Camilla Hesse

Standardization of measurement of beta-amyloid(1-42) in cerebrospinal fluid and plasma

The standardization and clinical validation of the measurement of β–amyloid. (Aβ42) in cerebrospinal fluid (CSF), plasma and urine is described using a commercially available sandwich–type ELISA with 2 IF12 and 3D6 as monoclonal antibodies. The INNOTEST™ β–amyloid(1–42) allows the specific and reliable measurement of (1–42) amyloid peptides in CSF and plasma. The Aβ42 concentrations in serum and urine were below the detection limit. In plasma, no differences were found in Aβ42 levels between controls and patients with different neurodegenerative disorders (Alzheimers disease (AD), Lewy body disease (LED), others). In contrast, CSF–Aβ42 concentrations were lower in AD and LBD patients as compared to controls. No correlation was found in AD patients between CSF and plasma concentrations of Aβ42 or between CSF Aβ42 levels and blood–brain–barrier function. The quantitative outcome of the test is in part dependent on confounding factors such as tube type, freeze/thaw cycles, temperature of incubation, standard preparation protocol, and antibody selection. Notwithstanding these aspects, it emerged that Aβ42 is a useful biochemical marker for the diagnosis of AD patients, but there is a need for an international Aβ standard, a universally accepted protocol for CSF preparation, and a thorough evaluation of assay performance in function of the boundary conditions.

Transient increase in total tau but not phospho-tau in human cerebrospinal fluid after acute stroke

An increase in cerebrospinal fluid (CSF)-total-tau, and recently also in CSF-phospho-tau, has been found in Alzheimers disease (AD). However, the mechanisms for these changes are not known. We examined longitudinal CSF samples from nine patients with acute stroke. As compared with baseline levels (day 0-1), CSF-total-tau showed an increase at day 2-3 (179%; P=0.018), day 7-9 (257%; P=0.003), and after 3 weeks (425%; P=0.002) and returned to normal levels after 3-5 months (140%; NS). In contrast, there was no significant change in CSF-phospho-tau. These findings suggest that total tau and phospho-tau in CSF reflect different pathogenic processes in the brain; total-tau the degree of neuronal damage and phospho-tau the phosphorylation state of tau and thus possibly the formation of neurofibrillary tangles.

Cerebrospinal fluid tau protein as a biochemical marker for Alzheimer’s disease: a community based follow up study

OBJECTIVES Biochemical markers for Alzheimer’s disease would be of great value, especially to help in diagnosis early in the course of the disease. A pronounced increase in CSF tau protein (CSF-tau) is found in most patients with Alzheimer’s disease. However, the specificity has to be further studied, as an increase in CSF-tau has also been found in other dementias, especially in vascular dementia. As most previous CSF studies have been based on selected inpatients, it was considered of special interest to examine the diagnostic potential of CSF-tau in a community population based sample of consecutive patients with dementia. Such patient material has been examined at the Piteå River Valley Hospital in Northern Sweden since 1986, and includes all those with memory disturbances in the community. The aim was also to study if an increase in CSF-tau is found early in the disease process, and whether CSF-tau changes during the progression of disease. METHODS Participants: Community population based sample of 75 demented patients (43 with Alzheimer’s disease, 21 with vascular dementia, and 11 with mixed Alzheimer’s disease/vascular dementia), 18 healthy subjects, and 18 neurological controls. A follow up investigation (including analysis of a new CSF sample) was performed in all patients after about one year. MAIN OUTCOME MEASURES Concentrations of total (both normal tau and PHF-tau) tau in CSF, clinical measures (duration and severity of dementia), and apoE polymorphism. RESULTS CSF-tau was markedly increased in Alzheimer’s disease, 41/43 (95%) patients had values above the cut off level (mean+2 SD) in controls (306 pg/ml). High CSF-tau concentrations were also found in most patients with vascular dementia, preferentially in patients with vascular dementia without progressive leukoaraiosis on CT, whereas patients with vascular dementia with progressive leukoaraiosis had normal CSF-tau. Concentrations of CSF-tau were stable at one year follow up in both patients with Alzheimer’s disease and patients with vascular dementia, and there was no correlation between CSF-tau and either duration or severity of dementia. CONCLUSIONS The findings confirm the high sensitivity of CSF-tau for the diagnosis of Alzheimer’s disease, but high CSF-tau was also found in vascular dementia, resulting in a lower specificity. However, high CSF-tau is preferentially found in patients with vascular dementia without progressive leukoaraiosis, which may constitute a group with concomitant Alzheimer’s disease pathology. High CSF-tau may be present during the whole course of the disease in Alzheimer’s disease. Possibly, therefore, the same high CSF-tau concentrations may be present before the onset of clinical dementia. Follow up studies on such patients will tell whether analysis of CSF-tau is useful as a biochemical marker for early Alzheimer’s disease.

Enrichment of glycopeptides for glycan structure and attachment site identification

We present a method to enrich for glycoproteins from proteomic samples. Sialylated glycoproteins were selectively periodate-oxidized, captured on hydrazide beads, trypsinized and released by acid hydrolysis of sialic acid glycosidic bonds. Mass spectrometric fragment analysis allowed identification of glycan structures, and additional fragmentation of deglycosylated ions yielded peptide sequence information, which allowed glycan attachment site and protein identification. We identified 36 N-linked and 44 O-linked glycosylation sites on glycoproteins from human cerebrospinal fluid.

Cerebrospinal fluid markers for Alzheimer's disease evaluated after acute ischemic stroke.

Potential cerebrospinal fluid (CSF) markers for Alzheimers disease (AD) include tau protein, the 42 amino-acid form of amyloid beta (amyloid beta(1-42)) and apolipoprotein E (apoE). To study new aspects of these protein markers, we examined consecutive CSF samples from 26 patients with acute ischemic stroke. CSF samples were taken on day 0-1, day 2-3, day 7-9, 3 weeks and 3-5 months after the stroke. CSF-tau showed a marked increase day 2-3, which peaked after 1 week and returned to normal after 3-5 months. CSF-tau also showed correlation (r=0.95; p<0.01) with the size of the infarct. In contrast, CSF-amyloid beta(1-42) and CSF-apoE showed no significant changes during the period. The marked increase in CSF-tau levels after acute ischemic stroke indicate that CSF-tau reflect the degree of neuronal damage. The reason for unchanged levels of CSF-amyloid beta(1-42) and CSF-apoE after ischemic stroke remains unclear.

A population study of apoE genotype at the age of 85: relation to dementia, cerebrovascular disease, and mortality

OBJECTIVES To study the association of apoE genotypes with dementia and cerebrovascular disorders in a population based sample of 85 year old people. METHODS A representative sample of 85 year old people (303 non-demented, 109 demented) were given a neuropsychiatric and a medical examination and head CT. The apoE isoforms were determined. Dementia was diagnosed according to DSM-III-R. RESULTS At the age of 85, carriers of the apoE ε4 allele had an increased odds ratio (OR) for dementia (1.9; p<0.01) and its subtypes Alzheimer’s disease (1.9; p<0.05) and vascular dementia (2.0; p<0.05). Among those categorised as having vascular dementia, the apoE ε4 allele was associated with mixed Alzheimer’s disease-multi-infarct dementia (OR 6.5; p<0.05), but not with pure multi-infarct dementia (OR 1.5; NS). Only carriers of the apoE ε4 allele who also had ischaemic white matter lesions on CT of the head had an increased OR for dementia (OR 6.1; p=0.00003), and its main subtypes Alzheimer’s disease (OR 6.8; p=0.002) and vascular dementia (OR 5.6; p=0.0007), whereas carriers of the apoE ε4 allele without white matter lesions had an OR for dementia of 1.0 (OR for Alzheimer’s disease 1.8; NS and for vascular dementia 0.6; NS) and non-carriers of the apoE ε4 allele with white matter lesions had an OR for dementia of 2.2; NS (OR for Alzheimer’s disease 2.7; NS and for vascular dementia 1.6; NS). The apoE allele variants were not related to mortality or incidence of dementia between the ages of 85 and 88. The ε2 allele was related to a higher prevalence of stroke or transient ischaemic attack at the age of 85 (OR 2.1; p<0.05) and a higher incidence of multi-infarct dementia during the follow up (OR 2.9; p<0.05). CONCLUSIONS Neither the apoE ε4 allele nor white matter lesions are sufficient risk factors by themselves for dementia at very old ages, whereas possession of both these entities increases the risk for Alzheimer’s disease and vascular dementia substantially.

Clusterin (Apolipoprotein J) Protein Levels Are Increased in Hippocampus and in Frontal Cortex in Alzheimer's Disease☆

We studied the multifunctional protein clusterin (apolipoprotein J, SGP-2, SP-40,40) in brain tissue using quantitative Western blotting and immunohistochemistry. The material included postmortem brains from 19 patients with Alzheimers disease (AD), 6 with vascular dementia (VAD), and 7 age-matched control subjects. Intense clusterin staining was found in the soma of both neuronal and astroglial cells. In addition, positive staining was found in a portion of senile plaques (SP) in AD brains. Quantitative analysis showed that clusterin levels were significantly increased in AD, both in frontal cortex (150% of the control value, P = 0.002) and in the hippocampus (179% of the control value, P < 0.001), while normal clusterin levels were found in cerebellum (104% of the control value). No significant changes were found in VAD. Within the AD group, there was a significant negative correlation between clusterin levels in hippocampus and severity of dementia (r = -0.40), while no such correlation was found in frontal cortex (r = 0.12). No significant correlations were found between clusterin levels and the number of SP or neurofibrillary tangles. No significant differences in clusterin levels were found in any brain region between AD patients possessing different numbers of the ApoE4 allele. The increased clusterin levels in AD brain, together with the absence of a correlation between SP counts and clusterin levels, and the finding that clusterin is only found in a smaller portion of SP do not suggest a link between clusterin and beta-amyloid dependence. Instead we hypothesize that the increase is part of a regional response in AD brain.

Proteome studies of human cerebrospinal fluid and brain tissue using a preparative two-dimensional electophoresis approach prior to mass spectrometry

A preparative proteomic approach, involving liquid phase isoelectric focusing (IEF) in combination with one‐dimensional electrophoresis and electroelution followed by mass spectrometry and database searches, was found to be an important tool for identifying low‐abundant proteins (μg/L) in human cerebrospinal fluid (CSF) and membrane proteins in human frontal cortex. Several neuron‐related proteins, such as amyloid precursor‐like protein, chromogranins A and B, glial fibrillary acid protein, β‐trace, transthyretin, ubiquitin, and cystatin C, were identified in CSF. Several types of proteins were also characterized from a detergent‐solubilized human frontal cortex homogenate including membrane proteins such as synaptophysin, syntaxin and Na+/K+ ATPase. One‐third of the identified proteins have not previously been identified in human CSF or human frontal cortex using proteomic techniques. The absence of these proteins in two‐dimensional electrophoresis maps might be due to insufficient amounts or low solubility. The advantages of using preparative liquid phase electrophoretic separations for identifying proteins from complex biological mixtures are speed of analysis, high loadability in the IEF separation, nondiscrimination of membrane proteins or low abundance proteins, yielding sufficient amounts for characterization by mass spectrometry. The use of this strategy in proteome studies of CSF/brain tissue is expected to offer new perspectives in studies of the pathology of neurodegenerative diseases, and reveal new potential markers for brain disorders.

Cerebrospinal fluid apolipoprotein E is reduced in Alzheimer's disease

Apolipoprotein E (ApoE) has been implicated in the pathogenesis of Alzheimers disease (AD). ApoE is synthesized within the brain and has been suggested to be involved in the re-utilization of membrane lipids during neuronal repair and remyelination after injury. Spherical ApoE-containing lipoprotein particles are found in the cerebrospinal fluid (CSF). To study further the pathogenetic role of ApoE in degenerative brain disorders, we analysed ApoE in CSF. A significant (p < 0.001) reduction of CSF ApoE (1.5 +/- 1.2 ng ml-1) was found in AD compared with controls (5.0 +/- 2.7 ng ml-1). A less pronounced reduction was also found in frontal lobe dementia (3.1 +/- 1.5 ng ml-1; p < 0.05). These findings support the hypothesis that ApoE is involved in the pathogenesis of degenerative brain disorders such as AD. An increased reutilization of ApoE-lipid complexes in the brain, as part of a generalized repair process, may explain the low CSF ApoE in AD. Alternatively, the reduction of CSF ApoE may be caused by absorption of ApoE to senile plaques and neurofibrillary tangles.

Human Urinary Glycoproteomics; Attachment Site Specific Analysis of N- and O-Linked Glycosylations by CID and ECD

Urine is a complex mixture of proteins and waste products and a challenging biological fluid for biomarker discovery. Previous proteomic studies have identified more than 2800 urinary proteins but analyses aimed at unraveling glycan structures and glycosylation sites of urinary glycoproteins are lacking. Glycoproteomic characterization remains difficult because of the complexity of glycan structures found mainly on asparagine (N-linked) or serine/threonine (O-linked) residues. We have developed a glycoproteomic approach that combines efficient purification of urinary glycoproteins/glycopeptides with complementary MS-fragmentation techniques for glycopeptide analysis. Starting from clinical sample size, we eliminated interfering urinary compounds by dialysis and concentrated the purified urinary proteins by lyophilization. Sialylated urinary glycoproteins were conjugated to a solid support by hydrazide chemistry and trypsin digested. Desialylated glycopeptides, released through mild acid hydrolysis, were characterized by tandem MS experiments utilizing collision induced dissociation (CID) and electron capture dissociation fragmentation techniques. In CID-MS2, Hex5HexNAc4-N-Asn and HexHexNAc-O-Ser/Thr were typically observed, in agreement with known N-linked biantennary complex-type and O-linked core 1-like structures, respectively. Additional glycoforms for specific N- and O-linked glycopeptides were also identified, e.g. tetra-antennary N-glycans and fucosylated core 2-like O-glycans. Subsequent CID-MS3, of selected fragment-ions from the CID-MS2 analysis, generated peptide specific b- and y-ions that were used for peptide identification. In total, 58 N- and 63 O-linked glycopeptides from 53 glycoproteins were characterized with respect to glycan- and peptide sequences. The combination of CID and electron capture dissociation techniques allowed for the exact identification of Ser/Thr attachment site(s) for 40 of 57 putative O-glycosylation sites. We defined 29 O-glycosylation sites which have, to our knowledge, not been previously reported. This is the first study of human urinary glycoproteins where “intact” glycopeptides were studied, i.e. the presence of glycans and their attachment sites were proven without doubt.