Studies of the human cerebrospinal fluid metabolome reveal alterations associated with amyotrophic lateral sclerosis and subtypes of the disease

• Background: The composition of the metabolome in the cerebrospinal fluid of patients with amyotrophic lateral sclerosis is unknown. Previous studies of single metabolites have shown conflicting results.Methods: Using GC-TOFMS and multivariate statistical modeling, we studied the metabolome signature of ~120 compounds in the cerebrospinal fluid of ALS patients stratified according to hereditary disposition and clinical subtypes of the disease.Findings: Sporadic ALS has a heterogeneous metabolite signature in the CSF, in some patients being almost identical to controls. Familial ALS without SOD1 gene mutation is less heterogeneous than sporadic ALS. The metabolome of the CSF of the 17 ALS patients with a SOD1 gene mutation appeared as a separate homogeneous group. Analysis of single metabolites revealed that glutamate, pyroglutamate and glutamine were all reduced, in particular in patients with a familial disposition.Interpretation: There are significant differences in the metabolite profile and composition among patients with familial ALS, sporadic ALS and patients carrying a mutation in the SOD1 gene suggesting that the neurodegenerative process in different subtypes of ALS may be different. Patients with a genetic predisposition to ALS have a more distinct signature than patients with a sporadic disease.

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