Ective role in cell death by sequestering toxic molecular species [15,16]. Regarding the formation of alphasynuclein containing inclusion bodies and their importance in neuropathological alterations, Braak et al. were able to indicate a topographical extent of these lesions with an initial onset in the dorsal IX/X-motor nucleus and the intermediate reticular zone in the brain stem, proceeding with an ascending course to cortical structures, beginning with the anteromedial temporal mesocortex [17,18,19]. As a possible link SC-1 site between neurotoxicity, aggregation and propagation it might be concluded that species of neurotoxic oligomers can be transformed to oligomers which are not neurotoxic, but have a higher tendency of further aggregation [20,21]. We and others made attempts to improve the early diagnosis of dementia in PD patients by measurement of alpha-synuclein or proposed alpha-synuclein aggregates and by known biomarkers in CSF and serum [22,23,24,25]. However, for prognosis of disease progression 18325633 in an individual patient this neurochemical profile is currently of limited use [22]. Using an optimized protocol for the proteomic analysis of CSF, which particularly accounts for the brain protein variation caused by CSF flow [26], we investigated a set of well defined clinical groups of patients with PD, PDD and a control group to find a marker which can differentiate between the 26001275 demented and nondemented persons. Thereby, we found that PDD patients can be identified on the basis of differentially sialylated isoforms of Serpin A1 in CSF. In a second step, this protein was validated in an independent set of patients and investigated in human brain material.immunoblot data. As the most likely explanation for this discrepancy was that the Serpin A1 regulation seen in 2D-DIGE was related to particular isoforms (which are not separated in the conventional 1D-immunoblotting method), we performed 2Dimmunoblots to test for the presence of differential Serpin A1 isoforms in the groups. Here indeed, a Chebulagic acid web different isoform-pattern was detected with usually #5 spots in PD and CON and 6 or more spots in PDD. Spots indicated as spot 1 and spot 2 are additionally seen in PDD patients (Figure 3C). These results could also be reproduced in the CSF-samples from Kuopio/Finland and Perugia/Italy, which were investigated in a blinded manner to test reproducibility of our data and to exclude a centre effect caused by preanalytical handling procedures of CSF-samples. In a next step, we were interested in the sensitivity and specificity of Serpin A1 regarding its relevance as a possible diagnostic marker to differentiate between PD and PDD. For this, we analysed the cut-off of 5.5 spots obtained by ROC analysis and also iterative testing. Using this cut-off (or 6 spots), we compared PD and PDD and found a specificity of 58 and a sensitivity of 100 by 2D immunoblot approach. In the relevant diagnostic PD group the additional spots were seen in 10 out of 24 patients; interestingly, two patients who presented with more than 6 spots developed a dementia in the course of disease (one patient developed dementia already after one year whereas the other one remained stable over a longer time). To test specificity among dementia subgroups, a small set of patients with other dementia like Alzheimer’s disease (AD) and fronto-temporal lobar degeneration (FTLD) were analyzed whereby the specificity in the subgroups ranged from 71 in AD to 33 in the FTLD group using the sam.Ective role in cell death by sequestering toxic molecular species [15,16]. Regarding the formation of alphasynuclein containing inclusion bodies and their importance in neuropathological alterations, Braak et al. were able to indicate a topographical extent of these lesions with an initial onset in the dorsal IX/X-motor nucleus and the intermediate reticular zone in the brain stem, proceeding with an ascending course to cortical structures, beginning with the anteromedial temporal mesocortex [17,18,19]. As a possible link between neurotoxicity, aggregation and propagation it might be concluded that species of neurotoxic oligomers can be transformed to oligomers which are not neurotoxic, but have a higher tendency of further aggregation [20,21]. We and others made attempts to improve the early diagnosis of dementia in PD patients by measurement of alpha-synuclein or proposed alpha-synuclein aggregates and by known biomarkers in CSF and serum [22,23,24,25]. However, for prognosis of disease progression 18325633 in an individual patient this neurochemical profile is currently of limited use [22]. Using an optimized protocol for the proteomic analysis of CSF, which particularly accounts for the brain protein variation caused by CSF flow [26], we investigated a set of well defined clinical groups of patients with PD, PDD and a control group to find a marker which can differentiate between the 26001275 demented and nondemented persons. Thereby, we found that PDD patients can be identified on the basis of differentially sialylated isoforms of Serpin A1 in CSF. In a second step, this protein was validated in an independent set of patients and investigated in human brain material.immunoblot data. As the most likely explanation for this discrepancy was that the Serpin A1 regulation seen in 2D-DIGE was related to particular isoforms (which are not separated in the conventional 1D-immunoblotting method), we performed 2Dimmunoblots to test for the presence of differential Serpin A1 isoforms in the groups. Here indeed, a different isoform-pattern was detected with usually #5 spots in PD and CON and 6 or more spots in PDD. Spots indicated as spot 1 and spot 2 are additionally seen in PDD patients (Figure 3C). These results could also be reproduced in the CSF-samples from Kuopio/Finland and Perugia/Italy, which were investigated in a blinded manner to test reproducibility of our data and to exclude a centre effect caused by preanalytical handling procedures of CSF-samples. In a next step, we were interested in the sensitivity and specificity of Serpin A1 regarding its relevance as a possible diagnostic marker to differentiate between PD and PDD. For this, we analysed the cut-off of 5.5 spots obtained by ROC analysis and also iterative testing. Using this cut-off (or 6 spots), we compared PD and PDD and found a specificity of 58 and a sensitivity of 100 by 2D immunoblot approach. In the relevant diagnostic PD group the additional spots were seen in 10 out of 24 patients; interestingly, two patients who presented with more than 6 spots developed a dementia in the course of disease (one patient developed dementia already after one year whereas the other one remained stable over a longer time). To test specificity among dementia subgroups, a small set of patients with other dementia like Alzheimer’s disease (AD) and fronto-temporal lobar degeneration (FTLD) were analyzed whereby the specificity in the subgroups ranged from 71 in AD to 33 in the FTLD group using the sam.
