Abstract
Background: The pathogenesis of hydrocephalus in human neonates with spina bifida aperta (SBA) is incompletely understood. Cerebrospinal fluid (CSF) outflow obstruction or arachnoideal resorption deficit may play an important role in the development of ventriculomegaly. In animal model, overexpression of transforming growth factor beta 1 (TGF beta 1) or increased local collagen turnover in the CSF lead to tissue proliferation and CSF malabsorption.
Objective: To determine the relative contribution of CSF malabsorption and CSF obstruction in the development of hydrocephalus in SBA neonates.
Patients / Methods: The CSF concentration of the aminoterminal propeptide of type 1 collagen (PINP; immunoassay, Roche Diagnostics) and TGF beta 1 (ELISA, DPC Biermann) were assessed in 3 groups of neonates with congenital hydrocephalus. Group1: SBA (n=10); group 2: neonatal aqueduct stenosis (obstructive hydrocephalus (n=4)); group 3: fetal intracerbral hemorrhage (communicative hydrocephalus (n=4)). Interleukin-6 concentrations in the CSF (IL-6; ELISA, DPC Biermann) were determined in all samples to estimate the proinflammatory state.
Results: PINP concentrations in the CSF of group 1 (median: 180.5 ng/ml, range 90–809) were significantly lower when compared with group 3 (median: 1074, range 978-1194; p=0.002). No significant differences in PINP values were found between group 1/group 2 or group 2/group3. TGF beta 1 concentrations were found significantly lower in group 1 (median 103.5, range 78–675 pg/ml) compared with group 3 (median 277 pg/ml, range 129–414; p= 0.03). No significant differences in TGF beta 1 concentrations were found between group 1 vs. group 2 or group 2 vs. group 3. Median IL-6 CSF concentrations were found to be low in all patient groups.
Conclusions: Present data on CSF biomarkers strongly indicate that CSF obstruction contributes more to the development of hydrocephalus in SBA neonates than CSF malabsorption.
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Heep, A., Bartmann, P., Stoffel-Wagner, B. et al. 172 Transforming Growth Factor Beta 1 and Procollagen 1 N- Propeptide in the CSF of Neonates with Spina Bifida Aperta Developing Hydrocephalus. Pediatr Res 58, 384 (2005). https://doi.org/10.1203/00006450-200508000-00201
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DOI: https://doi.org/10.1203/00006450-200508000-00201