Biomarkers in Traumatic Spinal Cord Injury—Technical and Clinical Considerations: A Systematic Review

Abstract

Objective. To examine (1) if serological or cerebrospinal fluid (CSF) biomarkers can be used as diagnostic and/or prognostic tools in patients with spinal cord injury (SCI) and (2) if literature provides recommendations regarding timing and source of biomarker evaluation. Data Sources. A systematic literature search to identify studies reporting on diagnostic and prognostic blood and/or CSF biomarkers in SCI was conducted in PubMed/MEDLINE, CINAHL, Science Direct, The Cochrane Library, ISI Web of Science, and PEDro. Study Selection. Clinical trials, cohort, and pilot studies on patients with traumatic SCI investigating at least one blood or CSF biomarker were included. Following systematic screening, 19 articles were included in the final analysis. PRISMA guidelines were followed to conduct this review. Data Extraction. Independent extraction of articles was completed by 2 authors using predefined inclusion criteria and study quality indicators. Data Synthesis. Nineteen studies published between 2002 and April 2019 with 1596 patients were included in the systematic review. In 14 studies, blood biomarkers were measured, 4 studies investigated CSF biomarkers, and 1 study used both blood and CSF samples. Conclusions. Serum/CSF concentrations of several biomarkers (S100b, IL-6, GFAP, NSE, tau, TNF-α, IL-8, MCP-1, pNF-H, and IP-10) following SCI are highly time dependent and related to injury severity. Future studies need to validate these markers as true biomarkers and should control for secondary complications associated with SCI. A deeper understanding of secondary pathophysiological events after SCI and their effect on biomarker dynamics may improve their clinical significance as surrogate parameters in future clinical studies.

Progressive spinal cord compression technique in experimental rabbit animal model for cervical spondylotic myelopathy

“…In line with studies, an increase in GFAP indicates the presence of astrocyte activity or progression which can be associated with chronic spinal cord injury. Research found that astrocytes also function to maintain the balance of BBB (blood-brain barrier)/BSCB (blood spinal cord barrier) and participate in various immune system reactions so that GFAP expression is considered a gliotic process due to inflammation or injury and GFAP can be markers of trauma and degenerative disease of the CNS [ 19 ]. Astrogliosis of the spinal cord causes scar formation, a barrier that blocks axon regeneration and causes myelopathy as shown in Fig.…”

Improving Diagnostic Workup Following Traumatic Spinal Cord Injury: Advances in Biomarkers

“…Additionally, during the pathophysiological events following SCI, each stage is characterized by up- and downregulations of specific proteins, which renders them an optimal target as biomarker for tracking the stages after SCI [ 65 ]. Particularly, assessing the injury severity of unresponsive patients by blood- or CSF-derived markers might facilitate diagnostic workup [ 66 ]. Due to the plethora of different compounds, we focus in this review on the most promising factors, whose diagnostic and prognostic usefulness could be replicated (Table 1 ).…”

Elevated Serum Neuropeptide FF Levels Are Associated with Cognitive Decline in Patients with Spinal Cord Injury

“…However, improved and early identification of SCI patients at risk for secondary complications of neurological and cognitive dysfunction can enable timely neuroprotective and rehabilitative treatment to improve clinical outcomes. Currently, there is a need to identify clinically relevant biomarkers of cognitive impairment early during SCI [ 22 ].…”