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Siddiqui A, Yang JH, Hua LH, Graves JS. Clinical and Treatment Considerations for the Pediatric and Aging Patients with Multiple Sclerosis. Neurol Clin 2024; 42:255-274. [PMID: 37980118 DOI: 10.1016/j.ncl.2023.07.003] [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: 11/20/2023]
Abstract
Chronologic aging is associated with multiple pathologic and immunologic changes that impact the clinical course of multiple sclerosis (MS). Clinical phenotypes evolve across the lifespan, from a highly inflammatory course in the very young to a predominantly neurodegenerative phenotype in older patients. Thus, unique clinical considerations arise for the diagnosis and management of the two age extremes of pediatric and geriatric MS populations. This review covers epidemiology, diagnosis, and treatment strategies for these populations with nuanced discussions on therapeutic approaches to effectively care for patients living with MS at critical transition points during their lifespan.
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Affiliation(s)
- Areeba Siddiqui
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV 89106, USA
| | - Jennifer H Yang
- Department of Neurosciences, University of California San Diego, 9500 Gilman Drive, Mail Code 0662, La Jolla, CA 92093, USA; Division of Pediatric Neurology, Rady Children's Hospital, 3020 Children's Way MC 5009, San Diego, CA 92123, USA
| | - Le H Hua
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Avenue, Las Vegas, NV 89106, USA.
| | - Jennifer S Graves
- Department of Neurosciences, University of California San Diego, 9500 Gilman Drive, Mail Code 0662, La Jolla, CA 92093, USA; Division of Pediatric Neurology, Rady Children's Hospital, 3020 Children's Way MC 5009, San Diego, CA 92123, USA
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Bunul SD. Comparing Clinical and Radiological Features in Familial and Sporadic Multiple Sclerosis. Cureus 2023; 15:e44504. [PMID: 37662512 PMCID: PMC10472085 DOI: 10.7759/cureus.44504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 09/05/2023] Open
Abstract
Objective To compare the initial presentation, clinical features, disease courses, and radiological parameters between familial multiple sclerosis (fMS) and sporadic multiple sclerosis (sMS) to determine if the two represent distinct clinical entities. Methods This retrospective study was conducted at the Neurology Clinic at Kocaeli University Hospital. Records of 114 fMS and 150 sMS patients, aged 18-65, diagnosed based on either the Poser criteria or the McDonald 2001 criteria were analyzed. Radiological data and Expanded Disability Status Scale (EDSS) evaluations were conducted by a specialist neurologist. Variables included age at MS onset, first symptoms, relapses, EDSS scores at diagnosis and last examination, and MRI findings. Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 28, Armonk, NY) was utilized for data analysis. Results Both fMS and sMS groups were comparable in age (43.55±12.50 and 42.35±10.61 years, respectively) and gender distribution (females: fMS 71.9%, sMS 71.3%). No significant difference was noted regarding disease onset age (fMS 29.83±10.77, sMS 30.42±9.7). Age of onset, final EDSS, and relapse rate didn't significantly vary among sMS, fMS with first-degree relatives having MS (fMS(1)), and fMS with second or third-degree relatives having MS (fMS(2)). The fMS group showed a significantly higher incidence of initial spinal cord lesions on MRI compared to the sMS group (38.6% vs. 17.3%; p<0.001). Within the fMS group, the presence of spinal cord lesions on initial MRI correlated with a higher relapse rate and elevated initial and final EDSS scores. Conclusion Despite overarching similarities between fMS and sMS, spinal cord lesions' prevalence and implications in fMS may point to a genetic underpinning warranting in-depth exploration.
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A Whole-Genome Sequencing Study Implicates GRAMD1B in Multiple Sclerosis Susceptibility. Genes (Basel) 2022; 13:genes13122392. [PMID: 36553660 PMCID: PMC9777893 DOI: 10.3390/genes13122392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
While the role of common genetic variants in multiple sclerosis (MS) has been elucidated in large genome-wide association studies, the contribution of rare variants to the disease remains unclear. Herein, a whole-genome sequencing study in four affected and four healthy relatives of a consanguineous Italian family identified a novel missense c.1801T > C (p.S601P) variant in the GRAMD1B gene that is shared within MS cases and resides under a linkage peak (LOD: 2.194). Sequencing GRAMD1B in 91 familial MS cases revealed two additional rare missense and two splice-site variants, two of which (rs755488531 and rs769527838) were not found in 1000 Italian healthy controls. Functional studies demonstrated that GRAMD1B, a gene with unknown function in the central nervous system (CNS), is expressed by several cell types, including astrocytes, microglia and neurons as well as by peripheral monocytes and macrophages. Notably, GRAMD1B was downregulated in vessel-associated astrocytes of active MS lesions in autopsied brains and by inflammatory stimuli in peripheral monocytes, suggesting a possible role in the modulation of inflammatory response and disease pathophysiology.
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Goris A, Vandebergh M, McCauley JL, Saarela J, Cotsapas C. Genetics of multiple sclerosis: lessons from polygenicity. Lancet Neurol 2022; 21:830-842. [PMID: 35963264 DOI: 10.1016/s1474-4422(22)00255-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 11/27/2022]
Abstract
Large-scale mapping studies have identified 236 independent genetic variants associated with an increased risk of multiple sclerosis. However, none of these variants are found exclusively in patients with multiple sclerosis. They are located throughout the genome, including 32 independent variants in the MHC and one on the X chromosome. Most variants are non-coding and seem to act through cell-specific effects on gene expression and splicing. The likely functions of these variants implicate both adaptive and innate immune cells in the pathogenesis of multiple sclerosis, provide pivotal biological insight into the causes and mechanisms of multiple sclerosis, and some of the variants implicated in multiple sclerosis also mediate risk of other autoimmune and inflammatory diseases. Genetics offers an approach to showing causality for environmental factors, through Mendelian randomisation. No single variant is necessary or sufficient to cause multiple sclerosis; instead, each increases total risk in an additive manner. This combined contribution from many genetic factors to disease risk, or polygenicity, has important consequences for how we interpret the epidemiology of multiple sclerosis and how we counsel patients on risk and prognosis. Ongoing efforts are focused on increasing cohort sizes, increasing diversity and detailed characterisation of study populations, and translating these associations into an understanding of the biology of multiple sclerosis.
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Affiliation(s)
- An Goris
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Laboratory for Neuroimmunology, Leuven, Belgium.
| | - Marijne Vandebergh
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Laboratory for Neuroimmunology, Leuven, Belgium
| | - Jacob L McCauley
- John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Janna Saarela
- Centre for Molecular Medicine Norway, University of Oslo, Oslo, Norway; Institute for Molecular Medicine Finland and Department of Clinical Genetics, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Chris Cotsapas
- Departments of Neurology and Genetics, Yale School of Medicine, New Haven, CT, USA
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Salehi Z, Almasi-Hashiani A, Sahraian MA, Ashtari F, Baghbanian SM, Razazian N, Moghadasi AN, Bayati A, Azimi AR, Beladimoghadam N, Harirchian MH, Poursadeghfard M, Navardi S, Shirkoohi R, Heidari H, Ghaffari M, Eskandarieh S. Epidemiology of familial multiple sclerosis in Iran: a national registry-based study. BMC Neurol 2022; 22:76. [PMID: 35248009 PMCID: PMC8897924 DOI: 10.1186/s12883-022-02609-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Admittedly, little is known about the epidemiological signatures of familial multiple sclerosis (FMS) in different geographical regions of Iran. Objective To determine the epidemiology and the risk of FMS incidence in several provinces of Iran with a different ethnic population including, Fars, Tehran, Isfahan (Persians), and Mazandaran (Mazanis), Kermanshah (Kurds), and Chaharmahal and Bakhtiari (Lors). Methods This cross-sectional registry-based study was performed on nationwide MS registry of Iran (NMSRI) data collected from 2018 to 2021. This system, registers baseline characteristics, clinical presentations and symptoms, diagnostic and treatments at regional and national levels. Results A total of 9200 patients including, 7003 (76.1%) female and 2197 (23.9%) male, were participated. About 19% of patients reported a family history of MS; the order from highest to lowest FMS prevalence was as follows: Fars (26.5%), Chaharmahal and Bakhtiari (21.1%), Tehran (20.5%), Isfahan (20.3%), Mazandaran (18.0%), and Kermanshah (12.5%). Of all FMS cases, 74.7% (1308 cases) were female and 25.3% (442 cases) were male. FMS occurrence was much more common in females than males (P-value = 0.001). Further, the mean age at onset was 30 years among FMS cases. A substantially higher probability of relapsing-remitting MS and secondary-progressive MS was found among FMS cases than sporadic MS (SMS) (P_value = 0.001). There was no significant difference in Expanded Disability Status Scale (EDSS) scores between FMS and SMS. The majority of FMS cases were observed among first-degree relatives, with the highest rate in siblings. There was a significant association between MS risk and positive familial history in both maternal and paternal aunt/uncle (P_value = 0.043 and P_value = 0.019, respectively). Multiple sclerosis occurrence among offspring of females was higher than males (P_value = 0.027). Conclusions In summary, our findings imply a noteworthy upward trend of FMS in Iran, even more than the global prevalence, which suggests a unique Atlas of FMS prevalence in this multi-ethnic population. Despite the highest rate of FMS within Persian and Lor ethnicities, no statistically significant difference was observed among the provinces.
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Kittel-Schneider S, Arteaga-Henriquez G, Vasquez AA, Asherson P, Banaschewski T, Brikell I, Buitelaar J, Cormand B, Faraone SV, Freitag CM, Ginsberg Y, Haavik J, Hartman CA, Kuntsi J, Larsson H, Matura S, McNeill RV, Ramos-Quiroga JA, Ribases M, Romanos M, Vainieri I, Franke B, Reif A. Non-mental diseases associated with ADHD across the lifespan: Fidgety Philipp and Pippi Longstocking at risk of multimorbidity? Neurosci Biobehav Rev 2021; 132:1157-1180. [PMID: 34757108 DOI: 10.1016/j.neubiorev.2021.10.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Abstract
Several non-mental diseases seem to be associated with an increased risk of ADHD and ADHD seems to be associated with increased risk for non-mental diseases. The underlying trajectories leading to such brain-body co-occurrences are often unclear - are there direct causal relationships from one disorder to the other, or does the sharing of genetic and/or environmental risk factors lead to their occurring together more frequently or both? Our goal with this narrative review was to provide a conceptual synthesis of the associations between ADHD and non-mental disease across the lifespan. We discuss potential shared pathologic mechanisms, genetic background and treatments in co-occurring diseases. For those co-occurrences for which published studies with sufficient sample sizes exist, meta-analyses have been published by others and we discuss those in detail. We conclude that non-mental diseases are common in ADHD and vice versa and add to the disease burden of the patient across the lifespan. Insufficient attention to such co-occurring conditions may result in missed diagnoses and suboptimal treatment in the affected individuals.
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Affiliation(s)
- Sarah Kittel-Schneider
- Center of Mental Health, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany.
| | - Gara Arteaga-Henriquez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Alejandro Arias Vasquez
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Departments of Psychiatry and Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Phil Asherson
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Isabell Brikell
- National Centre for Register-based Research, Department of Economics and Business Economics Aarhus BSS, Aarhus University, Fuglesangs Allé 26, DK-8210 Aarhus V, Aarhus, Denmark; iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, 171 77, Stockholm, Sweden
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands
| | - Bru Cormand
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Catalonia, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Catalonia, Spain
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, D-60528 Frankfurt am Main, Germany
| | - Ylva Ginsberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Jan Haavik
- Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Catharina A Hartman
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Jonna Kuntsi
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, 171 77, Stockholm, Sweden; Örebro University, School of Medical Sciences, Campus USÖ, S-701 82 Örebro, Sweden
| | - Silke Matura
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany
| | - Rhiannon V McNeill
- Center of Mental Health, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Marta Ribases
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Catalonia, Spain
| | - Marcel Romanos
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany
| | - Isabella Vainieri
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Barbara Franke
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Departments of Psychiatry and Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany
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Sadovnick AD, Yee IM, Criscuoli M, DeLuca GC. Genes and environment in multiple sclerosis: Impact of temporal changes in the sex ratio on recurrence risks. Mult Scler 2021; 28:359-368. [PMID: 34100315 PMCID: PMC8894679 DOI: 10.1177/13524585211020221] [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] [Indexed: 12/03/2022]
Abstract
Objective: To evaluate the impact of temporal increase of female to male (F:M) sex ratio
for persons with multiple sclerosis (MS) on the familial risk (empiric
recurrence risks or RRs) for biological relatives of affected
individuals. Methods: Detailed family histories were systematically obtained from people with MS
attending the University of British Columbia Hospital MS Clinic. The study
cohort was born in 1970 or more recently. Data were collected from 1
September 2015 to 31 January 2019. The study was designed to allow only one
proband per family. Age-corrected RRs for biological relatives of probands
were calculated based on a modification of the maximum-likelihood
approach. Results: Data analyses were possible for 746 unique probands (531 females; 215 males)
and 19,585 of their biological relatives. RRs were temporally impacted. Conclusion: Both genetic sharing and environmental factors are important in determining
RRs. It appears that there is an increase in MS risk due to environmental
factors in later life (i.e. not shared family environment). Environmental
exposures in genetically predisposed individuals might be driving the MS
risk. The increase in F:M ratio of RRs for sisters/brothers of female
probands over time is likely due to environmental differences.
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Affiliation(s)
- A Dessa Sadovnick
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada/Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada/UBC Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Irene M Yee
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Maria Criscuoli
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
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Chorazy M, Wawrusiewicz-Kurylonek N, Adamska-Patruno E, Czarnowska A, Zajkowska O, Kapica-Topczewska K, Posmyk R, Kretowski AJ, Kochanowicz J, Kułakowska A. Variants of Novel Immunomodulatory Fc Receptor Like 5 Gene Are Associated With Multiple Sclerosis Susceptibility in the Polish Population. Front Neurol 2021; 12:631134. [PMID: 33889124 PMCID: PMC8055847 DOI: 10.3389/fneur.2021.631134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
Fc receptors have been shown to play a role in several autoimmune diseases. We aimed to test, for the first time, whether some of the single nucleotide variants in the FCRL5 gene were associated with multiple sclerosis (MS) susceptibility and clinical manifestations in the Polish population. The case-control study included 94 individuals with MS and 160 healthy subjects. We genotyped two single nucleotide variants of the FCRL5 gene: rs2012199 and rs6679793. The age of onset, disease duration, and clinical condition of the MS subjects were analyzed. For statistical analysis, we used the chi-squared test confirmed with Fisher's exact test. We observed the significant differences in the distribution of investigated FCRL5 genotypes between MS subjects and healthy controls. The CC and CT genotypes, as well as the C allele of rs2012199, were significantly more common in the MS subjects, as were genotypes AA and AG, and allele A of rs6679793. We noted that decreased MS susceptibility was associated with the T allele rs2012199 (OR = 0.37, p = 0.0002) and G allele rs6679793 (OR = 0.6, p = 0.02). Our results support the role of the FCRL5 locus in MS predisposition and extend the evidence of its influence on autoimmunity.
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Affiliation(s)
- Monika Chorazy
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Natalia Wawrusiewicz-Kurylonek
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland.,Department of Clinical Genetics, Medical University of Bialystok, Bialystok, Poland
| | | | - Agata Czarnowska
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Olga Zajkowska
- Faculty of Economic Sciences, University of Warsaw, Warsaw, Poland
| | | | - Renata Posmyk
- Department of Clinical Genetics, Medical University of Bialystok, Bialystok, Poland
| | - Adam Jacek Kretowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland.,Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
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AlJumah M, Otaibi HA, Al Towaijri G, Hassan A, Kareem A, Kalakatawi M, Alrajeh S, Al Mejally M, Algahtani H, Almubarak A, Alawi S, Qureshi S, Al Malik Y, El-Metwally A, Shami S, Ishak S, Bunyan R. Familial aggregation of multiple sclerosis: Results from the national registry of the disease in Saudi Arabia. Mult Scler J Exp Transl Clin 2020; 6:2055217320960499. [PMID: 33110617 PMCID: PMC7556172 DOI: 10.1177/2055217320960499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/05/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
Background Multiple Sclerosis (MS) is a chronic CNS inflammatory disease commonly affecting young adults. Both genetics and environmental factors have been reported to have a role in pathophysiology of the disease. Objective This article aims to report familial nature and aspects of MS in Saudi Arabia. Method The study utilized data collected by the National Saudi MS Registry between 2015 and 2018; especially data relevant to the familial history of MS. SPSS 22 was used for all analysis and reporting. Statistical significance was set at p-value < 0.05. Results The registry included 20 hospitals and a total of 2516 patients from the different regions of Saudi Arabia with median age 32.00 (Range: 11-63) and 66.5% being female. About 12.8% of all registered patients reported a family history of MS (95%CI: 11.2-13.9). Reported parental consanguinity was significantly higher among patients with family history (FMS) (56.3%) compared to non-FMS patients (27.9%). 42.53% of FMS patients reported having siblings affected with MS (95%CI: 37.01-48.21), with more female siblings affected than males (63.4% vs 36.6% respectively). Conclusion Our Findings suggested that FMS was less prevalent than what was reported previously; however, parental consanguinity was significantly more prevalent among FMS patients than non-FMS. Our findings were in line with those reported in recent studies in the region, but lower than those reported by western countries indicating that increasing prevalence of MS in Saudi Arabia could be multifactorial and other environmental factors should be considered for understanding this recent rise in the prevalence of MS in Saudi Arabia.
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Affiliation(s)
- Mohammed AlJumah
- Neurology Department, King Fahd Medical City (KFMC), MOH, Riyadh, Saudi Arabia
| | - Hessa Al Otaibi
- Neurology Department, King Fahd General Hospital-Jeddah, Jeddah, Saudi Arabia
| | - Ghada Al Towaijri
- Neurology Department, King Fahd Medical City (KFMC), MOH, Riyadh, Saudi Arabia
| | - Ahmed Hassan
- Neurology Department, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Abid Kareem
- Neurology Department, King Fahd General Hospital-Al-Madinah, Madinah, Saudi Arabia
| | | | - Saad Alrajeh
- Neurology Department, Dr. Sulaiman Al Habib Hospital-Olaya Branch, Riyadh, Saudi Arabia
| | - Mousa Al Mejally
- Neurology Department, Heraa General Hospital, Makkah, Saudi Arabia
| | - Hussein Algahtani
- Neurology Department, King Abdul-Aziz Medical City (National Guard Health Affairs), Jeddah, Saudi Arabia
| | - Ali Almubarak
- Neurology Department, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Sadaga Alawi
- Neurology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Shireen Qureshi
- Neurology Department, Johns Hopkins Aramco Healthcare Company (JHAH), Dhahran, Saudi Arabia
| | - Yaser Al Malik
- Neurology Department, King Saud bin Abdulaziz University For Health Sciences, Riyadh, Saudi Arabia
| | - Ashraf El-Metwally
- King Saud bin Abdulaziz University For Health Sciences, Riyadh, Saudi Arabia
| | - Sahar Shami
- King Fahd Specialist Hospital (KFSH)-Dammam, Dammam, Saudi Arabia
| | - Samah Ishak
- Itkan Health Consulting, Riyadh, Saudi Arabia
| | - Reem Bunyan
- King Fahd Specialist Hospital (KFSH)-Dammam, Dammam, Saudi Arabia
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Salehi Z, Almasi-Hashiani A, Sahraian MA, Eskandarieh S. Epidemiology of familial multiple sclerosis: A population-based study in Tehran during 1999–2018. Mult Scler Relat Disord 2020; 43:102178. [DOI: 10.1016/j.msard.2020.102178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 12/27/2022]
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Demographic and clinical characteristics of familial and sporadic multiple sclerosis: A single center exploratory study from Abu Dhabi. J Clin Neurosci 2020; 76:145-147. [PMID: 32284288 DOI: 10.1016/j.jocn.2020.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
Abstract
Demographic and clinical characteristics of Familial Multiple Sclerosis (FMS) have not been fully investigated yet in Abu Dhabi. The aim of this single center exploratory study was to investigate demographic and clinical characteristics of FMS compared to sporadic MS (SMS) in Abu Dhabi. A chart review single center study was conducted in 98 patients with MS. Group comparisons were performed using Mann-Whitney and Chi-Square tests as appropriate. A p < 0.05 was considered statistically significant. 24.5% were patients with FMS and 83% were Emirates. No significant differences in demographic and clinical characteristics were found between patients with FMS and SMS in overall all MS patients and in the Emirati group analyzed alone. Patients with FMS did not differ in demographic and clinical characteristics compared to patients with SMS. Further prospective studies are needed to elucidate environmental and genetic risk factors contributing to FMS in the Emirati population.
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Katsavos S, Artemiadis A, Davaki P, Stamboulis E, Kilindireas K, Anagnostouli M. Familial multiple sclerosis in Greece: Distinct clinical and imaging characteristics in comparison with the sporadic disease. Clin Neurol Neurosurg 2018; 173:144-149. [PMID: 30125837 DOI: 10.1016/j.clineuro.2018.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 06/26/2018] [Accepted: 08/11/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Few studies are available worldwide concerning clinical, imaging and genetic/immunogenetic profile of familial multiple sclerosis (fMS). Recent but not systematic data concerning fMS, without direct comparison to sporadic MS (sMS) drove our aim towards further research in the field, given the total lack of information for the Greek population as well. Thus, in this case-control study we examined the clinical and imaging characteristics of 102 fMS-patients, compared to 282 patients suffering sMS. PATIENTS AND METHODS Patients recruited underwent medical interview (demographic, clinical and family history data collected). They were also assessed for disability and their MRI-scans were analyzed for lesion distribution. Statistical analyses were performed using SPSS v.21.0 software. RESULTS 49% of unrelated fMS cases had at least one 1st degree relative affected, while the rest had also at least one relative with MS, 3rd degree or closer. Only the former subgroup (1st degree relative) and not the entire fMS sample, had significantly younger age at onset (AAO) compared to sMS cases (mean AAO 28.08 vs 31.33 years, p = 0.036). AAO anticipation was noted in younger generation fMS patients (mean AAO 24.67 years in younger generation vs 37 years in older generation, p = 0.001). With regard to our MRI findings, subcortical lesions were less frequent in fMS (71% in fMS vs 81.9% in sMS patients, p = 0.028), whereas cervical cord lesions more frequent (93% in fMS vs 79.9% in sMS patients, p = 0.033, only in the 1st degree relative subgroup). Double vision was a less common first symptom in fMS (4.1% in fMS vs 14.8% in sMS patients, p = 0.005). 1st degree relatives of fMS patients were more often diagnosed with Hashimoto's (8.9% in fMS relatives vs 3.3% in sMS relatives, p = 0.033). CONCLUSION Younger AAO and different lesion distribution in brain and possibly spinal cord was observed in fMS in comparison to sMS patients. The hypothesis of increased genetic burden in fMS could offer some explanation for these differences, which needs though further validation as a next step, through genetic/immunogenetic testing in larger cohorts, of different ethnic groups.
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Affiliation(s)
- Serafeim Katsavos
- Immunogenetics Laboratory, 1st Dept. of Neurology, Medical School of Athens National and Kapodistrian University, Aeginition Hospital, Vas. Sofias Ave. 72-74, Athens, Greece
| | - Artemios Artemiadis
- Immunogenetics Laboratory, 1st Dept. of Neurology, Medical School of Athens National and Kapodistrian University, Aeginition Hospital, Vas. Sofias Ave. 72-74, Athens, Greece
| | - Panagiota Davaki
- 1st Dept. of Neurology, Medical School of Athens National and Kapodistrian University, Aeginition Hospital, Vas. Sofias Ave. 72-74, Athens, Greece
| | - Eleftherios Stamboulis
- 1st Dept. of Neurology, Medical School of Athens National and Kapodistrian University, Aeginition Hospital, Vas. Sofias Ave. 72-74, Athens, Greece
| | - Konstantinos Kilindireas
- 1st Dept. of Neurology, Medical School of Athens National and Kapodistrian University, Aeginition Hospital, Vas. Sofias Ave. 72-74, Athens, Greece
| | - Maria Anagnostouli
- Immunogenetics Laboratory, 1st Dept. of Neurology, Medical School of Athens National and Kapodistrian University, Aeginition Hospital, Vas. Sofias Ave. 72-74, Athens, Greece; 1st Dept. of Neurology, Medical School of Athens National and Kapodistrian University, Aeginition Hospital, Vas. Sofias Ave. 72-74, Athens, Greece.
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Jokubaitis VG, Zhou Y, Butzkueven H, Taylor BV. Genotype and Phenotype in Multiple Sclerosis-Potential for Disease Course Prediction? Curr Treat Options Neurol 2018; 20:18. [PMID: 29687310 DOI: 10.1007/s11940-018-0505-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW This review will examine the current evidence that genetic and/or epigenetic variation may influence the multiple sclerosis (MS) clinical course, phenotype, and measures of MS severity including disability progression and relapse rate. RECENT FINDINGS There is little evidence that MS clinical phenotype is under significant genetic control. There is increasing evidence that there may be genetic determinants of the rate of disability progression. However, studies that can analyse disability progression and take into account all the confounding variables such as treatment, clinical characteristics, and environmental factors are by necessity longitudinal, relatively small, and generally of short duration, and thus do not lend themselves to the assessment of hundreds of thousands of genetic variables obtained from GWAS. Despite this, there is recent evidence to support the association of genetic loci with relapse rate. Recent progress suggests that genetic variations could be associated with disease severity, but not MS clinical phenotype, but these findings are not definitive and await replication. Pooling of study results, application of other genomic techniques including epigenomics, and analysis of biomarkers of progression could functionally validate putative severity markers.
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Affiliation(s)
- Vilija G Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
- Department of Neurology, Box Hill Hospital, Box Hill, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
- Department of Neurology, Royal Hobart Hospital, Hobart, Australia.
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Pytel V, Matías-Guiu JA, Torre-Fuentes L, Montero P, Gómez-Graña Á, García-Ramos R, Moreno-Ramos T, Oreja-Guevara C, Fernández-Arquero M, Gómez-Pinedo U, Matías-Guiu J. Familial multiple sclerosis and association with other autoimmune diseases. Brain Behav 2018; 8:e00899. [PMID: 29568694 PMCID: PMC5853641 DOI: 10.1002/brb3.899] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/19/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Autoimmune diseases (AID) follow a complex, probably polygenic, pattern of inheritance and often cluster in families of patients with multiple sclerosis (MS). Our objective was to analyze family patterns and characteristics in families including more than one patient with MS. MATERIALS AND METHODS We analyzed personal and family history of neurological, systemic, and autoimmune diseases in 84 MS patients from 40 different families. Families were classified in two groups: families with cases of MS in at least two different generations (15 families) and families in which cases of MS belonged to only one generation (25 families). RESULTS The two previously established groups presented different clinical patterns and frequency of association with another AID. In one group, the second generation displayed a higher annual relapse rate than the first generation, higher frequency of progressive forms of MS, and more patients with another AID in addition to MS. Relapsing-remitting forms of MS (RRMS) were more frequent in the other group. CONCLUSIONS Families that include more than one MS patient may show two distinct patterns. This finding seems important for the compression and analysis of genetic information on MS.
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Affiliation(s)
- Vanesa Pytel
- Department of Neurology Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain.,Neurobiology Laboratory Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain
| | - Jordi A Matías-Guiu
- Department of Neurology Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain
| | - Laura Torre-Fuentes
- Neurobiology Laboratory Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain
| | - Paloma Montero
- Department of Neurology Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain
| | - Álvaro Gómez-Graña
- Neurobiology Laboratory Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain
| | - Rocío García-Ramos
- Department of Neurology Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain
| | - Teresa Moreno-Ramos
- Department of Neurology Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain
| | - Celia Oreja-Guevara
- Department of Neurology Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain
| | - Miguel Fernández-Arquero
- Department of Immunology Hospital Clínico San Carlos Instituto de Investigación Sanitaria San Carlos Universidad Complutense de Madrid Madrid Spain
| | - Ulises Gómez-Pinedo
- Neurobiology Laboratory Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain
| | - Jorge Matías-Guiu
- Department of Neurology Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain.,Neurobiology Laboratory Institute of Neurosciences Hospital Clínico San Carlos Madrid Spain
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Prevalence of familial multiple sclerosis in Iran: A systematic review and meta-analysis. IRANIAN JOURNAL OF NEUROLOGY 2017; 16:90-95. [PMID: 28761631 PMCID: PMC5526783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Familial history of multiple sclerosis (MS) has been considered as one of the etiologic factors of MS by several studies. It is valuable to combine the results of these studies. The aim of this study is to estimate the pooled prevalence of familial MS in Iran using meta-analysis. Methods: Using relevant keywords, national and international databanks were searched. Considering the significant heterogeneity between the results, random effect model was utilized to estimate the pooled prevalence of familial MS using Stata software. Results: After screening the selected articles, 15 studies with total sample size of 6248 (from 60 to 1718) were identified eligible for final meta-analysis. Overall prevalence of familial MS in Iran was estimated as of 11.4% [95% confidence interval (CI): 8.7-14.1]. Point prevalence varied between 3.3% and 26.7%. Conclusion: Our study showed that the familial prevalence of MS among Iranian people is relatively high. More studies are warranted to investigate the effect of familial history as a risk factor for MS.
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Alvarez C, Gotuzzo E, Vandamme AM, Verdonck K. Family Aggregation of Human T-Lymphotropic Virus 1-Associated Diseases: A Systematic Review. Front Microbiol 2016; 7:1674. [PMID: 27840624 PMCID: PMC5083714 DOI: 10.3389/fmicb.2016.01674] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/06/2016] [Indexed: 01/09/2023] Open
Abstract
Human T-lymphotropic virus 1 (HTLV-1) is a retrovirus that produces a persistent infection. Two transmission routes (from mother to child and via sexual intercourse) favor familial clustering of HTLV-1. It is yet unknown why most HTLV-1 carriers remain asymptomatic while about 10% of them develop complications. HTLV-1 associated diseases were originally described as sporadic entities, but familial presentations have been reported. To explore what is known about family aggregation of HTLV-1-associated diseases we undertook a systematic review. We aimed at answering whether, when, and where family aggregation of HTLV-1-associated diseases was reported, which relatives were affected and which hypotheses were proposed to explain aggregation. We searched MEDLINE, abstract books of HTLV conferences and reference lists of selected papers. Search terms used referred to HTLV-1 infection, and HTLV-1-associated diseases, and family studies. HTLV-1-associated diseases considered are adult T-cell leukemia/lymphoma (ATLL), HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), HTLV-1-associated uveitis, and infective dermatitis. Seventy-four records reported HTLV-1-associated diseases in more than one member of the same family and were included. Most reports came from HTLV-1-endemic countries, mainly Japan (n = 30) and Brazil (n = 10). These reports described a total of 270 families in which more than one relative had HTLV-1-associated diseases. In most families, different family members suffered from the same disease (n = 223). The diseases most frequently reported were ATLL (115 families) and HAM/TSP (102 families). Most families (n = 144) included two to four affected individuals. The proportion of ATLL patients with family history of ATLL ranged from 2 to 26%. The proportion of HAM/TSP patients with family history of HAM/TSP ranged from 1 to 48%. The predominant cluster types for ATLL were clusters of siblings and parent-child pairs and for HAM/TSP, an affected parent with one or more affected children. The evidence in the literature, although weak, does suggest that HTLV-1-associated diseases sometimes cluster in families. Whether familial transmission of HTLV-1 is the only determining factor, or whether other factors are also involved, needs further research.
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Affiliation(s)
- Carolina Alvarez
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano HerediaLima, Peru; Department of Microbiology and Immunology, Clinical and Epidemiological Virology, Rega Institute for Medical Research, KU Leuven-University of LeuvenLeuven, Belgium
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano HerediaLima, Peru; Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano HerediaLima, Peru
| | - Anne-Mieke Vandamme
- Department of Microbiology and Immunology, Clinical and Epidemiological Virology, Rega Institute for Medical Research, KU Leuven-University of LeuvenLeuven, Belgium; Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de LisboaLisbon, Portugal
| | - Kristien Verdonck
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano HerediaLima, Peru; Department of Public Health, Institute of Tropical Medicine AntwerpAntwerp, Belgium
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17
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Mescheriakova JY, Broer L, Wahedi S, Uitterlinden AG, van Duijn CM, Hintzen RQ. Burden of genetic risk variants in multiple sclerosis families in the Netherlands. Mult Scler J Exp Transl Clin 2016; 2:2055217316648721. [PMID: 28607725 PMCID: PMC5433503 DOI: 10.1177/2055217316648721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/08/2016] [Indexed: 01/22/2023] Open
Abstract
Background Approximately 20% of multiple sclerosis patients have a family history of multiple sclerosis. Studies of multiple sclerosis aggregation in families are inconclusive. Objective To investigate the genetic burden based on currently discovered genetic variants for multiple sclerosis risk in patients from Dutch multiple sclerosis multiplex families versus sporadic multiple sclerosis cases, and to study its influence on clinical phenotype and disease prediction. Methods Our study population consisted of 283 sporadic multiple sclerosis cases, 169 probands from multiplex families and 2028 controls. A weighted genetic risk score based on 102 non-human leukocyte antigen loci and HLA-DRB1*1501 was calculated. Results The weighted genetic risk score based on all loci was significantly higher in familial than in sporadic cases. The HLA-DRB1*1501 contributed significantly to the difference in genetic burden between the groups. A high weighted genetic risk score was significantly associated with a low age of disease onset in all multiple sclerosis patients, but not in the familial cases separately. The genetic risk score was significantly but modestly better in discriminating familial versus sporadic multiple sclerosis from controls. Conclusion Familial multiple sclerosis patients are more loaded with the common genetic variants than sporadic cases. The difference is mainly driven by HLA-DRB1*1501. The predictive capacity of genetic loci is poor and unlikely to be useful in clinical settings.
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Affiliation(s)
| | - Linda Broer
- Department of Neurology, Erasmus Medical Centre, the Netherlands
| | - Simin Wahedi
- Department of Neurology, Erasmus Medical Centre, the Netherlands
| | | | | | - Rogier Q Hintzen
- Department of Neurology, Erasmus Medical Centre, the Netherlands
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18
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Akkad DA, Lee DH, Bruch K, Haghikia A, Epplen JT, Hoffjan S, Linker RA. Multiple sclerosis in families: risk factors beyond known genetic polymorphisms. Neurogenetics 2016; 17:131-5. [DOI: 10.1007/s10048-016-0474-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 02/02/2016] [Indexed: 11/25/2022]
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