Chitotriosidase as a biomarker of cerebral adrenoleukodystrophy

Paul J. Orchard, Troy Lund, Wes Miller, Steven M. Rothman, Gerald Raymond, David Nascene, Lisa Basso, James Cloyd, Jakub Tolar

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Background: Adrenoleukodystrophy (ALD) is an X-linked peroxisomal disorder characterized by the abnormal beta-oxidation of very long chain fatty acids (VLCFA). In 35-40% of children with ALD, an acute inflammatory process occurs in the central nervous system (CNS) leading to demyelination that is rapidly progressive, debilitating and ultimately fatal. Allogeneic hematopoietic stem cell transplantation (HSCT) can halt disease progression in cerebral ALD (C-ALD) if performed early. In contrast, for advanced patients the risk of morbidity and mortality is increased with transplantation. To date there is no means of quantitating neuroinflammation in C-ALD, nor is there an accepted measure to determine prognosis for more advanced patients.Methods: As cellular infiltration has been observed in C-ALD, including activation of monocytes and macrophages, we evaluated the activity of chitotriosidase in the plasma and spinal fluid of boys with active C-ALD. Due to genotypic variations in the chitotriosidase gene, these were also evaluated.Results: We document elevations in chitotriosidase activity in the plasma of patients with C-ALD (n = 38; median activity 1,576 ng/mL/hr) vs. controls (n = 16, median 765 ng/mL/hr, p = 0.0004), and in the CSF of C-ALD patients (n = 38; median activity 4,330 ng/mL/hr) vs. controls (n = 16, median 0 ng/mL/hr, p < 0.0001). In addition, activity levels of plasma and CSF chitotriosidase prior to transplant correlated with progression as determined by the Moser/Raymond functional score 1 year following transplantation (p = 0.002 and < 0.0001, respectively).Conclusions: These findings confirm elevation of chitotriosidase activity in patients with active C-ALD, and suggest that these levels predict prognosis of patients with C-ALD undergoing transplantation.

Original languageEnglish (US)
Article number144
JournalJournal of Neuroinflammation
StatePublished - Oct 20 2011

Bibliographical note

Funding Information:
We thank Teresa Kivisto for her integral work in patient care and data monitoring, and Dr. Larry Charnas for his interest and thoughtful discussions regarding this work. Also our appreciation to Todd Defor for his biostatistical expertise and advice. Support These studies were supported by the Children’s Cancer Research Fund (CCRF), as well as by an anonymous private foundation 1Department of Pediatrics, Program in Blood & Marrow Transplantation, University of Minnesota, Minneapolis, USA. 2Department of Pediatrics, Program in Neurology, University of Minnesota, Minneapolis, USA. 3Department of Neurology, Kennedy Krieger Institute, Baltimore MD, USA. 4Department of Diagnostic Radiology, University of Minnesota, Minneapolis, USA. 5Department of Experimental and Clinical Pharmacology, Center for Orphan Drug Research, University of Minnesota, Minneapolis, USA.


  • Adrenoleukodystrophy
  • Biomarker
  • Chitotriosidase
  • Neuroinflammation


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