Identification of Plasma Growth Factors and Cytokines as Diagnostic Biomarkers for Lafora Disease

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Abstract
Lafora progressive myoclonus epilepsy (LD, OMIM#254780, ORPHA:501) is an ultra-rare and severe autosomal recessive neurological disorder that typically manifests in early adolescence. It is characterized by the accumulation of insoluble forms of aberrant glycogen in the brain and peripheral tissues. Given the urgent need for reliable tools for diagnosis and to monitor disease progression, in this work, we aimed to identify reliable biomarkers in minimally invasive fluids, which could also provide valuable insights into the natural history of the disease. Plasma-EDTA samples from eleven LD patients and healthy controls were analyzed to identify potential biomarkers of LD. Eleven cytokines and growth factors were identified to be significantly reduced in LD patient samples compared to healthy controls. Among these, four mediators [platelet-derived growth factor subunit B (PDGF-BB), epidermal growth factor (EGF), brain derived growth factor (BDNF), and macrophage migration inhibitory factor (MIF)], exhibited the greatest fold change between the groups and were further validated. Receiver operating characteristic (ROC) analysis confirmed the robust diagnostic potential of these four proteins. Notably, the levels of these proteins were reduced even in asymptomatic patients, suggesting potential utility for early diagnosis. Given the minimally invasive nature of plasma sampling and the straightforward quantification via ELISA assays, these biomarkers hold strong promise for rapid translation to the clinic, potentially enhancing early diagnosis in LD patients. Our findings offer a promising step toward the development of accessible, non-invasive diagnostic tools for LD.,. Key points: - Several plasma biomarkers associated with Lafora disease (LD) have been identified. - These biomarkers are reduced in LD patients compared to healthy controls. - Reduced levels of these biomarkers were detectable even in asymptomatic patients. - Their reduced levels may contribute to the neurological alterations observed in LD.

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