Diagnosis and
monitoring of primary brain tumours, brain metastasis and acute
ischaemic stroke all require invasive, burdensome and costly
diagnostics, frequently lacking adequate sensitivity, particularly
during disease monitoring. Monocytes are known to migrate to damaged
tissues, where they act as tissue macrophages, continuously scavenging,
phagocytizing and digesting apoptotic cells and other tissue debris. We
hypothesize that upon completion of their tissue-cleaning task, these
tissue macrophages might migrate via the lymph system to the
bloodstream, where they can be detected and evaluated for their
phagolysosomal contents. We discovered a blood monocyte subpopulation
carrying the brain-specific glial fibrillary acidic protein in glioma
patients and in patients with brain metastasis and evaluated the
diagnostic potential of this finding. Blood samples were collected in a
cross-sectional study before or during surgery from adult patients with
brain lesions suspected of glioma. Together with blood samples from
healthy controls, these samples were flowing cytometrically evaluated
for intracellular glial fibrillary acidic protein in monocyte subsets.
Acute ischaemic stroke patients were tested at multiple time points
after onset to evaluate the presence of glial fibrillary acidic
protein-carrying monocytes in other forms of brain tissue damage.
Clinical data were collected retrospectively. High-grade gliomas (N = 145), brain metastasis (N = 21) and large stroke patients (>100 cm3) (N = 3
versus 6; multiple time points) had significantly increased frequencies
of glial fibrillary acidic protein+CD16+ monocytes compared to healthy
controls. Based on both a training and validation set, a cut-off value
of 0.6% glial fibrillary acidic protein+CD16+ monocytes was established,
with 81% sensitivity (95% CI 75–87%) and 85% specificity (95% CI
80–90%) for brain lesion detection. Acute ischaemic strokes of
>100 cm3 reached >0.6% of glial fibrillary acidic
protein+CD16+ monocytes within the first 2–8 h after hospitalization and
subsided within 48 h. Glioblastoma patients with >20% glial
fibrillary acidic protein+CD16+ non-classical monocytes had a
significantly shorter median overall survival (8.1 versus 12.1 months).
Our results and the available literature, support the hypothesis of a
tissue-origin of these glial fibrillary acidic protein-carrying
monocytes. Blood monocytes carrying glial fibrillary acidic protein have
a high sensitivity and specificity for the detection of brain lesions
and for glioblastoma patients with a decreased overall survival.
Furthermore, their very rapid response to acute tissue damage identifies
large areas of ischaemic tissue damage within 8 h after an ischaemic
event. These studies are the first to report the clinical applicability
for brain tissue damage detection through a minimally invasive
diagnostic method, based on blood monocytes and not serum markers, with
direct consequences for disease monitoring in future (therapeutic)
studies and clinical decision making in glioma and acute ischaemic
stroke patients.
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