Peripheral white blood cell responses as emerging biomarkers for patient stratification and prognosis in acute spinal cord injury

Abstract

Purpose of review To date, prognostication of patients after acute traumatic spinal cord injury (SCI) mostly relies on the neurological assessment of residual function attributed to lesion characteristics. With emerging treatment candidates awaiting to be tested in early clinical trials, there is a need for wholistic high-yield prognostic biomarkers that integrate both neurogenic and nonneurogenic SCI pathophysiology as well as premorbid patient characteristics. Recent findings It is becoming clearer that effective prognostication after acute SCI would benefit from integrating an assessment of pathophysiological changes on a systemic level, and with that, extend from a lesion-centric approach. Immunological markers mirror tissue injury as well as host immune function and are easily accessible through routine blood sampling. New studies have highlighted the value of circulating white blood cells, neutrophils and lymphocytes in particular, as prognostic systemic indicators of SCI severity and outcomes. Summary We survey recent advances in methods and approaches that may allow for a more refined diagnosis and better prognostication after acute SCI, discuss how these may help deepen our understanding of SCI pathophysiology, and be of use in clinical trials.

Identification of Immune-Associated Genes in Diagnosing Aortic Valve Calcification With Metabolic Syndrome by Integrated Bioinformatics Analysis and Machine Learning

“…Samples regarding the MS dataset used in the study are all from peripheral blood; therefore, we only need to collect peripheral blood from MS patients and evaluate the expression of the five discovered immune-associated genes to infer the probability of AVC incidence in MS patients, which is an efficient and practical method for clinical usage. The application of peripheral blood tests in diagnosing different diseases has also been widely accepted ( 34 , 35 ). Moreover, although we confirmed that gene expression level can be used as an independent diagnostic marker, we intend to develop a more comprehensive diagnosis pattern by converting it into a score and taking all these five markers into consideration ( 36 ).…”

A comprehensive proteomic and bioinformatics analysis of human spinal cord injury plasma identifies proteins associated with the complement cascade and liver function as potential prognostic indicators of neurological outcome

“…(Wang et al 2018) More recently, circulating white blood cell populations have also been identified as potential SCI injury biomarkers, with a 2021 study showing that elevated levels of neutrophils were associated with no AIS grade conversion, while conversely an increase in lymphocytes during the first week post-SCI were associated with an AIS grade improvement. (Jogia et al 2021) A number of individual proteins have been shown to be altered in the bloods post-SCI, including multiple interleukins (IL), tumour necrosis factor alpha (TNF-α) and C-reactive protein (CRP). (Segal et al 1997;Hayes et al 2002;Frost et al 2005) 2 Further, changes in inflammatory marker levels detected in acute SCI patients were found to be mirrored in donor-matched blood and CSF, albeit at lower absolute concentrations systemically.…”

“…(Wang et al 2018) More recently, circulating white blood cell populations have also been identified as potential SCI injury biomarkers, with a 2021 study showing that elevated levels of neutrophils were associated with no AIS grade conversion, while conversely an increase in lymphocytes during the first week post-SCI were associated with an AIS grade improvement. (Jogia et al 2021)…”

Epidemiological and hematological profile of traumatic spinal cord injury: a retrospective study

“…Additionally, Current prognostication of patients after TSCI mostly relies on the neurological assessment of residual function attributed to lesion characteristics [5] . However, it is often impractical to perform these tests soon after patient admission, which is too time-consuming and unreliable in emergency situations, especially if the patient is unresponsive or compromised.…”

“…Therefore, it is urgent to select biomarkers that can be easily extractable from clinical data and routinely used across different healthcare institutions, which can indicate the neurologic outcome and prognosis of TSCI, and routine blood samples seem to meet this requirement. Due to blood samples are easily collected when patient admission and often also measured frequently during the rst week after injury, at least for critically ill patients [5] . Any changes of them may be practical and convenient for predicting SCI.…”