Cerebrospinal Fluid Neopterin Analysis in Neuropediatric Patients Establishment of a New Cut Off-Value for the Identification of Inflammatory-Immune Mediated Processes.docVIP

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Cerebrospinal Fluid Neopterin Analysis in Neuropediatric Patients Establishment of a New Cut Off-Value for the Identification of Inflammatory-Immune Mediated Processes.doc

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Cerebrospinal Fluid Neopterin Analysis in Neuropediatric Patients Establishment of a New Cut Off-Value for the Identification of Inflammatory-Immune Mediated Processes

CerebrospinalFluidNeopterinAnalysisinNeuropediatric Patients:EstablishmentofaNewCutOff-Valueforthe IdentificationofInflammatory-ImmuneMediated Processes MartaMolero-Luis1*,SergioFerna′ndez-Uren?a2,IolandaJorda′n2,MercedesSerrano1,AidaOrmaza′bal1, Angels` Garcia-Cazorla1,RafaelArtuch1,theNeopterinworkinggroup1,2,3 1ClinicalBiochemistryandNeuropediatrcDepartments,UniversityHospitalSantJoandeDe′u,andCentreforBiomedicalResearchonRareDiseases(CIBER-ER),Instituto deSaludCarlosIII,Barcelona,Spain,2IntensivePediatricCareUnitService,UniversityHospitalSaintJoandeDe′u,Barcelona,Spain,3MolecularMicrobiologyDepartment, MicrobiologyService,UniversityHospitalSantJoandeDe′u,Barcelona,Spain Abstract Objective:Ahighlevelofcerebrospinalfluid(CSF)neopterinisamarkerofcentralnervoussysteminflammatory-immune mediated processes. We aimed to assess data from 606 neuropediatric patients, describing the clinical and biochemical featuresofthoseneurologicaldisorderspresentingCSFneopterinvaluesaboveanewcut-offvaluethatwasdefinedinour laboratory. Methods: To establish the new CSF neopterin cut-off value, we studied two groups of patients: Group 1 comprised 68 patientswithmeningoencephalitis,andGroup2comprised52childrenwithaconfirmedperipheralinfectionandnocentral nervoussysteminvolvement.Westudied606CSFsamplesfromneuropediatricpatientswhowereclassifiedinto3groups: geneticdiagnosis(A),acquired/unknownetiologicneurologicdiseases(B)andinflammatory-immunemediatedprocesses (C). Results:TheCSFneopterincut-offvaluewas61nmol/L.Outof606cases,56presentedaCSFneopterinlevelabovethis value. Group C had significantly higher CSF neopterin, protein and leukocyte values than the other groups. Sixteen of twenty-three patients in this group had a CSF neopterin level above the cut-off, whereas three and seven patients presentedincreasedleukocyteandproteinvalues,respectively.AsignificantassociationwasfoundamongCSFneopterin, proteins and leukocytes in the 606 patients. White matter disturbances were associated w