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July 2022; 9 (4) Research ArticlesOpen Access

Role of Chitinase 3–like 1 as a Biomarker in Multiple Sclerosis

A Systematic Review and Meta-analysis

Stefano Floro, View ORCID ProfileTiziana Carandini, View ORCID ProfileAnna Margherita Pietroboni, Milena Alessandra De Riz, View ORCID ProfileElio Scarpini, View ORCID ProfileDaniela Galimberti
First published May 9, 2022, DOI: https://doi.org/10.1212/NXI.0000000000001164
Stefano Floro
From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy.
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Tiziana Carandini
From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy.
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  • ORCID record for Tiziana Carandini
  • For correspondence: tizianacarandini@gmail.com
Anna Margherita Pietroboni
From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy.
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  • ORCID record for Anna Margherita Pietroboni
  • For correspondence: pb.anna@libero.it
Milena Alessandra De Riz
From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy.
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  • For correspondence: milena.deriz@policlinico.mi.it
Elio Scarpini
From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy.
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  • ORCID record for Elio Scarpini
  • For correspondence: elio.scarpini@unimi.it
Daniela Galimberti
From the Fondazione IRCCS Ca' Granda (S.F., T.C., A.M.P., M.A.D.R., E.S., D.G.), Ospedale Policlinico; and University of Milan (S.F., E.S., D.G.), Milan, Italy.
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  • ORCID record for Daniela Galimberti
  • For correspondence: daniela.galimberti@unimi.it
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Role of Chitinase 3–like 1 as a Biomarker in Multiple Sclerosis
A Systematic Review and Meta-analysis
Stefano Floro, Tiziana Carandini, Anna Margherita Pietroboni, Milena Alessandra De Riz, Elio Scarpini, Daniela Galimberti
Neurol Neuroimmunol Neuroinflamm Jul 2022, 9 (4) e1164; DOI: 10.1212/NXI.0000000000001164

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    Figure 1 Selection of the Studies Included in the Analysis

    Study selection process according to the new 2020 update of the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statements.

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    Figure 2 Comparison Between Multiple Sclerosis vs Healthy Controls

    Forest plot of meta-analysis (with sensitivity analysis) (A) CHI3L1 levels in CSF in patients with MS vs healthy controls (HC); (B) subgroups analysis comparing CHI3L1 levels in CSF in HC vs relapsing-remitting + progressive forms (RRMS+PMS) and in HC vs RRMS only. Random-effects model was used. Outcomes are expressed as standardized mean difference (SMD) with 95% CI. Overall effect is expressed with Z score; heterogeneity is expressed with Tau and coefficients. Subgroup differences are expressed through score. The SMD of the studies excluded from the analysis compared in the forest plot as “not estimable.” (C) Standardization of absolute value of CSF levels of CHI3L1 with Z-scores extraction.

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    Figure 3 Comparison Between Multiple Sclerosis vs Clinically Isolated Syndrome
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    Figure 4 Comparison Between Relapsing-Remitting vs Progressive Multiple Sclerosis

    Forest plot of meta-analysis showing CHI3L1 levels in CSF in patients with relapsing remitting MS (RRMS) vs progressive MS (PMS). Random-effects model was used. Overall effect is expressed with Z score; heterogeneity is expressed with Tau and coefficients. Subgroup differences are expressed through score. PPMS = primary progressive MS; SPMS = secondary progressive MS.

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    Figure 5 Comparison Between Primary vs Secondary Progressive Multiple Sclerosis

    Forest plot of meta-analysis (with sensitivity analysis) showing CHI3L1 levels in CSF in patients with primary progressive MS (PPMS) vs secondary progressive MS (SPMS). Random-effects model was used. Overall effect is expressed with Z score; heterogeneity is expressed with Tau and coefficients. The SMD of the studies excluded from the analysis compared in the forest plot as “not estimable.”

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    Figure 6 Comparison Between Relapse vs Remission Stage of Disease

    Forest plot of meta-analysis showing: (A) CHI3L1 levels in CSF in patients with acute relapse vs remission stage of the disease; (B) proportions of patients with gadolinium enhancing lesion (GD+) on MRI in those with higher vs lower CHI3L1 levels in CSF. To compare the proportions, the Mantel-Haenszel model was used. Outcomes are expressed as Odds-Ratio, with 95% CI. Random-effects model was used for all the analysis. Overall effect is expressed with Z score; heterogeneity is expressed with Tau and coefficients.

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    Figure 7 Comparison Between Serum Levels of CHI3L1 Between Relapsing-Remitting Multiple Sclerosis vs Healthy Controls

    Forest plot of meta-analysis showing CHI3L1 levels in serum in patients with relapsing-remitting MS (RRMS) vs healthy controls (HC). Random-effects model was used for all the analysis. Overall effect is expressed with Z score; heterogeneity is expressed with Tau and coefficients.

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