A multi-analyte blood test for acute spinal cord injury

The Journal of Clinical Investigation, 2025 · DOI: https://doi.org/10.1172/JCI185463 · Published: January 14, 2025

Spinal Cord Injury Healthcare Bioinformatics

Simple Explanation

This study explores the potential of using a blood test to diagnose and predict outcomes in patients with acute spinal cord injury (SCI). The test looks for specific DNA fragments and proteins released from the injured spinal cord into the bloodstream. The researchers identified unique methylation patterns in spinal cord DNA that can be detected in blood samples. They also measured levels of certain proteins in the blood that are associated with SCI. By combining the DNA and protein measurements into a single score (SCII), they were able to distinguish between SCI patients and healthy individuals, assess the severity of the injury, and predict the likelihood of neurologic improvement.

Study Duration

Not specified

Participants

50 patients with acute SCI and 20 non-SCI control subjects

Evidence Level

Not specified

Key Findings

1
A ddPCR assay detected spinal cord–derived cfDNA in plasma of 50 patients with acute SCI (AUC: 0.89, 95% CI 0.83–0.95, P < 0.0001).
2
Levels of cfDNA were highest in patients with the most severe injury, i.e., ASIA A, compared with those with ASIA B (P = 0.04), ASIA C (P = 0.009), and ASIA D injuries (P < 0.001).
3
The Spinal Cord Injury Index (SCII), which has high sensitivity and specificity for SCI diagnosis (AUC: 0.91, 95% CI 0.82–0.99, P < 0.0001), correlates with injury severity (P < 0.0001), and predicts 6-month neurologic improvement (AUC: 0.77, 95% CI 0.61–0.93, P = 0.006).

Research Summary

This study introduces a multi-analyte blood test for acute SCI, utilizing spinal cord–derived cfDNA and plasma protein alterations to inform diagnosis and prognosis. The Spinal Cord Injury Index (SCII), derived from cfDNA and protein measurements, demonstrated high sensitivity and specificity for SCI diagnosis, correlated with injury severity, and predicted 6-month neurologic improvement. The findings suggest that a blood-based biomarker can provide a minimally invasive and widely accessible means of diagnosing SCI, especially in resource-limited settings where MRI may not be readily available.

Practical Implications

Improved SCI Diagnosis

A blood test can offer a quicker and more accessible diagnostic tool, particularly where MRI is not immediately available.

Objective Injury Assessment

The SCII provides a quantitative measure of injury severity, potentially overcoming the limitations of subjective clinical assessments like the ASIA grading system.

Predicting Patient Outcomes

The ability to predict neurologic improvement can aid in treatment planning and patient counseling.

Study Limitations

1
Similar methylation patterns may be shared by tissue types not specifically assessed.
2
The study employed a proteomic panel that measured known protein markers of CNS disease; discovery-oriented investigations may identify novel protein biomarkers.
3
Rapid time from sample collection to data acquisition is limited by our methylation-based ddPCR approach for measuring spinal cord–derived cfDNA.

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