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CSF proteomics for Glioma Espionage.
              Terry C. Burns MD, PhD. Burns.terry@mayo.edu
              Dept. Neurosurgery, Mayo Clinic, Rochester, Minnesota.
              Co-author names, Cecile Riviere-Cazaux, BS, Samar Ikram MD, Lucas Carlstrom
              MD, PhD,, Siobhan Chantigian BS, Masum Rahman MD, Arthur Warrington PhD
              INTRODUCTION: The relative inaccessibility of glioma throughout a patient’s
              disease course precludes individualized insights into tumor biology and
              responses to therapeutic challenge. Serial cerebrospinal fluid (CSF) sampling
              could provide an avenue to perform biomarker discovery for analytes that are
              sensitive to tumor burden. To that end, we have established a CSF biorepository
              to collect CSF intraoperatively and longitudinally from patients consenting to
              serial LPs or Ommaya reservoirs placement for CSF biomarker discovery.
              METHODS: Global proteomic CSF analysis was performed on the Somalogic
              platform, an aptamer-based technology for sensitive and specific analysis of over
              7,000 proteins. Ranked protein lists were generated for each patient by
              comparing to a consensus CSF proteome from control patients without gliomas.
              Enrichment analysis was performed to identify consistently differentially abundant
              proteins across glioma samples. Paired patient samples were used to filter for
              proteins that reproducibly decreased with resection and increased with
              recurrence.
              RESULTS: Forty-four proteins met specified selection criteria. This candidate
              high-grade glioma proteomic signature was then evaluated in an independent
              cohort of twelve glioma patients, as compared to a separate control cohort,
              revealing significant signature enrichment (FDR=0.000) in all patients. When
              available, comparison of post-resection to pre-resection serial samples revealed
              decline in the glioma proteomic signature. Top enriched proteins included
              LANC2, DPYL3, Sorcin, Integrin A1B1, and lactate dehydrogenase (FC of glioma
              vs. control: 145.3x, 113.9x, 78.0x, 71.6x, and 62.7x, respectively). Interestingly,
              despite having explicitly chosen samples with little-to-no hemoglobin in the
              discovery cohort, this HGG signature was also highly enriched for plasma-like
              proteins, illustrating the impact of blood-brain barrier disruption on the high-grade
              glioma CSF proteome.
              CONCLUSION: our data demonstrate the presence of a conserved CSF glioma
              proteome that reflects glioma biology and the impacts of blood-brain barrier
              disruption. Our findings support the feasibility of leveraging this proteome for




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