neopterin and quinolinic acid are biomarkers of neuroinflammation and neurotoxicity in FIRES and other infection-triggered encephalopathy syndromes.
Dale, RC
Thomas, T
Patel, S
Han, VX
Kothur, K
Troedson, C
Gupta, S
Gill, D
Malone, S
Waak, M
Calvert, S
Subramanian, G
Andrews, PI
Kandula, T
Menezes, MP
Ardern-Holmes, S
Mohammad, S
Bandodkar, S
Yan, J
- Publisher:
- Wiley
- Publication Type:
- Journal Article
- Citation:
- Ann Clin Transl Neurol, 2023, 10, (8), pp. 1417-1432
- Issue Date:
- 2023-08
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Full metadata record
| Field | Value | Language |
|---|---|---|
| dc.contributor.author | Dale, RC | |
| dc.contributor.author | Thomas, T | |
| dc.contributor.author | Patel, S | |
| dc.contributor.author | Han, VX | |
| dc.contributor.author | Kothur, K | |
| dc.contributor.author | Troedson, C | |
| dc.contributor.author | Gupta, S | |
| dc.contributor.author | Gill, D | |
| dc.contributor.author | Malone, S | |
| dc.contributor.author | Waak, M | |
| dc.contributor.author | Calvert, S | |
| dc.contributor.author | Subramanian, G | |
| dc.contributor.author | Andrews, PI | |
| dc.contributor.author | Kandula, T | |
| dc.contributor.author | Menezes, MP | |
| dc.contributor.author | Ardern-Holmes, S | |
| dc.contributor.author | Mohammad, S | |
| dc.contributor.author | Bandodkar, S | |
| dc.contributor.author | Yan, J | |
| dc.date.accessioned | 2024-10-21T00:59:09Z | |
| dc.date.available | 2023-06-05 | |
| dc.date.available | 2024-10-21T00:59:09Z | |
| dc.date.issued | 2023-08 | |
| dc.identifier.citation | Ann Clin Transl Neurol, 2023, 10, (8), pp. 1417-1432 | |
| dc.identifier.issn | 2328-9503 | |
| dc.identifier.issn | 2328-9503 | |
| dc.identifier.uri | http://hdl.handle.net/10453/181475 | |
| dc.description.abstract | OBJECTIVE: Infection-triggered encephalopathy syndromes (ITES) are potentially devastating neuroinflammatory conditions. Although some ITES syndromes have recognisable MRI neuroimaging phenotypes, there are otherwise few biomarkers of disease. Early detection to enable immune modulatory treatments could improve outcomes. METHODS: We measured CSF neopterin, quinolinic acid, kynurenine and kynurenine/tryptophan ratio using a liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) system. The CSF of 18 children with ITES were compared with acute encephalitis (n = 20), and three control groups, namely epilepsy (n = 20), status epilepticus (n = 18) and neurogenetic controls (n = 20). RESULTS: The main ITES phenotypes in 18 patients were acute encephalopathy with biphasic seizures and late restricted diffusion (AESD, n = 4), febrile infection-related epilepsy syndrome (FIRES n = 4) and other ITES phenotypes. Influenza A was the most common infectious trigger (n = 5), and 50% of patients had a preceding notable neurodevelopmental or family history. CSF neopterin, quinolinic acid and kynurenine were elevated in ITES group compared to the three control groups (all p < 0.0002). The ROC (area under curve) for CSF neopterin (99.3%, CI 98.1-100) was significantly better than CSF pleocytosis (87.3% CI 76.4-98.2) (p = 0.028). Elevated CSF neopterin could discriminate ITES from other causes of seizures, status epilepticus and febrile status epilepticus (all p < 0.0002). The elevated CSF metabolites normalised during longitudinal testing in two patients with FIRES. INTERPRETATION: CSF neopterin and quinolinic acid are neuroinflammatory and excitotoxic metabolites. This CSF metabolomic inflammatory panel can discriminate ITES from other causes of new onset seizures or status epilepticus, and rapid results (4 h) may facilitate early immune modulatory therapy. | |
| dc.format | Print-Electronic | |
| dc.language | eng | |
| dc.publisher | Wiley | |
| dc.relation.ispartof | Ann Clin Transl Neurol | |
| dc.relation.isbasedon | 10.1002/acn3.51832 | |
| dc.rights | info:eu-repo/semantics/openAccess | |
| dc.subject | 1103 Clinical Sciences, 1109 Neurosciences | |
| dc.subject.classification | 3209 Neurosciences | |
| dc.subject.classification | 5203 Clinical and health psychology | |
| dc.subject.mesh | Humans | |
| dc.subject.mesh | Neopterin | |
| dc.subject.mesh | Quinolinic Acid | |
| dc.subject.mesh | Kynurenine | |
| dc.subject.mesh | Syndrome | |
| dc.subject.mesh | Neuroinflammatory Diseases | |
| dc.subject.mesh | Chromatography, Liquid | |
| dc.subject.mesh | Tandem Mass Spectrometry | |
| dc.subject.mesh | Brain Diseases | |
| dc.subject.mesh | Seizures | |
| dc.subject.mesh | Status Epilepticus | |
| dc.subject.mesh | Encephalitis | |
| dc.subject.mesh | Biomarkers | |
| dc.subject.mesh | Humans | |
| dc.subject.mesh | Encephalitis | |
| dc.subject.mesh | Brain Diseases | |
| dc.subject.mesh | Seizures | |
| dc.subject.mesh | Status Epilepticus | |
| dc.subject.mesh | Syndrome | |
| dc.subject.mesh | Quinolinic Acid | |
| dc.subject.mesh | Neopterin | |
| dc.subject.mesh | Kynurenine | |
| dc.subject.mesh | Chromatography, Liquid | |
| dc.subject.mesh | Tandem Mass Spectrometry | |
| dc.subject.mesh | Biomarkers | |
| dc.subject.mesh | Neuroinflammatory Diseases | |
| dc.subject.mesh | Humans | |
| dc.subject.mesh | Neopterin | |
| dc.subject.mesh | Quinolinic Acid | |
| dc.subject.mesh | Kynurenine | |
| dc.subject.mesh | Syndrome | |
| dc.subject.mesh | Neuroinflammatory Diseases | |
| dc.subject.mesh | Chromatography, Liquid | |
| dc.subject.mesh | Tandem Mass Spectrometry | |
| dc.subject.mesh | Brain Diseases | |
| dc.subject.mesh | Seizures | |
| dc.subject.mesh | Status Epilepticus | |
| dc.subject.mesh | Encephalitis | |
| dc.subject.mesh | Biomarkers | |
| dc.title | CSF neopterin and quinolinic acid are biomarkers of neuroinflammation and neurotoxicity in FIRES and other infection-triggered encephalopathy syndromes. | |
| dc.type | Journal Article | |
| utslib.citation.volume | 10 | |
| utslib.location.activity | United States | |
| utslib.for | 1103 Clinical Sciences | |
| utslib.for | 1109 Neurosciences | |
| pubs.organisational-group | University of Technology Sydney | |
| pubs.organisational-group | University of Technology Sydney/Faculty of Science | |
| pubs.organisational-group | University of Technology Sydney/Faculty of Science/School of Mathematical and Physical Sciences | |
| utslib.copyright.status | open_access | * |
| dc.date.updated | 2024-10-21T00:58:59Z | |
| pubs.issue | 8 | |
| pubs.publication-status | Published | |
| pubs.volume | 10 | |
| utslib.citation.issue | 8 |
Abstract:
OBJECTIVE: Infection-triggered encephalopathy syndromes (ITES) are potentially devastating neuroinflammatory conditions. Although some ITES syndromes have recognisable MRI neuroimaging phenotypes, there are otherwise few biomarkers of disease. Early detection to enable immune modulatory treatments could improve outcomes. METHODS: We measured CSF neopterin, quinolinic acid, kynurenine and kynurenine/tryptophan ratio using a liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) system. The CSF of 18 children with ITES were compared with acute encephalitis (n = 20), and three control groups, namely epilepsy (n = 20), status epilepticus (n = 18) and neurogenetic controls (n = 20). RESULTS: The main ITES phenotypes in 18 patients were acute encephalopathy with biphasic seizures and late restricted diffusion (AESD, n = 4), febrile infection-related epilepsy syndrome (FIRES n = 4) and other ITES phenotypes. Influenza A was the most common infectious trigger (n = 5), and 50% of patients had a preceding notable neurodevelopmental or family history. CSF neopterin, quinolinic acid and kynurenine were elevated in ITES group compared to the three control groups (all p < 0.0002). The ROC (area under curve) for CSF neopterin (99.3%, CI 98.1-100) was significantly better than CSF pleocytosis (87.3% CI 76.4-98.2) (p = 0.028). Elevated CSF neopterin could discriminate ITES from other causes of seizures, status epilepticus and febrile status epilepticus (all p < 0.0002). The elevated CSF metabolites normalised during longitudinal testing in two patients with FIRES. INTERPRETATION: CSF neopterin and quinolinic acid are neuroinflammatory and excitotoxic metabolites. This CSF metabolomic inflammatory panel can discriminate ITES from other causes of new onset seizures or status epilepticus, and rapid results (4 h) may facilitate early immune modulatory therapy.
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