Brain proteome profiling implicates the complement and coagulation cascade in multiple system atrophy brain pathology

Rasmus Rydbirk, Ole Østergaard, Jonas Folke, Casper Hempel, Brian DellaValle, Thomas L. Andresen, Annemette Løkkegaard, Anne Mette Hejl, Matthias Bode, Morten Blaabjerg, Mette Møller, Erik H. Danielsen, Lisette Salvesen, Charlotte C. Starhof, Sara Bech, Kristian Winge, Jørgen Rungby, Bente Pakkenberg, Tomasz Brudek, Jesper V. OlsenSusana Aznar*


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Background: Multiple system atrophy (MSA) is a rare, progressive, neurodegenerative disorder presenting glia pathology. Still, disease etiology and pathophysiology are unknown, but neuro-inflammation and vascular disruption may be contributing factors to the disease progression. Here, we performed an ex vivo deep proteome profiling of the prefrontal cortex of MSA patients to reveal disease-relevant molecular neuropathological processes. Observations were validated in plasma and cerebrospinal fluid (CSF) of novel cross-sectional patient cohorts. Methods: Brains from 45 MSA patients and 30 normal controls (CTRLs) were included. Brain samples were homogenized and trypsinized for peptide formation and analyzed by high-performance liquid chromatography tandem mass spectrometry (LC–MS/MS). Results were supplemented by western blotting, immuno-capture, tissue clearing and 3D imaging, immunohistochemistry and immunofluorescence. Subsequent measurements of glial fibrillary acid protein (GFAP) and neuro-filament light chain (NFL) levels were performed by immunoblotting in plasma of 20 MSA patients and 20 CTRLs. Finally, we performed a proteome profiling of 144 CSF samples from MSA and CTRLs, as well as other parkinsonian disorders. Data were analyzed using relevant parametric and non-parametric two-sample tests or linear regression tests followed by post hoc tests corrected for multiple testing. Additionally, high-throughput bioinformatic analyses were applied. Results: We quantified more than 4,000 proteins across samples and identified 49 differentially expressed proteins with significantly different abundances in MSA patients compared with CTRLs. Pathway analyses showed enrichment of processes related to fibrinolysis and complement cascade activation. Increased fibrinogen subunit β (FGB) protein levels were further verified, and we identified an enriched recognition of FGB by IgGs as well as intra-parenchymal accumulation around blood vessels. We corroborated blood–brain barrier leakage by a significant increase in GFAP and NFL plasma levels in MSA patients that correlated to disease severity and/or duration. Proteome profiling of CSF samples acquired during the disease course, confirmed increased total fibrinogen levels and immune-related components in the soluble fraction of MSA patients. This was also true for the other atypical parkinsonian disorders, dementia with Lewy bodies and progressive supra-nuclear palsy, but not for Parkinson’s disease patients. Conclusion: Our results implicate activation of the fibrinolytic cascade and immune system in the brain as contributing factors in MSA associated with a more severe disease course.

TidsskriftCellular and Molecular Life Sciences
Udgave nummer6
Antal sider22
StatusUdgivet - jun. 2022

Bibliografisk note

Funding Information:
The MRC London Brain Bank for Neurodegenerative Diseases provided some of the samples for the present study. The authors are grateful to Hans Jørgen Jensen and Susanne Sørensen for help with conducting experiments.

Funding Information:
This work has been supported by the Brdr. Hartmann Foundation, Oda og Hans Svenningsens Fond, the Hørslev Foundation, the Jascha Foundation, Danmodis, the Parkinson Foundation Denmark, the Lundbeck Foundation, the Research Foundation of Bispebjerg-Frederiksberg Hospital, the Danish National Association for Multiple System Atrophy and the Novo Nordisk Foundation (grant no. NNF14CC0001). The sponsors were not involved in the design of the study, data collection, analysis, or interpretation, preparation of the manuscript, or in the decision to publish.


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