Journal
CLINICAL CHEMISTRY AND LABORATORY MEDICINE
Volume 60, Issue 7, Pages 1124-1132Publisher
WALTER DE GRUYTER GMBH
DOI: 10.1515/cclm-2022-0097
Keywords
biomarkers; brain injury; cerebrospinal fluid; Lyme neuroborreliosis; pathogenesis
Categories
Funding
- Swedish Society of Medicine
- Medical Research Council of South East Sweden (FORSS)
- Futurum -the Academy of Health and Welfare, Region Jonkoping County
- Swedish Research Council [2018-02532, 2017-00915, 2018-02776]
- European Research Council [681712]
- Swedish State Support for Clinical Research [ALFGBG-720931]
- Alzheimer Drug Discovery Foundation (ADDF), USA [201809-2016862, RDAPB-201809-2016615]
- AD Strategic Fund and the Alzheimer's Association [ADSF-21-831376-C, ADSF-21-831381-C, ADSF-21831377-C]
- Olav Thon Foundation
- Erling-Persson Family Foundation
- Stiftelsen for Gamla Tjanarinnor, Hjarnfonden, Sweden [FO2019-0228]
- European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant [860197]
- UK Dementia Research Institute at UCL
- Swedish Alzheimer Foundation [AF-742881]
- Hjarnfonden, Sweden [FO2017-0243]
- Swedish government [ALFGBG-715986]
- Swedish County Councils, the ALF-agreement [ALFGBG-715986]
- European Union Joint Program for Neurodegenerative Disorders [JPND2019466-236]
- National Institute of Health (NIH), USA [1R01AG068398-01]
- Alzheimer's Association 2021 Zenith Award [ZEN-21-848495]
- Medical Inflammation and Infection Centre (MIIC)
- ALF grants Region Ostergotland [RO-936276]
- Swedish Research Council [2018-02776] Funding Source: Swedish Research Council
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The levels and kinetics of cerebrospinal fluid markers of inflammation and brain injury were evaluated in patients with Lyme neuroborreliosis. The results indicate a predominance of microglial and neuroinflammatory involvement in CSF at diagnosis of LNB and a prompt decline after antibiotic treatment.
Objectives The purpose of this study was to evaluate levels and kinetics of cerebrospinal fluid (CSF) markers of inflammation and brain injury in patients with Lyme neuroborreliosis (LNB). Methods Adult patients with clinically suspected LNB were enrolled, in a prospective clinical study in the South East of Sweden. Patients were classified according to the European Federation of Neurological Societies' guidelines. Definite cases of LNB were re-examined one month later including a repeat CSF investigation. Routine laboratory parameters were investigated along with CSF levels of neurodegenerative markers glial fibrillary acidic protein (GFAp), total tau (t-tau) and neurofilament light protein (NFL), as well as neuroinflammatory markers soluble triggering receptor expressed on myeloid cells 2 (sTREM2), YKL-40 and CXCL13. Non-LNB served as controls. An additional comparison group consisted of spinal anesthesia subjects (SAS) without known central nervous system conditions. Results CSF levels of sTREM2 and CXCL13 were elevated in definite LNB patients at diagnosis compared with non-LNB patients (p<0.001) and SAS (p <= 0.01). In addition, CSF levels of sTREM2, YKL-40 and CXCL13 rapidly declined in at follow-up after antibiotic treatment. In contrast, CSF levels of GFAp and t-tau did not differ across LNB groups, and did not change after treatment. Conclusions Although in a limited number of LNB patients, the results indicate a predominance of microglial and neuroinflammatory involvement rather than parenchymal CNS injury in CSF at diagnosis of LNB with a prompt decline after antibiotic treatment. The findings provide pathogenetic insights and may be of value in differential diagnosis of CSF findings.
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