Correlation between Intrathecal Sulfatide and TNF-α Levels in Patients with Vascular Dementia

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Abstract
Objectives: Subcortical vascular dementia (SVD) is associated with white matter lesions and demyelination. The aim of the present study was to examine the cerebrospinal fluid (CSF) levels of TNF-α, a proinflammatory cytokine mediating myelin damage, in SVD patients. The intrathecal TNF-α levels were related to the clinical symptoms of dementia, as well as to intrathecal levels of sulfatide, a marker of white matter degradation, and of neurofilament, a marker of neuronal degeneration. Methods: CSF levels of TNF-a, sulfatide and neurofilament were all analyzed by immunoenzymatic procedures in 17 patients with SVD and in 26 healthy controls. Results: The intrathecal concentration of TNF-α was significantly increased in SVD patients compared to healthy controls (p = 0.0001). The intrathecal levels of TNF-α were significantly correlated (r = 0.6, p = 0.02) to the levels of sulfatide, but not to the levels of neurofilament, (r = 0.08, NS). Conclusions: We have demonstrated intrathecal production of TNF-α in SVD patients. The correlation between TNF-a and sulfatide levels in the CSF suggests that this apoptosis-inducing cytokine leads to the death of oligodendrocytes, thereby contributing to white matter degeneration, a hallmark of SVD.