Comparative diagnostic utility of cerebrospinal fluid biomarkers in multiple sclerosis.

Background

Multiple sclerosis (MS) diagnosis depends on clinical and magnetic resonance imaging (MRI) data; the need for confirmatory cerebrospinal fluid (CSF) biomarkers for differential diagnosis is a crucial step.

Objective

We aim to investigate and compare the diagnostic value of CSF markers (e.g., chitinase 3-like 1 (CHI3L1), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP)) compared to the established supportive diagnostic oligoclonal bands test (OCBs) in MS.

Methods

We collected 62 CSF samples from suspected MS patients with T2-Hyperintense lesions and investigated OCBs and enzyme-linked immunosorbent assay (ELISA) for NfL, CHI3L1, and GFAP.

Results

The CSF levels of NfL (p < 0.001) and CHI3L1 (p < 0.001) were significantly elevated in the MS group compared to the non-MS group, in contrast to GFAP (p = 0.17). Diagnostic criteria for MS diagnosis was excellent for OCBs (Area under curve (AUC) = 0.978, p < 0.001; 95% Confidence Interval (CI): 0.929-1.000), good for CHI3L1 (AUC = 0.838, p < 0.001; 95% CI: 0.738-0.939), acceptable for NfL (AUC = 0.729, p = 0.003; 95% CI: 0.602-0.855) and poor for GFAP (AUC = 0.604, p = 0.173; 95% CI: 0.477-0.762).

Conclusion

Among the studied biomarkers, CHI3L1 showed potential as an adjunctive biomarker for discriminating MS from non-MS patients. Its diagnostic accuracy was higher than that of NfL in our cohort, but GFAP has limited diagnostic accuracy, which could restrict its use in MS diagnosis.