Cerebrospinal fluid CXCL13 in multiple sclerosis: a suggestive prognostic marker for the disease course.
BACKGROUND
Levels of CXCL13, a potent B-cell chemoattractant, are elevated in the cerebrospinal fluid (CSF) during multiple sclerosis (MS) and are associated with markers of MS activity. Levels decrease upon effective treatments.


OBJECTIVE
Here we validate the potential role of CSF CXCL13 as a biomarker for aspects of MS in a large amount of clinical material, the majority collected at early diagnostic work-up.


METHODS
CXCL13 was measured by ELISA in 837 subjects: relapsing-remitting MS (RRMS; n=323), secondary progressive MS (SPMS; n=40), primary progressive MS (PPMS; n=24), clinically isolated syndrome (CIS; n=79), other neurological diseases (ONDs; n=181), ONDs with signs of inflammation or viral/bacterial infections (iONDs; n=176) and healthy controls (n=14).


RESULTS
Subjects with viral/bacterial infections had extremely high CXCL13 levels compared to all included groups (p<0.0001). CXCL13 was otherwise significantly higher in MS compared to the remaining controls (p<0.0001), and CIS (p<0.01). A significant and positive correlation between CXCL13 and relapse rate, the results obtained for the Expanded Disability Status Scale (EDSS) and the number of lesions detected by MRI was demonstrated. CXCL13 was increased in CIS conversion to clinically definite MS (p<0.001). Oligoclonal immunoglobulin band (OCB)-positive CIS or MS had significantly increased CXCL13 levels compared to OCB-negative CIS or MS (p<0.001 and p<0.0001, respectively).


CONCLUSIONS
CXCL13 was associated with disease exacerbations and unfavourable prognosis in RRMS. Increased CXCL13 was not specific for MS since subjects with viral/bacterial infections exhibited even higher levels. High levels predicted CIS conversion to MS. We suggest that measurement of CSF CXCL13 can be part of the armamentarium in the diagnostic and prognostic work-up in MS and be of help in future treatment decisions.
Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska University Hospital, Stockholm, Sweden. mohsen.khademi@ki.se
Mohsen
M
Khademi
Ingrid
I
Kockum
Magnus L
ML
Andersson
Ellen
E
Iacobaeus
Lou
L
Brundin
Finn
F
Sellebjerg
Jan
J
Hillert
Fredrik
F
Piehl
Tomas
T
Olsson
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000134:cerebrospinal fluid; D054382:Chemokine CXCL13 / Q000134:cerebrospinal fluid*; D003711:Demyelinating Diseases / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000276:immunology; D004185:Disability Evaluation; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000276:immunology; D043025:Oligoclonal Bands / Q000134:cerebrospinal fluid; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D013548:Sweden; D013997:Time Factors; D015854:Up-Regulation; D055815:Young Adult
D015415:Biomarkers; C110663:CXCL13 protein, human; D054382:Chemokine CXCL13; D043025:Oligoclonal Bands