■Glycans在神经系统中起着重要的功能作用,其病理生物学相关性在许多脑部疾病中得到了越来越多的认可,但在创伤性脑损伤(TBI)中尚未完全探索。我们调查了中度至重度TBI(格拉斯哥昏迷量表[GCS]评分≤12)患者的纵向血糖模式,以表征糖生物标志物特征及其与临床特征和长期预后的关系。
■这项前瞻性单中心观察性研究包括51名成年TBI患者(GCS≤12),Pecs,匈牙利,2018年6月至2019年4月。我们使用高通量液相色谱-串联质谱平台来评估损伤后3天的血清N-聚糖水平。在受伤后12个月使用格拉斯哥结果扩展量表(GOS-E)评估结果。多元统计技术,包括主成分分析和正交偏最小二乘判别分析,用于分析糖组学数据,并定义高度有影响力的结构驱动类区别。接收器工作特征分析用于确定预后准确性。
■我们鉴定出94个包含所有典型结构类型的N-聚糖,包括寡甘露糖,混合动力车,和复杂类型的实体。高甘露糖水平,杂种和唾液酸化结构在时间上发生了改变(p<0·05)。鉴定了四种有影响的聚糖。两种大脑特有的结构,HexNAc5Hex3DeoxyHex0NeuAc0和HexNAc5Hex4DeoxyHex0NeuAc1在预后不良(GOS-E≤4)的患者受伤后早期显着增加(曲线下面积[AUC]=0·75[95CI0·59-0·90]和AUC=0·71[0·52-0·89],分别)。在预后良好的患者中,HexNAc7Hex7DeoxyHex1NeuAc2和HexNAc8Hex6DeoxyHex0NeuAc0的血清水平持续升高,但在那些不利结果的人中却无法察觉。在患有肿块病变的患者和需要去骨瓣减压术的患者中,HexNAc5Hex4DeoxyHex0NeuAc1的水平急剧升高。
■尽管这项研究具有探索性,患者数量相对较少,据我们所知,我们的研究结果提供了初步证据,支持糖组学方法用于TBI中生物标志物发现和患者表型分析的实用性.将需要进一步的更大的多中心研究来验证我们的发现并确定其病理生物学价值和在实践中的潜在应用。
■这项工作由意大利卫生部资助(拨款编号GR-2013-02354960),也得到NIH资助(1R01GM112490-08)的部分支持。
UNASSIGNED: Glycans play essential functional roles in the nervous system and their pathobiological relevance has become increasingly recognized in numerous brain disorders, but not fully explored in traumatic brain injury (TBI). We investigated longitudinal glycome patterns in patients with moderate to severe TBI (Glasgow Coma Scale [GCS] score ≤12) to characterize glyco-biomarker signatures and their relation to clinical features and long-term outcome.
UNASSIGNED: This prospective single-center observational
study included 51 adult patients with TBI (GCS ≤12) admitted to the neurosurgical unit of the University Hospital of Pecs, Pecs, Hungary, between June 2018 and April 2019. We used a high-throughput liquid chromatography-tandem mass spectrometry platform to assess serum levels of N-glycans up to 3 days after injury. Outcome was assessed using the Glasgow Outcome Scale-Extended (GOS-E) at 12 months post-injury. Multivariate statistical techniques, including principal component analysis and orthogonal partial least squares discriminant analysis, were used to analyze
glycomics data and define highly influential structures driving class distinction. Receiver operating characteristic analyses were used to determine prognostic accuracy.
UNASSIGNED: We identified 94 N-glycans encompassing all typical structural types, including oligomannose, hybrid, and complex-type entities. Levels of high mannose, hybrid and sialylated structures were temporally altered (p<0·05). Four influential glycans were identified. Two brain-specific structures, HexNAc5Hex3DeoxyHex0NeuAc0 and HexNAc5Hex4DeoxyHex0NeuAc1, were substantially increased early after injury in patients with unfavorable outcome (GOS-E≤4) (area under the curve [AUC]=0·75 [95%CI 0·59-0·90] and AUC=0·71 [0·52-0·89], respectively). Serum levels of HexNAc7Hex7DeoxyHex1NeuAc2 and HexNAc8Hex6DeoxyHex0NeuAc0 were persistently increased in patients with favorable outcome, but undetectable in those with unfavorable outcome. Levels of HexNAc5Hex4DeoxyHex0NeuAc1 were acutely elevated in patients with mass lesions and in those requiring decompressive craniectomy.
UNASSIGNED: In spite of the exploratory nature of the
study and the relatively small number of patients, our results provide to the best of our knowledge initial evidence supporting the utility of
glycomics approaches for biomarker discovery and patient phenotyping in TBI. Further larger multicenter studies will be required to validate our findings and to determine their pathobiological value and potential applications in practice.
UNASSIGNED: This work was funded by the Italian Ministry of Health (grant number GR-2013-02354960), and also partially supported by a NIH grant (1R01GM112490-08).