Chitinase 3-like 1: Prognostic biomarker in clinically isolated syndromes

Ester Canto, Mar Tintore, Luisa M. Villar, Carme Costa, Ramil Nurtdinov, José C. Alvarez-Cermeno, Georgina Arrambide, Ferran Reverter, Florian Deisenhammer, Harald Hegen, Mohsen Khademi, Tomas Olsson, Hayrettin Tumani, Eulalia Rodriguez-Martin, Fredrik Piehl, Ales Bartos, Denisa Zimova, Jolana Kotoucova, Jens Kuhle, Ludwig KapposJuan Antonio Garcia-Merino, Antonio José Sánchez, Albert Saiz, Yolanda Blanco, Rogier Hintzen, Naghmeh Jafari, David Brassat, Florian Lauda, Romy Roesler, Konrad Rejdak, Ewa Papuc, Clara De Andrés, Stefan Rauch, Michael Khalil, Christian Enzinger, Daniela Galimberti, Elio Scarpini, Charlotte Teunissen, Alex Sánchez, Alex Rovira, Xavier Montalban, Manuel Comabella

Research output: Contribution to journalArticleResearchpeer-review

120 Citations (Scopus)


© 2015 The Author. Chitinase 3-like 1 (CHI3L1) has been proposed as a biomarker associated with the conversion to clinically definite multiple sclerosis in patients with clinically isolated syndromes, based on the finding of increased cerebrospinal fluid CHI3L1 levels in clinically isolated syndrome patients who later converted to multiple sclerosis compared to those who remained as clinically isolated syndrome. Here, we aimed to validate CHI3L1 as a prognostic biomarker in a large cohort of patients with clinically isolated syndrome. This is a longitudinal cohort study of clinically isolated syndrome patients with clinical, magnetic resonance imaging, and cerebrospinal fluid data prospectively acquired. A total of 813 cerebrospinal fluid samples from patients with clinically isolated syndrome were recruited from 15 European multiple sclerosis centres. Cerebrospinal fluid CHI3L1 levels were measured by enzyme-linked immunosorbent assay. Multivariable Cox regression models were used to investigate the association between cerebrospinal fluid CHI3L1 levels and time to conversion to multiple sclerosis and time to reach Expanded Disability Status Scale 3.0. CHI3L1 levels were higher in patients who converted to clinically definite multiple sclerosis compared to patients who continued as clinically isolated syndrome (P = 8.1 × 10-11). In the Cox regression analysis, CHI3L1 levels were a risk factor for conversion to multiple sclerosis (hazard ratio = 1.7; P = 1.1 × 10-5 using Poser criteria; hazard ratio = 1.6; P = 3.7 × 10-6 for McDonald criteria) independent of other covariates such as brain magnetic resonance imaging abnormalities and presence of cerebrospinal fluid oligoclonal bands, and were the only significant independent risk factor associated with the development of disability (hazard ratio = 3.8; P = 2.5 × 10-8). High CHI3L1 levels were associated with shorter time to multiple sclerosis (P = 3.2 × 10-9 using Poser criteria; P = 5.6 × 10-11 for McDonald criteria) and more rapid development of disability (P = 1.8 × 10-10). These findings validate cerebrospinal fluid CHI3L1 as a biomarker associated with the conversion to multiple sclerosis and development of disability and reinforce the prognostic role of CHI3L1 in patients with clinically isolated syndrome. We propose that determining cerebrospinal fluid chitinase 3-like 1 levels at the time of a clinically isolated syndrome event will help identify those patients with worse disease prognosis.
Original languageEnglish
Pages (from-to)918-931
Issue number4
Publication statusPublished - 1 Jan 2015


  • biomarker
  • clinically isolated syndrome
  • disability progression
  • multiple sclerosis


Dive into the research topics of 'Chitinase 3-like 1: Prognostic biomarker in clinically isolated syndromes'. Together they form a unique fingerprint.

Cite this