title: Untargeted 1H-NMR metabolomics in CSF: toward a diagnostic biomarker for motor neuron disease.
abstract: OBJECTIVE
  To develop a CSF metabolomics signature for motor neuron disease (MND) using (1)H-NMR spectroscopy and to evaluate the predictive value of the profile in a separate cohort.
  
  
  METHODS
  We collected CSF from patients with MND and controls and analyzed the samples using (1)H-NMR spectroscopy. We divided the total patient sample in a 4:1 ratio into a training cohort and a test cohort. First, a metabolomics signature was created by statistical modeling in the training cohort, and then the analyses tested the predictive value of the signature in the test cohort. We conducted 10 independent trials for each step. Finally, we identified the compounds that contributed most consistently to the metabolome profile.
  
  
  RESULTS
  Analysis of CSF from 95 patients and 86 controls identified a diagnostic profile for MND (R(2)X > 22%, R(2)Y > 93%, Q(2) > 66%). The best model selected the correct diagnosis with mean probability of 99.31% in the training cohort. The profile discriminated between diagnostic groups with 78.9% sensitivity and 76.5% specificity in the test cohort. Metabolites linked to pathophysiologic pathways in MND (i.e., threonine, histidine, and molecules related to the metabolism of branched amino acids) were among the discriminant compounds.
  
  
  CONCLUSIONS
  CSF metabolomics using (1)H-NMR spectroscopy can detect a reproducible metabolic signature for MND with reasonable performance. To our knowledge, this is the first metabolomics study that shows that a validation in separate cohorts is feasible. These data should be considered in future biomarker studies.
  
  
  METHODS
  This study provides Class III evidence that CSF metabolomics accurately distinguishes MNDs from other neurologic diseases.
authors.affiliation: From UMR Inserm U930 (H.B., L.N.-D., C.A., C.V.-D., S.M., P.E., C.R.A., P.C.), Tours; Université François-Rabelais (H.B., L.N.-D., C.A., C.V.-D., S.M., P.E., C.R.A., P.C.), Tours; Laboratoire de Biochimie et Biologie Moléculaire (H.B., C.A., P.E., C.R.A.), CHRU de Tours; PPF-ASB (L.N.-D., P.E.), Université François-Rabelais, Tours; Fédération des Maladies du Système Nerveux (P.-F.P., P.H.G.), Centre Référent Maladie Rare SLA, Hôpital de la Pitié-Salpétrière, Paris; Service de Neurologie (C.M., D.D.), CHRU de Lille; and Centre SLA (P.C.), Service de Neurologie, CHRU Bretonneau, Tours, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Blasco
authors.forename: Lydie
authors.initials: L
authors.lastname: Nadal-Desbarats
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Pradat
authors.forename: Paul H
authors.initials: PH
authors.lastname: Gordon
authors.forename: Catherine
authors.initials: C
authors.lastname: Antar
authors.forename: Charlotte
authors.initials: C
authors.lastname: Veyrat-Durebex
authors.forename: Caroline
authors.initials: C
authors.lastname: Moreau
authors.forename: David
authors.initials: D
authors.lastname: Devos
authors.forename: Sylvie
authors.initials: S
authors.lastname: Mavel
authors.forename: Patrick
authors.initials: P
authors.lastname: Emond
authors.forename: Christian R
authors.initials: CR
authors.lastname: Andres
authors.forename: Philippe
authors.initials: P
authors.lastname: Corcia
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000134:cerebrospinal fluid; D015331:Cohort Studies; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D055432:Metabolomics / Q000379:methods*; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000134:cerebrospinal fluid* / Q000175:diagnosis*
chemical_list: D015415:Biomarkers