Selected serum cytokines and nitric oxide as potential multi-marker biosignature panels for Parkinson disease of varying durations: a case-control study

BackgroundDopaminergic neuronal loss begins years before motor symptoms appear in Parkinson disease (PD). Thus, reliable biomarkers for early diagnosis and prognosis of PD are an essential pre-requisite to develop disease modifying therapies. Inflammation-derived oxidative stress is postulated to contribute to nigrostriatal degeneration. We evaluated the role of selected serum immune mediators (IFN, TNF, IL-10, and NOx) in PD progression and estimated their usefulness in preclinical diagnosis.MethodsThis case-control study recruited 72 PD patients with varying disease durations (<1-year, n=12 patients; 1-3years, n=30; >3years, n=30) and 56 age- and gender-matched controls (26 with other neurological disorders as disease controls, and 30 healthy controls). Serum cytokine levels and NOx quantified using Sandwich Enzyme Linked Immunosorbent Assay kits, and the Griess test, respectively, were evaluated for diagnostic accuracy of optimal marker combinations by the CombiROC method. PD patients were clinically evaluated for motor and non-motor symptoms, and staged based on Hoehn and Yahr (H-Y) scale.ResultsA significant increase in serum IFN and IL-10 was observed in PD compared to healthy controls (p<0.001). The Th1: Th2 (IFN: IL-10) cytokine ratio was higher in PD of 3-12years compared with PD <1year (p<0.001). Highest levels of NOx manifested during early PD (1-3years) through a subsequent decline with disease duration. TNF level was highest at PD onset. A low serum NOx level was associated with cognitive impairment (p=0.002). The potential of using multi-biomarker panel, IFN, IL-10 and TNF, for detection of PD onset was evident (sensitivity [SE]=83.3%, specificity [SP] =80.4%, area under curve [AUC]=0.868), while for early and late PD the multi-biomarker signature of IFN, IL-10and NOx appeared to be more promising (SE=93.3%, SP=87.5%, AUC=0.924).ConclusionA Th1 cytokine-biased immune response predominates with PD progression. Both IFN and IL-10 are involved in disease severity. However, TNF-mediated neurotoxicity appears to occur in early PD.