Objective: This study explores a large panel of cytokines in plasma and CSF of patients with Aicardi-Goutières syndrome (AGS) at different ages, in order to establish signatures of cytokines most predictive of AGS.Methods: Plasma from 22 subjects with known mutations were assayed for cytokines using the Milliplex MAP Immunobead system, and compared to results from 8 age-matched normal controls. CSF of 11 additional patients with mutation-proven AGS was tested in an identical manner and compared to results from age-matched controls. Samples were banked and analysis was carried out retrospectively.Results: Significant elevations were seen in FMS-related tyrosine kinase 3 ligand, IP-10, interleukin (IL)-12p40, IL-15, tumor necrosis factor a, and soluble IL 2 receptor a in both AGS patient plasma and CSF relative to controls. Additionally, this cytokine signature was able to correctly cluster 9 of 11 AGS cases based on CSF values. While most cytokines decreased exponentially with age, a subgroup including IP-10 demonstrated persistent elevation beyond early childhood.
Conclusion: Patients with AGS exhibit plasma and CSF elevations of proinflammatory cytokines.Selected cytokines remain persistently elevated beyond the initial disease phase. This panel of proinflammatory cytokines may be considered for use as diagnostic and therapeutic markers of disease, and may permit improved understanding of disease pathogenesis. Neurology Aicardi-Goutières syndrome (AGS) is a heritable disorder, characterized by basal ganglia and white matter calcifications, leukoencephalopathy, and elevated CSF interferon-a (IFN-a).1,2 AGS has long been understood as a neuroimmune disorder with characteristic presentations ranging from a syndrome that mimics in utero viral infections to lupus-like sterile pyrexias, skin, and joint manifestations.2 The disease is caused by mutations in any one of several genes encoding nucleases or other proteins involved in innate cellular immunity: TREX1, 3 RNASEH2A, RNASEH2B, RNASEH2C, 4 and SAMHD1. 5 It is thought that failure of these enzymes in AGS results in accumulation of intracellular nucleic acid species, with subsequent activation of an innate immune response, and neurodegeneration. The exact mechanisms underlying activation of the innate cellular immune response and subsequent disease remains unclear; however, these observations indicate that the disease might be treatable by interrupting the accumulation of endogenous nucleic acids.6 Thus, identifying biomarkers, both to monitor disease progression and to better understand disease pathophysiology, is essential to the ongoing study of AGS.