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Cholesterol esterification (CE) has been implicated as a disease mechanism involved in the remyelination process. We investigated whether cerebrospinal fluid (CSF) 18:2 cholesterol ester (18:2\n                    <jats:sc>CE<\/jats:sc>\n                    ) levels at diagnosis could predict 10-year MS progression. We aimed to determine if CSF 18:2\n                    <jats:sc>CE<\/jats:sc>\n                    levels correlate with long-term disease progression. In a retrospective case\u2013control single-centre study with 115 MS patients and 57 controls, we conducted targeted lipidomic analysis of CSF. Clinical data, oligoclonal bands, brain and spinal cord MRI, and CSF 18:2\n                    <jats:sc>CE<\/jats:sc>\n                    levels were collected. Elevated CSF 18:2\n                    <jats:sc>CE<\/jats:sc>\n                    levels were significantly associated with a higher risk of 10-year MS progression, with an AUC of 0.91 in a multivariable logistic regression model. Patients initially treated with a high-efficacy drug did not show a worse prognosis despite presenting elevated CE18:2 levels at the time of diagnosis. However, patients treated with a high-efficacy drug as a second or third option showed a positive correlation between CE18:2 levels and EDSS at 10\u00a0years. CSF 18:2\n                    <jats:sc>CE<\/jats:sc>\n                    is a potential prognostic biomarker for predicting long-term MS progression, potentially indicating reduced remyelination capacity. These findings hold promise for improved patient management and warrant prospective validation.\n                  <\/jats:p>","DOI":"10.1007\/s12035-026-05915-8","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T07:38:17Z","timestamp":1781681897000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["18:2 Cholesterol Ester is a Novel Prognostic Biomarker of Disease Progression in Multiple Sclerosis"],"prefix":"10.1007","volume":"63","author":[{"given":"Pascual","family":"Torres","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Gil","family":"S\u00e1nchez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agust\u00edn","family":"Sancho-Salda\u00f1a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Quibus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"San Pedro Murillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Ruiz-Fern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Peralta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Jos\u00e9","family":"Solana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Brieva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Gonz\u00e1lez-Mingot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"5915_CR1","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/J.JAUT.2014.01.022","volume":"48\u201349","author":"D Karussis","year":"2014","unstructured":"Karussis D (2014) The diagnosis of multiple sclerosis and the various related demyelinating syndromes: a critical review. 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