Bäckryd Emmanuel, Ghafouri Bijar, Carlsson Anders K, Olausson Patrik, Gerdle Björn
Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden ; Pain and Rehabilitation Centre, Anaesthetics, Operations and Specialty Surgery Centre, Region Östergötland, Linköping, Sweden.
J Pain Res. 2015 Jul 1;8:321-33. doi: 10.2147/JPR.S82970. eCollection 2015.
Pain medicine lacks objective biomarkers to guide diagnosis and treatment. Combining two-dimensional gel proteomics with multivariate data analysis by projection, we exploratively analyzed the cerebrospinal fluid of eleven patients with severe peripheral neuropathic pain due to trauma and/or surgery refractory to conventional treatment and eleven healthy controls. Using orthogonal partial least squares discriminant analysis, we identified a panel of 36 proteins highly discriminating between the two groups. Due to a possible confounding effect of age, a new model with age as outcome variable was computed for patients (n=11), and four out of 36 protein spots were excluded due to a probable influence of age. Of the 32 remaining proteins, the following seven had the highest discriminatory power between the two groups: an isoform of angiotensinogen (upregulated in patients), two isoforms of alpha-1-antitrypsin (downregulated in patients), three isoforms of haptoglobin (upregulated in patients), and one isoform of pigment epithelium-derived factor (downregulated in patients). It has recently been hypothesized that the renin-angiotensin system may play a role in the pathophysiology of neuropathic pain, and a clinical trial of an angiotensin II receptor antagonist was recently published. It is noteworthy that when searching for neuropathic pain biomarkers with a purely explorative methodology, it was indeed a renin-angiotensin system protein that had the highest discriminatory power between patients and controls in the present study. The results from this hypothesis-generating pilot study have to be confirmed in larger, hypothesis-driven studies with age-matched controls, but the present study illustrates the fruitfulness of combining proteomics with multivariate data analysis in hypothesis-generating pain biomarker studies in humans.
疼痛医学缺乏用于指导诊断和治疗的客观生物标志物。我们将二维凝胶蛋白质组学与投影多元数据分析相结合,对11例因创伤和/或手术导致严重周围神经性疼痛且对传统治疗无效的患者以及11名健康对照者的脑脊液进行了探索性分析。使用正交偏最小二乘判别分析,我们鉴定出一组36种蛋白质,可高度区分两组。由于年龄可能存在混杂效应,我们为患者(n = 11)计算了一个以年龄为结果变量的新模型,36个蛋白质斑点中有4个因年龄的可能影响而被排除。在剩下的32种蛋白质中,以下7种在两组之间具有最高的判别力:血管紧张素原的一种同工型(在患者中上调)、α-1抗胰蛋白酶的两种同工型(在患者中下调)、触珠蛋白的三种同工型(在患者中上调)以及色素上皮衍生因子的一种同工型(在患者中下调)。最近有人提出,肾素-血管紧张素系统可能在神经性疼痛的病理生理学中起作用,并发表了一项血管紧张素II受体拮抗剂的临床试验。值得注意的是,在使用纯探索性方法寻找神经性疼痛生物标志物时,本研究中确实是一种肾素-血管紧张素系统蛋白在患者和对照之间具有最高的判别力。这项产生假设的初步研究结果必须在更大规模、以年龄匹配对照为驱动的假设性研究中得到证实,但本研究说明了在人类产生假设的疼痛生物标志物研究中,将蛋白质组学与多元数据分析相结合的成效。