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Oh J, Arbour N, Giuliani F, Guenette M, Kolind S, Lynd L, Marrie RA, Metz LM, Prat A, Schabas A, Smyth P, Tam R, Traboulsee A, Yong VW, Patten SB. The Canadian Prospective Cohort Study to understand progression in multiple sclerosis: baseline characteristics. Ther Adv Neurol Disord 2024; 17:17562864241273045. [PMID: 39282637 PMCID: PMC11402083 DOI: 10.1177/17562864241273045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/08/2024] [Indexed: 09/19/2024] Open
Abstract
Background Disease progression is observed across the spectrum of people with multiple sclerosis (MS) and identification of effective treatment strategies to halt progression remains one of the greatest unmet clinical needs. Objectives The Canadian Prospective Cohort Study to Understand Progression in MS (CanProCo) was designed to evaluate a wide range of factors associated with the onset and rate of clinical disease progression in MS and to describe the interplay between these factors. Design A prospective cohort study. Methods CanProCo is a national, prospective, observational cohort study that has recruited 944 individuals from 5 large academic MS centers in Canada. Participants include people with radiologically isolated syndrome (RIS), early relapsing-remitting and primary progressive MS (RRMS, PPMS), and healthy controls (HCs). Annually, participants complete self-reported questionnaires, undergo clinical evaluation and, if clinically indicated, magnetic resonance images (MRIs) of the brain and cervical spinal cord; in a subset of participants (n = 399), blood, and research MRIs of the brain and cervical spinal cord are collected. Linkages to health administrative databases are available at three sites. Results Overall, 944 participants were recruited (53 HCs, 63 RIS, 751 RRMS, 77 PPMS). RIS and MS participants had a mean age of 39.0 years and 70.5% female. The mean time since diagnosis was 2.7 years. There were differences observed in the Expanded Disability Status Scale score and components of the MS performance test (walking speed test, manual dexterity test, processing speed test, and low-contrast visual acuity) between RIS and MS subtypes. Questionnaires revealed more symptoms of depression and anxiety and impaired physical and mental quality of life in people with RIS/MS versus HCs and differences across RIS/MS subtypes. Conclusion Physical and mental neurological disability is prevalent even in the earliest stages of MS. Transdisciplinary approaches such as those used in CanProCo are needed to better characterize clinical progression in MS. Additional CanProCo results, including MRI, biological, and pharmaco-economic data will be forthcoming. Going forward, CanProCo's data sharing and collaborative vision will facilitate numerous global collaborations, which will inform the development and implementation of effective interventions for people with MS around the world.
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Affiliation(s)
- Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, 30 Bond Street, PGT 17-742, Toronto, ON M5B 1W8, Canada
| | - Nathalie Arbour
- Department of Neurosciences, Faculty of Medicine, Université de Montréal and Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Fabrizio Giuliani
- Division of Neurology, Department of Medicine, Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Melanie Guenette
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shannon Kolind
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - Larry Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, BC, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Luanne M Metz
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Alexandre Prat
- Department of Neurosciences, Faculty of Medicine, Université de Montréal and Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Alice Schabas
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Penelope Smyth
- Division of Neurology, Department of Medicine, Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Voon Wee Yong
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Zarghami A, Hussain MA, van der Mei I, Simpson-Yap S, Ponsonby AL, Lechner-Scott J, Broadley SA, Lucas RM, Zhou Y, Lin X, Investigator Group A, Taylor BV. Long-term disability trajectories in multiple sclerosis: a group-based trajectory analysis of the AusLong cohort. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333632. [PMID: 39231584 DOI: 10.1136/jnnp-2024-333632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 08/21/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Previous natural history studies highlighted a consistent heterogeneity of disability trajectories among individuals with primary or secondary progressive multiple sclerosis (MS). However, evidence on disability progression in relapsing onset MS is scarce.The aim of this study was to investigate heterogeneity in disability accumulation over 10 years following a first clinical diagnosis of central nervous system demyelination (FCD) and identify genetic, demographic, environmental and clinical factors associated with these trajectories. METHODS We used group-based trajectory models to measure heterogeneity in disability trajectories based on the Expanded Disability Status Scale (EDSS) in a prospectively assessed cohort of 263 participants. To capture sustained neurological impairments and avoid issues related to significant changes in EDSS associated with relapse, we did not consider EDSS points recorded within 3 months of a relapse. RESULTS We identified three distinct and clinically meaningful disability trajectories: No/minimal, moderate and severe. Those in the no/minimal disability trajectory showed no appreciable progression of disability (median EDSS∼1 at 10-year review) while those in the moderate and severe disability trajectories experienced disability worsening (median time to reach EDSS 4 was 9 and 7 years, respectively). Compared with the no/minimal disability trajectory, those with older age, a higher number of relapses within the first 5 years post-FCD, and a higher number of comorbidities at baseline were more likely to be in the worse disability trajectory. Surprisingly, baseline MRI and anatomical site of initial symptoms did not influence long-term outcomes. CONCLUSIONS Those at higher risk of faster MS disability progression can be identified based on their early clinical characteristics with potential therapeutic implications for early intervention and treatment escalation.
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Affiliation(s)
- Amin Zarghami
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Mohammad Akhtar Hussain
- Barwon South West Public Health Unit, Barwon Health, Geelong, Australia, Geelong, Victoria, Australia
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Neuroepidemiology unit, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Anne-Louise Ponsonby
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jeanette Lechner-Scott
- The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
- The University of Newcastle School of Medicine and Public Health, Callaghan, New South Wales, Australia
| | - Simon A Broadley
- School of Medicine, Griffith University, Nathan, Queensland, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Xin Lin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Binder MD, Nwoke EC, Morwitch E, Dwyer C, Li V, Xavier A, Lea RA, Lechner-Scott J, Taylor BV, Ponsonby AL, Kilpatrick TJ. HLA-DRB1*15:01 and the MERTK Gene Interact to Selectively Influence the Profile of MERTK-Expressing Monocytes in Both Health and MS. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200190. [PMID: 38150649 PMCID: PMC10752576 DOI: 10.1212/nxi.0000000000200190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/31/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND AND OBJECTIVES HLA-DRB1*15:01 (DR15) and MERTK are 2 risk genes for multiple sclerosis (MS). The variant rs7422195 is an expression quantitative trait locus for MERTK in CD14+ monocytes; cells with phagocytic and immunomodulatory potential. We aimed to understand how drivers of disease risk and pathogenesis vary with HLA and MERTK genotype and disease activity. METHODS We investigated how proportions of monocytes vary with HLA and MERTK genotype and disease activity in MS. CD14+ monocytes were isolated from patients with MS at relapse (n = 40) and 3 months later (n = 23). Healthy controls (HCs) underwent 2 blood collections 3 months apart. Immunophenotypic profiling of monocytes was performed by flow cytometry. Methylation of 35 CpG sites within and near the MERTK gene was assessed in whole blood samples of individuals experiencing their first episode of clinical CNS demyelination (n = 204) and matched HCs (n = 345) using an Illumina EPIC array. RESULTS DR15-positive patients had lower proportions of CD14+ MERTK+ monocytes than DR15-negative patients, independent of genotype at the MERTK SNP rs7422195. Proportions of CD14+ MERTK+ monocytes were further reduced during relapse in DR15-positive but not DR15-negative patients. Patients homozygous for the major G allele at rs7422195 exhibited higher proportions of CD14+ MERTK+ monocytes at both relapse and remission compared with controls. We observed that increased methylation of the MERTK gene was significantly associated with the presence of DR15. DISCUSSION DR15 and MERTK genotype independently influence proportions of CD14+ MERTK+ monocytes in MS. We confirmed previous observations that the MERTK risk SNP rs7422195 is associated with altered MERTK expression in monocytes. We identified that expression of MERTK is stratified by disease in people homozygous for the major G allele of rs7422195. The finding that the proportion of CD14+ MERTK+ monocytes is reduced in DR15-positive individuals supports prior data identifying genetic links between these 2 loci in influencing MS risk. DR15 genotype-dependent alterations in methylation of the MERTK gene provides a molecular link between these loci and identifies a potential mechanism by which MERTK expression is influenced by DR15. This links DR15 haplotype to MS susceptibility beyond direct influence on antigen presentation and suggests the need for HLA-based stratification of approaches to MERTK as a therapeutic target.
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Affiliation(s)
- Michele D Binder
- From the Florey Institute of Neuroscience and Mental Health (M.D.B., E.C.N., E.M., C.D., V.L., A.-L.P., T.J.K.); Department of Anatomy and Physiology (M.D.B.), University of Melbourne, Parkville; Crux Biolabs (E.C.N.), Bayswater; Department of Neurology (C.D.), Royal Melbourne Hospital, Parkville; Department of Neurology (A.X., J.L.-S.), John Hunter Hospital, Newcastle; Hunter Medical Research Institute (A.X., J.L.-S.), University of Newcastle, New South Wales Genomics Research Centre (R.A.L.), Centre of Genomics and Personalised Health, Queensland University of Technology; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Hobart, Australia
| | - Eze C Nwoke
- From the Florey Institute of Neuroscience and Mental Health (M.D.B., E.C.N., E.M., C.D., V.L., A.-L.P., T.J.K.); Department of Anatomy and Physiology (M.D.B.), University of Melbourne, Parkville; Crux Biolabs (E.C.N.), Bayswater; Department of Neurology (C.D.), Royal Melbourne Hospital, Parkville; Department of Neurology (A.X., J.L.-S.), John Hunter Hospital, Newcastle; Hunter Medical Research Institute (A.X., J.L.-S.), University of Newcastle, New South Wales Genomics Research Centre (R.A.L.), Centre of Genomics and Personalised Health, Queensland University of Technology; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Hobart, Australia
| | - Ellen Morwitch
- From the Florey Institute of Neuroscience and Mental Health (M.D.B., E.C.N., E.M., C.D., V.L., A.-L.P., T.J.K.); Department of Anatomy and Physiology (M.D.B.), University of Melbourne, Parkville; Crux Biolabs (E.C.N.), Bayswater; Department of Neurology (C.D.), Royal Melbourne Hospital, Parkville; Department of Neurology (A.X., J.L.-S.), John Hunter Hospital, Newcastle; Hunter Medical Research Institute (A.X., J.L.-S.), University of Newcastle, New South Wales Genomics Research Centre (R.A.L.), Centre of Genomics and Personalised Health, Queensland University of Technology; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Hobart, Australia
| | - Chris Dwyer
- From the Florey Institute of Neuroscience and Mental Health (M.D.B., E.C.N., E.M., C.D., V.L., A.-L.P., T.J.K.); Department of Anatomy and Physiology (M.D.B.), University of Melbourne, Parkville; Crux Biolabs (E.C.N.), Bayswater; Department of Neurology (C.D.), Royal Melbourne Hospital, Parkville; Department of Neurology (A.X., J.L.-S.), John Hunter Hospital, Newcastle; Hunter Medical Research Institute (A.X., J.L.-S.), University of Newcastle, New South Wales Genomics Research Centre (R.A.L.), Centre of Genomics and Personalised Health, Queensland University of Technology; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Hobart, Australia
| | - Vivien Li
- From the Florey Institute of Neuroscience and Mental Health (M.D.B., E.C.N., E.M., C.D., V.L., A.-L.P., T.J.K.); Department of Anatomy and Physiology (M.D.B.), University of Melbourne, Parkville; Crux Biolabs (E.C.N.), Bayswater; Department of Neurology (C.D.), Royal Melbourne Hospital, Parkville; Department of Neurology (A.X., J.L.-S.), John Hunter Hospital, Newcastle; Hunter Medical Research Institute (A.X., J.L.-S.), University of Newcastle, New South Wales Genomics Research Centre (R.A.L.), Centre of Genomics and Personalised Health, Queensland University of Technology; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Hobart, Australia
| | - Alexandre Xavier
- From the Florey Institute of Neuroscience and Mental Health (M.D.B., E.C.N., E.M., C.D., V.L., A.-L.P., T.J.K.); Department of Anatomy and Physiology (M.D.B.), University of Melbourne, Parkville; Crux Biolabs (E.C.N.), Bayswater; Department of Neurology (C.D.), Royal Melbourne Hospital, Parkville; Department of Neurology (A.X., J.L.-S.), John Hunter Hospital, Newcastle; Hunter Medical Research Institute (A.X., J.L.-S.), University of Newcastle, New South Wales Genomics Research Centre (R.A.L.), Centre of Genomics and Personalised Health, Queensland University of Technology; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Hobart, Australia
| | - Rodney A Lea
- From the Florey Institute of Neuroscience and Mental Health (M.D.B., E.C.N., E.M., C.D., V.L., A.-L.P., T.J.K.); Department of Anatomy and Physiology (M.D.B.), University of Melbourne, Parkville; Crux Biolabs (E.C.N.), Bayswater; Department of Neurology (C.D.), Royal Melbourne Hospital, Parkville; Department of Neurology (A.X., J.L.-S.), John Hunter Hospital, Newcastle; Hunter Medical Research Institute (A.X., J.L.-S.), University of Newcastle, New South Wales Genomics Research Centre (R.A.L.), Centre of Genomics and Personalised Health, Queensland University of Technology; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Hobart, Australia
| | - Jeannette Lechner-Scott
- From the Florey Institute of Neuroscience and Mental Health (M.D.B., E.C.N., E.M., C.D., V.L., A.-L.P., T.J.K.); Department of Anatomy and Physiology (M.D.B.), University of Melbourne, Parkville; Crux Biolabs (E.C.N.), Bayswater; Department of Neurology (C.D.), Royal Melbourne Hospital, Parkville; Department of Neurology (A.X., J.L.-S.), John Hunter Hospital, Newcastle; Hunter Medical Research Institute (A.X., J.L.-S.), University of Newcastle, New South Wales Genomics Research Centre (R.A.L.), Centre of Genomics and Personalised Health, Queensland University of Technology; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Hobart, Australia
| | - Bruce V Taylor
- From the Florey Institute of Neuroscience and Mental Health (M.D.B., E.C.N., E.M., C.D., V.L., A.-L.P., T.J.K.); Department of Anatomy and Physiology (M.D.B.), University of Melbourne, Parkville; Crux Biolabs (E.C.N.), Bayswater; Department of Neurology (C.D.), Royal Melbourne Hospital, Parkville; Department of Neurology (A.X., J.L.-S.), John Hunter Hospital, Newcastle; Hunter Medical Research Institute (A.X., J.L.-S.), University of Newcastle, New South Wales Genomics Research Centre (R.A.L.), Centre of Genomics and Personalised Health, Queensland University of Technology; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Hobart, Australia
| | - Anne-Louise Ponsonby
- From the Florey Institute of Neuroscience and Mental Health (M.D.B., E.C.N., E.M., C.D., V.L., A.-L.P., T.J.K.); Department of Anatomy and Physiology (M.D.B.), University of Melbourne, Parkville; Crux Biolabs (E.C.N.), Bayswater; Department of Neurology (C.D.), Royal Melbourne Hospital, Parkville; Department of Neurology (A.X., J.L.-S.), John Hunter Hospital, Newcastle; Hunter Medical Research Institute (A.X., J.L.-S.), University of Newcastle, New South Wales Genomics Research Centre (R.A.L.), Centre of Genomics and Personalised Health, Queensland University of Technology; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Hobart, Australia
| | - Trevor J Kilpatrick
- From the Florey Institute of Neuroscience and Mental Health (M.D.B., E.C.N., E.M., C.D., V.L., A.-L.P., T.J.K.); Department of Anatomy and Physiology (M.D.B.), University of Melbourne, Parkville; Crux Biolabs (E.C.N.), Bayswater; Department of Neurology (C.D.), Royal Melbourne Hospital, Parkville; Department of Neurology (A.X., J.L.-S.), John Hunter Hospital, Newcastle; Hunter Medical Research Institute (A.X., J.L.-S.), University of Newcastle, New South Wales Genomics Research Centre (R.A.L.), Centre of Genomics and Personalised Health, Queensland University of Technology; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Hobart, Australia
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4
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Li Y, Saul A, Taylor B, Ponsonby AL, Simpson-Yap S, Blizzard L, Broadley S, Lechner-Scott J, Karabudak R, Patti F, Eichau S, Onofrj M, Ozakbas S, Horakova D, Kubala Havrdova E, Grand'Maison F, Alroughani R, Gerlach O, Amato MP, Altintas A, Girard M, Duquette P, Blanco Y, Ramo-Tello C, Laureys G, Kalincik T, Khoury SJ, Shaygannejad V, Etemadifar M, Singhal B, Mrabet S, Foschi M, Habek M, John N, Hughes S, McCombe P, Ampapa R, van der Walt A, Butzkueven H, de Gans K, McGuigan C, Oreja-Guevara C, Sa MJ, Petersen T, Al-Harbi T, Sempere AP, Van Wijmeersch B, Grigoriadis N, Prevost J, Gray O, Castillo-Triviño T, Macdonell R, Lugaresi A, Sajedi SA, van der Mei I. Examining the environmental risk factors of progressive-onset and relapsing-onset multiple sclerosis: recruitment challenges, potential bias, and statistical strategies. J Neurol 2024; 271:472-485. [PMID: 37768389 PMCID: PMC10770262 DOI: 10.1007/s00415-023-11980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
It is unknown whether the currently known risk factors of multiple sclerosis reflect the etiology of progressive-onset multiple sclerosis (POMS) as observational studies rarely included analysis by type of onset. We designed a case-control study to examine associations between environmental factors and POMS and compared effect sizes to relapse-onset MS (ROMS), which will offer insights into the etiology of POMS and potentially contribute to prevention and intervention practice. This study utilizes data from the Primary Progressive Multiple Sclerosis (PPMS) Study and the Australian Multi-center Study of Environment and Immune Function (the AusImmune Study). This report outlines the conduct of the PPMS Study, whether the POMS sample is representative, and the planned analysis methods. The study includes 155 POMS, 204 ROMS, and 558 controls. The distributions of the POMS were largely similar to Australian POMS patients in the MSBase Study, with 54.8% female, 85.8% POMS born before 1970, mean age of onset of 41.44 ± 8.38 years old, and 67.1% living between 28.9 and 39.4° S. The POMS were representative of the Australian POMS population. There are some differences between POMS and ROMS/controls (mean age at interview: POMS 55 years vs. controls 40 years; sex: POMS 53% female vs. controls 78% female; location of residence: 14.3% of POMS at a latitude ≤ 28.9°S vs. 32.8% in controls), which will be taken into account in the analysis. We discuss the methodological issues considered in the study design, including prevalence-incidence bias, cohort effects, interview bias and recall bias, and present strategies to account for it. Associations between exposures of interest and POMS/ROMS will be presented in subsequent publications.
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Affiliation(s)
- Ying Li
- Menzies Institute of Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Alice Saul
- Menzies Institute of Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Bruce Taylor
- Menzies Institute of Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Anne-Louise Ponsonby
- Florey Institute for Neuroscience, University of Melbourne, Melbourne, VIC, Australia
| | - Steve Simpson-Yap
- Menzies Institute of Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
- Melbourne School of Population and Global Health, Neuroepidemiology Unit, The University of Melbourne, Melbourne, VIC, Australia
| | - Leigh Blizzard
- Menzies Institute of Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Simon Broadley
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia
| | | | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico "G Rodloico-San Marco", University of Catania, Catania, Italy
| | - Sara Eichau
- Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | - Dana Horakova
- Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | | | - Oliver Gerlach
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Ayse Altintas
- Department of Neurology and Koc University Research Center for Translational Medicine (KUTTAM), Koc University, School of Medicine, Istanbul, Turkey
| | - Marc Girard
- CHUM and Universite de Montreal, Montreal, Canada
| | | | | | | | | | - Tomas Kalincik
- Department of Neurology, Neroimmunology Centre, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, CORe, University of Melbourne, Melbourne, Australia
| | - Samia J Khoury
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Bhim Singhal
- Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Saloua Mrabet
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, University Hospital Razi-Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
| | - Matteo Foschi
- S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1, L'Aquila, Italy
| | - Mario Habek
- University Hospital Center Zagreb, Zagreb, Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Nevin John
- Monash Medical Centre, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | - Pamela McCombe
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | | | - Anneke van der Walt
- The Alfred Hospital, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | | | | | - Chris McGuigan
- St Vincent's University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | | | - Maria Jose Sa
- Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | | | - Talal Al-Harbi
- King Fahad Specialist Hospital-Dammam, Khobar, Saudi Arabia
| | | | | | | | | | - Orla Gray
- South Eastern HSC Trust, Belfast, UK
| | | | - Richard Macdonell
- Austin Health, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Florey Institute for Neuroscience, The University of Melbourne, Melbourne, VIC, Australia
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | - Ingrid van der Mei
- Menzies Institute of Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
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Lucas RM, Lay MLJ, Grant J, Cherbuin N, Toi CS, Dear K, Taylor BV, Dwyer DE, Ponsonby AL. Risk of a first clinical diagnosis of central nervous system demyelination in relation to human herpesviruses in the context of Epstein-Barr virus. Eur J Neurol 2023; 30:2752-2760. [PMID: 37306550 DOI: 10.1111/ene.15919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/26/2023] [Accepted: 06/07/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE Epstein-Barr virus (EBV) is implicated in multiple sclerosis (MS) risk; evidence for other herpesviruses is inconsistent. Here, we test blood markers of infection with human herpesvirus 6 (HHV-6), varicella zoster virus (VZV), and cytomegalovirus (CMV) as risk factors for a first clinical diagnosis of central nervous system demyelination (FCD) in the context of markers of EBV infection. METHODS In the Ausimmune case-control study, cases had an FCD, and population controls were matched on age, sex, and study region. We quantified HHV-6- and VZV-DNA load in whole blood and HHV-6, VZV, and CMV antibodies in serum. Conditional logistic regression tested associations with FCD risk, adjusting for Epstein-Barr nuclear antigen (EBNA) IgG, EBV-DNA load, and other covariates. RESULTS In 204 FCD cases and 215 matched controls, only HHV-6-DNA load (positive vs. negative) was associated with FCD risk (adjusted odds ratio = 2.20, 95% confidence interval = 1.08-4.46, p = 0.03). Only EBNA IgG and HHV-6-DNA positivity were retained in a predictive model of FCD risk; the combination had a stronger association than either alone. CMV-specific IgG concentration modified the association between an MS risk-related human leucocyte antigen gene and FCD risk. Six cases and one control had very high HHV-6-DNA load (>1.0 × 106 copies/mL). CONCLUSIONS HHV-6-DNA positivity and high load (possibly due to inherited HHV-6 chromosomal integration) were associated with increased FCD risk, particularly in association with markers of EBV infection. With growing interest in prevention/management of MS through EBV-related pathways, there should be additional consideration of the role of HHV-6 infection.
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Affiliation(s)
- Robyn M Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Meav-Lang J Lay
- Clinical Virology Department, Centre for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - James Grant
- ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicolas Cherbuin
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Cheryl S Toi
- Clinical Virology Department, Centre for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Keith Dear
- University of Adelaide, Adelaide, South Australia, Australia
| | - Bruce V Taylor
- Menzies Research Institute Tasmania, Hobart, Tasmania, Australia
| | - Dominic E Dwyer
- Clinical Virology Department, Centre for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
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6
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Maltby V, Xavier A, Ewing E, Campagna MP, Sampangi S, Scott RJ, Butzkueven H, Jokubaitis V, Kular L, Bos S, Slee M, van der Mei IA, Taylor BV, Ponsonby AL, Jagodic M, Lea R, Lechner-Scott J. Evaluation of Cell-Specific Epigenetic Age Acceleration in People With Multiple Sclerosis. Neurology 2023; 101:e679-e689. [PMID: 37541839 PMCID: PMC10437016 DOI: 10.1212/wnl.0000000000207489] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/20/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In multiple sclerosis (MS), accelerated aging of the immune system (immunosenescence) may be associated with disease onset or drive progression. DNA methylation (DNAm) is an epigenetic factor that varies among lymphocyte subtypes, and cell-specific DNAm is associated with MS. DNAm varies across the life span and can be used to accurately estimate biological age acceleration, which has been linked to a range of morbidities. The objective of this study was to test for cell-specific epigenetic age acceleration (EAA) in people with MS. METHODS This was a case-control study of EAA using existing DNAm data from several independent previously published studies. Data were included if .idat files from Illumina 450K or EPIC arrays were available for both a case with MS and an age-matched and sex-matched control, from the same study. Multifactor statistical modeling was performed to assess the primary outcome of EAA. We explored the relationship of EAA and MS, including interaction terms to identify immune cell-specific effects. Cell-sorted DNA methylation data from 3 independent datasets were used to validate findings. RESULTS We used whole blood DNA methylation data from 583 cases with MS and 643 non-MS controls to calculate EAA using the GrimAge algorithm. The MS group exhibited an increased EAA compared with controls (approximately 9 mths, 95% CI 3.6-14.4), p = 0.001). Statistical deconvolution showed that EAA is associated with MS in a B cell-dependent manner (β int = 1.7, 95% CI 0.3-2.8), p = 0.002), irrespective of B-cell proportions. Validation analysis using 3 independent datasets enriched for B cells showed an EAA increase of 5.1 years in cases with MS compared with that in controls (95% CI 2.8-7.4, p = 5.5 × 10-5). By comparison, there was no EAA difference in MS in a T cell-enriched dataset. We found that EAA was attributed to the DNAm surrogates for Beta-2-microglobulin (difference = 47,546, 95% CI 10,067-85,026; p = 7.2 × 10-5), and smoking pack-years (difference = 8.1, 95% CI 1.9-14.2, p = 0.002). DISCUSSION This study provides compelling evidence that B cells exhibit marked EAA in MS and supports the hypothesis that premature B-cell immune senescence plays a role in MS. Future MS studies should focus on age-related molecular mechanisms in B cells.
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Affiliation(s)
- Vicki Maltby
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Alexandre Xavier
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Ewoud Ewing
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Maria-Pia Campagna
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Sandeep Sampangi
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Rodney J Scott
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia.
| | - Helmut Butzkueven
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Vilija Jokubaitis
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Lara Kular
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Steffan Bos
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Mark Slee
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Ingrid A van der Mei
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Bruce V Taylor
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Anne-Louise Ponsonby
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Maja Jagodic
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Rodney Lea
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia
| | - Jeannette Lechner-Scott
- From the School of Medicine and Public Health (V.M., R.L., J.L.-S.), University of Newcastle, University Drive, Callaghan; Immune Health Program (V.M., A.X., J.L.-S.), Hunter Medical Research Institute; Department of Neurology (V.M., J.L.-S.), John Hunter Hospital, New Lambton Heights; School of Biomedical Sciences and Pharmacy (A.X.), University of Newcastle, University Drive, Callaghan, Australia; Department of Clinical Neuroscience (E.E., L.K., M.J.), Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Neuroscience (M.-P.C., S.S., H.B., V.J.), Central Clinical School, Monash University, Victoria; Division of Molecular Genetics (R.J.S.), Pathology North, John Hunter Hospital, New Lambton Heights; MSBase Foundation (H.B.), Melbourne, Australia; Institute of Clinical Medicine (S.B.), University of Oslo,; Department of Neurology (S.B.), Oslo University Hospital, Norway; Flinders University (M.S.), Adelaide; Menzies Institute for Medical Research (I.A.M., B.V.T.), University of Tasmania, Hobart; Florey Institute of Neuroscience and Mental Health (A.-L.P.), The University of Melbourne; Centre of Epidemiology and Biostatistics (A.-L.P.), School of Population and Global Health, University of Melbourne; Murdoch Children's Research Institute (A.-L.P.), Royal Children's Hospital, Melbourne; and Centre for Genomics and Personalized Health (R.L.), School of Biomedical Science, Queensland University of Technology, Kelvin Grove, Australia.
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7
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Xavier A, Maltby VE, Ewing E, Campagna MP, Burnard SM, Tegner JN, Slee M, Butzkueven H, Kockum I, Kular L, Jokubaitis VG, Kilpatrick T, Alfredsson L, Jagodic M, Ponsonby AL, Taylor BV, Scott RJ, Lea RA, Lechner-Scott J. DNA Methylation Signatures of Multiple Sclerosis Occur Independently of Known Genetic Risk and Are Primarily Attributed to B Cells and Monocytes. Int J Mol Sci 2023; 24:12576. [PMID: 37628757 PMCID: PMC10454485 DOI: 10.3390/ijms241612576] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Epigenetic mechanisms can regulate how DNA is expressed independently of sequence and are known to be associated with various diseases. Among those epigenetic mechanisms, DNA methylation (DNAm) is influenced by genotype and the environment, making it an important molecular interface for studying disease etiology and progression. In this study, we examined the whole blood DNA methylation profiles of a large group of people with (pw) multiple sclerosis (MS) compared to those of controls. We reveal that methylation differences in pwMS occur independently of known genetic risk loci and show that they more strongly differentiate disease (AUC = 0.85, 95% CI 0.82-0.89, p = 1.22 × 10-29) than known genetic risk loci (AUC = 0.72, 95% CI: 0.66-0.76, p = 9.07 × 10-17). We also show that methylation differences in MS occur predominantly in B cells and monocytes and indicate the involvement of cell-specific biological pathways. Overall, this study comprehensively characterizes the immune cell-specific epigenetic architecture of MS.
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Affiliation(s)
- Alexandre Xavier
- School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (A.X.); (S.M.B.); (R.J.S.)
| | - Vicki E. Maltby
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (V.E.M.); (R.A.L.)
- Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - Ewoud Ewing
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden; (E.E.); (I.K.); (L.K.); (L.A.); (M.J.)
| | - Maria Pia Campagna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (M.P.C.); (H.B.); (V.G.J.)
| | - Sean M. Burnard
- School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (A.X.); (S.M.B.); (R.J.S.)
| | - Jesper N. Tegner
- Biological and Environmental Science and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia;
- Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
- Unit of Computational Medicine, Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, L8:05, 17176 Stockholm, Sweden
- Science for Life Laboratory, Tomtebodavagen 23A, 17165 Solna, Sweden
| | - Mark Slee
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (M.P.C.); (H.B.); (V.G.J.)
- MSBase Foundation, Melbourne, VIC 3004, Australia
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden; (E.E.); (I.K.); (L.K.); (L.A.); (M.J.)
| | - Lara Kular
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden; (E.E.); (I.K.); (L.K.); (L.A.); (M.J.)
| | | | - Vilija G. Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (M.P.C.); (H.B.); (V.G.J.)
| | - Trevor Kilpatrick
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC 3052, Australia; (T.K.); (A.-L.P.)
| | - Lars Alfredsson
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden; (E.E.); (I.K.); (L.K.); (L.A.); (M.J.)
| | - Maja Jagodic
- Department of Clinical Neuroscience, Karolinska Institutet, Center for Molecular Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden; (E.E.); (I.K.); (L.K.); (L.A.); (M.J.)
| | - Anne-Louise Ponsonby
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC 3052, Australia; (T.K.); (A.-L.P.)
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT 2601, Australia
| | - Bruce V. Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia;
| | - Rodney J. Scott
- School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (A.X.); (S.M.B.); (R.J.S.)
- Department of Molecular Genetics, Pathology North, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - Rodney A. Lea
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (V.E.M.); (R.A.L.)
- Centre for Genomics and Personalised Health, School of Biomedical Science, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW 2305, Australia; (V.E.M.); (R.A.L.)
- Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
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8
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Fuh-Ngwa V, Charlesworth JC, Zhou Y, van der Mei I, Melton PE, Broadley SA, Ponsonby AL, Simpson-Yap S, Lechner-Scott J, Taylor BV. The association between disability progression, relapses, and treatment in early relapse onset MS: an observational, multi-centre, longitudinal cohort study. Sci Rep 2023; 13:11584. [PMID: 37463930 DOI: 10.1038/s41598-023-38415-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
The indirect contribution of multiple sclerosis (MS) relapses to disability worsening outcomes, and vice-versa, remains unclear. Disease modifying therapies (DMTs) are potential modulators of this association. Understanding how these endo-phenotypes interact may provide insights into disease pathogenesis and treatment practice in relapse-onset MS (ROMS). Utilising a unique, prospectively collected clinical data from a longitudinal cohort of 279 first demyelinating event cases followed for up to 15 years post-onset, we examined indirect associations between relapses and treatment and the risk of disability worsening, and vice-versa. Indirect association parameters were estimated using joint models for longitudinal and survival data. Early relapses within 2.5 years of MS onset predicted early disability worsening outcomes (HR = 3.45, C.I 2.29-3.61) per relapse, but did not contribute to long-term disability worsening thereinafter (HR = 0.21, C.I 0.15-0.28). Conversely, disability worsening outcomes significantly contributed to relapse risk each year (HR = 2.96, C.I 2.91-3.02), and persisted over time (HR = 3.34, C.I 2.90-3.86), regardless of DMT treatments. The duration of DMTs significantly reduced the hazards of relapses (1st-line DMTs: HR = 0.68, C.I 0.58-0.79; 3rd-line DMTs: HR = 0.37, C.I 0.32-0.44) and disability worsening events (1st-line DMTs: HR = 0.74, C.I 0.69-0.79; 3rd-line DMTs: HR = 0.90, C.I 0.85-0.95), respectively. Results from time-dynamic survival probabilities further revealed individuals having higher risk of future relapses and disability worsening outcomes, respectively. The study provided evidence that in ROMS, relapses accrued within 2.5 years of MS onset are strong indicators of disability worsening outcomes, but late relapses accrued 2.5 years post onset are not overt risk factors for further disability worsening. In contrast, disability worsening outcomes are strong positive predictors of current and subsequent relapse risk. Long-term DMT use and older age strongly influence the individual outcomes and their associations.
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Affiliation(s)
- Valery Fuh-Ngwa
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia.
| | - Jac C Charlesworth
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Phillip E Melton
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Simon A Broadley
- Menzies Health Institute Queensland and School of Medicine, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Anne-Louise Ponsonby
- Florey Institute for Neuroscience and Mental Health, Parkville, VIC, 3052, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
- Neuroepidemiology Unit, Center for Epidemiology and Biostatistics, The University of Melbourne School of Population & Global Health, Melbourne, VIC, 3053, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health New Lambton, Hunter New England Health, New Lambton Heights, NSW, Australia
- Department of Neurology, The University of Newcastle Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia.
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9
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Xavier A, Campagna MP, Maltby VE, Kilpatrick T, Taylor BV, Butzkueven H, Ponsonby AL, Scott RJ, Jokubaitis VG, Lea RA, Lechner-Scott J. Interferon beta treatment is a potent and targeted epigenetic modifier in multiple sclerosis. Front Immunol 2023; 14:1162796. [PMID: 37325639 PMCID: PMC10266220 DOI: 10.3389/fimmu.2023.1162796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Multiple Sclerosis (MS) has a complex pathophysiology that involves genetic and environmental factors. DNA methylation (DNAm) is one epigenetic mechanism that can reversibly modulate gene expression. Cell specific DNAm changes have been associated with MS, and some MS therapies such as dimethyl fumarate can influence DNAm. Interferon Beta (IFNβ), was one of the first disease modifying therapies in multiple sclerosis (MS). However, how IFNβ reduces disease burden in MS is not fully understood and little is known about the precise effect of IFNβ treatment on methylation. Methods The objective of this study was to determine the changes in DNAm associated with INFβ use, using methylation arrays and statistical deconvolutions on two separate datasets (total ntreated = 64, nuntreated = 285). Results We show that IFNβ treatment in people with MS modifies the methylation profile of interferon response genes in a strong, targeted, and reproducible manner. Using these identified methylation differences, we constructed a methylation treatment score (MTS) that is an accurate discriminator between untreated and treated patients (Area under the curve = 0.83). This MTS is time-sensitive and in consistent with previously identified IFNβ treatment therapeutic lag. This suggests that methylation changes are required for treatment efficacy. Overrepresentation analysis found that IFNβ treatment recruits the endogenous anti-viral molecular machinery. Finally, statistical deconvolution revealed that dendritic cells and regulatory CD4+ T cells were most affected by IFNβ induced methylation changes. Discussion In conclusion, our study shows that IFNβ treatment is a potent and targeted epigenetic modifier in multiple sclerosis.
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Affiliation(s)
- Alexandre Xavier
- School of Biomedical Science and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Maria Pia Campagna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Vicki E. Maltby
- Hunter Medical Research Institute, Immune Health research program, Newcastle, NSW, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Trevor Kilpatrick
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Bruce V. Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Neuro-Immunology Registry, MSBase Foundation, Melbourne, VIC, Australia
| | - Anne-Louise Ponsonby
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Rodney J. Scott
- School of Biomedical Science and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- New South Wales (NSW) Health Pathology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Vilija G. Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Rodney A. Lea
- School of Biomedical Science and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
- Centre of Genomics and Personalised Health, School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, Immune Health research program, Newcastle, NSW, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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10
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Mannino A, Daly A, Dunlop E, Probst Y, Ponsonby AL, van der Mei IAF, Black LJ. Higher consumption of ultra-processed foods and increased likelihood of central nervous system demyelination in a case-control study of Australian adults. Eur J Clin Nutr 2023; 77:611-614. [PMID: 36754977 PMCID: PMC10169648 DOI: 10.1038/s41430-023-01271-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Consumption of ultra-processed foods (UPFs) has been linked to risk of chronic diseases, with scant evidence in relation to multiple sclerosis (MS). METHODS We tested associations between UPF consumption and likelihood of a first clinical diagnosis of central nervous system demyelination (FCD) (267 cases, 508 controls), a common precursor to MS. We used data from the 2003-2006 Ausimmune Study and logistic regression with full propensity score matching for age, sex, region of residence, education, smoking history, body mass index, physical activity, history of infectious mononucleosis, dietary misreporting, and total energy intake. RESULTS Higher UPF consumption was statistically significantly associated with an increased likelihood of FCD (adjusted odds ratio = 1.08; 95% confidence interval = 1.0,1.15; p = 0.039), representing an 8% increase in likelihood of FCD per one energy-adjusted serving/day of UPFs. CONCLUSION Higher intakes of UPF were associated with increased likelihood of FCD in this Australian cohort. Nutrition education and awareness of healthy eating patterns may benefit those at high risk of FCD.
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Affiliation(s)
- Adriana Mannino
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Alison Daly
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Eleanor Dunlop
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Yasmine Probst
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Neuroepidemiology, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Ingrid A F van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Lucinda J Black
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.
- Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.
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11
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Lin X, Yang Y, Fuh-Ngwa V, Yin X, Simpson-Yap S, van der Mei I, Broadley SA, Ponsonby AL, Burdon KP, Taylor BV, Zhou Y. Genetically determined serum serine level has a novel causal effect on multiple sclerosis risk and predicts disability progression. J Neurol Neurosurg Psychiatry 2023:jnnp-2022-330259. [PMID: 36732044 DOI: 10.1136/jnnp-2022-330259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND There are currently no specific biomarkers for multiple sclerosis (MS). Identifying robust biomarkers for MS is crucial to improve disease diagnosis and management. METHODS This study first used six Mendelian randomisation methods to assess causal relationship of 174 metabolites with MS, incorporating data from European-ancestry metabolomics (n=8569-86 507) and MS (n=14 802 MS cases, 26 703 controls) genomewide association studies. Genetic scores for identified causal metabolite(s) were then computed to predict MS disability progression in an independent longitudinal cohort (AusLong study) of 203 MS cases with up to 15-year follow-up. RESULTS We found a novel genetic causal effect of serine on MS onset (OR=1.67, 95% CI 1.51 to 1.84, p=1.73×10-20), such that individuals whose serine level is 1 SD above the population mean will have 1.67 times the risk of developing MS. This is robust across all sensitivity methods (OR ranges from 1.49 to 1.67). In an independent longitudinal MS cohort, we then constructed time-dynamic and time-fixed genetic scores based on serine genetic instrument single-nucleotide polymorphisms, where higher scores for raised serum serine level were associated with increased risk of disability worsening, especially in the time-dynamic model (RR=1.25, 95% CI 1.10 to 1.42, p=7.52×10-4). CONCLUSIONS These findings support investigating serine as an important candidate biomarker for MS onset and disability progression.
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Affiliation(s)
- Xin Lin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Yuanhao Yang
- Mater Research Institute, Translational Research Institute, Woolloongabba, Queensland, Australia.,Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia
| | - Valery Fuh-Ngwa
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Xianyong Yin
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Neuroepidemiology Unit, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Simon A Broadley
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, Victoria, Australia.,Neuroepidemiology Group, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | | | - Kathryn P Burdon
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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12
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Fuh-Ngwa V, Zhou Y, Melton PE, van der Mei I, Charlesworth JC, Lin X, Zarghami A, Broadley SA, Ponsonby AL, Simpson-Yap S, Lechner-Scott J, Taylor BV. Ensemble machine learning identifies genetic loci associated with future worsening of disability in people with multiple sclerosis. Sci Rep 2022; 12:19291. [PMID: 36369345 PMCID: PMC9652373 DOI: 10.1038/s41598-022-23685-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
Limited studies have been conducted to identify and validate multiple sclerosis (MS) genetic loci associated with disability progression. We aimed to identify MS genetic loci associated with worsening of disability over time, and to develop and validate ensemble genetic learning model(s) to identify people with MS (PwMS) at risk of future worsening. We examined associations of 208 previously established MS genetic loci with the risk of worsening of disability; we learned ensemble genetic decision rules and validated the predictions in an external dataset. We found 7 genetic loci (rs7731626: HR 0.92, P = 2.4 × 10-5; rs12211604: HR 1.16, P = 3.2 × 10-7; rs55858457: HR 0.93, P = 3.7 × 10-7; rs10271373: HR 0.90, P = 1.1 × 10-7; rs11256593: HR 1.13, P = 5.1 × 10-57; rs12588969: HR = 1.10, P = 2.1 × 10-10; rs1465697: HR 1.09, P = 1.7 × 10-128) associated with risk worsening of disability; most of which were located near or tagged to 13 genomic regions enriched in peptide hormones and steroids biosynthesis pathways by positional and eQTL mapping. The derived ensembles produced a set of genetic decision rules that can be translated to provide additional prognostic values to existing clinical predictions, with the additional benefit of incorporating relevant genetic information into clinical decision making for PwMS. The present study extends our knowledge of MS progression genetics and provides the basis of future studies regarding the functional significance of the identified loci.
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Affiliation(s)
- Valery Fuh-Ngwa
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Yuan Zhou
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Phillip E. Melton
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Ingrid van der Mei
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Jac C. Charlesworth
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Xin Lin
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Amin Zarghami
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
| | - Simon A. Broadley
- grid.1022.10000 0004 0437 5432Menzies Health Institute Queensland and School of Medicine, Griffith University Gold Coast, G40 Griffith Health Centre, QLD 4222, Australia
| | - Anne-Louise Ponsonby
- grid.1058.c0000 0000 9442 535XDeveloping Brain Division, The Florey Institute for Neuroscience and Mental Health, Royal Children’s Hospital, University of Melbourne Murdoch Children’s Research Institute, Parkville, VIC 3052 Australia
| | - Steve Simpson-Yap
- grid.1008.90000 0001 2179 088XNeuroepidemiology Unit, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC 3053 Australia
| | - Jeannette Lechner-Scott
- grid.266842.c0000 0000 8831 109XDepartment of Neurology, Hunter Medical Research Institute, Hunter New England Health, University of Newcastle, Callaghan, NSW 2310 Australia
| | - Bruce V. Taylor
- grid.1009.80000 0004 1936 826XMenzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000 Australia
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13
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Chapman C, Lucas RM, Ponsonby AL, Taylor B, Chapman C, Coulthard A, Dear K, Dwyer T, Kilpatrick T, Lucas R, McMichael T, Pender M, Ponsonby AL, Taylor B, Valery PC, van der Mei I, Williams D. Predictors of progression from a first demyelinating event to clinically definite multiple sclerosis. Brain Commun 2022; 4:fcac181. [PMID: 35891671 PMCID: PMC9308470 DOI: 10.1093/braincomms/fcac181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/07/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Understanding the predictors of progression from a first to a second demyelinating event (and formerly, a diagnosis of clinically definite multiple sclerosis) is important clinically. Previous studies have focused on predictors within a single domain, e.g. radiological, lacking prospective data across multiple domains. We tested a comprehensive set of personal, environmental, neurological, MRI and genetic characteristics, considered together, as predictors of progression from a first demyelinating event to clinically definite multiple sclerosis. Participants were aged 18–59 years and had a first demyelinating event during the study recruitment period (1 November 2003–31 December 2006) for the Ausimmune Study (n = 216) and had follow-up data to 2–3 years post-initial interview. Detailed baseline data were available on a broad range of demographic and environmental factors, MRI, and genetic and viral studies. Follow-up data included confirmation of clinically definite multiple sclerosis (or not) and changes in environmental exposures during the follow-up period. We used multivariable logistic regression and Cox proportional hazards regression modelling to test predictors of, and time to, conversion to clinically definite multiple sclerosis. On review, one participant had an undiagnosed event prior to study recruitment and was excluded (n = 215). Data on progression to clinically definite multiple sclerosis were available for 91.2% (n = 196); 77% were diagnosed as clinically definite multiple sclerosis at follow-up. Mean (standard deviation) duration of follow-up was 2.7 (0.7) years. The set of predictors retained in the best predictive model for progression from a first demyelinating event to clinically definite multiple sclerosis were as follows: younger age at first demyelinating event [adjusted odds ratio (aOR) = 0.92, 95% confidence interval (CI) = 0.87–0.97, per additional year of age); being a smoker at baseline (versus not) (aOR = 2.55, 95% CI 0.85–7.69); lower sun exposure at age 6–18 years (aOR = 0.86, 95% CI 0.74–1.00, per 100 kJ/m2 increment in ultraviolet radiation dose), presence (versus absence) of infratentorial lesions on baseline magnetic resonance imaging (aOR = 7.41, 95% CI 2.08–26.41); and single nucleotide polymorphisms in human leukocyte antigen (HLA)-B (rs2523393, aOR = 0.25, 95% CI 0.09–0.68, for any G versus A:A), TNFRSF1A (rs1800693, aOR = 5.82, 95% CI 2.10–16.12, for any C versus T:T), and a vitamin D-binding protein gene (rs7041, aOR = 3.76, 95% CI 1.41–9.99, for any A versus C:C). The final model explained 36% of the variance. Predictors of more rapid progression to clinically definite multiple sclerosis (Cox proportional hazards regression) were similar. Genetic and magnetic resonance imaging characteristics as well as demographic and environmental factors predicted progression, and more rapid progression, from a first demyelinating event to a second event and clinically definite multiple sclerosis.
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Affiliation(s)
- Caron Chapman
- Barwon Health , PO Box 281, Geelong, VIC 3220 , Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University , Cnr Mills and Eggleston Roads, Canberra 2601 , Australia
| | - Anne-Louise Ponsonby
- The Florey Institute of Neuroscience and Mental Health , 30 Royal Pde, Parkville, VIC 3052 , Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania , 17 Liverpool St, Hobart , Australia
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Dieu DYR, Dunlop E, Daly A, Lucas RM, Probst Y, Black LJ. Total Dairy Consumption Is Not Associated With Likelihood of a First Clinical Diagnosis of Central Nervous System Demyelination. Front Neurol 2022; 13:888559. [PMID: 35645978 PMCID: PMC9136160 DOI: 10.3389/fneur.2022.888559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022] Open
Abstract
Background The evidence associating consumption of dairy products and risk of MS is contradictory and inconclusive. Objective To test associations between dairy consumption and the likelihood of a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS. Methods We used data from the 2003–2006 Ausimmune Study, a population-based Australian, multicentre, matched case-control study (272 cases, 519 controls). Total dairy consumption (servings/day) was calculated by summing consumption of milk, cheese and yogurt. Covariate-adjusted treatment effects using augmented inverse probability weighting was used to test for associations with FCD. We conducted sensitivity analyses in the subset of participants who had had a classic first demyelinating event (FDE), defined as a single, first episode of symptoms suggestive of CNS demyelination. Results There were no statistically significant associations between total dairy consumption (per one serving/day) and FCD (adjusted OR 1.00; 95% CI 0.93, 1.07; p = 0.979). However, yogurt consumption (vs. no yogurt consumption) was associated with an 11% decreased likelihood of FDE (adjusted OR 0.89; 95% CI 0.89, 0.79; p = 0.046). Conclusion While total dairy consumption was not associated with FCD in this Australian case-control study, yogurt consumption was associated with reduced likelihood of FDE.
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Affiliation(s)
| | - Eleanor Dunlop
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Alison Daly
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Robyn M. Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, WA, Australia
| | - Yasmine Probst
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Lucinda J. Black
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, WA, Australia
- *Correspondence: Lucinda J. Black
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15
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Tiller C, Black LJ, Ponsonby AL, Taylor B, van der Mei I, Clarke MW, Lucas RM. Vitamin D metabolites and risk of first clinical diagnosis of central nervous system demyelination. J Steroid Biochem Mol Biol 2022; 218:106060. [PMID: 35031430 DOI: 10.1016/j.jsbmb.2022.106060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
Low 25-hydroxyvitamin D (25(OH)D) concentration is a recognised risk factor for multiple sclerosis (MS). Associations with vitamin D metabolites and vitamin D binding globulin (VDBG) have not been widely studied. We assessed the association between vitamin D metabolites (25(OH)D2, 25(OH)D3, c3-epimer 25(OH)D3, 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), and 24,25-dihydroxyvitamin D3 (24,25(OH)2D3)) measured by liquid chromatography-tandem mass spectrometry assays, VDBG measured using a polyclonal immunoassay, and calculated free and bioavailable 25(OH)D, free 1,25(OH)2D3, and the 24,25(OH)2D3: total 25(OH)D and total 1,25(OH)2D: total 25(OH)D ratios with risk of a first clinical diagnosis of CNS demyelination (FCD) in an Australian case-control study (n = 196 cases, n = 241 controls, matched on age, sex and study region). Higher 25(OH)D (adjusted odds ratio (AOR) = 0.94 (95 % confidence interval (CI) 0.85-1.03) per 10 nmol/L increment) and 24,25(OH)2D3 (AOR = 0.81 (95 %CI 0.65-1.00) per 1 nmol/L increment) concentrations were associated with reduced FCD risk. Our results were compatible with no association for the other vitamin D metabolites, ratios, or VDBG with FCD risk. Thus, using standardised assays, and a comprehensive range of vitamin D metabolites, we confirmed the association of higher 25(OH)D and reduced FCD risk, and describe a similar effect for 24,25(OH)2D3; free or bioavailable 25(OH)D were not associated with FCD risk.
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Affiliation(s)
- Courtney Tiller
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia; Graduate Medicine, University of Wollongong, New South Wales, Australia
| | - Lucinda J Black
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Anne-Louise Ponsonby
- Florey Institute for Neuroscience, University of Melbourne, Melbourne, Australia
| | - Bruce Taylor
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Ingrid van der Mei
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Michael W Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, WA, 6009, Australia; School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, 6009, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia.
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Markers of Epstein-Barr virus and Human Herpesvirus-6 infection and multiple sclerosis clinical progression. Mult Scler Relat Disord 2022; 59:103561. [DOI: 10.1016/j.msard.2022.103561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/09/2022] [Accepted: 01/23/2022] [Indexed: 11/17/2022]
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Fuh-Ngwa V, Zhou Y, Charlesworth JC, Ponsonby AL, Simpson-Yap S, Lechner-Scott J, Taylor BV. Developing a clinical-environmental-genotypic prognostic index for relapsing-onset multiple sclerosis and clinically isolated syndrome. Brain Commun 2021; 3:fcab288. [PMID: 34950873 PMCID: PMC8691056 DOI: 10.1093/braincomms/fcab288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/26/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022] Open
Abstract
Our inability to reliably predict disease outcomes in multiple sclerosis remains an issue for clinicians and clinical trialists. This study aims to create, from available clinical, genetic and environmental factors; a clinical–environmental–genotypic prognostic index to predict the probability of new relapses and disability worsening. The analyses cohort included prospectively assessed multiple sclerosis cases (N = 253) with 2858 repeated observations measured over 10 years. N = 219 had been diagnosed as relapsing-onset, while N = 34 remained as clinically isolated syndrome by the 10th-year review. Genotype data were available for 199 genetic variants associated with multiple sclerosis risk. Penalized Cox regression models were used to select potential genetic variants and predict risk for relapses and/or worsening of disability. Multivariable Cox regression models with backward elimination were then used to construct clinical–environmental, genetic and clinical–environmental–genotypic prognostic index, respectively. Robust time-course predictions were obtained by Landmarking. To validate our models, Weibull calibration models were used, and the Chi-square statistics, Harrell’s C-index and pseudo-R2 were used to compare models. The predictive performance at diagnosis was evaluated using the Kullback–Leibler and Brier (dynamic) prediction error (reduction) curves. The combined index (clinical–environmental–genotypic) predicted a quadratic time-dynamic disease course in terms of worsening (HR = 2.74, CI: 2.00–3.76; pseudo-R2=0.64; C-index = 0.76), relapses (HR = 2.16, CI: 1.74–2.68; pseudo-R2 = 0.91; C-index = 0.85), or both (HR = 3.32, CI: 1.88–5.86; pseudo-R2 = 0.72; C-index = 0.77). The Kullback–Leibler and Brier curves suggested that for short-term prognosis (≤5 years from diagnosis), the clinical–environmental components of disease were more relevant, whereas the genetic components reduced the prediction errors only in the long-term (≥5 years from diagnosis). The combined components performed slightly better than the individual ones, although their prognostic sensitivities were largely modulated by the clinical–environmental components. We have created a clinical–environmental–genotypic prognostic index using relevant clinical, environmental, and genetic predictors, and obtained robust dynamic predictions for the probability of developing new relapses and worsening of symptoms in multiple sclerosis. Our prognostic index provides reliable information that is relevant for long-term prognostication and may be used as a selection criterion and risk stratification tool for clinical trials. Further work to investigate component interactions is required and to validate the index in independent data sets.
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Affiliation(s)
- Valery Fuh-Ngwa
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Jac C Charlesworth
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Anne-Louise Ponsonby
- Developing Brain Division, The Florey Institute for Neuroscience and Mental Health, University of Melbourne Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia.,Neuroepidemiology Unit, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, 3053, Australia
| | - Jeannette Lechner-Scott
- Department of Neurology, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, 2310, Australia.,Department of Neurology, John Hunter Hospital, Newcastle, NSW, 2310, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
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18
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Pilotto S, Gencarelli J, Bova S, Gerosa L, Baroncini D, Olivotto S, Alfei E, Zaffaroni M, Suppiej A, Cocco E, Trojano M, Amato MP, D'Alfonso S, Martinelli-Boneschi F, Waubant E, Ghezzi A, Bergamaschi R, Pugliatti M. Etiological research in pediatric multiple sclerosis: A tool to assess environmental exposures (PEDiatric Italian Genetic and enviRonment ExposurE Questionnaire). Mult Scler J Exp Transl Clin 2021; 7:20552173211059048. [PMID: 34868629 PMCID: PMC8640303 DOI: 10.1177/20552173211059048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background The etiology of pediatric-onset multiple sclerosis is unknown although putative genetic and environmental factors appear to be involved. Among children multiple sclerosis onset occurs closer to the susceptibility window thank in adults and the exposure to etiological environmental factors is more informative. An Italian multicentre case-control study (the PEDiatric Italian Genetic and enviRonment ExposurE, PEDIGREE study) was designed to investigate environmental exposures in pediatric-onset multiple sclerosis and their interaction with genetics. Objectives To collect evidence on exposures to environmental risk factors in pediatric-onset multiple sclerosis, a questionnaire was developed for the Italian population (PEDIGREE Questionnaire) and is presented. Methods PEDIGREE Questionnaire develops from an existing tool used in case-control studies on pediatric-onset multiple sclerosis in US Americans, and was translated, adapted and tested for the contents perceived relevance, acceptability, feasibility and reliability in a population of Italian pediatric subjects and their parents recruited from clinics and general population. Results PEDIGREE Questionnaire contents were overall deemed relevant by the study population, acceptable for 100% participants and feasible for at least 98%. PEDIGREE Questionnaire degree of reliability ranged 56% to 72%. Conclusion PEDIGREE Questionnaire proves to be an efficient tool to assess environmental exposures in the Italian pediatric population. We encourage the dissemination of population-specific questionnaires and shared methodology to optimize efforts in MS etiological research.
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Affiliation(s)
- Silvy Pilotto
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Jessica Gencarelli
- Department of Medical Sciences - Pediatric Section, University of Ferrara, Ferrara, Italy
| | - Stefania Bova
- Pediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Leonardo Gerosa
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | | | - Enrico Alfei
- Pediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate, Italy
| | - Agnese Suppiej
- Department of Medical Sciences - Pediatric Section, University of Ferrara, Ferrara, Italy
| | - Eleonora Cocco
- Department Medical Science and Public Health, University of Cagliari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | | | | | | | - Emmanuelle Waubant
- Department of Neurology, UC San Francisco, San Francisco, California, USA
| | - Angelo Ghezzi
- Multiple Sclerosis Centre, ASST Valle Olona, Gallarate, Italy
| | | | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, Interdepartmental Research Center for the Study of Multiple Sclerosis and Inflammatory and Degenerative Diseases of the Nervous System, University of Ferrara, Ferrara, Italy
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A proinflammatory diet is associated with an increased likelihood of first clinical diagnosis of central nervous system demyelination in women. Mult Scler Relat Disord 2021; 57:103428. [PMID: 34856497 DOI: 10.1016/j.msard.2021.103428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND While a number of studies have examined associations between dietary factors and risk of multiple sclerosis (MS), little is known about intakes of inflammation-modulating foods and nutrients and risk of MS. OBJECTIVES To test associations between the Dietary Inflammatory Index (DII®) and risk of a first clinical diagnosis of central nervous system (CNS) demyelination (FCD) (267 cases, 507 controls) using data from the Ausimmune Study. METHODS The 2003-2006 Ausimmune Study was a multicentre, matched, case-control study examining environmental risk factors for an FCD, a common precursor to MS. The DII is a well-recognised tool that categorises individuals' diets on a continuum from maximally anti-inflammatory to maximally pro-inflammatory. The DII score was calculated from dietary intake data collected using a food frequency questionnaire. Conditional logistic regression models were used to estimate the association between DII and FCD separately for men and women. RESULTS In women, a higher DII score was associated with increased likelihood of FCD, with a 17% increase in likelihood of FCD per one-unit increase in DII score (adjusted odds ratio 1.17, 95% confidence interval 1.04-1.33). There was no association between DII and FCD in men (adjusted odds ratio 0.88, 95% confidence interval 0.73-1.07). CONCLUSIONS These findings suggest that a pro-inflammatory diet is associated with an increased likelihood of FCD in women.
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20
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Daly A, Martin C, Sherriff J, Mori TA, Pereira G, Lucas RM, Ponsonby AL, Taylor B, van der Mei I, Black LJ. Omega-3 Index, fish consumption, use of fish oil supplements and first clinical diagnosis of central nervous system demyelination. Mult Scler Relat Disord 2021; 55:103210. [PMID: 34399318 DOI: 10.1016/j.msard.2021.103210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Higher intakes of omega-3 polyunsaturated fatty acids (n3PUFAs) have been associated with lower MS risk. We aimed to test associations between the Omega-3 Index, blood levels of n3PUFAs, fish oil supplement use, and fish consumption with a first clinical diagnosis of CNS demyelination (FCD). Cases (n = 250) had a higher Omega-3 Index compared with a matched group of controls (n = 471) (average treatment effect (ATE)=0.31, p = 0.047, based on augmented inverse probability weighting). A higher percentage of cases than controls used fish oil supplements (cases=17% vs. controls=10%). We found that Omega-3 Index increased as time between FCD and study interview increased (e.g., at or below median (112 days), based on ATE, mean=5.30, 95% CI 5.08, 5.53; above median, mean=5.90, 95% CI 5.51, 6.30). Fish oil supplement use increased in a similar manner (at or below median (112 days), based on ATE, proportion=0.12, 95% CI 0.06, 0.18; above the median, proportion=0.21, 95% CI 0.14, 0.28). Our results suggest a behaviour change post FCD with increased use of fish oil supplements.
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Affiliation(s)
- Alison Daly
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Christopher Martin
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Jill Sherriff
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Trevor A Mori
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, WA, Australia; enAble Institute, Curtin University, Perth, WA, Australia; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, WA, Australia
| | - Anne-Louise Ponsonby
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Lucinda J Black
- Curtin School of Population Health, Curtin University, Perth, WA, Australia.
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The increasing economic burden of multiple sclerosis by disability severity in Australia in 2017: Results from updated and detailed data on types of costs. Mult Scler Relat Disord 2020; 44:102247. [DOI: 10.1016/j.msard.2020.102247] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/08/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022]
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Simpson-Yap S, Oddy WH, Taylor B, Lucas RM, Black LJ, Ponsonby AL, Blizzard L, van der Mei I. High Prudent diet factor score predicts lower relapse hazard in early multiple sclerosis. Mult Scler 2020; 27:1112-1124. [PMID: 32701031 DOI: 10.1177/1352458520943087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dietary patterns and their association with subsequent clinical course have not been well studied in early multiple sclerosis (MS). OBJECTIVES To describe dietary patterns in people in 5 years following first clinical demyelination and assess associations with MS conversion and relapse. METHODS This study included baseline food frequency questionnaire dietary intake (entry to the Ausimmune Study) and 5-year follow-up; iterated principal factor analysis was applied. MS conversion and relapse risks were assessed by Cox proportional hazards models, adjusted for age, sex, study site, education, body mass index (BMI), smoking and omega-3 supplement use. RESULTS In cases with a first clinical diagnosis of central nervous system (CNS) demyelination, we identified three major dietary patterns, 'Prudent', 'High-Vegetable' and 'Mixed', explaining 43%, 37% and 24% of diet variance in dietary intake, respectively. Fruits, vegetables, fish, wholegrains and nuts loaded highly on the Prudent pattern, starchy vegetables and legumes on the High-Vegetable pattern, and meats and alcohol on the Mixed pattern. Diet factor scores were not associated with MS conversion risk. Those with baseline Prudent scores above the median had significantly lower relapse risk (adjusted hazard ratio = 0.54, 95% confidence interval (CI) 0.37, 0.81) with some evidence of a plateau effect. CONCLUSION Prudent diet factor score above the median was prospectively associated with lower relapse risk in the 5 years following the first clinical demyelinating event.
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Affiliation(s)
- Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Wendy H Oddy
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology & Population Health, Research School of Population Health, The Australian National University, Acton, ACT, Australia/Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, WA, Australia
| | - Lucinda J Black
- School of Public Health, Curtin University, Bentley, WA, Australia
| | - Anne-Louise Ponsonby
- National Centre for Epidemiology & Population Health, Research School of Population Health, The Australian National University, Acton, ACT, Australia/Murdoch Children's Research Institute, The University of Melbourne, Melbourne, VIC, Australia/Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Hughes AM, Ponsonby AL, Dear K, Dwyer T, Taylor BV, van der Mei I, Valery PC, Lucas RM. Childhood infections, vaccinations, and tonsillectomy and risk of first clinical diagnosis of CNS demyelination in the Ausimmune Study. Mult Scler Relat Disord 2020; 42:102062. [PMID: 32305688 DOI: 10.1016/j.msard.2020.102062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The association between childhood vaccinations and infections and risk of multiple sclerosis is unclear; few studies have considered age at vaccination/infection. OBJECTIVE To explore age-related associations between childhood vaccinations, infection and tonsillectomy and risk of a first clinical diagnosis of CNS demyelination. METHODS Data on case (n = 275, 76.6% female; mean age 38.6 years) and age- and sex-matched control (n = 529) participants in an incident population-based case-control study included self-reported age at time of childhood vaccinations, infections, and tonsillectomy. Conditional logistic regression models were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS Poliomyelitis vaccination prior to school-age was associated with increased risk of a first clinical diagnosis of CNS demyelination (AOR = 2.60, 95%CI 1.02-6.68), based on a very small unvaccinated reference group. Late (11-15 years) rubella vaccination (compared to none) was associated with lower odds of being a case (AOR = 0.47, 95%CI 0.27-0.83). Past infectious mononucleosis at 11-15 years (AOR = 2.84, 95%CI 1.0-7.57) and 16-20 years (AOR = 1.92, 95%CI 1.12-3.27) or tonsillectomy in adolescence (11-15 years: AOR = 2.45, 95%CI 1.12-5.35), including after adjustment for IM, were associated with increased risk of a first clinical diagnosis of CNS demyelination. CONCLUSIONS Age at vaccination, infection or tonsillectomy may alter the risk of subsequent CNS demyelination. Failing to account for age effects may explain inconsistencies in past findings.
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Affiliation(s)
- A M Hughes
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; The Canberra Hospital, Canberra, Australia
| | - A-L Ponsonby
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - K Dear
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - T Dwyer
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - B V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - I van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - R M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia.
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Marion S, Leonid C, Belinda B, Joanne D, Elise H, Leeanne C, Richard M. Effects of modified-release fampridine on upper limb impairment in patients with Multiple Sclerosis. Mult Scler Relat Disord 2020; 40:101971. [PMID: 32062444 DOI: 10.1016/j.msard.2020.101971] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 12/17/2019] [Accepted: 01/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Modified-release 4-aminopyridine (fampridine-MR) is used in the symptomatic treatment of walking disability in patients with multiple sclerosis (MS). Its potential for use in other MS symptoms remains unproven and its mode of action in this context is uncertain. Interest is growing in the use of upper limb outcome measures in clinical trials in patients with Multiple Sclerosis, particularly in advanced or progressive disease. This study tests the following hypotheses: (1) Fampridine-MR improves upper limb function in patients with MS and upper limb impairment. (2) Treatment with fampridine-MR is associated with measurable alterations in objective electrophysiological parameters (evoked potentials and transcranial magnetic stimulation (TMS)) which may predict response to drug treatment. METHODS Study population: patients with MS of any disease subtype, duration and severity who have symptomatic impairment of one or both upper limbs. A healthy control group was included for validation of clinical and electrophysiological measures. Study design: randomised double blind placebo-controlled trial. Treatment details: participants allocated to either fampridine-MR 10 mg bd or placebo of identical appearance for 8 weeks. Primary outcome: performance on 9-hole peg test (9HPT) after 4 weeks. Secondary outcomes: persistence of effect on 9HPT; grip strength; visual acuity and contrast sensitivity; modified fatigue impact scale score; sensory discrimination capacity; visual, somatosensory and motor evoked potentials; resting motor threshold; paired-pulse TMS; peripheral nerve conduction studies. RESULTS 40 patients with MS (60% female, median age 52, median disease duration 13.5 years, median EDSS 6.0) were enrolled. Treatment with fampridine-MR was not associated with any change in upper limb function as measured by the clinical primary or secondary outcomes. Treatment with fampridine-MR was also not associated with any difference in electrophysiological measures of upper limb function. This held true after adjustment for hand dominance, disease duration and severity. Four patients withdrew from the trial because of lack of efficacy or side-effects; all were in the placebo arm. Three patients were admitted to hospital during the study period; one with MS exacerbation (placebo group), one with syncope (drug group) and one with UTI (drug group); otherwise there were no serious adverse events. CONCLUSION Treatment with fampridine-MR was well-tolerated but did not produce clinical benefit in terms of upper limb function, vision or fatigue, nor was there any measurable effect on objective electrophysiological parameters.
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Affiliation(s)
- Simpson Marion
- Department of Neurology, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia; Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, VIC 3084, Australia.
| | - Churilov Leonid
- Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, VIC 3084, Australia.
| | - Bardsley Belinda
- Department of Neurology, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia.
| | - Dimovitis Joanne
- Department of Neurology, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia.
| | - Heriot Elise
- Department of Neurology, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia.
| | - Carey Leeanne
- Department of Neurology, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia.
| | - Macdonell Richard
- Department of Neurology, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia; Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, VIC 3084, Australia.
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Higher fish consumption and lower risk of central nervous system demyelination. Eur J Clin Nutr 2019; 74:818-824. [PMID: 31395972 DOI: 10.1038/s41430-019-0476-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/25/2019] [Accepted: 07/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES The evidence for diet as a risk factor for multiple sclerosis (MS) is inconclusive. We examined the associations between fish consumption and risk of a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS. METHODS The 2003-2006 Ausimmune Study was a case-control study examining environmental risk factors for FCD, with participants recruited from four regions of Australia and matched on age, sex, and study region. Dietary intake data were collected using a food frequency questionnaire. We used conditional logistic regression models to test associations between fish consumption (total, tinned, grilled, and fried) and risk of FCD (249 cases and 438 controls), adjusting for history of infectious mononucleosis, smoking, serum 25-hydroxyvitamin D concentrations, socio-economic status, omega-3 supplement use, dietary under-reporting, and total energy intake. RESULTS Higher total fish consumption (per 30 g/day, equivalent to two serves/week) was associated with an 18% reduced risk of FCD (AOR 0.82; 95% CI 0.70, 0.97). While we found no statistically significant associations between grilled and fried fish consumption and risk of FCD, higher tinned fish consumption (per 30 g/day) was associated with a 41% reduced risk of FCD (AOR 0.59; 95% CI 0.39, 0.89). CONCLUSIONS Tinned fish is predominantly oily, whereas grilled and fried fish are likely to be a combination of oily and white types. Oily fish is high in vitamin D and very long chain polyunsaturated omega-3 fatty acids, both of which may be beneficial in relation to MS.
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Black LJ, Baker K, Ponsonby AL, van der Mei I, Lucas RM, Pereira G. A Higher Mediterranean Diet Score, Including Unprocessed Red Meat, Is Associated with Reduced Risk of Central Nervous System Demyelination in a Case-Control Study of Australian Adults. J Nutr 2019; 149:1385-1392. [PMID: 31131415 DOI: 10.1093/jn/nxz089] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/15/2019] [Accepted: 04/09/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The evidence associating diet and risk of multiple sclerosis (MS) is inconclusive. OBJECTIVES The aim of this study was to investigate associations between a Mediterranean diet and risk of a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS. METHODS We used data from the 2003-2006 Ausimmune Study, an Australian multicenter, case-control study examining environmental risk factors for FCD, with participants matched on age, sex, and study region (282 cases, 558 controls; 18-59 y old; 78% female). The alternate Mediterranean diet score (aMED) was calculated based on data from a food-frequency questionnaire. We created a modified version of the aMED (aMED-Red) where ∼1 daily serving (65 g) of unprocessed red meat received 1 point. All other components remained the same as aMED. Conditional logistic regression (254 cases, 451 controls) was used to test associations between aMED and aMED-Red scores and categories and risk of FCD, adjusting for history of infectious mononucleosis, serum 25-hydroxyvitamin D concentrations, smoking, education, total energy intake, and dietary underreporting. RESULTS There was no statistically significant association between aMED and risk of FCD [per 1-SD increase in aMED score: adjusted odds ratio (aOR): 0.89; 95% CI: 0.75, 1.06; P = 0.181]. There was evidence of a nonlinear relation between aMED-Red and risk of FCD when a quadratic term was used (P = 0.016). Compared with the lowest category of aMED-Red, higher categories were significantly associated with reduced risk of FCD, corresponding to a 37% (aOR: 0.63; 95% CI: 0.41, 0.98; P = 0.039), 52% (aOR: 0.48; 95% CI: 0.28, 0.83; P = 0.009), and 42% (aOR: 0.58; 95% CI: 0.35, 0.96; P = 0.034) reduced risk of FCD in categories 2, 3, and 4, respectively. CONCLUSIONS A Mediterranean diet, including unprocessed red meat, was associated with reduced risk of FCD in this Australian adult population. The addition of unprocessed red meat to a Mediterranean diet may be beneficial for those at high risk of MS.
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Affiliation(s)
- Lucinda J Black
- School of Public Health, Curtin University, Perth, Australia
| | - Kimberley Baker
- School of Public Health, Curtin University, Perth, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Australia
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Black LJ, Bowe GS, Pereira G, Lucas RM, Dear K, van der Mei I, Sherriff JL. Higher Non-processed Red Meat Consumption Is Associated With a Reduced Risk of Central Nervous System Demyelination. Front Neurol 2019; 10:125. [PMID: 30837942 PMCID: PMC6389668 DOI: 10.3389/fneur.2019.00125] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/30/2019] [Indexed: 11/20/2022] Open
Abstract
The evidence associating red meat consumption and risk of multiple sclerosis is inconclusive. We tested associations between red meat consumption and risk of a first clinical diagnosis of central nervous system demyelination (FCD), often presaging a diagnosis of multiple sclerosis. We used food frequency questionnaire data from the 2003–2006 Ausimmune Study, an incident, matched, case-control study examining environmental risk factors for FCD. We calculated non-processed and processed red meat density (g/1,000 kcal/day). Conditional logistic regression models (with participants matched on age, sex, and study region) were used to estimate odds ratios (ORs), 95% confidence intervals (95% CI) and p-values for associations between non-processed (n = 689, 250 cases, 439 controls) and processed (n = 683, 248 cases, 435 controls) red meat density and risk of FCD. Models were adjusted for history of infectious mononucleosis, serum 25-hydroxyvitamin D concentrations, smoking, race, education, body mass index and dietary misreporting. A one standard deviation increase in non-processed red meat density (22 g/1,000 kcal/day) was associated with a 19% reduced risk of FCD (AOR = 0.81; 95%CI 0.68, 0.97; p = 0.02). When stratified by sex, higher non-processed red meat density (per 22 g/1,000 kcal/day) was associated with a 26% reduced risk of FCD in females (n = 519; AOR = 0.74; 95%CI 0.60, 0.92; p = 0.01). There was no statistically significant association between non-processed red meat density and risk of FCD in males (n = 170). We found no statistically significant association between processed red meat density and risk of FCD. Further investigation is warranted to understand the important components of a diet that includes non-processed red meat for lower FCD risk.
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Affiliation(s)
- Lucinda J Black
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Gabrielle S Bowe
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, WA, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Robyn M Lucas
- Research School of Population Health, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, WA, Australia
| | - Keith Dear
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Jill L Sherriff
- School of Public Health, Curtin University, Perth, WA, Australia
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Lingham G, Yazar S, Lucas RM, Walsh JP, Zhu K, Hunter M, Lim EM, Cooke BR, Mackey DA. Low 25-Hydroxyvitamin D Concentration Is Not Associated With Refractive Error in Middle-Aged and Older Western Australian Adults. Transl Vis Sci Technol 2019; 8:13. [PMID: 30697464 PMCID: PMC6348994 DOI: 10.1167/tvst.8.1.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/15/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose To investigate the association between serum 25-hydroxyvitamin D (25[OH]D) concentration and refractive error in a community-based cohort of adults aged 46 to 69 years. Methods Residents of the City of Busselton in Western Australia born between 1946 and 1964 were invited to participate. Participants underwent cycloplegic autorefraction and completed questionnaires on education, occupational sun exposure, and physical activity. Blood samples were collected and serum frozen at −80°C. Serum 25[OH]D concentration was measured by immunoassay. Data on 25[OH]D were deseasonalized and multivariate models built to analyze the association between 25[OH]D concentration and spherical equivalent and myopia, defined as spherical equivalent <−0.50 D. Results After exclusions, data were available for 4112 participants. Serum 25[OH]D concentration was not associated with spherical equivalent or myopia after adjustment for confounding factors (β = −0.01, 95% confidence interval [CI]: −0.03 to −0.008, P = 0.25, and odds ratio = 1.02, 95% CI: 0.99 to 1.05, P = 0.12, respectively). When participants were classified into 25[OH]D groups of lower (<50 nmol/L), medium (≥50 to <75 nmol/L), and upper (≥75 nmol/L), the upper group had slightly greater myopic refractive error than the medium group (P = 0.02) but not the lower group, after adjustment for confounders. Conclusions There was no substantial association between 25[OH]D levels and spherical equivalent or odds of myopia in this study. The association previously noted between low serum 25[OH]D level and myopia in younger Western Australians is not evident in later adulthood. Translational Relevance This study provides further evidence suggesting that vitamin D levels are unrelated to myopia risk in adults and thus not a suitable target for myopia intervention.
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Affiliation(s)
- Gareth Lingham
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Seyhan Yazar
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Robyn M Lucas
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - John P Walsh
- Medical School, University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kun Zhu
- Medical School, University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Busselton, Australia.,School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Ee Mun Lim
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia
| | - Brian R Cooke
- PathWest Laboratory Medicine, Fiona Stanley Hospital, Perth, Australia
| | - David A Mackey
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
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Black LJ, Rowley C, Sherriff J, Pereira G, Ponsonby AL, Lucas RM. A healthy dietary pattern associates with a lower risk of a first clinical diagnosis of central nervous system demyelination. Mult Scler 2018; 25:1514-1525. [PMID: 30084751 DOI: 10.1177/1352458518793524] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The evidence associating diet and risk of multiple sclerosis is inconclusive. OBJECTIVE We investigated associations between dietary patterns and risk of a first clinical diagnosis of central nervous system demyelination, a common precursor to multiple sclerosis. METHODS We used data from the 2003-2006 Ausimmune Study, a case-control study examining environmental risk factors for a first clinical diagnosis of central nervous system demyelination, with participants matched on age, sex and study region. Using data from a food frequency questionnaire, dietary patterns were identified using principal component analysis. Conditional logistic regression models (n = 698, 252 cases, 446 controls) were adjusted for history of infectious mononucleosis, serum 25-hydroxyvitamin D concentrations, smoking, race, education, body mass index and dietary misreporting. RESULTS We identified two major dietary patterns - healthy (high in poultry, fish, eggs, vegetables, legumes) and Western (high in meat, full-fat dairy; low in wholegrains, nuts, fresh fruit, low-fat dairy), explaining 9.3% and 7.5% of variability in diet, respectively. A one-standard deviation increase in the healthy pattern score was associated with a 25% reduced risk of a first clinical diagnosis of central nervous system demyelination (adjusted odds ratio 0.75; 95% confidence interval 0.60, 0.94; p = 0.011). There was no statistically significant association between the Western dietary pattern and risk of a first clinical diagnosis of central nervous system demyelination. CONCLUSION Following healthy eating guidelines may be beneficial for those at high risk of multiple sclerosis.
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Affiliation(s)
- Lucinda J Black
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Charlotte Rowley
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Jill Sherriff
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, The University of Melbourne, Melbourne, VIC, Australia/National Centre for Epidemiology & Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology & Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia/Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, WA, Australia
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Tao C, Simpson S, Taylor BV, Blizzard L, Lucas RM, Ponsonby AL, Broadley S, van der Mei I. Onset Symptoms, Tobacco Smoking, and Progressive-Onset Phenotype Are Associated With a Delayed Onset of Multiple Sclerosis, and Marijuana Use With an Earlier Onset. Front Neurol 2018; 9:418. [PMID: 29937751 PMCID: PMC6003245 DOI: 10.3389/fneur.2018.00418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/22/2018] [Indexed: 01/15/2023] Open
Abstract
Background: Age at symptom onset (ASO) is a prognostic factor that could affect the accrual of disability in multiple sclerosis (MS) patients. Some factors are known to influence the risk of multiple sclerosis (MS), but their influence on the ASO is less well-investigated. Objective: Examine the associations between known or emerging MS risk factors and ASO. Methods: This was a multicenter study, incident cases (n = 279) with first clinical diagnosis of demyelinating event aged 18–59 years recruited at four Australian centres (latitudes 27°-43°S), from 1 November 2003 to 31 December 2006. Environmental/behavioral variables and initial symptoms were recorded at baseline interview. Linear regression was used to assess the association between risk factors and ASO. Results: Five factors were significantly associated with ASO: a history of tobacco smoking was associated with 3.05-years later ASO (p = 0.002); a history of marijuana use was associated with 6.03-years earlier ASO (p < 0.001); progressive-onset cases had 5.61-years later ASO (p = 0.001); an initial presentation of bowel & bladder and cerebral dysfunctional were associated with 3.39 (p = 0.017) and 4.37-years (p = 0.006) later ASO, respectively. Other factors, including sex, offspring number, latitude of study site, history of infectious mononucleosis, HLA-DR15 & HLA-A2 genotype, 25(OH)D levels, and ultraviolet radiation exposure were not associated with ASO. Including all five significant variables into one model explained 12% of the total variance in ASO. Conclusion: We found a novel association between a history of tobacco smoking and later onset, whereas marijuana use was associated with earlier onset. Behavioral factors seem important drivers of MS onset timing although much of the variance remains unexplained.
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Affiliation(s)
- Chunrong Tao
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Institute for Health & Ageing, Australian Catholic University, Melbourne, VIC, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Canberra, ACT, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Broadley
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | | | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Russell RD, Lucas RM, Brennan V, Sherriff JL, Begley A, Black LJ. Reported Changes in Dietary Behavior Following a First Clinical Diagnosis of Central Nervous System Demyelination. Front Neurol 2018; 9:161. [PMID: 29615960 PMCID: PMC5870150 DOI: 10.3389/fneur.2018.00161] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/05/2018] [Indexed: 11/18/2022] Open
Abstract
Background/objectives Although the current evidence is insufficient to recommend a special diet for people with multiple sclerosis (MS), dietary advice for people with MS is prolific online and in the media. This study aimed to describe dietary changes made in the year following a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS. Subjects/methods We used follow-up data from the Ausimmune Study, a multicentre matched case-control study examining the environmental risk factors for a FCD. A total of 244 cases (60 male, 184 female) completed a 1-year follow-up interview, which included a question about dietary changes. We described the number and proportion (%) of participants who reported making dietary changes and the type of change made. We investigated independent predictors of making a dietary change using a multivariable logistic regression model. Results A total of 38% (n = 92) of participants at the 1-year follow-up reported making at least one dietary change over the last year. There were no statistically significant independent associations between any participant characteristic and odds of making a dietary change. Of those who made at least one dietary change, the most common changes were increasing fruit and/or vegetable intake (27%, n = 25) and following a low-fat diet (25%, n = 23). Conclusion A considerable proportion of the study population reported making at least one dietary change in the year following a FCD, with the majority of changes being toward a healthier diet. Further research is warranted to investigate the reasons behind any dietary changes adopted by people with a FCD or with MS, and whether making a dietary change has benefits for the progression of demyelinating diseases, e.g., to a diagnosis of MS, as well as for general health and well-being.
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Affiliation(s)
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, WA, Australia
| | - Vanessa Brennan
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Jill L Sherriff
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Andrea Begley
- School of Public Health, Curtin University, Perth, WA, Australia
| | | | - Lucinda J Black
- School of Public Health, Curtin University, Perth, WA, Australia
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Simpson S, van der Mei I, Lucas RM, Ponsonby AL, Broadley S, Blizzard L, Taylor B. Sun Exposure across the Life Course Significantly Modulates Early Multiple Sclerosis Clinical Course. Front Neurol 2018; 9:16. [PMID: 29449827 PMCID: PMC5799286 DOI: 10.3389/fneur.2018.00016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background Low vitamin D and/or sun exposure have been associated with increased risk of multiple sclerosis (MS) onset. However, comparatively, few studies have prospectively examined associations between these factors and clinical course. Objectives To evaluate the association of sun exposure parameters and vitamin D levels with conversion to MS and relapse risk in a prospectively monitored cohort of 145 participants followed after a first demyelinating event up to 5-year review (AusLong Study). Methods Sun exposure prior to and after onset measured by annual questionnaire; ultraviolet radiation (UVR) "load" estimated by location of residence over the life course and ambient UVR levels. Serum 25-hydroxyvitamin D [25(OH)D] concentrations measured at baseline, 2/3-year, and 5-year review. MS conversion and relapse assessed by neurologist assessment and medical record review. Results Over two-thirds (69%) of those followed to 5-year review (100/145) converted to MS, with a total of 252 relapses. Higher pre-MS onset sun exposure was associated with reduced risk of MS conversion, with internal consistency between measures and dose-response relationships. Analogous associations were also seen with risk of relapse, albeit less strong. No consistent associations were observed between postonset sun exposure and clinical course, however. Notably, those who increased their sun exposure during follow-up had significantly reduced hazards of MS conversion and relapse. Serum 25(OH)D levels and vitamin D supplementation were not associated with conversion to MS or relapse hazard. Conclusion We found that preonset sun exposure was protective against subsequent conversion to MS and relapses. While consistent associations between postonset sun exposure or serum 25(OH)D level and clinical course were not evident, possibly masked by behavior change, those participants who markedly increased their sun exposure demonstrated a reduced MS conversion and relapse hazard, suggesting beneficial effects of sun exposure on clinical course.
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Affiliation(s)
- Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Anne-Louise Ponsonby
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Royal Melbourne Hospital, School of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Broadley
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | | | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Zhou Y, Graves JS, Simpson S, Charlesworth JC, Mei IVD, Waubant E, Barcellos LF, Belman A, Krupp L, Lucas R, Ponsonby AL, Taylor BV. Genetic variation in the gene LRP2 increases relapse risk in multiple sclerosis. J Neurol Neurosurg Psychiatry 2017; 88:864-868. [PMID: 28739605 DOI: 10.1136/jnnp-2017-315971] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Due to the lack of prospective studies with longitudinal data on relapse, past genetic studies have not attempted to identify genetic factors that predict relapse risk (the primary endpoint of many pivotal clinical trials testing the efficacy of multiple sclerosis (MS) disease-modifying drugs) at a genome-wide scale. METHODS We conducted a genome-wide association analysis (GWAS) to identify genetic variants that predict MS relapse risk, using a three-stage approach. First, GWAS was conducted using the southern Tasmania MS Longitudinal Study with 141 cases followed prospectively for a mean of 2.3 years. Second, GWAS was conducted using the Ausimmune Longitudinal Study with 127 cases having a classic first demyelinating event followed for 5 years from onset. Third, the top hits with p<5.0×10-6 from the first two stages were combined with a longitudinal US paediatric MS cohort with 181 cases followed for 5 years after onset. Predictors of time to relapse were evaluated by a mixed effects Cox model. An inverse variance fixed effects model was then used to undertake a meta-analysis. RESULTS In the pooled results, using these three unique longitudinal MS cohorts, we discovered one novel locus (LRP2; most significant single nucleotide polymorphism rs12988804) that reached genome-wide significance in predicting relapse risk (HR=2.18, p=3.30×10-8). LRP2 is expressed on the surface of many central nervous system cells including neurons and oligodendrocytes and is a critical receptor in axonal guidance. CONCLUSIONS The finding of a genetic locus that has extensive effects on neuronal development and repair is of interest as a potential modulator of MS disease course.
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Affiliation(s)
- Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jennifer S Graves
- Department of Neurology, University of California, San Francisco, USA
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia
| | - Jac C Charlesworth
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Lisa F Barcellos
- Division of Epidemiology, School of Public Health, University of California, Berkeley, USA
| | - Anita Belman
- Stonybrook University, Stonybrook, New York, USA
| | | | - Robyn Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Correale J, Farez MF, Gaitán MI. Environmental factors influencing multiple sclerosis in Latin America. Mult Scler J Exp Transl Clin 2017. [PMID: 28638627 PMCID: PMC5472234 DOI: 10.1177/2055217317715049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
It is generally accepted that autoimmune diseases like multiple sclerosis (MS) arise from complex interactions between genetic susceptibility and environmental factors. Genetic variants confer predisposition to develop MS, but cannot be therapeutically modified. On the other hand, several studies have shown that different lifestyle and environmental factors influence disease development, as well as activity levels and progression. Unlike genetic risk factors, these can be modified, with potential for prevention, particularly in high-risk populations. Most studies identifying particular lifestyle and environmental factors have been carried out in Caucasian patients with MS. Little or no data is available on the behavior of these factors in Latin American populations. Ethnic and geographic differences between Latin America and other world regions suggest potential regional variations in MS, at least with respect to some of these factors. Furthermore, particular environmental characteristics observed more frequently in Latin America could explain regional differences in MS prevalence. Site-specific studies exploring influences of local environmental factors are warranted.
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Affiliation(s)
- Jorge Correale
- Department of Neurology, Institute for Neurological Research Dr Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - Mauricio F Farez
- Department of Neurology, Institute for Neurological Research Dr Raúl Carrea, FLENI, Buenos Aires, Argentina
| | - María Inés Gaitán
- Center for Research on Neuroimmunological Diseases (CIEN) from the Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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Tettey P, Simpson S, Taylor B, Ponsonby AL, Lucas RM, Dwyer T, Kostner K, van der Mei IA. An adverse lipid profile and increased levels of adiposity significantly predict clinical course after a first demyelinating event. J Neurol Neurosurg Psychiatry 2017; 88:395-401. [PMID: 28320766 DOI: 10.1136/jnnp-2016-315037] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/23/2017] [Accepted: 02/21/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the prospective associations between adiposity and lipid-related variables and conversion to multiple sclerosis (MS), time to subsequent relapse and progression in disability. METHODS A cohort of 279 participants with a first clinical diagnosis of central nervous system demyelination was prospectively followed to 5-year review. Height, weight, waist and hip circumference were measured, and serum samples taken for measurement of lipids and apolipoproteins. Survival analysis was used for conversion to MS and time to relapse, and linear regression for annualised change in disability (Expanded Disability Status Scale). RESULTS Higher body mass index (BMI; adjusted HR (aHR): 1.22 (1.04 to 1.44) per 5 kg/m2 increase), hip circumference (aHR: 1.32 (1.12 to 1.56) per 10 cm increase) and triglyceride levels (aHR: 1.20 (1.03 to 1.40) per unit increase) were associated with increased risk of subsequent relapse, while adiposity and lipid-related measures were not associated with conversion to MS. In addition, higher BMI (β: 0.04 (0.01 to 0.07) per 5 kg/m2 increase), hip circumference (β: 0.04 (0.02 to 0.08) per 10 cm increase), waist circumference (β: 0.04 (0.02 to 0.07) per 10 cm increase), total cholesterol to high-density lipoprotein ratio (TC/HDL ratio; β: 0.05 (0.001 to 0.10) and non-HDL; β: 0.04 (0.001 to 0.08) at study entry) were associated with a higher subsequent annual change in disability. CONCLUSIONS Higher levels of adiposity, non-HDL and TC/HDL ratio were prospectively associated with a higher rate of disability progression, and higher adiposity and triglycerides were associated with relapse but not with conversion to MS. Improving the lipid profile and losing weight into the healthy range could reduce the accumulation of disability.
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Affiliation(s)
- Prudence Tettey
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Turning Point, Monash University, Fitzroy, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Terence Dwyer
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Karam Kostner
- Mater Hospital, University of Queensland, Queensland, Australia
| | | | - Ingrid Af van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Zhou Y, Simpson S, Charlesworth JC, van der Mei I, Lucas RM, Ponsonby AL, Taylor BV. Variation within MBP gene predicts disease course in multiple sclerosis. Brain Behav 2017; 7:e00670. [PMID: 28413712 PMCID: PMC5390844 DOI: 10.1002/brb3.670] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/17/2017] [Accepted: 01/29/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Prognosis following a first demyelinating event is difficult to predict, with no genetic markers of MS progression currently identified. Myelin basic protein (MBP) is a major component of the myelin sheath of CNS neurons and may play a central role in demyelinating diseases such as MS. However, genetic variation in MBP has not been implicated in MS onset risk in large genome-wide association studies. We hypothesized that genetic variations in MBP may be a determinant of MS clinical course. MATERIALS AND METHODS We investigated whether variations in the MBP gene altered clinical course (conversion to MS and/or relapse, and annualized change in disability), using a prospectively collected longitudinal cohort study of 127 persons who had had a first demyelinating event, followed up to the 5-year review. RESULTS We found one variant, rs12959006, predicted worse clinical outcomes. The risk genotype (CT + TT) was significantly associated with hazard of relapse (HR = 1.74, 95% CI = 1.19-2.56, p = .005) and of greater annualized disability progression (β = 0.18, 95% CI = 0.06-0.30, p = .004). We also found a significant interaction between the risk genotype and baseline anti-HHV6 IgG in predicting MS (pinteraction = 0.05) and relapse (pinteraction = 0.02). Functional prediction analysis showed this variant is the target of many transcription factors and the binding sites of miR-218 and miR-188-3p. CONCLUSIONS Our results provide novel insights into the role of genetic variation within the MBP gene predicting MS clinical course, both directly and by interaction with known environmental MS risk factors.
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Affiliation(s)
- Yuan Zhou
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
| | - Steve Simpson
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
| | - Jac C Charlesworth
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health Canberra ACT Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute University of Melbourne Melbourne VIC Australia
| | | | - Bruce V Taylor
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
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Odenthal C, Simpson S, Oughton J, van der Mei I, Rose S, Fripp J, Lucas R, Taylor B, Dear K, Ponsonby AL, Coulthard A. Midsagittal corpus callosum area and conversion to multiple sclerosis after clinically isolated syndrome: A multicentre Australian cohort study. J Med Imaging Radiat Oncol 2016; 61:453-460. [DOI: 10.1111/1754-9485.12570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/05/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Cara Odenthal
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Steve Simpson
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania Australia
| | - Justin Oughton
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania Australia
| | - Stephen Rose
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- ICT - Australian e-Health Research Centre; Brisbane Queensland Australia
| | - Jurgen Fripp
- ICT - Australian e-Health Research Centre; Brisbane Queensland Australia
| | - Robyn Lucas
- National Centre for Epidemiology and Population Health; Australian National University; Canberra Australian Capital Territory Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania Australia
| | | | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute; Royal Children's Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Alan Coulthard
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
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van der Mei I, Lucas RM, Taylor BV, Valery PC, Dwyer T, Kilpatrick TJ, Pender MP, Williams D, Chapman C, Otahal P, Ponsonby AL. Population attributable fractions and joint effects of key risk factors for multiple sclerosis. Mult Scler 2016; 22:461-9. [PMID: 26199349 DOI: 10.1177/1352458515594040] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 04/01/2015] [Indexed: 03/25/2024]
Abstract
AIM We examined the combined effect of having multiple key risk factors and the interactions between the key risk factors of multiple sclerosis (MS). METHODS We performed an incident case-control study including cases with a first clinical diagnosis of central nervous system demyelination (FCD) and population-based controls. RESULTS Compared to those without any risk factors, those with one, two, three, and four or five risk factors had increased odds of being an FCD case of 2.12 (95% confidence interval (CI), 1.11-4.03), 4.31 (95% CI, 2.24-8.31), 7.96 (95% CI, 3.84-16.49), and 21.24 (95% CI, 5.48-82.40), respectively. Only HLA-DR15 and history of infectious mononucleosis interacted significantly on the additive scale (Synergy index, 3.78; p = 0.03). The five key risk factors jointly accounted for 63.8% (95% CI, 43.9-91.4) of FCD onset. High anti-EBNA IgG was another important contributor. CONCLUSIONS A high proportion of FCD onset can be explained by the currently known risk factors, with HLA-DR15, ever smoking and low cumulative sun exposure explaining most. We identified a significant interaction between HLA-DR15 and history of IM in predicting an FCD of CNS demyelination, which together with previous observations suggests that this is a true interaction.
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Affiliation(s)
| | - R M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Australia
| | | | - P C Valery
- Queensland Institute of Medical Research, Australia
| | - T Dwyer
- International Agency for Research on Cancer, France
| | - T J Kilpatrick
- Centre for Neuroscience, The University of Melbourne, Australia
| | - M P Pender
- Department of Neurophysiology, John Hunter Hospital, Australia
| | - D Williams
- Department of Neurophysiology, John Hunter Hospital, Australia
| | - C Chapman
- Department of Neurology, Barwon Health, Australia
| | - P Otahal
- Menzies Research Institute, Australia
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Black LJ, Anderson D, Clarke MW, Ponsonby AL, Lucas RM. Analytical Bias in the Measurement of Serum 25-Hydroxyvitamin D Concentrations Impairs Assessment of Vitamin D Status in Clinical and Research Settings. PLoS One 2015; 10:e0135478. [PMID: 26266807 PMCID: PMC4534132 DOI: 10.1371/journal.pone.0135478] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/22/2015] [Indexed: 11/18/2022] Open
Abstract
Measured serum 25-hydroxyvitamin D concentrations vary depending on the type of assay used and the specific laboratory undertaking the analysis, impairing the accurate assessment of vitamin D status. We investigated differences in serum 25-hydroxyvitamin D concentrations measured at three laboratories (laboratories A and B using an assay based on liquid chromatography-tandem mass spectrometry and laboratory C using a DiaSorin Liaison assay), against a laboratory using an assay based on liquid chromatography-tandem mass spectrometry that is certified to the standard reference method developed by the National Institute of Standards and Technology and Ghent University (referred to as the 'certified laboratory'). Separate aliquots from the same original serum sample for a subset of 50 participants from the Ausimmune Study were analysed at the four laboratories. Bland-Altman plots were used to visually check agreement between each laboratory against the certified laboratory. Compared with the certified laboratory, serum 25-hydroxyvitamin D concentrations were on average 12.4 nmol/L higher at laboratory A (95% limits of agreement: -17.8,42.6); 12.8 nmol/L higher at laboratory B (95% limits of agreement: 0.8,24.8); and 10.6 nmol/L lower at laboratory C (95% limits of agreement: -48.4,27.1). The prevalence of vitamin D deficiency (defined here as 25-hydroxyvitamin D <50 nmol/L) was 24%, 16%, 12% and 41% at the certified laboratory, and laboratories A, B, and C, respectively. Our results demonstrate considerable differences in the measurement of 25-hydroxyvitamin D concentrations compared with a certified laboratory, even between laboratories using assays based on liquid chromatography-tandem mass spectrometry, which is often considered the gold-standard assay. To ensure accurate and reliable measurement of serum 25-hydroxyvitamin D concentrations, all laboratories should use an accuracy-based quality assurance system and, ideally, comply with international standardisation efforts.
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Affiliation(s)
- Lucinda J. Black
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- * E-mail:
| | - Denise Anderson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
| | - Michael W. Clarke
- Centre for Metabolomics, Metabolomics Australia, The University of Western Australia, Perth, Western Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, The University of Melbourne, Melbourne, Australia
| | - Robyn M. Lucas
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
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Gresle MM, Liu Y, Dagley LF, Haartsen J, Pearson F, Purcell AW, Laverick L, Petzold A, Lucas RM, Van der Walt A, Prime H, Morris DR, Taylor BV, Shaw G, Butzkueven H. Serum phosphorylated neurofilament-heavy chain levels in multiple sclerosis patients. J Neurol Neurosurg Psychiatry 2014; 85:1209-13. [PMID: 24639436 DOI: 10.1136/jnnp-2013-306789] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We evaluated whether the measurement of serum phosphorylated neurofilament heavy chain (pNF-H) titre is likely to be a valid biomarker of axonal injury in multiple sclerosis (MS). METHODS Serum pNF-H concentrations were measured by ELISA in cases with relapsing-remitting (RR)-MS (n=81), secondary progressive (SP) MS (n=13) and primary progressive (PP)-MS; n=6) MS; first demyelinating event (FDE; n=82); and unaffected controls (n=135). A subset of MS cases (n=45) were re-sampled on one or multiple occasions. The Multiple Sclerosis Severity Score (MSSS) and MRI measures were used to evaluate associations between serum pNF-H status, disease severity and cerebral lesion load and activity. RESULTS We confirmed the presence of pNF-H peptides in serum by ELISA. We showed that a high serum pNF-H titre was detectable in 9% of RR-MS and FDE cases, and 38.5% of SP-MS cases. Patients with a high serum pNF-H titre had higher average MSSS scores and T2 lesion volumes than patients with a low serum pNF-H titre. Repeated sampling of a subset of MS cases showed that pNF-H levels can fluctuate over time, likely reflecting temporal dynamics of axonal injury in MS. CONCLUSIONS A subset of FDE/MS cases was found to have a high serum pNF-H titre, and this was associated with changes in clinical outcome measures. We propose that routine measurement of serum pNF-H should be further investigated for monitoring axonal injury in MS.
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Affiliation(s)
- M M Gresle
- The Department of Medicine, University of Melbourne, Parkville, Victoria, Australia Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Y Liu
- Department of Radiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - L F Dagley
- Bio21 Institute, University of Melbourne, Parkville, Victoria, Australia
| | - J Haartsen
- Eastern Clinical Research Unit Box-Hill Hospital, Victoria, Australia
| | - F Pearson
- Eastern Clinical Research Unit Box-Hill Hospital, Victoria, Australia
| | - A W Purcell
- Bio21 Institute, University of Melbourne, Parkville, Victoria, Australia Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia
| | - L Laverick
- The Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - A Petzold
- Department of Neuroimmunology, UCL institute of Neurology, London, UK
| | - R M Lucas
- National Centre for Epidemiology and Population Health, College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - A Van der Walt
- Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - H Prime
- Eastern Clinical Research Unit Box-Hill Hospital, Victoria, Australia MRI services, MIA, Box Hill, Victoria, Australia
| | - D R Morris
- The Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - B V Taylor
- The Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | | | - G Shaw
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA EnCor Biotechnology Inc. Gainesville, Florida
| | - H Butzkueven
- The Department of Medicine, University of Melbourne, Parkville, Victoria, Australia Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia Eastern Clinical Research Unit Box-Hill Hospital, Victoria, Australia
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Wallingford SC, Jones G, Kobayashi LC, Grundy A, Miao Q, Tranmer J, Aronson KJ. UV and dietary predictors of serum 25-hydroxyvitamin D concentrations among young shift-working nurses and implications for bone density and skin cancer. Public Health Nutr 2014; 17:772-9. [PMID: 23835190 PMCID: PMC10282299 DOI: 10.1017/s1368980013001754] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/03/2013] [Accepted: 05/20/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE In 2011, the U.S. Institute of Medicine updated the definition of vitamin D inadequacy to serum 25-hydroxyvitamin D (25(OH)D) concentration of 30-<50 nmol/l and of deficiency to serum 25(OH)D < 30 nmol/l. We describe the prevalence of these conditions according to these definitions, seasonal variation in 25(OH)D and predictors of serum 25(OH)D concentrations among working, white women. DESIGN Participants recorded lifestyle factors and dietary intake and provided fasting blood samples for measurement of serum 25(OH)D in both summer and winter. Predictors of serum 25(OH)D variation were analysed using linear regression and generalized linear mixed models. SETTING Kingston General Hospital in Kingston, Ontario, Canada, from April 2008 to July 2009. SUBJECTS Female premenopausal nurses (n 83) working full-time rotating shifts. RESULTS Deficient or inadequate vitamin D status was observed in 9% of participants following summer/autumn and in 13% following winter/spring. Predictors of serum 25(OH)D concentration were vitamin D supplement use, tanning bed use and season. Tanning bed use increased serum 25(OH)D by 23.24 nmol/l (95% CI 8.78, 37.69 nmol/l, P = 0.002) on average. CONCLUSIONS According to the 2011 Institute of Medicine bone health guidelines, over 10% of nurses had deficient or inadequate vitamin D status following winter. Higher serum concentrations were associated with use of tanning beds and vitamin D supplements. As health promotion campaigns and legal restrictions are successful in reducing tanning bed use among women, our data suggest that increased prevalence of vitamin D inadequacy and deficiency may be a consequence, and that low vitamin D status will need to be countered with supplementation.
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Affiliation(s)
- Sarah C Wallingford
- Department of Community Health and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON K7L 3N6, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Glenville Jones
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Lindsay C Kobayashi
- Department of Community Health and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON K7L 3N6, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Anne Grundy
- Department of Community Health and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON K7L 3N6, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Qun Miao
- Department of Community Health and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON K7L 3N6, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Joan Tranmer
- Department of Community Health and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON K7L 3N6, Canada
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Kristan J Aronson
- Department of Community Health and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON K7L 3N6, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
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Guo S, Lucas RM, Ponsonby AL. A novel approach for prediction of vitamin d status using support vector regression. PLoS One 2013; 8:e79970. [PMID: 24302994 PMCID: PMC3841172 DOI: 10.1371/journal.pone.0079970] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 10/07/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Epidemiological evidence suggests that vitamin D deficiency is linked to various chronic diseases. However direct measurement of serum 25-hydroxyvitamin D (25(OH)D) concentration, the accepted biomarker of vitamin D status, may not be feasible in large epidemiological studies. An alternative approach is to estimate vitamin D status using a predictive model based on parameters derived from questionnaire data. In previous studies, models developed using Multiple Linear Regression (MLR) have explained a limited proportion of the variance and predicted values have correlated only modestly with measured values. Here, a new modelling approach, nonlinear radial basis function support vector regression (RBF SVR), was used in prediction of serum 25(OH)D concentration. Predicted scores were compared with those from a MLR model. METHODS Determinants of serum 25(OH)D in Caucasian adults (n = 494) that had been previously identified were modelled using MLR and RBF SVR to develop a 25(OH)D prediction score and then validated in an independent dataset. The correlation between actual and predicted serum 25(OH)D concentrations was analysed with a Pearson correlation coefficient. RESULTS Better correlation was observed between predicted scores and measured 25(OH)D concentrations using the RBF SVR model in comparison with MLR (Pearson correlation coefficient: 0.74 for RBF SVR; 0.51 for MLR). The RBF SVR model was more accurately able to identify individuals with lower 25(OH)D levels (<75 nmol/L). CONCLUSION Using identical determinants, the RBF SVR model provided improved prediction of serum 25(OH)D concentrations and vitamin D deficiency compared with a MLR model, in this dataset.
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Affiliation(s)
- Shuyu Guo
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Robyn M. Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
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Curley M, Josey L, Lucas R, Dear K, Taylor BV, Coulthard A, Chapman C, Coulthard A, Dear K, Dwyer T, Kilpatrick T, Lucas R, McMichael T, Pender MP, Ponsonby AL, Taylor B, Valery P, van der Mei I, Williams D. Adherence to MRI protocol consensus guidelines in multiple sclerosis: an Australian multi-centre study. J Med Imaging Radiat Oncol 2013; 56:594-8. [PMID: 23210577 DOI: 10.1111/1754-9485.12000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 09/28/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a debilitating disease that causes significant morbidity within a young demographic. Diagnostic guidelines for MS have evolved, and imaging has played an increasingly important role in diagnosis over the last two decades. For imaging to contribute to diagnosis in a meaningful way, it must be reproducible. Consensus guidelines for MRI in MS exist to define correct sequence type and imaging technique, but it is not clear to what extent they are followed. This study reviewed MRI studies performed on Australian individuals presenting with a first clinical diagnosis of central nervous system demyelination (FCD) for adherence to published guidelines and discussed practical implementation of MS guidelines in light of recent updates. METHODS The Ausimmune study was a prospective case control study of Australian participants presenting with FCD from 2003 to 2006. Baseline cranial and spinal cord MRI studies of 226 case participants from four separate Australian regions were reviewed. MRI sequences were classified according to anatomical location, slice plane, tissue weighting and use of gadolinium-containing contrast media. Results were compared with the 2003 Consortium of Multiple Sclerosis Centres MRI protocol for the diagnosis of MS. RESULTS The composition of core cranial MRI sequences performed varied across the 226 scans. Of the studies, 91% included sagittal fluid attenuated inversion recovery (FLAIR) sequences. Cranial axial T2-weighted, axial FLAIR and axial proton density-weighted sequences were performed in 88%, 60% and 16% (respectively) of scans. Only 25% of the studies included a T1-weighted contrast-enhanced sequence. Concordance with the guidelines in all sequences was very low (2). CONCLUSION Only a small number of MRI investigations performed included all of the sequences stipulated by consensus guidelines. This is likely due to poor awareness in the imaging community of the guidelines and the rationale behind certain sequences. Radiologists with a sub-speciality interest in neuroradiology should take ownership of this issue and ensure that recommended imaging guidelines are followed.
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Affiliation(s)
- Michael Curley
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Australia
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Lucas RM, Ponsonby AL, Dear K, Valery PC, Taylor B, van der Mei I, McMichael AJ, Pender MP, Chapman C, Coulthard A, Kilpatrick TJ, Stankovich J, Williams D, Dwyer T. Vitamin D status: multifactorial contribution of environment, genes and other factors in healthy Australian adults across a latitude gradient. J Steroid Biochem Mol Biol 2013; 136:300-8. [PMID: 23395985 DOI: 10.1016/j.jsbmb.2013.01.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/17/2013] [Accepted: 01/24/2013] [Indexed: 12/15/2022]
Abstract
Vitamin D deficiency is common and implicated in risk of several human diseases. Evidence on the relative quantitative contribution of environmental, genetic and phenotypic factors to vitamin D status (assessed by the serum concentration of 25-hydroxyvitamin D, 25(OH)D) in free-living populations is sparse. We conducted a cross-sectional study of 494 Caucasian adults aged 18-61years, randomly selected from the Australian Electoral Roll according to groups defined by age, sex and region (spanning 27°-43°South). Data collected included personal characteristics, sun exposure behaviour, biomarkers of skin type and past sun exposure, serum 25(OH)D concentration and candidate single nucleotide polymorphisms. Ambient ultraviolet radiation (UVR) levels in the month six weeks before blood sampling best predicted vitamin D status. Serum 25(OH)D concentration increased by 10nmol/L as reported time in the sun doubled. Overall, 54% of the variation in serum 25(OH)D concentration could be accounted for: 36% of the variation was explained by sun exposure-related factors; 14% by genetic factors (including epistasis) and 3.5% by direct measures of skin phenotype. Novel findings from this study are demonstration of gene epistasis, and quantification of the relative contribution of a wide range of environmental, constitutional and genetic factors to vitamin D status. Ambient UVR levels and time in the sun were of prime importance but it is nonetheless important to include the contribution of genetic factors when considering sun exposure effects. This article is part of a Special Issue entitled 'Vitamin D Workshop'.
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Affiliation(s)
- Robyn M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra 0200, Australia.
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Hughes AM, Lucas RM, McMichael AJ, Dwyer T, Pender MP, van der Mei I, Taylor BV, Valery P, Chapman C, Coulthard A, Dear K, Kilpatrick TJ, Williams D, Ponsonby AL. Early-life hygiene-related factors affect risk of central nervous system demyelination and asthma differentially. Clin Exp Immunol 2013; 172:466-74. [PMID: 23600835 DOI: 10.1111/cei.12077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2013] [Indexed: 11/26/2022] Open
Abstract
The increasing prevalence of immune-related diseases, including multiple sclerosis, may be partly explained by reduced microbial burden during childhood. Within a multi-centre case-control study population, we examined: (i) the co-morbid immune diseases profile of adults with a first clinical diagnosis of central nervous system demyelination (FCD) and (ii) sibship structure in relation to an autoimmune (FCD) and an allergic (asthma) disease. FCD cases (n = 282) were aged 18-59 years; controls (n = 558) were matched on age, sex and region. Measures include: history of doctor-diagnosed asthma; sibling profile (number; dates of birth); and regular childcare attendance. FCD cases did not differ from controls with regard to personal or family history of allergy, but had a greater likelihood of chronic fatigue syndrome [odds ratio (OR) = 3·11; 95% confidence interval (CI) 1·11, 8·71]. Having any younger siblings showed reduced odds of FCD (OR = 0·68; 95% CI: 0·49, 0·95) but not asthma (OR = 1·47; 95% CI: 0·91, 2·38). In contrast, an increasing number of older siblings was associated with reduced risk of asthma (P trend = 0·04) but not FCD (P trend = 0·66). Allergies were not over-represented among people presenting with FCD. Sibship characteristics influence both FCD and asthma risk but the underlying mechanisms differ, possibly due to the timing of the putative 'sibling effect'.
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Affiliation(s)
- A-M Hughes
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
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Toi CS, Lay MLJ, Lucas R, Chew CB, Taylor J, Ponsonby AL, Dwyer DE. Varicella zoster virus quantitation in blood from symptomatic and asymptomatic individuals. J Med Virol 2013; 85:1491-7. [DOI: 10.1002/jmv.23605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Cheryl S. Toi
- Clinical Virology, Centre for Infectious Diseases and Microbiology-Public Health and Laboratory Services, Institute of Clinical Pathology and Medical Research; Westmead Hospital and University of Sydney; Westmead NSW Australia
| | - Meav-Lang J. Lay
- Clinical Virology, Centre for Infectious Diseases and Microbiology-Public Health and Laboratory Services, Institute of Clinical Pathology and Medical Research; Westmead Hospital and University of Sydney; Westmead NSW Australia
| | - Robyn Lucas
- National Centre for Epidemiology and Population Health; College of Medicine, Biology and Environment, The Australian National University; Canberra ACT Australia
| | - Choo Beng Chew
- Clinical Virology, Centre for Infectious Diseases and Microbiology-Public Health and Laboratory Services, Institute of Clinical Pathology and Medical Research; Westmead Hospital and University of Sydney; Westmead NSW Australia
| | - Janette Taylor
- Clinical Virology, Centre for Infectious Diseases and Microbiology-Public Health and Laboratory Services, Institute of Clinical Pathology and Medical Research; Westmead Hospital and University of Sydney; Westmead NSW Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute; The Royal Children's Hospital; Parkville Victoria Australia
| | - Dominic E. Dwyer
- Clinical Virology, Centre for Infectious Diseases and Microbiology-Public Health and Laboratory Services, Institute of Clinical Pathology and Medical Research; Westmead Hospital and University of Sydney; Westmead NSW Australia
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Ponsonby AL, Lucas RM, Dear K, van der Mei I, Taylor B, Chapman C, Coulthard A, Dwyer T, Kilpatrick TJ, McMichael AJ, Pender MP, Valery PC, Williams D. The physical anthropometry, lifestyle habits and blood pressure of people presenting with a first clinical demyelinating event compared to controls: The Ausimmune study. Mult Scler 2013; 19:1717-25. [DOI: 10.1177/1352458513483887] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Lifestyle factors prior to a first clinical demyelinating event (FCD), a disorder often preceding the development of clinically definite multiple sclerosis (MS), have not previously been examined in detail. Past tobacco smoking has been consistently associated with MS. Methods: This was a multicentre incident case-control study. Cases ( n = 282) were aged 18–59 years with an FCD and resident within one of four Australian centres (from latitudes 27°S to 43°S), from 1 November 2003 to 31 December 2006. Controls ( n = 558) were matched to cases on age, sex and study region, without CNS demyelination. Exposures measured included current and past tobacco and marijuana, alcohol and beverage use, physical activity patterns, blood pressure and physical anthropometry. Results: A history of smoking ever was associated with FCD risk (AOR 1.89 (95%CL 1.82, 3.52)). Marijuana use was not associated with FCD risk after adjusting for confounders such as smoking ever but the estimates were imprecise because of a low prevalence of use. Alcohol consumption was common and not associated with FCD risk. No case-control differences in blood pressure or physical anthropometry were observed. Conclusions: Past tobacco smoking was positively associated with a risk of FCD but most other lifestyle factors were not. Prevention efforts against type 2 diabetes and cardiovascular disease by increasing physical activity and reducing obesity are unlikely to alter MS incidence, and more targeted campaigns will be required.
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Affiliation(s)
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Australia
| | - Keith Dear
- National Centre for Epidemiology and Population Health, The Australian National University, Australia
| | | | - Bruce Taylor
- Menzies Research Institute Tasmania, Australia
- Otago University, New Zealand
| | | | - Alan Coulthard
- The University of Queensland and Royal Brisbane and Women’s Hospital, Australia
| | | | | | - Anthony J McMichael
- National Centre for Epidemiology and Population Health, The Australian National University, Australia
| | - Michael P Pender
- The University of Queensland and Royal Brisbane and Women’s Hospital, Australia
| | - Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Australia
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Valery PC, Lucas RM, Williams DB, Pender MP, Chapman C, Coulthard A, Dear K, Dwyer T, Kilpatrick TJ, McMichael AJ, van der Mei I, Taylor BV, Ponsonby AL. Occupational exposure and risk of central nervous system demyelination. Am J Epidemiol 2013; 177:954-61. [PMID: 23585328 DOI: 10.1093/aje/kws361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inconsistent evidence exists regarding the association between work-related factors and risk of multiple sclerosis (MS). We examined the association between occupational exposures and risk of a first clinical diagnosis of central nervous system demyelination (FCD), which is strongly associated with progression to MS, in a matched case-control study of 276 FCD cases and 538 controls conducted in Australia (2003-2006). Using a personal residence and work calendar, information on occupational history and exposure to chemicals and animals was collected through face-to-face interviews. Few case-control differences were noted. Fewer cases had worked as professionals (≥6 years) than controls (adjusted odds ratio (AOR) = 0.60, 95% confidence interval (CI): 0.37, 0.96). After further adjustment for number of children, cases were more likely to have ever been exposed to livestock than controls (AOR = 1.54, 95% CI: 1.03, 2.29). Among women, there was an increase in FCD risk associated with 10 or more years of exposure to livestock (AOR = 2.78, 95% CI: 1.22, 6.33) or 6 or more years of farming (AOR = 2.00, 95% CI: 1.23, 3.25; also adjusted for number of children). Similar findings were not evident among men. Thus, farming and exposure to livestock may be important factors in the development of FCD among women, with this finding further revealed after the confounding effect of parity or number of children is considered.
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Williamson DM, Marrie RA, Ashley-Koch A, Schiffer R, Trottier J, Wagner L. Design, methodological issues and participation in a multiple sclerosis case-control study. Acta Neurol Scand 2012; 126:197-204. [PMID: 22171574 DOI: 10.1111/j.1600-0404.2011.01629.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study was conducted to determine whether the risk of developing multiple sclerosis (MS) was associated with certain environmental exposures or genetic factors previously reported to influence MS risk. This paper describes the methodological issues, study design and characteristics of the study population. MATERIALS AND METHODS Individuals with definite MS were identified from a prevalence study conducted in three geographic areas. The target number of cases was not reached, so an additional study area was added. Identifying clinic controls was inefficient, so controls were recruited using random digit dialing. All study participants completed a detailed questionnaire regarding environmental exposures using computer-assisted telephone interviewing, and blood was collected for genetic analysis. RESULTS In total, 276 cases and 590 controls participated, but participation rates were low, ranging from 28.4% to 38.9%. Only one-third (33.6%) of individuals identified in the prevalence study agreed to participate in the case-control study. Cases were more likely to be non-Hispanic white and older than their source populations as identified in the preceding prevalence study (P < 0.05). Most participants provided a blood sample for genotyping (91%; n = 789). CONCLUSIONS Epidemiological studies play a key role in identifying genetic and environmental factors that are associated with complex diseases like MS. Methodological issues arise in every study, and investigators need to be able to detect, respond to and correct problems in a timely and scientifically valid manner.
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Affiliation(s)
- D. M. Williamson
- Division of Reproductive Health; Centers for Disease Control and Prevention; Atlanta; GA; USA
| | - R. A. Marrie
- Mellen Center for MS Treatment and Research; Cleveland Clinic Foundation; Cleveland; OH; USA
| | - A. Ashley-Koch
- Center for Human Genetics; Duke University Medical Center; Durham; NC; USA
| | - R. Schiffer
- Neuropsychiatry Behavioral Sciences; Texas Tech University Health Sciences Center; Lubbock; TX; USA
| | - J. Trottier
- Lorain County General Health District; Elyria; OH; USA
| | - L. Wagner
- Environmental Epidemiology and Disease Registries Section; Texas Department of State Health Services; Austin; TX; USA
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