Dysregulation of cerebrospinal fluid metabolism profiles in spinal muscular atrophy patients: a case control study

Background Spinal muscular atrophy (SMA) is a neurodegenerative disorder. Although prior studies have investigated the metabolomes of SMA in various contexts, there is a gap in research on cerebrospinal fluid (CSF) metabolomics compared to healthy controls. CSF metabolomics can provide insights into central nervous system function and patient outcomes. This study aims to investigate CSF metabolite profiles in untreated SMA patients to enhance our understanding of SMA metabolic dysregulation. Methods This case control study included 15 SMA patients and 14 control subjects. CSF samples were collected, and untargeted metabolomics was conducted to detect metabolites in SMA and control groups. Results A total of 118 metabolites abundance were significantly changed between the SMA and control groups. Of those, 27 metabolites with variable importance for the projection (VIP) >= 1.5 were identified. The top 5 differential metabolites were N-acetylneuraminic acid (VIP = 2.38, Fold change = 0.43, P = 5.49 x 10(-5)), 2,3-dihydroxyindole (VIP = 2.33, Fold change = 0.39, P = 1.81 x 10(-4)), lumichrome (VIP = 2.30, Fold change = 0.48, P = 7.90 x 10(-5)), arachidic acid (VIP = 2.23, Fold change = 10.79, P = 6.50 x 10(-6)), and 10-hydroxydecanoic acid (VIP = 2.23, Fold change = 0.60, P = 1.44 x 10(-4)). Cluster analysis demonstrated that the differentially metabolites predominantly clustered within two main categories: protein and amino acid metabolism, and lipid metabolism. Conclusions The findings highlight the complexity of SMA, with widespread effects on multiple metabolic pathways, particularly in amino acid and lipid metabolism. N-acetylneuraminic acid may be a potential treatment for functional improvement in SMA. The exact mechanisms and potential therapeutic targets associated with metabolic dysregulation in SMA require further investigation.