title: Cytokines and matrix metalloproteinases in the cerebrospinal fluid of patients with acute transverse myelitis: an outcome analysis.
abstract: BACKGROUND
  Role of cytokines as well as matrix metalloproteinases (MMPs) is well defined in various central nervous system inflammatory diseases. However, the role of these cytokines and MMPs in acute transverse myelitis is inadequately studied.
  
  
  METHODS
  Patients with acute transverse myelitis, fulfilling the inclusion and exclusion criteria defined by Transverse Myelitis Consortium Working Group, were enrolled along with age and sex matched controls. A detailed clinical evaluation and magnetic resonance imaging of patients was done. Cerebrospinal fluid (CSF) samples both from patients and controls were collected. CSF samples were analyzed for cytokines [interleukin (IL)-6, IL-8, IL-10 and IL-17)] and matrix metalloproteinases (MMP-2, MMP-9). Patients were followed up for 3 months. Disability was assessed using modified Barthel index (MBI).
  
  
  RESULTS
  CSF levels of all cytokines IL-6, IL-8, IL-10, MMP-2 and MMP-9, except IL-17, were significantly higher in patients with acute transverse myelitis (p < 0.001). CSF IL-6 and IL-8 were significantly associated with severity of the disease (MBI ≤ 12). After 3 months, quadriparesis (p = 0.001, odd's ratio 19.5, 95 % CI 2.34-62.39) and long-segment myelitis (p = 0.035, odd's ratio 4.37, 95 % CI 1.17-5.95) were significantly associated with poor outcome. Among cytokines and MMPs, IL-6 levels at baseline correlated significantly with the MBI at 3 months (Spearmen's ρ = -0.335, p = 0.01).
  
  
  CONCLUSIONS
  In conclusion, both anti-inflammatory and pro-inflammatory cytokines, MMP-2, and MMP-9 are elevated in the acute phase of transverse myelitis. Possibly, IL-6 plays a role in determining the disability.
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India.
authors.forename: Puneet
authors.initials: P
authors.lastname: Dixit
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India. garg50@yahoo.com.
authors.forename: Ravindra Kumar
authors.initials: RK
authors.lastname: Garg
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India.
authors.forename: Hardeep Singh
authors.initials: HS
authors.lastname: Malhotra
authors.affiliation: Department of Microbiology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Amita
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Verma
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India.
authors.forename: Praveen Kumar
authors.initials: PK
authors.lastname: Sharma
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D016207:Cytokines / Q000134:cerebrospinal fluid*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000134:cerebrospinal fluid*; D020780:Matrix Metalloproteinase 9 / Q000134:cerebrospinal fluid*; D009188:Myelitis, Transverse / Q000134:cerebrospinal fluid* / Q000453:epidemiology; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D016207:Cytokines; C522361:MMP2 protein, human; D020778:Matrix Metalloproteinase 2; C579270:MMP9 protein, human; D020780:Matrix Metalloproteinase 9
keywords: Cerebrospinal fluid; Cytokines; Interleukin; Longitudinally extensive transverse myelitis; Matrix metalloproteinases