{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T09:05:02Z","timestamp":1766999102387,"version":"3.48.0"},"reference-count":44,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T00:00:00Z","timestamp":1766793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Adrenomedullin (ADM) is a multifunctional peptide with vasoregulatory, antimicrobial, and anti-inflammatory properties. Its stable fragment, mid-regional pro-adrenomedullin (MR-proADM), is a validated biomarker in sepsis and systemic infections, but its role in viral neuroinfections remains unexplored. Tick-borne encephalitis (TBE), caused by the tick-borne encephalitis virus (TBEV), is a major viral infection of the central nervous system (CNS) associated with long-term neurological sequelae. This study aimed to assess MR-proADM levels in cerebrospinal fluid (CSF) and serum of patients with TBE and to evaluate their diagnostic utility and pathophysiological significance. Methods: This retrospective observational study included 20 patients with confirmed TBE and 14 non-infectious neurological controls. MR-proADM concentrations were measured in paired CSF and serum samples using an ELISA assay. Statistical analyses included group comparisons (Mann\u2013Whitney U test), correlation analyses (Spearman\u2019s r), and receiver operating characteristic (ROC) curve evaluation. Results: Serum MR-proADM levels at baseline (SER1) were significantly lower in TBE patients compared with controls (p = 0.0197). The CSF\/serum MR-proADM ratio differed significantly between groups (p = 0.0063) and showed the best diagnostic performance (AUC = 0.816, 95% CI 0.63\u20130.93; sensitivity 79%, specificity 80%). MR-proADM concentrations in CSF correlated with total CSF protein (r = 0.53), suggesting an association with blood\u2013CSF barrier dysfunction. Strong reproducibility was observed for serum MR-proADM between sampling points (r = 0.83). Conclusions: MR-proADM levels in CSF and serum are altered in patients with TBE, indicating its potential as a biomarker of CNS infection and inflammation. The CSF\/serum MR-proADM ratio may serve as a sensitive indicator of blood\u2013CSF barrier involvement, while decreased serum levels may reflect impaired systemic neuroprotective response. These findings highlight a possible role of ADM in neuroimmune regulation during viral encephalitis and warrant validation in larger prospective studies.<\/jats:p>","DOI":"10.3390\/diagnostics16010095","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T08:47:27Z","timestamp":1766998047000},"page":"95","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the Role of Cerebrospinal Fluid and Serum Mid-Regional Pro-Adrenomedullin in Tick-Borne Encephalitis: A Pilot Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1041-5500","authenticated-orcid":false,"given":"Gabriela","family":"Trojan","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, 15-089 Bialystok, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3994-8785","authenticated-orcid":false,"given":"Anna","family":"Moniuszko-Malinowska","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, 15-089 Bialystok, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5779-0539","authenticated-orcid":false,"given":"Joanna","family":"Okli\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, 15-089 Bialystok, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wioletta","family":"Pawlak-Zalewska","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, 15-089 Bialystok, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6015-2351","authenticated-orcid":false,"given":"Ewelina","family":"Kruszewska","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, 15-089 Bialystok, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnieszka","family":"Kulczy\u0144ska-Przybik","sequence":"additional","affiliation":[{"name":"Department of Neurodegeneration Diagnostics, Medical University of Bialystok, 15-089 Bialystok, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Mroczko","sequence":"additional","affiliation":[{"name":"Department of Biochemical Diagnostics, Medical University of Bialystok, 15-089 Bialystok, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0072-2180","authenticated-orcid":false,"given":"Piotr","family":"Czupryna","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, 15-089 Bialystok, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Corr, M.P., Fairley, D., McKenna, J.P., Shields, M.D., and Waterfield, T. 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