CSF Chitinase-3-Like Protein 1 Level Not Predictor of RIS Conversion

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Gadolinium-enhanced brain and spinal cord lesions were less frequently present in patients with radiologically isolated syndrome than clinically isolated syndrome and RRMS.
Gadolinium-enhanced brain and spinal cord lesions were less frequently present in patients with radiologically isolated syndrome than clinically isolated syndrome and RRMS.

Radiologically isolated syndrome is correlated to elevated cerebrospinal fluid (CSF) chitinase-3-like protein 1 (CHI3L1) levels, but that cannot be used as an independent predictor of a patient's risk for conversion from radiologically isolated syndrome to relapsing-remitting multiple sclerosis, according to a study recently published in Multiple Sclerosis Journal.

Approximately one-third of patients with radiologically isolated syndrome convert to relapsing-remitting multiple sclerosis after 5 years. The current study sought to identify if elevated CSF CHI3L1 have a prognostic value in determining whether a patient with radiologically isolated syndrome will convert to relapsing-remitting multiple sclerosis.

The multicenter, retrospective cohort study included 211 patients: 50 with relapsing-remitting multiple sclerosis, 48 with clinically isolated syndrome, 71 with radiologically isolated syndrome, and 42 symptomatic controls. The CSF CHI3L1 concentrations in all study participants were compared, and the influence of radiological, epidemiological, and CSF parameters on the risk for conversion were analyzed. The multivariate analysis found that patients with at least 1 spinal cord lesion should be considered at high risk for conversion from radiologically isolated syndrome to relapsing-remitting multiple sclerosis. These findings echo the results of previous studies, confirming that spinal cord lesions are the most important risk factor for predicting the conversion to relapsing-remitting multiple sclerosis from radiologically isolated syndrome.

Study investigators also found that when 4 Barkhof criteria, positive CSF, or elevated levels of CSF CHI3L1 are associated with the presence of spinal cord lesions, the mean conversion time is similarly reduced, although when taken separately, these factors cannot be used as independent predictors.

Investigators conclude, “The reproducibility of a quantitative measurement of CSF CHI3L1 levels by [enzyme-linked immunosorbent assay] compared with the qualitative analysis of [oligoclonal bands] makes it as a promising tool for [radiologically isolated syndrome] diagnosis and prognosis that should be considered in combination with MRI parameters in the follow-up or treatment of [radiologically isolated syndrome] patients.”

Reference

Thouvenot E, Hinsinger G, Demattei C, et al; on behalf of SFSEP and RISC. Cerebrospinal fluid chitinase-3-like protein 1 level is not an independent predictive factor for the risk of clinical conversion in radiologically isolated syndrome [published online March 22, 2018]. Mult Scler. doi: 10.1177/1352458518767043

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