Evaluation of S-100b as a Specific Marker for Neuronal Damage Due to Minor Head Trauma

Chirurgische Klinik und Poliklinik/Standort Innenstadt, Ludwig-Maximilians-Universität München, Germany.
World Journal of Surgery (Impact Factor: 2.64). 01/2001; 25(1):93-7. DOI: 10.1007/s002680020370
Source: PubMed


Management of patients with minor head trauma (MHT) continues to be debated in the literature. Measurement of S-100b in serum has been introduced into the discussion as an additional screening tool for intracerebral injuries because routine cranial computed tomography (CCT) of a large number of patients causes logistic difficulties, and the neurologic examination is often impaired by a high frequency of coincidental intoxication. The aim of our study was to determine the diagnostic value of measuring S-100b in the serum of MHT patients to identify risk groups. Additional validity should be aquired by a comparison with plasma levels of polymorphonuclear neutrophil (PMN) elastase an established general trauma marker. A series of 52 patients with MHT were included in the prospective study. At admission the patients underwent a routine CCT scan to detect intracerebral lesions, and blood samples were drawn to investigate circulating levels of S-100b and PMN elastase. For comparison, data for a positive control group of 10 severe head trauma patients (initial Glasgow Coma Scale score < 8) and for a negative control group with 20 healthy volunteers were obtained. The interval between MHT and admission to our hospital was 73.4 +/- 47.0 minutes. The initial S-100b serum levels of MHT patients were 0.470 +/- 0.099 ng/ml, those of the positive control group were 7.16 +/- 3.77 ng/ml, and those of the negative control group were 0.05 +/- 0.01 ng/ml. Relevant pathologic CCT scans were detected in 28.8% of MHT patients; one patient of that group was subjected to immediate surgical intervention (1.9%). At a cut-off point of 0.1 ng/ml, the sensitivity of positive S-100b levels reached 100% and the specificity 40.5%. Plasma levels of PMN elastase reached 60.52 +/- 10.75 ng/ml in the MHT group, 66.4 +/- 14.92 ng/ml in the severely head-injured group, and 23.26 +/- 1.53 ng/ml in the negative control group. Serum levels of S-100b seem to be a highly sensitive but not very specific marker for isolated neurotrauma. Measurement of this parameter may be helpful as an additional screening tool to identify high risk groups in the cohort of MHT patients.

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    • "S100B is a protein produced primarily by brain astrocytes, and it is an established peripheral biomarker of altered BBB permeability associated with various CNS diseases [32,33]. Elevated S100B protein levels accurately reflect the presence of neuropathological conditions, including traumatic head injuries [33-35], psychiatric disorders [36], cerebrovascular insults [37] and neurodegenerative diseases [38], whereas normal levels reliably exclude major CNS pathology [35,39,40]. Thus the increase of serum S100B protein levels in autistic patients may indicate the presence of an underlying neuropathological condition. "
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    ABSTRACT: S100B is a calcium-binding protein that is produced primarily by astrocytes. Increased serum S100B protein levels reflect neurological damage. Autoimmunity may have a role in the pathogenesis of autism in some patients. Autoantibodies may cross the blood-brain barrier and combine with brain tissue antigens, forming immune complexes and resulting in neurological damage. We are the first to investigate the relationship between serum levels of S100B protein, a marker of neuronal damage, and antiribosomal P protein antibodies in autistic children. Serum S100B protein and antiribosomal P antibodies were measured in 64 autistic children in comparison to 46 matched healthy children. Autistic children had significantly higher serum S100B protein levels than healthy controls (P < 0.001). Children with severe autism had significantly higher serum S100B protein than patients with mild to moderate autism (P = 0.01). Increased serum levels of antiribosomal P antibodies were found in 40.6% of autistic children. There were no significant correlations between serum levels of S100B protein and antiribosomal P antibodies (P = 0.29). S100B protein levels were elevated in autistic children and significantly correlated to autistic severity. This may indicate the presence of an underlying neuropathological condition in autistic patients. Antiribosomal P antibodies may not be a possible contributing factor to the elevated serum levels of S100B protein in some autistic children. However, further research is warranted to investigate the possible link between serum S100B protein levels and other autoantibodies, which are possible indicators of autoimmunity to central nervous system in autism.
    Journal of Neuroinflammation 03/2012; 9(1):54. DOI:10.1186/1742-2094-9-54 · 5.41 Impact Factor
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    • "In addition, serum S-100B also has demonstrated value as a marker for brain injury [1,8–10]. Elevated concentrations have been reported in patients after both minor and traumatic head injuries [11] [12] [13] [14], subarachnoid hemorrhage [15] [16], and stroke [17] [18], and in cardiac patients with neurological complications [19] [20]. "
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    ABSTRACT: Serum S-100B has clinical value in monitoring malignant melanoma and in monitoring and predicting outcomes in patients with traumatic brain injury. Analytical performance characteristic and split-sample method comparison studies for three commercial S-100B immunoassays (CanAg® S100, Sangtec® 100, YK150 Human S-100 β) were performed. Reference intervals (97.5th percentile) for each assay were established by non-parametric analysis of results from healthy volunteers. Linearity results were slope=1.014, intercept=65.1, r(2)=0.999 for the Sangtec assay; slope=1.038, intercept=31.1, r(2)=0.999 for the CanAg assay; slope=1.123, intercept=-105.4, r(2)=0.997 for the YK150 assay. Within-run CVs were ≤5.7, ≤6.3 and ≤10.8 for the Sangtec, CanAg and YK150 ELISAs, respectively. Between-run CVs were ≤11.3, ≤5.9 and ≤9.5, respectively. Upper reference interval limits of 141, 96 and 735 ng/l S-100B were established for the Sangtec, CanAg and YK150 ELISAs, respectively. Deming regression generated the following: CanAg vs. Sangtec, slope=0.339, intercept=24.1, r(2)=0.932; YK150 vs. Sangtec, slope=0.266, intercept=-140.0, r(2)=0.690; YK150 vs. CanAg, slope=1.376, intercept=-13.1, r(2)=0.860. The configurations, procedures and performance characteristics of the Sangtec and CanAg S-100B ELISAs are comparable and better than those of the YK150 assay. Poor agreement and large biases prevent interchangeable use of results.
    Clinica chimica acta; international journal of clinical chemistry 07/2011; 412(23-24):2122-7. DOI:10.1016/j.cca.2011.07.020 · 2.82 Impact Factor
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    • "An important application of serum S100B testing is the selection of patients with minor head injury who do not need further neuroradiological evaluation, as studies comparing CT (computerized tomography) scans and S100B levels have demonstrated S100B values below 0.1 ng/mL are associated with low risk of obvious neuroradiological changes (such as intracranial hemorrhage) or significant clinical sequelae [10]. In addition, several papers have shown that the high negative predictive value (NPV = TN/(TN+FN), where TN =  true negative and FN =  false negative) of S100B in several neurological conditions is due to the fact that serum S100B levels reflect blood-brain barrier permeability changes even in absence of neuronal injury [1]–[9]. "
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    ABSTRACT: S100B, established as prevalent protein of the central nervous system, is a peripheral biomarker for blood-brain barrier disruption and often also a marker of brain injury. However, reports of extracranial sources of S100B, especially from adipose tissue, may confound its interpretation in the clinical setting. The objective of this study was to characterize the tissue specificity of S100B and assess how extracranial sources of S100B affect serum levels. The extracranial sources of S100B were determined by analyzing nine different types of human tissues by ELISA and Western blot. In addition, brain and adipose tissue were further analyzed by mass spectrometry. A study of 200 subjects was undertaken to determine the relationship between body mass index (BMI) and S100B serum levels. We also measured the levels of S100B homo- and heterodimers in serum quantitatively after blood-brain barrier disruption. Analysis of human tissues by ELISA and Western blot revealed variable levels of S100B expression. By ELISA, brain tissue expressed the highest S100B levels. Similarly, Western blot measurements revealed that brain tissue expressed high levels of S100B but comparable levels were found in skeletal muscle. Mass spectrometry of brain and adipose tissue confirmed the presence of S100B but also revealed the presence of S100A1. The analysis of 200 subjects revealed no statistically significant relationship between BMI and S100B levels. The main species of S100B released from the brain was the B-B homodimer. Our results show that extracranial sources of S100B do not affect serum levels. Thus, the diagnostic value of S100B and its negative predictive value in neurological diseases in intact subjects (without traumatic brain or bodily injury from accident or surgery) are not compromised in the clinical setting.
    PLoS ONE 09/2010; 5(9). DOI:10.1371/journal.pone.0012691 · 3.23 Impact Factor
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