Plasma UCHL-1 as a Biomarker of Brain Injury in Hospitalized Foals With Neonatal Encephalopathy.
Authors: Ryan Clare A, Giguère Steeve, Morresey Peter R
Journal: Journal of equine veterinary science
Summary
# Editorial Summary: Plasma UCHL-1 as a Biomarker in Neonatal Foal Encephalopathy Neonatal encephalopathy (NE) remains challenging to diagnose definitively in hospitalised foals, prompting Clare and colleagues to investigate whether ubiquitin carboxyl-terminal hydrolase L1 (UCHL-1)—a plasma protein released during brain injury—could serve as a diagnostic and prognostic tool. Their prospective analysis measured admission UCHL-1 concentrations via ELISA in 331 hospitalised foals aged ≤4 days, stratifying them into four clinical groups: NE only (n=77), sepsis only (n=34), concurrent NE and sepsis (n=85), and other diagnoses (n=101). Foals with NE or NE+sepsis showed significantly elevated UCHL-1 levels (18.22 and 17.42 ng/mL respectively) compared to the other diagnosis group (7.77 ng/mL), and nonsurvivors had higher admission concentrations than survivors; however, diagnostic performance was modest (AUC 0.61, 73% sensitivity, 49% specificity), whilst the timing of lowest UCHL-1 showed better prognostic value for predicting nonsurvival (AUC 0.72, 86% sensitivity). Although UCHL-1 demonstrates biological relevance to brain injury in foals with NE, its standalone diagnostic utility is limited at admission, suggesting it may be most useful as part of a combined assessment rather than as a single decision-making tool for equine practitioners managing neonatal cases.
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Practical Takeaways
- •While plasma UCHL-1 levels are elevated in foals with neonatal encephalopathy, the test alone has insufficient diagnostic accuracy to reliably distinguish NE from other conditions in clinical practice
- •Time to lowest UCHL-1 concentration may provide prognostic value for identifying at-risk foals, but limited specificity (43%) means elevated results should not be used as standalone prognostic indicators
- •UCHL-1 measurement could be part of a multi-marker diagnostic approach but should not replace clinical assessment and other diagnostic methods in hospitalized foals with neurological signs
Key Findings
- •Median plasma UCHL-1 was significantly higher in foals with neonatal encephalopathy (18.22 ng/mL) and neonatal encephalopathy with sepsis (17.42 ng/mL) compared to other diagnoses (7.77 ng/mL)
- •Admission UCHL-1 concentration had limited diagnostic performance for neonatal encephalopathy with AUC of 0.61, sensitivity 73%, and specificity 49%
- •Time to lowest UCHL-1 concentration showed better prognostic performance (AUC 0.72) for predicting nonsurvival with 86% sensitivity and 43% specificity
- •Nonsurviving foals had significantly higher admission UCHL-1 concentrations (16.66 ng/mL) compared to survivors (10.27 ng/mL)