Presence of CHI3L1 and NFL in CSF Predicts Risk for Demyelinating Syndromes

cerebrospinal fluid csf
cerebrospinal fluid csf
Investigators assess the diagnostic value of 2 CSF biomarkers to distinguish pediatric acquired demyelinating syndromes from non-acquired demyelinating syndromes.

Chitinase 3-like 1 (CHI3L1) and neurofilament light chain (NFL) in cerebrospinal fluid are associated with pediatric acquired demyelinating syndromes (ADS), according to a study in Multiple Sclerosis and Related Disorders. The findings from this study also demonstrate that the CHI3L1 biomarker may hold additional utility in differentiating between acute disseminated encephalomyelitis and multiple sclerosis in pediatric patients.

Children who were referred to the hospital for potential neuroinflammatory disease were enrolled in this retrospective study (n=193). Enzyme-linked immunosorbent assays were used to quantify NFL and CHI3L1 concentrations. Differences in CHI3L1 and NFL cerebrospinal concentrations among 5 diagnostic groups (ie, ADS [n=33], controls [n=37], inflammatory neurologic disease [n=49], other neurologic disease [n = 55], and systemic inflammatory disease [n=19]) comprised the primary end point.

The presence of CHI3L1 in the cerebrospinal fluid was significantly higher among the ADS group compared with controls (P <.0001) and those with other neurologic disease (P <.0001), inflammatory neurologic disease (P =.0065), and systemic inflammatory disease (P =.0008). Pediatric patients with inflammatory neurologic disease also had significantly higher levels of CHI3L1 compared with controls (P <.0001) and patients with other neurologic disease (P =.002). There were significantly higher NFL concentrations among the ADS group vs controls (P =.001) and those with other neurologic disease (P =.001) and inflammatory neurological disease (P =.009).

NFL was a significant predictor for an ADS vs a non-ADS diagnosis (area under the curve 0.75; 95% CI, 0.66-0.84; P =.03). Specifically, cerebrospinal fluid concentrations of NFL ≥800 ng/L were associated with a 3-times increased risk for ADS in the cohort. In addition, CHI3L1 was deemed a significant predictor for an ADS vs a non-ADS diagnosis (area under the curve 0.81; 95% CI, 0.73-0.89; P <.001), with an 8-fold increased risk for ADS being observed with CHI3L1 concentrations ≥133 µg/L.

The retrospective analysis of medical records and the lack of disability measures in pediatric patients with ADS represent potential limitations of the study.

Additional studies may be necessary to “investigate the relationship between increased [cerebrospinal fluid] concentrations of CHI3L1 and NFL and long-term prognosis in children with ADS.”

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Boesen MS, Jensen PEH, Magyari M, et al. Increased cerebrospinal fluid chitinase 3-like 1 and neurofilament light chain in pediatric acquired demyelinating syndromes. Mult Scler Relat Disord. 2018;24:175-183.