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Jacobs BM, Schalk L, Tregaskis-Daniels E, Tank P, Hoque S, Peter M, Tuite-Dalton K, Witts J, Bove R, Dobson R. The relationship between ethnicity and multiple sclerosis characteristics in the United Kingdom: A UK MS Register study. Mult Scler 2024:13524585241277018. [PMID: 39301820 DOI: 10.1177/13524585241277018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
BACKGROUND Previous studies have suggested differences in multiple sclerosis (MS) severity according to ethnicity. METHODS Data were obtained from the UK MS Register, a prospective longitudinal cohort study of persons with MS. We examined the association between self-reported ethnic background and age at onset, symptom of onset and a variety of participant-reported severity measures. We used adjusted multivariable linear regression models to explore the association between ethnicity and impact of MS, and Cox proportional hazards models to assess disability progression. RESULTS We analysed data from 17,314 people with MS, including participants from self-reported Black (n = 157) or South Asian (n = 230) ethnic backgrounds. Age at MS onset and diagnosis was lower in those of South Asian (median 30.0) and Black (median 33.0) ethnicity compared with White ethnicity (median 35.0). In participants with online MS severity measures available, we found no statistically significant evidence for an association between ethnic background and physical disability in MS in both cross-sectional and longitudinal analyses. CONCLUSION We found no association between ethnic background and MS severity in a large, diverse UK cohort. These findings suggest that other factors, such as socioeconomic status and structural inequalities, may explain previous findings.
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Affiliation(s)
- Benjamin M Jacobs
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK Department of Neurology, Royal London Hospital, London, UK
| | - Luisa Schalk
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Emily Tregaskis-Daniels
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Pooja Tank
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Sadid Hoque
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Michelle Peter
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | | | - James Witts
- UK MS Register, University of Swansea, Swansea, UK
| | - Riley Bove
- UCSF Weill Institute for Neurosciences, UCSF, San Francisco, CA, USA
| | - Ruth Dobson
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK Department of Neurology, Royal London Hospital, London, UK
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Jacobs BM, Tank P, Bestwick JP, Noyce AJ, Marshall CR, Mathur R, Giovannoni G, Dobson R. Modifiable risk factors for multiple sclerosis have consistent directions of effect across diverse ethnic backgrounds: a nested case-control study in an English population-based cohort. J Neurol 2024; 271:241-253. [PMID: 37676298 PMCID: PMC10769990 DOI: 10.1007/s00415-023-11971-0] [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: 08/05/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Multiple sclerosis is a leading cause of non-traumatic neurological disability among young adults worldwide. Prior studies have identified modifiable risk factors for multiple sclerosis in cohorts of White ethnicity, such as infectious mononucleosis, smoking, and obesity during adolescence/early adulthood. It is unknown whether modifiable exposures for multiple sclerosis have a consistent impact on risk across ethnic groups. AIM To determine whether modifiable risk factors for multiple sclerosis have similar effects across diverse ethnic backgrounds. METHODS We conducted a nested case-control study using data from the UK Clinical Practice Research Datalink. Multiple sclerosis cases diagnosed from 2001 until 2022 were identified from electronic healthcare records and matched to unaffected controls based on year of birth. We used stratified logistic regression models and formal statistical interaction tests to determine whether the effect of modifiable risk factors for multiple sclerosis differed by ethnicity. RESULTS We included 9662 multiple sclerosis cases and 118,914 age-matched controls. The cohort was ethnically diverse (MS: 277 South Asian [2.9%], 251 Black [2.6%]; Controls: 5043 South Asian [5.7%], 4019 Black [4.5%]). The age at MS diagnosis was earlier in the Black (40.5 [SD 10.9]) and Asian (37.2 [SD 10.0]) groups compared with White cohort (46.1 [SD 12.2]). There was a female predominance in all ethnic groups; however, the relative proportion of males was higher in the South Asian population (proportion of women 60.3% vs 71% [White] and 75.7% [Black]). Established modifiable risk factors for multiple sclerosis-smoking, obesity, infectious mononucleosis, low vitamin D, and head injury-were consistently associated with multiple sclerosis in the Black and South Asian cohorts. The magnitude and direction of these effects were broadly similar across all ethnic groups examined. There was no evidence of statistical interaction between ethnicity and any tested exposure, and no evidence to suggest that differences in area-level deprivation modifies these risk factor-disease associations. These findings were robust to a range of sensitivity analyses. CONCLUSIONS AND RELEVANCE Established modifiable risk factors for multiple sclerosis are applicable across diverse ethnic backgrounds. Efforts to reduce the population incidence of multiple sclerosis by tackling these risk factors need to be inclusive of people from diverse ethnicities.
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Affiliation(s)
- Benjamin M Jacobs
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
- Department of Neurology, Royal London Hospital, London, UK
| | - Pooja Tank
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
| | - Jonathan P Bestwick
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
| | - Alastair J Noyce
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
- Department of Neurology, Royal London Hospital, London, UK
| | - Charles R Marshall
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
- Department of Neurology, Royal London Hospital, London, UK
| | - Rohini Mathur
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, UK
| | - Gavin Giovannoni
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
- Department of Neurology, Royal London Hospital, London, UK
- Blizard Institute, Queen Mary University London, London, UK
| | - Ruth Dobson
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK.
- Department of Neurology, Royal London Hospital, London, UK.
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Mallawaarachchi G, Rog DJ, Das J. Ethnic disparities in the epidemiological and clinical characteristics of multiple sclerosis. Mult Scler Relat Disord 2024; 81:105153. [PMID: 38043364 DOI: 10.1016/j.msard.2023.105153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/13/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a neuroinflammatory disorder which affects 2.8 million people world-wide. A growing body of evidence shows ethnic disparities in MS. This review aims to evaluate differences, based upon ethnic background, in the incidence, prevalence, disease course, and efficacy of disease-modifying therapies (DMTs) among people with MS (PwMS). METHOD Ethnicities were classified as White, Black, Hispanic, Asian, and Middle Eastern and North African (MENA). A literature search was conducted using the PubMed search engine to identify articles on MS and ethnicity that were published in the English language between 01/01/2005 and 31/05/2022. RESULTS 101 studies met all inclusion criteria. Although the incidence and prevalence of MS varied among ethnicities, findings were inconsistent and depended on the continent of the study. Ethnicity may have an impact on the disease course. PwMS from Black, Hispanic, and MENA, but not Asian ethnicities, appeared to accumulate physical disability at a faster rate than those from White ethnicity. Although there was a lack of studies evaluating the relative safety and efficacy of DMTs among various ethnicities, interferon-beta was found to be less efficacious in PwMS from Black ethnicity. CONCLUSIONS Further studies, with more uniform definitions of ethnicity are required to comprehensively understand ethnic disparities in MS, in particular to identify underlying causes, to facilitate the delivery of personalised medical care and avoid inequity.
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Affiliation(s)
| | - David J Rog
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, United Kingdom M6 8HD
| | - Joyutpal Das
- University of Manchester, Oxford Rd, Manchester, United Kingdom M13 9PL; Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, United Kingdom M6 8HD.
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Fan JH, Alexander J, Poole S, Wijangco J, Henson LJ, Dobson R, Guo CY, Bove R. Characteristics of multiple sclerosis and demyelinating disease in an Asian American population. Mult Scler 2023; 29:1216-1228. [PMID: 37548214 DOI: 10.1177/13524585231188486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Race and ancestry influence the course of multiple sclerosis (MS). OBJECTIVES Explore clinical characteristics of MS and neuromyelitis optica spectrum disorder (NMOSD) in Asian American patients. METHODS Chart review was performed for 282 adults with demyelinating disease who self-identified as Asian at a single North American MS center. Demographics and clinical characteristics were compared to non-Asian MS patients and by region of Asian ancestry. RESULTS Region of ancestry was known for 181 patients. Most (94.7%) preferred English, but fewer East Asian patients did (80%, p = 0.0001). South Asian patients had higher neighborhood household income (p = 0.002). Diagnoses included MS (76.2%) and NMOSD (13.8%). More patients with NMOSD than MS were East and Southeast Asian (p = 0.004). For MS patients, optic nerve and spinal cord involvement were similar across regions of ancestry. Asian MS patients were younger at symptom onset and diagnosis than non-Asian MS patients. MS Severity Scale scores were similar to non-Asian MS patients but worse among Southeast Asians (p = 0.006). CONCLUSIONS MS severity was similar between Asian American patients and non-Asian patients. Region of ancestry was associated with differences in sociodemographics and MS severity. Further research is needed to uncover genetic, socioeconomic, or environmental factors causing these differences.
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Affiliation(s)
- Jessica H Fan
- Department of Neurology, UCSF Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, Kaiser Permanente, Oakland, CA, USA
| | - Jessa Alexander
- Department of Neurology, UCSF Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA
| | - Shane Poole
- Department of Neurology, UCSF Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA
| | - Jaeleene Wijangco
- Department of Neurology, UCSF Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA
| | | | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University, London, UK
- Department of Neurology, Royal London Hospital, London, UK
| | - Chu-Yueh Guo
- Department of Neurology, UCSF Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA
| | - Riley Bove
- Department of Neurology, UCSF Weill Institute for Neuroscience, University of California San Francisco, San Francisco, CA, USA
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Sharma-Oates A, Zemedikun DT, Kumar K, Reynolds JA, Jain A, Raza K, Williams JA, Bravo L, Cardoso VR, Gkoutos G, Nirantharakumar K, Lord JM. Early onset of immune-mediated diseases in minority ethnic groups in the UK. BMC Med 2022; 20:346. [PMID: 36224602 PMCID: PMC9558944 DOI: 10.1186/s12916-022-02544-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/01/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The prevalence of some immune-mediated diseases (IMDs) shows distinct differences between populations of different ethnicities. The aim of this study was to determine if the age at diagnosis of common IMDs also differed between different ethnic groups in the UK, suggestive of distinct influences of ethnicity on disease pathogenesis. METHODS This was a population-based retrospective primary care study. Linear regression provided unadjusted and adjusted estimates of age at diagnosis for common IMDs within the following ethnic groups: White, South Asian, African-Caribbean and Mixed-race/Other. Potential disease risk confounders in the association between ethnicity and diagnosis age including sex, smoking, body mass index and social deprivation (Townsend quintiles) were adjusted for. The analysis was replicated using data from UK Biobank (UKB). RESULTS After adjusting for risk confounders, we observed that individuals from South Asian, African-Caribbean and Mixed-race/Other ethnicities were diagnosed with IMDs at a significantly younger age than their White counterparts for almost all IMDs. The difference in the diagnosis age (ranging from 2 to 30 years earlier) varied for each disease and by ethnicity. For example, rheumatoid arthritis was diagnosed at age 49, 48 and 47 years in individuals of African-Caribbean, South Asian and Mixed-race/Other ethnicities respectively, compared to 56 years in White ethnicities. The earlier diagnosis of most IMDs observed was validated in UKB although with a smaller effect size. CONCLUSION Individuals from non-White ethnic groups in the UK had an earlier age at diagnosis for several IMDs than White adults.
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Affiliation(s)
- Archana Sharma-Oates
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK. .,School of Biosciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Dawit T Zemedikun
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - John A Reynolds
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | | | - Karim Raza
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - John A Williams
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.,Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK
| | - Laura Bravo
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Victor Roth Cardoso
- Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Georgios Gkoutos
- Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
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Sauerbier A, Schrag A, Brown R, Martinez-Martin P, Aarsland D, Mulholland N, Vivian G, Dafsari HS, Rizos A, Corcoran B, Jarosz J, Siakallis L, Ray Chaudhuri K. Clinical Non-Motor Phenotyping of Black and Asian Minority Ethnic Compared to White Individuals with Parkinson's Disease Living in the United Kingdom. JOURNAL OF PARKINSONS DISEASE 2021; 11:299-307. [PMID: 33104038 DOI: 10.3233/jpd-202218] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Ethnic phenotypic differences in Parkinson's disease (PD) are important to understand the heterogeneity of PD and develop biomarkers and clinical trials. OBJECTIVE To investigate (i) whether there are non-motor symptoms (NMS)- and comorbidity-based phenotypic differences between Black, Asian and Minority Ethnic (BAME) and White PD patients and (ii) whether clinically available biomarkers may help differentiate and explain the differences between the groups. METHODS This is a multicentre (four sites, London), real-life, cross-sectional study including PD patients of BAME or White ethnicity. The primary outcome was a detailed NMS assessment; additional measurements included disease and motor stage, comorbidity, sociodemographic parameters and brain MRI imaging. RESULTS 271 PD patients (54 Asian, 71 Black, and 146 White) were included balanced for age, gender, and disease severity (HY). Black patients had a shorter disease duration compared to White and Asian populations. The SCOPA-Motor activities of daily living scores as well as the NMSS scores were significantly higher in both Black (total score and domain "miscellaneous") and Asian (total score and domains "sleep/fatigue", "mood/apathy" and "perception/hallucinations") than White individuals. Both BAME populations had higher prevalence of arterial hypertension, and the Black population had a higher prevalence of diabetes mellitus. Brain MRI revealed a greater severity of white matter changes in Black compared to the White and Asian cohorts. CONCLUSION These findings suggest differences in phenotype of PD in BAME populations with greater burden of NMS and motor disability and a higher rate of cardiovascular comorbidities.
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Affiliation(s)
- Anna Sauerbier
- National Parkinson's Centre of Excellence, King's College Hospital, Denmark Hill, London, UK.,Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.,Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, University College London, London, UK
| | - Richard Brown
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Dag Aarsland
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Gill Vivian
- Department of Nuclear Medicine, King's College Hospital, London, UK
| | - Haidar S Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Alexandra Rizos
- National Parkinson's Centre of Excellence, King's College Hospital, Denmark Hill, London, UK
| | - Ben Corcoran
- Department of Nuclear Medicine, King's College Hospital, London, UK
| | - Jozef Jarosz
- Department of Neuroradiology, King's College Hospital, London, UK
| | - Loizos Siakallis
- Department of Neuroradiology, King's College Hospital, London, UK
| | - K Ray Chaudhuri
- National Parkinson's Centre of Excellence, King's College Hospital, Denmark Hill, London, UK.,Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
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Bove R, Chua AS, Xia Z, Chibnik L, De Jager PL, Chitnis T. Complex relation of HLA-DRB1*1501, age at menarche, and age at multiple sclerosis onset. NEUROLOGY-GENETICS 2016; 2:e88. [PMID: 27504495 PMCID: PMC4962522 DOI: 10.1212/nxg.0000000000000088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/17/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the relationship between 2 markers of early multiple sclerosis (MS) onset, 1 genetic (HLA-DRB1*1501) and 1 experiential (early menarche), in 2 cohorts. METHODS We included 540 white women with MS or clinically isolated syndrome (N = 156 with genetic data available) and 1,390 white women without MS but with a first-degree relative with MS (Genes and Environment in Multiple Sclerosis [GEMS]). Age at menarche, HLA-DRB1*1501 status, and age at MS onset were analyzed. RESULTS In both cohorts, participants with at least 1 HLA-DRB1*1501 allele had a later age at menarche than did participants with no risk alleles (MS: mean difference = 0.49, 95% confidence interval [CI] = [0.03-0.95], p = 0.036; GEMS: mean difference = 0.159, 95% CI = [0.012-0.305], p = 0.034). This association remained after we adjusted for body mass index at age 18 (available in GEMS) and for other MS risk alleles, as well as a single nucleotide polymorphism near the HLA-A region previously associated with age of menarche (available in MS cohort). Confirming previously reported associations, in our MS cohort, every year decrease in age at menarche was associated with a 0.65-year earlier MS onset (95% CI = [0.07-1.22], p = 0.027, N = 540). Earlier MS onset was also found in individuals with at least 1 HLA-DRB1*1501 risk allele (mean difference = -3.40 years, 95% CI = [-6.42 to -0.37], p = 0.028, N = 156). CONCLUSIONS In 2 cohorts, a genetic marker for earlier MS onset (HLA-DRB1*1501) was inversely related to earlier menarche, an experiential marker for earlier symptom onset. This finding warrants broader investigations into the association between the HLA region and hormonal regulation in determining the onset of autoimmune disease.
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Affiliation(s)
- Riley Bove
- Department of Neurology (R.B., A.S.C., Z.X., P.L.D.J., T.C.), Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Brookline, MA; and Ann Romney Center for Neurologic Diseases (R.B., A.S.C., Z.X., L.C., P.L.D.J., T.C.), Harvard Medical School (R.B., Z.X., L.C., P.L.D.J., T.C.), Boston, MA
| | - Alicia S Chua
- Department of Neurology (R.B., A.S.C., Z.X., P.L.D.J., T.C.), Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Brookline, MA; and Ann Romney Center for Neurologic Diseases (R.B., A.S.C., Z.X., L.C., P.L.D.J., T.C.), Harvard Medical School (R.B., Z.X., L.C., P.L.D.J., T.C.), Boston, MA
| | - Zongqi Xia
- Department of Neurology (R.B., A.S.C., Z.X., P.L.D.J., T.C.), Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Brookline, MA; and Ann Romney Center for Neurologic Diseases (R.B., A.S.C., Z.X., L.C., P.L.D.J., T.C.), Harvard Medical School (R.B., Z.X., L.C., P.L.D.J., T.C.), Boston, MA
| | - Lori Chibnik
- Department of Neurology (R.B., A.S.C., Z.X., P.L.D.J., T.C.), Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Brookline, MA; and Ann Romney Center for Neurologic Diseases (R.B., A.S.C., Z.X., L.C., P.L.D.J., T.C.), Harvard Medical School (R.B., Z.X., L.C., P.L.D.J., T.C.), Boston, MA
| | - Philip L De Jager
- Department of Neurology (R.B., A.S.C., Z.X., P.L.D.J., T.C.), Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Brookline, MA; and Ann Romney Center for Neurologic Diseases (R.B., A.S.C., Z.X., L.C., P.L.D.J., T.C.), Harvard Medical School (R.B., Z.X., L.C., P.L.D.J., T.C.), Boston, MA
| | - Tanuja Chitnis
- Department of Neurology (R.B., A.S.C., Z.X., P.L.D.J., T.C.), Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Brookline, MA; and Ann Romney Center for Neurologic Diseases (R.B., A.S.C., Z.X., L.C., P.L.D.J., T.C.), Harvard Medical School (R.B., Z.X., L.C., P.L.D.J., T.C.), Boston, MA
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Graves JS, Barcellos LF, Shao X, Noble J, Mowry EM, Quach H, Belman A, Casper TC, Krupp LB, Waubant E. Genetic predictors of relapse rate in pediatric MS. Mult Scler 2016; 22:1528-1535. [PMID: 26769066 DOI: 10.1177/1352458515624269] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/25/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Genetic ancestry, sex, and individual alleles have been associated with multiple sclerosis (MS) susceptibility. OBJECTIVE To determine whether established risk factors for disease onset are associated with relapse rate in pediatric MS. METHODS Whole-genome genotyping was performed for 181 MS or high-risk clinically isolated syndrome patients from two pediatric MS centers. Relapses and disease-modifying therapies were recorded as part of continued follow-up. Participants were characterized for 25-hydroxyvitamin D serum status. Ancestral estimates (STRUCTURE v2.3.1), human leukocyte antigen (HLA)-DRB1*15 carrier status (direct sequencing), sex, and a genetic risk score (GRS) of 110 non-HLA susceptibility single-nucleotide polymorphisms (SNPs) were evaluated for association with relapse rate with Cox and negative binomial regression models. RESULTS Over 622 patient-years, 408 relapses were captured. Girls had greater relapse rate than boys (incident rate ratio (IRR) = 1.40, 95% confidence interval (CI) = 1.04-1.87, p = 0.026). Participants were genetically diverse; ~40% (N = 75) had <50% European ancestry. HLA-DRB1*15 status modified the association of vitamin D status (pixn = 0.022) with relapse rate (per 10 ng/mL, in DRB1*15+ hazard ratio (HR) = 0.72, 95% CI = 0.58-0.88, p = 0.002; in DRB1*15- HR = 0.96, 95% CI = 0.83-1.12, p = 0.64). Neither European ancestry nor GRS was associated with relapse rate. CONCLUSION We demonstrate that HLA-DRB1*15 modifies the association of vitamin D status with relapse rate. Our findings emphasize the need to pursue disease-modifying effects of MS genes in the context of environmental factors.
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Affiliation(s)
| | - Lisa F Barcellos
- Genetic Epidemiology and Genomics Lab, School of Public Health, and California Institute for Quantitative Biosciences, University of California-Berkeley, Berkeley, CA, USA
| | - Xiaorong Shao
- Genetic Epidemiology and Genomics Lab, School of Public Health, and California Institute for Quantitative Biosciences, University of California-Berkeley, Berkeley, CA, USA
| | - Janelle Noble
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Ellen M Mowry
- The Multiple Sclerosis Center, Johns Hopkins University, Baltimore, MD, USA
| | - Hong Quach
- Genetic Epidemiology and Genomics Lab, School of Public Health, and California Institute for Quantitative Biosciences, University of California-Berkeley, Berkeley, CA, USA
| | - Anita Belman
- National Pediatric Multiple Sclerosis Center, Stony Brook, NY, USA
| | - T Charles Casper
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, UT, USA
| | - Lauren B Krupp
- National Pediatric Multiple Sclerosis Center, Stony Brook, NY, USA
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