Altered levels of alpha-melanocyte stimulating hormone in cerebrospinal fluid and plasma of patients with traumatic brain injury

摘要

Traumatic brain injury (TBI) is closely associated with marked inflammation. Although alpha-Melanocyte-Stimulating Hormone (alpha-MSH) exerts powerful anti-inflammatory effects, changes in endogenous alpha-MSH levels following TBI remain poorly understood. We investigated the changes of alpha-MSH levels in the cerebrospinal fluid (CSF) and plasma of post-TBI patients and the association of these changes with the severity of TBI and inflammation. TBI severity was assessed by the GCS coma scale from which, patients were separated into three groups. Clinical data were collected on days 1, 3, 5, and 7 including levels of alpha-MSH, tumor necrosis factor (TNF-alpha), and intracranial pressure (ICP). alpha-MSH levels in CSF steadily increased for one week (peak at day 5) but plasma alpha-MSH decreased and remained low. These changes were more substantial in the Severe Group of TBI with lower GCS. TNF-alpha levels were similarly increased in both CSF and plasma (peak at day 3). In the early phase of TBI elevated TNF-alpha and ICP dominated, and CSF alpha-MSH displayed a slow and insufficient increase. In later phases of TBI, TNF-alpha and ICP levels were alleviated concordantly with sustained increases in central alpha-MSH, wherein an anti-inflammatory environment might predominate. The relationship between plasma alpha-MSH and TNF-alpha showed significant negative correlation, and the relationship between CSF alpha-MSH and TNF-alpha showed significant positive correlation with a two-day lag. In conclusion, plasma alpha-MSH levels decreased, but CSF levels increased slowly following TBI. These changes were more substantial in severe patients with a lower GCS. Increases in central alpha-MSH paralleled alleviation of inflammation. (C) 2018 Elsevier B.V. All rights reserved.