Abstract
BackgroundElevated plasma fibrinogen levels are a well known finding in acute infectious diseases, acute stroke and myocardial infarction. However its role in the cerebrospinal fluid (CSF) of acute and chronic central (CNS) and peripheral nervous system (PNS) diseases is unclear.FindingsWe analyzed CSF and plasma fibrinogen levels together with routine parameters in patients with multiple sclerosis (MS), acute inflammatory diseases of the CNS (bacterial and viral meningoencephalitis, BM and VM) and PNS (Guillain-Barré syndrome; GBS), as well as in non-inflammatory neurological controls (OND) in a total of 103 patients. Additionally, MS patients underwent cerebral MRI scans at time of lumbar puncture.CSF and plasma fibrinogen levels were significantly lower in patients with MS and OND patients as compared to patients with BM, VM and GBS. There was a close correlation between fibrinogen levels and albumin quotient (rho = 0.769, p < 0.001) which strongly suggests passive transfer of fibrinogen through the blood-CSF-barrier during acute inflammation. Hence, in MS, the prototype of chronic neuroinflammation, CSF fibrinogen levels were not elevated and could not be correlated to clinical and neuroradiological outcome parameters.ConclusionsAlthough previous work has shown clear evidence of the involvement of fibrinogen in MS pathogenesis, this is not accompanied by increased fibrinogen in the CSF compartment.
Highlights
Elevated plasma fibrinogen levels are a well known finding in acute infectious diseases, acute stroke and myocardial infarction
Conclusions: previous work has shown clear evidence of the involvement of fibrinogen in multiple sclerosis (MS) pathogenesis, this is not accompanied by increased fibrinogen in the cerebrospinal fluid (CSF) compartment
Elevated plasma fibrinogen levels have been described in acute infectious diseases, in acute stroke and myocardial infarction; chronically raised plasma fibrinogen levels have been associated with an increased risk for cardiovascular diseases [3]
Summary
Elevated plasma fibrinogen levels are a well known finding in acute infectious diseases, acute stroke and myocardial infarction. Its role in the cerebrospinal fluid (CSF) of acute and chronic central (CNS) and peripheral nervous system (PNS) diseases is unclear. Apart from its pivotal role in thrombogenesis, inflammation, immune responses and atherogenesis, it is a prominent acute-phase reactant. Elevated plasma fibrinogen levels have been described in acute infectious diseases, in acute stroke and myocardial infarction; chronically raised plasma fibrinogen levels have been associated with an increased risk for cardiovascular diseases [3]. Whilst the significance of plasma fibrinogen is well established, the Accumulations of fibrinogen and its degradation products have been demonstrated in the central nervous system (CNS) tissue of stroke, bacterial meningitis (BM), HIV-encephalitis, Alzheimer’s disease and multiple sclerosis (MS) patients [7]. In experimental allergic encephalomyelitis (EAE), an animal model of MS, a close correlation was found between perivascular fibrin deposition and relapses and, pathology was ameliorated after administration of anti-coagulants or fibrinogen depletion [9,10]
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