Temporal Alterations in Cerebrospinal Fluid Amyloid β-Protein and Apolipoprotein E After Subarachnoid Hemorrhage

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Abstract
Background and Purpose— The mechanism underlying the association between possession of the APOEε4 allele and less favorable outcome after subarachnoid hemorrhage (SAH) remains to be determined. After SAH the level of apolipoprotein E (apoE) in the cerebrospinal fluid (CSF) is decreased, and lower levels are associated with more severe injury and less favorable outcome. This study examined serial CSF samples to determine the time course for the decrease in CSF apoE and the relationship between CSF apoE and amyloid β-protein (Aβ), testing the hypothesis that apoE-Aβ interactions occur in vivo after SAH. Methods— Enzyme-linked immunosorbent assay was used to assay apoE, Aβ1–40, and Aβ1–42 in serial ventricular CSF samples from 19 patients with SAH and 13 controls. CSF S100B and τ were assayed as surrogate markers of brain injury. Results— There was a sustained decrease in CSF apoE (P<0.001) and Aβ (P<0.001) after SAH in contrast to the observed elevation in CSF S100B (P<0.001) and τ (P<0.001) concentration. ...