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Bali B, Sellers A, Chinea A, Jallo GI, Shimony N. Intramedullary spinal cord tumors in pediatric patients presenting later with brain lesions: case series and systematic review of the literature. Childs Nerv Syst 2024; 40:1079-1089. [PMID: 38321255 DOI: 10.1007/s00381-024-06311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Intramedullary spinal cord tumors are an uncommon pathology in adults and children. Most descriptive studies of intramedullary spinal cord tumors have not focused on a possible association with future brain lesions. To the best of our knowledge, few reports describe this potential relationship. This is one of the most extensive case series of secondary brain lesions of intramedullary spinal cord tumors in the pediatric population. METHODS Retrospective chart review was performed on pediatric patients (21 years old and younger) who underwent resection of an intramedullary spinal cord tumor at two tertiary care hospitals from 2001 to 2020. Patients previously treated or diagnosed with spinal cord tumor, and subsequent development of intracranial manifestation of the same or different tumor, were included. Data regarding epidemiology, surgical intervention, and clinical and follow-up course were gathered. Data analysis was performed according to a standardized clinical protocol with a literature review. RESULT More than 500 patients underwent intradural spinal tumor resection surgeries at participating hospitals from 2001 to 2020. After excluding adult patients (older than 21 years old) and those with extramedullary lesions, 103 pediatric patients were identified who underwent resection of an intramedullary spinal cord tumor. Four underwent resection of an intermedullary tumor and later in their follow-up course developed a secondary intracranial neoplasm. In every case, the secondary neoplasm had the same pathology as the intramedullary tumor. Three of the patients had tumors at the cervico-thoracic junction, and one patient had a high cervical tumor. These patients had a negative primary workup for any metastatic disease at the time of the presentation or diagnosis. Complete and near complete resection was performed in three patients and subtotal in one patient. CONCLUSION Secondary brain tumors disseminated after initial spinal cord tumor are extremely rare. This study aims to allow specialists to better understand these pathologies and treat these rare tumors with more certainty and better expectations of unusual associated lesions and conditions.
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Affiliation(s)
- Bassel Bali
- Institute for Brain Protection Science, Johns Hopkins All Children's Hospital, 601 5th St S, Suite 511, St. Petersburg, FL, 33701, USA
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Austin Sellers
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, 601 5th St S, Suite 511, St. Petersburg, FL, 33701, USA
| | - Angel Chinea
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA
| | - George I Jallo
- Institute for Brain Protection Science, Johns Hopkins All Children's Hospital, 601 5th St S, Suite 511, St. Petersburg, FL, 33701, USA.
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA.
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Nir Shimony
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
- Semmes-Murphey Clinic, Memphis, TN, USA
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Williams MJ, Amezcua L, Chinea A, Cohan S, Okai A, Okuda DT, Vargas W, Belviso N, Božin I, Jiang X, Lewin JB, Lyons J, Shen C, England SM, Grimes N. Real-World Safety and Effectiveness After 5 Years of Dimethyl Fumarate Treatment in Black and Hispanic Patients with Multiple Sclerosis in ESTEEM. Neurol Ther 2023; 12:1669-1682. [PMID: 37354276 PMCID: PMC10444730 DOI: 10.1007/s40120-023-00517-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/07/2023] [Indexed: 06/26/2023] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) clinical trials have included low numbers of patients from racial and ethnic minority populations; therefore, it is uncertain whether differences exist in response to disease-modifying therapies. We evaluated the real-world safety and effectiveness of dimethyl fumarate (DMF) treatment over 5 years in four patient cohorts: Black, non-Black, Hispanic, and non-Hispanic people with relapsing-remitting MS. METHODS ESTEEM is an ongoing, 5-year, multinational, prospective study evaluating the long-term safety and effectiveness of DMF in people with MS. The analysis included patients newly prescribed DMF in routine practice at 393 sites globally. RESULTS Overall, 5251 patients were analyzed (220 Black, 5031 non-Black; 105 Hispanic, 5146 non-Hispanic). Median (min-max) months of follow-up was 32 (0-72) for Black, 29 (1-77) for Hispanic, and 41 (0-85) for both the non-Black and non-Hispanic populations. In total, 39 (18%) Black and 29 (28%) Hispanic patients reported adverse events leading to treatment discontinuation versus 1126 (22%) non-Black and 1136 (22%) non-Hispanic patients; gastrointestinal disorders were the most common in all subgroups. Median lymphocyte counts decreased by 37% in Black, 40% in non-Black, 10% in Hispanic, and 39% in non-Hispanic patients in the first year, then remained stable and above the lower limit of normal in most patients. Annualized relapse rates (ARRs) (95% confidence intervals) up to 5 years were 0.054 (0.038-0.078) for Black, 0.077 (0.072-0.081) for non-Black, 0.069 (0.043-0.112) for Hispanic, and 0.076 (0.072-0.081) for non-Hispanic populations, representing reductions of 91-92% compared with ARR 12 months before study entry (all p < 0.0001). CONCLUSION The safety profile of DMF in these subgroups was consistent with the overall ESTEEM population. Relapse rates remained low in Black and Hispanic patients, and consistent with non-Black and non-Hispanic patients. These data demonstrate a comparable real-world treatment benefit of DMF in Black and Hispanic patients. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02047097.
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Affiliation(s)
| | - Lilyana Amezcua
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Stanley Cohan
- Providence Portland Medical Center, Portland, OR, USA
| | - Annette Okai
- North Texas Institute of Neurology and Headache, Plano, TX, USA
| | - Darin T Okuda
- Neuroinnovation Program, UT Southwestern Medical Center, Dallas, TX, USA
| | - Wendy Vargas
- Columbia University Medical Center, New York City, NY, USA
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Beecham AH, Amezcua L, Chinea A, Manrique CP, Gomez L, Martinez A, Beecham GW, Patsopoulos NA, Chitnis T, Weiner HL, De Jager PL, Burchard EG, Lund BT, Fitzgerald KC, Calabresi PA, Delgado SR, Oksenberg JR, McCauley JL. Ancestral risk modification for multiple sclerosis susceptibility detected across the Major Histocompatibility Complex in a multi-ethnic population. PLoS One 2022; 17:e0279132. [PMID: 36548255 PMCID: PMC9778564 DOI: 10.1371/journal.pone.0279132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
The Major Histocompatibility Complex (MHC) makes the largest genetic contribution to multiple sclerosis (MS) susceptibility, with 32 independent effects across the region explaining 20% of the heritability in European populations. Variation is high across populations with allele frequency differences and population-specific risk alleles identified. We sought to identify MHC-specific MS susceptibility variants and assess the effect of ancestral risk modification within 2652 Latinx and Hispanic individuals as well as 2435 Black and African American individuals. We have identified several novel susceptibility alleles which are rare in European populations including HLA-B*53:01, and we have utilized the differing linkage disequilibrium patterns inherent to these populations to identify an independent role for HLA-DRB1*15:01 and HLA-DQB1*06:02 on MS risk. We found a decrease in Native American ancestry in MS cases vs controls across the MHC, peaking near the previously identified MICB locus with a decrease of ~5.5% in Hispanics and ~0.4% in African Americans. We have identified several susceptibility variants, including within the MICB gene region, which show global ancestry risk modification and indicate ancestral differences which may be due in part to correlated environmental factors. We have also identified several susceptibility variants for which MS risk is modified by local ancestry and indicate true ancestral genetic differences; including HLA-DQB1*06:02 for which MS risk for European allele carriers is almost two times the risk for African allele carriers. These results validate the importance of investigating MS susceptibility at an ancestral level and offer insight into the epidemiology of MS phenotypic diversity.
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Affiliation(s)
- Ashley H. Beecham
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Dr. John T. Macdonald Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Lilyana Amezcua
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Angel Chinea
- San Juan MS Center, Guaynabo, Puerto Rico, United States of America
| | - Clara P. Manrique
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Lissette Gomez
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Andrea Martinez
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Gary W. Beecham
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Dr. John T. Macdonald Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Nikolaos A. Patsopoulos
- Ann Romney Center for Neurological Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Tanuja Chitnis
- Ann Romney Center for Neurological Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Howard L. Weiner
- Ann Romney Center for Neurological Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Philip L. De Jager
- Center For Translational & Computational Neuroimmunology and the Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Esteban G. Burchard
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Brett T. Lund
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Kathryn C. Fitzgerald
- Department of Neurology and The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Peter A. Calabresi
- Department of Neurology and The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Silvia R. Delgado
- Multiple Sclerosis Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Jorge R. Oksenberg
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Jacob L. McCauley
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Dr. John T. Macdonald Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, United States of America
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Chinea A, Ríos-Bedoya CF, Vicente I, Vega-Corteguera RJ, Martínez-Maldonado V, Carmona-Burgos DX, Rubí C, Amezcua L, Gilman CK, Díaz de la Matta PG, Rivera EP. Epidemiologic trends of multiple sclerosis in Puerto Rico (2013-2020). Mult Scler Relat Disord 2022; 68:104240. [PMID: 36544310 DOI: 10.1016/j.msard.2022.104240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/30/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous studies have demonstrated higher multiple sclerosis (MS) incidence and prevalence in Puerto Rico (PR) than in other Caribbean and Latin American countries. Our objectives are to update the epidemiologic trends in MS incidence and prevalence rates for PR from 2017 through 2020 and compare them to prior rate data from 2013 to 2016. METHODS We used the Puerto Rico MS Foundation's registry (PRMS Registry) data to identify all newly diagnosed MS cases between January 2017 and December 2020. The study population included 568 MS patients, 406 women and 162 men living in PR. All individuals were 18 years and older and met the 2017 revised McDonald criteria for MS diagnosis. In addition, age- and sex-standardized incidence rates were estimated. RESULTS A total of 568 new MS cases were diagnosed in Puerto Rico between 2017 and 2020. The 2020 MS cumulative prevalence for Puerto Rico was 95.3/100,000 (95% CI: 91.6, 99.1), higher than previously reported. The age- and sex-standardized MS incidence rate for Puerto Rico decreased from 6.5/100,000 (2017) to 6.3/100,000 (2020). The annual age-standardized MS incidence rates declined for females: from 9.5/100,000 (2017) to 8.2/100,000 (2020) but increased for males from 3.6/100,000 to 4.6/100,000 during the same period. CONCLUSION These incidence and prevalence rates are among the highest reported among Caribbean and Latin American countries. A peak in the age- and sex-standardized MS incidence rate was observed after hurricane María (2018) and a decline during the first year of the COVID-19 pandemic (2020). Further investigation is needed to determine whether there was a causal relationship between the fluctuations observed and those natural events.
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Affiliation(s)
- Angel Chinea
- San Juan MS Center, Guaynabo, Puerto Rico; San Juan Bautista School of Medicine, Caguas, Puerto Rico; Puerto Rico Multiple Sclerosis Foundation, Guaynabo, Puerto Rico; School of Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico
| | - Carlos F Ríos-Bedoya
- Corporate Director of the Division of Scholarly Inquiry, McLaren Health Care, Graduate Medical Education, 10362 Edgewood Ct, Grand Blanc, MI 48439, USA.
| | - Ivonne Vicente
- San Juan MS Center, Guaynabo, Puerto Rico; San Juan Bautista School of Medicine, Caguas, Puerto Rico
| | - Ramón J Vega-Corteguera
- San Juan MS Center, Guaynabo, Puerto Rico; Puerto Rico Multiple Sclerosis Foundation, Guaynabo, Puerto Rico
| | | | | | | | - Lilyana Amezcua
- Department of Neurology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Casey K Gilman
- San Juan Bautista School of Medicine, Caguas, Puerto Rico
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Celis K, Rajabli F, Simon SA, Wang L, Hamilton‐Nelson KL, Adams LD, Mena PR, Whitehead PL, Van Booven D, Feliciano‐Astacio BE, Chinea A, Feliciano NI, Acosta H, Dalgard CL, Haines JL, Vance JM, Cuccaro ML, Beecham GW, Dykxhoorn DM, Griswold AJ, Pericak‐Vance MA. Fine‐mapping of chromosome 9p21 linkage in Puerto Rican Alzheimer disease families. Alzheimers Dement 2022. [DOI: 10.1002/alz.067835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Katrina Celis
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Farid Rajabli
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine Miami FL USA
| | - Shaina A Simon
- Dr. John T. MacDonald Foundation Department of Human Genetics Miami FL USA
| | - Liyong Wang
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Kara L. Hamilton‐Nelson
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Larry D. Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine Miami FL USA
| | - Pedro Ramon Mena
- John P. Hussman Institute for Human Genomics, University of Miami Miami FL USA
| | - Patrice L. Whitehead
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Derek Van Booven
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | | | | | | | | | | | - Jonathan L. Haines
- Case Western Reserve University School of Medicine, Department of Population & Quantitative Health Sciences, Cleveland Institute for Computational Biology Cleveland OH USA
| | - Jeffery M. Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miami FL USA
| | - Michael L. Cuccaro
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Gary W. Beecham
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Derek M. Dykxhoorn
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Anthony J. Griswold
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Margaret A. Pericak‐Vance
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
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Rajabli F, Feliciano-Astacio BE, Cukier HN, Wang L, Griswold AJ, Hamilton-Nelson KL, Adams LD, Rodriguez VC, Mena PR, Tejada S, Celis K, Whitehead PL, Van Booven DJ, Hofmann NK, Bussies PL, Prough M, Chinea A, Feliciano NI, Vardarajan BN, Reitz C, Lee JH, Prince MJ, Jimenez IZ, Mayeux RP, Acosta H, Dalgard CL, Haines JL, Vance JM, Cuccaro ML, Beecham GW, Pericak-Vance MA. Linkage of Alzheimer disease families with Puerto Rican ancestry identifies a chromosome 9 locus. Neurobiol Aging 2021; 104:115.e1-115.e7. [PMID: 33902942 DOI: 10.1016/j.neurobiolaging.2021.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/08/2021] [Accepted: 02/23/2021] [Indexed: 12/30/2022]
Abstract
The genetic admixture of Caribbean Hispanics provides an opportunity to discover novel genetic factors in Alzheimer disease (AD). We sought to identify genetic variants for AD through a family-based design using the Puerto Rican (PR) Alzheimer Disease Initiative (PRADI). Whole-genome sequencing (WGS) and parametric linkage analysis were performed for 100 individuals from 23 multiplex PRADI families. Variants were prioritized by minor allele frequency (<0.01), functional potential [combined annotation dependent depletion score (CADD) >10], and co-segregation with AD. Variants were further ranked using an independent PR case-control WGS dataset (PR10/66). A genome-wide significant linkage peak was found in 9p21 with a heterogeneity logarithm of the odds score (HLOD) >5.1, which overlaps with an AD linkage region from two published independent studies. The region harbors C9orf72, but no expanded repeats were observed in the families. Seven variants prioritized by the PRADI families also displayed evidence for association in the PR10/66 (p < 0.05), including a missense variant in UNC13B. Our study demonstrated the importance of family-based design and WGS in genetic study of AD.
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Affiliation(s)
- Farid Rajabli
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Holly N Cukier
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Liyong Wang
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anthony J Griswold
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kara L Hamilton-Nelson
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Larry D Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vanessa C Rodriguez
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pedro R Mena
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sergio Tejada
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Celis
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Patrice L Whitehead
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Derek J Van Booven
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Natalia K Hofmann
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Parker L Bussies
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael Prough
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Angel Chinea
- Universidad Central del Caribe, Bayamón, PR, USA
| | - Nereida I Feliciano
- Hospital De Psiquiatría Estatal Dr. Ramón Fernández Marina-Centro Médico, San Juan, PR, USA
| | - Badri N Vardarajan
- Departments of Neurology, Psychiatry, and Epidemiology, Gertrude H. Sergievsky Center, Taub Institute for Research on the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Christiane Reitz
- Departments of Neurology, Psychiatry, and Epidemiology, Gertrude H. Sergievsky Center, Taub Institute for Research on the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Joseph H Lee
- Departments of Neurology, Psychiatry, and Epidemiology, Gertrude H. Sergievsky Center, Taub Institute for Research on the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Martin J Prince
- Department of Epidemiological Psychiatry, Centre for Public Mental Health, Institute of Psychiatry, King's College, London, UK
| | | | - Richard P Mayeux
- Departments of Neurology, Psychiatry, and Epidemiology, Gertrude H. Sergievsky Center, Taub Institute for Research on the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Clifton L Dalgard
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jonathan L Haines
- Department of Population & Quantitative Health Sciences, Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jeffery M Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael L Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gary W Beecham
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA.
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Chiong-Rivero H, Robers M, Martinez A, Manrique CP, Diaz A, Polito K, Vajdi B, Chan C, Burnett M, Delgado SR, Chinea A, McCauley JL, Amezcua L. Effectiveness of film as a health communication tool to improve perceptions and attitudes in multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:2055217321995947. [PMID: 33717502 PMCID: PMC7923991 DOI: 10.1177/2055217321995947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/29/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Health communication tools like film are capable of reducing health disparities and could be effective in addressing negative illness perceptions of MS in Hispanics/Latinx. OBJECTIVE To test the feasibility of using a culturally appropriate short narrative film to examine illness perceptions overtime and attitudes in Hispanics/Latinx affected with MS. METHODS Participants were assigned to view a short narrative film (n = 130) or not (n = 106). The Brief Illness Perception Questionnaire (BIPQ) was used to examine illness perceptions at baseline, one and three months. Focus groups were conducted at 6 months. Measures of sociocultural integration were obtained. Individual group BIPQ domains were evaluated over time using paired sample t-test. Multivariate linear regression was used to examine predictors of BIPQ change. RESULTS A more positive perception of treatment (p < 0.0001) and understanding (p = 0.0003) were seen at 3 months for those exposed to film. Focus groups were effective in highlighting that the perceived disease prognosis, family support and awareness of MS contributes to attitudes. Exposure to film was found to be the strongest predictor (Beta:6.31, p = 0.01) of BIPQ change at three months. CONCLUSION Our results provide support that a short narrative film of MS in Hispanics/Latinx is a feasible intervention to change perceptions of MS to a more positive view.
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Affiliation(s)
- Horacio Chiong-Rivero
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michael Robers
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Andrea Martinez
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Clara P Manrique
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Kelly Polito
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Borna Vajdi
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Chan Chan
- Statistics, Division of Dental Public Health and Pediatric Dentistry, University of Southern California, Los Angeles, CA
| | - Margaret Burnett
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Silvia R Delgado
- Department of Neurology, Multiple Sclerosis Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jacob L McCauley
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lilyana Amezcua
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Feliciano‐Astacio BE, Beecham GW, Silva C, Mena PR, Inciute JD, Tejada S, Adams LD, Rodriguez VC, Celis K, Prough M, Bussies P, Sierra‐Lopez CB, Contreras M, Manrique P, Feliciano NI, Chinea A, McCauley JL, Acosta H, Vance JM, Cuccaro ML, Pericak‐Vance MA. PRADI cohort case‐control study on related factors of Alzheimer’s disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.046443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Pedro Ramon Mena
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Jovita D. Inciute
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Sergio Tejada
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Larry D. Adams
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Vanessa C. Rodriguez
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Katrina Celis
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Michael Prough
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Parker Bussies
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | | | - Maricarmen Contreras
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Patricia Manrique
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | | | | | | | | | - Jeffery M. Vance
- Dr. John T. Macdonald Department of Genetics University of Miami Miller School of Medicine Miami FL USA
| | - Michael L. Cuccaro
- Dr. John T. Macdonald Foundation Department of Human Genetics University of Miami Miller School of Medicine Miami FL USA
| | - Margaret A. Pericak‐Vance
- Dr. John T. Macdonald Foundation Department of Human Genetics University of Miami Miller School of Medicine Miami FL USA
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Chinea A, Amezcua L, Vargas W, Okai A, Williams MJ, Su R, Parks B, Mendoza JP, Lewin JB, Jones CC. Real-World Safety and Effectiveness of Dimethyl Fumarate in Hispanic or Latino Patients with Multiple Sclerosis: 3-Year Results from ESTEEM. Neurol Ther 2020; 9:495-504. [PMID: 32472385 PMCID: PMC7606387 DOI: 10.1007/s40120-020-00192-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Compared with the non-Hispanic/non-Latino population, Hispanic/Latino patients with multiple sclerosis (MS) are reported to exhibit greater disease severity. Geographical location and genetics play a role in differences observed across Hispanic/Latino subpopulations. We evaluated real-world safety and effectiveness of dimethyl fumarate (DMF) on MS disease activity in Hispanic/Latino patients. METHODS ESTEEM is an ongoing, 5-year, multinational, prospective study evaluating long-term safety and effectiveness of DMF in patients with MS. This interim analysis included patients newly prescribed DMF in routine practice at 394 sites globally. RESULTS Overall, 4986 non-Hispanic/non-Latino and 98 Hispanic/Latino patients were analyzed; median (range) follow-up was 18 (2-37) months. Unadjusted annualized relapse rates (ARRs) for 12 months before DMF initiation versus 36 months post DMF initiation, respectively, were: non-Hispanic/non-Latino patients, 0.82 (95% CI 0.80-0.84) versus 0.10 (95% CI 0.09-0.10), 88% lower ARR (P < 0.0001); Hispanic/Latino patients, 0.80 (95% CI 0.65-1.00) versus 0.09 (95% CI 0.06-0.14), 89% lower ARR (P < 0.0001). In total, 28 (29%) Hispanic/Latino patients reported adverse events leading to treatment discontinuation; gastrointestinal (GI) disorders (n = 10, 10%) were the most common, consistent with the non-Hispanic/non-Latino population (8%). Median lymphocyte counts decreased by approximately 24% in the first year (vs 36% decrease in non-Hispanic/non-Latino patients) then remained stable and above the lower limit of normal in most patients. CONCLUSIONS Relapse rates remained low in Hispanic/Latino patients, consistent with non-Hispanic/non-Latino patients. The safety profile of DMF in Hispanic/Latino patients was consistent with safety findings from the non-Hispanic/non-Latino ESTEEM population, demonstrating the real-world treatment benefit of DMF in the Hispanic/Latino patient cohort.
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Affiliation(s)
- Angel Chinea
- From the San Juan Multiple Sclerosis Center, Guaynabo, Puerto Rico
| | - Lilyana Amezcua
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wendy Vargas
- Columbia University Medical Center, New York, NY, USA
| | - Annette Okai
- Multiple Sclerosis Treatment Center of Dallas, Dallas, TX, USA
| | | | - Ray Su
- Biogen, Cambridge, MA, USA
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Silva C, Mena PR, Tejada S, Adams LD, Rodriguez VC, Celis K, Prough M, Bussies P, Sierra‐Lopez CB, Contreras M, Manrique P, Feliciano NI, Chinea A, McCauley JL, Acosta H, Vance JM, Cuccaro ML, Beecham GW, Pericak‐Vance MA, Feliciano‐Astacio BE. Recruitment strategies for the genetics of Alzheimer disease in the Puerto Rican population. Alzheimers Dement 2020. [DOI: 10.1002/alz.043468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Pedro Ramon Mena
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Sergio Tejada
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Larry D Adams
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Vanessa C Rodriguez
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Katrina Celis
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Michael Prough
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Parker Bussies
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | | | - Maricarmen Contreras
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Patricia Manrique
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | | | | | | | | | - Jeffery M Vance
- Dr. John T. Macdonald Department of Genetics University of Miami Miller School of Medicine Miami FL USA
| | - Michael L Cuccaro
- Dr. John T. Macdonald Foundation Department of Human Genetics University of Miami Miller School of Medicine Miami FL USA
| | - Gary W Beecham
- Dr. John T. Macdonald Foundation Department of Human Genetics University of Miami Miller School of Medicine Miami FL USA
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Beecham AH, Amezcua L, Chinea A, Manrique CP, Rubi C, Isobe N, Lund BT, Santaniello A, Beecham GW, Burchard EG, Comabella M, Patsopoulos N, Fitzgerald K, Calabresi PA, De Jager P, Conti DV, Delgado SR, Oksenberg JR, McCauley JL. The genetic diversity of multiple sclerosis risk among Hispanic and African American populations living in the United States. Mult Scler 2020; 26:1329-1339. [PMID: 31368393 PMCID: PMC6994382 DOI: 10.1177/1352458519863764] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Substantial progress has been made toward unraveling the genetic architecture of multiple sclerosis (MS) within populations of European ancestry, but few genetic studies have focused on Hispanic and African American populations within the United States. OBJECTIVE We sought to test the relevance of common European MS risk variants outside of the major histocompatibility complex (n = 200) within these populations. METHODS Genotype data were available on 2652 Hispanics (1298 with MS, 1354 controls) and 2435 African Americans (1298 with MS, 1137 controls). We conducted single variant, pathway, and cumulative genetic risk score analyses. RESULTS We found less replication than statistical power suggested, particularly among African Americans. This could be due to limited correlation between the tested and causal variants within the sample or alternatively could indicate allelic and locus heterogeneity. Differences were observed between pathways enriched among the replicating versus all 200 variants. Although these differences should be examined in larger samples, a potential role exists for gene-environment or gene-gene interactions which alter phenotype differentially across racial and ethnic groups. Cumulative genetic risk scores were associated with MS within each study sample but showed limited diagnostic capability. CONCLUSION These findings provide a framework for fine-mapping efforts in multi-ethnic populations of MS.
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Affiliation(s)
- A H Beecham
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA/The Dr. John T. Macdonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - L Amezcua
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Chinea
- San Juan MS Center, Guaynabo, Puerto Rico, USA; Universidad Central del Caribe, Bayamon, Puerto Rico, USA
| | - C P Manrique
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - C Rubi
- San Juan MS Center, Guaynabo, Puerto Rico, USA; Universidad Central del Caribe, Bayamon, Puerto Rico, USA
| | - N Isobe
- Department of Neurological Therapeutics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - B T Lund
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Santaniello
- Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - G W Beecham
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA/The Dr. John T. Macdonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - E G Burchard
- Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California at San Francisco, San Francisco, CA, USA
| | - M Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Patsopoulos
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - K Fitzgerald
- Department of Neurology and The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P A Calabresi
- Department of Neurology and The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P De Jager
- Center for Translational and Computational Neuroimmunology, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - D V Conti
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S R Delgado
- Multiple Sclerosis Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - J R Oksenberg
- Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - J L McCauley
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA/The Dr. John T. Macdonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, USA
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12
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Chinea A, Honeycutt WD, Miller T, Graves D, Jacobs A, Wu J, LaGanke CC. Effect of Alemtuzumab Infusions on Vital Signs: A Prospective Observational Study in Patients with Relapsing-Remitting Multiple Sclerosis. Int J MS Care 2020; 22:53-59. [PMID: 32410899 DOI: 10.7224/1537-2073.2018-076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Alemtuzumab efficacy and safety were established in phase 3 randomized trials. We characterize vital signs during and after the first alemtuzumab infusion course. Methods Patients with relapsing-remitting multiple sclerosis commercially prescribed alemtuzumab 12 mg/day on 5 consecutive days (initial course) were enrolled in this prospective, observational study. Preinfusion medications included methylprednisolone, antihistamine, and antipyretics. Primary end point: change from precourse baseline in vital signs during and 2 hours after each alemtuzumab infusion. Secondary end points: infusion duration and serious adverse events (AEs) starting within 24 hours and within 7 days after infusion (AEs collected up to 15 days after treatment). Potentially clinically significant vital sign abnormalities were based on predefined thresholds from literature review. Results In the 304 patients treated, minimal increases in mean systolic (≤8 mm Hg) and diastolic (≤3 mm Hg) blood pressures from precourse baseline were observed on infusion days 3 to 5. An increase in mean heart rate (20 beats per minute) during the first infusion day normalized by day 2, and smaller increases (5 beats per minute) occurred during subsequent infusions. Serious AEs occurred in two patients (0.7%) during or within 24 hours after infusion and in three patients (1.0%) within 7 days. Mean/median infusion duration was 4 hours. Vital sign abnormalities with potential clinical significance occurred in 62.5% of patients. Conclusions Although most patients had potentially clinically significant vital sign abnormalities, mean changes from baseline during and after infusion of the first alemtuzumab course were clinically insignificant. No new safety signals were detected.
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Zarei S, Maldonado I, Franqui-Dominguez L, Rubi C, Rosa YT, Diaz-Marty C, Coronado G, Nieves MCR, Akhlaghipour G, Chinea A. Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients. Surg Neurol Int 2019; 10:200. [PMID: 31768280 PMCID: PMC6826276 DOI: 10.25259/sni_252_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are limited data on multiple sclerosis (MS) patients in underserved groups, including Puerto Rico. In this study, we analyzed the characteristic of MS symptoms and number of relapses in Puerto Rican patients. We then compare these characteristics with MS patients from the US. The number of MS relapses is highly correlated with the treatment onset and adherence. Patients in Puerto Rico have been experiencing lengthy treatment delay. We will discuss the possible causes of such delay and its impact on MS prognosis. METHODS This retrospective cohort study consisted of the evaluation of 325 medical records from MS patients attending the Caribbean Neurological Center from 2014 to 2019. We gathered symptoms and comorbidities data as binary objects. The treatment delay was calculated based on the mean value of days between diagnosis and treatment onset for these groups of patients. RESULTS We found that on average, the treatment delay for MS patients in Puerto Rico (PR) to receive their medication was 120 days. The most common MS subtype was relapsing-remitting 72.8%, with a mean of 1.684 relapses per year. Initial symptoms were sensory 54%, visual 33.1%, motor 28.8%, coordination 23.2%, fatigue 9.7%, memory 7.3%, depression 6.5%, urinary 4.9%, gastrointestinal 2.4%, and sexual dysfunction 1.6%. The most common comorbidities were hypertension 18.4%, asthma 13.6%, and thyroid disease 12.8%. When we compared the comorbidities between the two populations, immune thrombocytopenia had the highest percent change with the value of almost 200% (0.001% of US patient vs. 0.8% of Puerto Rican MS patients). CONCLUSION Patients from Puerto Rico had a 33% higher relapse rate compared to the one reported for MS patients in the US. This higher rate may be related to the long delay in receiving their medications. They also had a higher rate of complex comorbidities such as immune thrombocytopenia or thyroid disease. Our findings provide a proof of concept that delay in receiving medications can increase the number of relapses and complex comorbidities among MS patients.
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Affiliation(s)
- Sara Zarei
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Irvin Maldonado
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | | | - Yanibel Tapia Rosa
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Cristina Diaz-Marty
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Guadalupe Coronado
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
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14
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Rajabli F, Feliciano-Astacio BE, Celis K, Hamilton-Nelson KL, Adams LD, Rodriguez VC, Mena PR, Whitehead PL, Hofmann NK, Bussies P, Prough M, Sierra-Lopez CB, Acosta H, Chinea A, Feliciano NI, Vance JM, Cuccaro ML, Beecham GW, Pericak-Vance MA. P2-140: GENOME-WIDE LINKAGE ANALYSIS OF CARIBBEAN HISPANIC PUERTO RICAN FAMILIES SUPPORTS EVIDENCE OF LINKAGE TO C9ORF72 REGION OF CHROMOSOME 9. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Farid Rajabli
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
| | | | - Katrina Celis
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
| | - Kara L. Hamilton-Nelson
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
| | - Larry D. Adams
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
| | - Vanessa C. Rodriguez
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
| | - Pedro Ramon Mena
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
| | - Patrice L. Whitehead
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
| | - Natalia K. Hofmann
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
| | - Parker Bussies
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
| | - Michael Prough
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
| | | | | | | | - Nereida I. Feliciano
- Hospital De Psiquiatría Estatal Dr. Ramón Fernández Marina-Centro Médico; San Juan PR USA
| | - Jeffery M. Vance
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics; University of Miami; Miami FL USA
| | - Michael L. Cuccaro
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics; University of Miami; Miami FL USA
| | - Gary W. Beecham
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
- The Dr. John T. Macdonald Foundation Department of Human Genetics; University of Miami Miller School of Medicine; Miami FL USA
| | - Margaret A. Pericak-Vance
- John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
- The Dr. John T. Macdonald Foundation Department of Human Genetics; University of Miami Miller School of Medicine; Miami FL USA
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15
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Feliciano-Astacio BE, Celis K, Ramos J, Rajabli F, Adams LD, Rodriguez A, Rodriguez V, Bussies PL, Sierra C, Manrique P, Mena PR, Grana A, Prough M, Hamilton-Nelson KL, Feliciano N, Chinea A, Acosta H, McCauley JL, Vance JM, Beecham GW, Pericak-Vance MA, Cuccaro ML. The Puerto Rico Alzheimer Disease Initiative (PRADI): A Multisource Ascertainment Approach. Front Genet 2019; 10:538. [PMID: 31275353 PMCID: PMC6593074 DOI: 10.3389/fgene.2019.00538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 05/17/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Puerto Ricans, the second largest Latino group in the continental US, are underrepresented in genomic studies of Alzheimer disease (AD). To increase representation of this group in genomic studies of AD, we developed a multisource ascertainment approach to enroll AD patients, and their family members living in Puerto Rico (PR) as part of the Alzheimer’s Disease Sequencing Project (ADSP), an international effort to advance broader personalized/precision medicine initiatives for AD across all populations. Methods The Puerto Rico Alzheimer Disease Initiative (PRADI) multisource ascertainment approach was developed to recruit and enroll Puerto Rican adults aged 50 years and older for a genetic research study of AD, including individuals with cognitive decline (AD, mild cognitive impairment), their similarly, aged family members, and cognitively healthy unrelated individuals age 50 and up. Emphasizing identification and relationship building with key stakeholders, we conducted ascertainment across the island. In addition to reporting on PRADI ascertainment, we detail admixture analysis for our cohort by region, group differences in age of onset, cognitive level by region, and ascertainment source. Results We report on 674 individuals who met standard eligibility criteria [282 AD-affected participants (42% of the sample), 115 individuals with mild cognitive impairment (MCI) (17% of the sample), and 277 cognitively healthy individuals (41% of the sample)]. There are 43 possible multiplex families (10 families with 4 or more AD-affected members and 3 families with 3 AD-affected members). Most individuals in our cohort were ascertained from the Metro, Bayamón, and Caguas health regions. Across health regions, we found differences in ancestral backgrounds, and select clinical traits. Discussion The multisource ascertainment approach used in the PRADI study highlights the importance of enlisting a broad range of community resources and providers. Preliminary results provide important information about our cohort that will be useful as we move forward with ascertainment. We expect that results from the PRADI study will lead to a better understanding of genetic risk for AD among this population.
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Affiliation(s)
| | - Katrina Celis
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jairo Ramos
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Farid Rajabli
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Larry Deon Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Alejandra Rodriguez
- Department of Internal Medicine, Universidad Central Del Caribe, Bayamón, PR, United States
| | - Vanessa Rodriguez
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Parker L Bussies
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Carolina Sierra
- Department of Internal Medicine, Universidad Central Del Caribe, Bayamón, PR, United States
| | - Patricia Manrique
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Pedro R Mena
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Antonella Grana
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michael Prough
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kara L Hamilton-Nelson
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | | | - Angel Chinea
- Department of Internal Medicine, Universidad Central Del Caribe, Bayamón, PR, United States
| | | | - Jacob L McCauley
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jeffery M Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gary W Beecham
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michael L Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, United States
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16
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Rajabli F, Feliciano BE, Celis K, Hamilton-Nelson KL, Whitehead PL, Adams LD, Bussies PL, Manrique CP, Rodriguez A, Rodriguez V, Starks T, Byfield GE, Sierra Lopez CB, McCauley JL, Acosta H, Chinea A, Kunkle BW, Reitz C, Farrer LA, Schellenberg GD, Vardarajan BN, Vance JM, Cuccaro ML, Martin ER, Haines JL, Byrd GS, Beecham GW, Pericak-Vance MA. Ancestral origin of ApoE ε4 Alzheimer disease risk in Puerto Rican and African American populations. PLoS Genet 2018; 14:e1007791. [PMID: 30517106 PMCID: PMC6281216 DOI: 10.1371/journal.pgen.1007791] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/25/2018] [Indexed: 11/19/2022] Open
Abstract
The ApoE ε4 allele is the most significant genetic risk factor for late-onset Alzheimer disease. The risk conferred by ε4, however, differs across populations, with populations of African ancestry showing lower ε4 risk compared to those of European or Asian ancestry. The cause of this heterogeneity in risk effect is currently unknown; it may be due to environmental or cultural factors correlated with ancestry, or it may be due to genetic variation local to the ApoE region that differs among populations. Exploring these hypotheses may lead to novel, population-specific therapeutics and risk predictions. To test these hypotheses, we analyzed ApoE genotypes and genome-wide array data in individuals from African American and Puerto Rican populations. A total of 1,766 African American and 220 Puerto Rican individuals with late-onset Alzheimer disease, and 3,730 African American and 169 Puerto Rican cognitively healthy individuals (> 65 years) participated in the study. We first assessed average ancestry across the genome ("global" ancestry) and then tested it for interaction with ApoE genotypes. Next, we assessed the ancestral background of ApoE alleles ("local" ancestry) and tested if ancestry local to ApoE influenced Alzheimer disease risk while controlling for global ancestry. Measures of global ancestry showed no interaction with ApoE risk (Puerto Rican: p-value = 0.49; African American: p-value = 0.65). Conversely, ancestry local to the ApoE region showed an interaction with the ApoE ε4 allele in both populations (Puerto Rican: p-value = 0.019; African American: p-value = 0.005). ApoE ε4 alleles on an African background conferred a lower risk than those with a European ancestral background, regardless of population (Puerto Rican: OR = 1.26 on African background, OR = 4.49 on European; African American: OR = 2.34 on African background, OR = 3.05 on European background). Factors contributing to the lower risk effect in the ApoE gene ε4 allele are likely due to ancestry-specific genetic factors near ApoE rather than non-genetic ethnic, cultural, and environmental factors.
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Affiliation(s)
- Farid Rajabli
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | | | - Katrina Celis
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Kara L. Hamilton-Nelson
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Patrice L. Whitehead
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Larry D. Adams
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Parker L. Bussies
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Clara P. Manrique
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Alejandra Rodriguez
- Universidad Central del Caribe, Bayamón, Puerto Rico, United States of America
| | - Vanessa Rodriguez
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Takiyah Starks
- Center for Outreach in Alzheimer’s, Aging and Community Health at North Carolina A&T State University, Greensboro, North Carolina, United States of America
| | - Grace E. Byfield
- Center for Outreach in Alzheimer’s, Aging and Community Health at North Carolina A&T State University, Greensboro, North Carolina, United States of America
| | | | - Jacob L. McCauley
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Heriberto Acosta
- Clinica de la Memoria, San Juan, Puerto Rico, United States of America
| | - Angel Chinea
- Universidad Central del Caribe, Bayamón, Puerto Rico, United States of America
| | - Brian W. Kunkle
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Christiane Reitz
- Gertrude H. Sergievsky Center, Taub Institute for Research on the Aging Brain, Departments of Neurology, Psychiatry, and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Lindsay A. Farrer
- Departments of Medicine (Biomedical Genetics), Neurology, Ophthalmology, Epidemiology, and Biostatistics, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, United States of America
| | - Gerard D. Schellenberg
- Penn Neurodegeneration Genomics Center, Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Badri N. Vardarajan
- Gertrude H. Sergievsky Center, Taub Institute for Research on the Aging Brain, Departments of Neurology, Psychiatry, and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Jeffery M. Vance
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. MacDonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Michael L. Cuccaro
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. MacDonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Eden R. Martin
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. MacDonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Jonathan L. Haines
- Department of Population & Quantitative Health Sciences, Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Goldie S. Byrd
- Center for Outreach in Alzheimer’s, Aging and Community Health at North Carolina A&T State University, Greensboro, North Carolina, United States of America
| | - Gary W. Beecham
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. MacDonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Margaret A. Pericak-Vance
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Dr. John T. MacDonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- * E-mail:
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Zarei S, Eggert J, Franqui-Dominguez L, Carl Y, Boria F, Stukova M, Avila A, Rubi C, Chinea A. Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico. Surg Neurol Int 2018; 9:242. [PMID: 30603227 PMCID: PMC6293609 DOI: 10.4103/sni.sni_224_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
Neuromyelitis optica (NMO) is an immune-mediated inflammatory disorder of the central nervous system. It is characterized by concurrent inflammation and demyelination of the optic nerve (optic neuritis [ON]) and the spinal cord (myelitis). Multiple studies show variations in prevalence, clinical, and demographic features of NMO among different populations. In addition, ethnicity and race are known as important factors on disease phenotype and clinical outcomes. There are little data on information about NMO patients in underserved groups, including Puerto Rico (PR). In this research, we will provide a comprehensive overview of all aspects of NMO, including epidemiology, environmental risk factors, genetic factors, molecular mechanism, symptoms, comorbidities and clinical differentiation, diagnosis, treatment, its management, and prognosis. We will also evaluate the demographic features and clinical phenotype of NMO patients in PR. This will provide a better understanding of NMO and establish a basis of knowledge that can be used to improve care. Furthermore, this type of population-based study can distinguish the clinical features variation among NMO patients and will provide insight into the potential mechanisms that cause these variations.
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Affiliation(s)
- Sara Zarei
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - James Eggert
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Yonatan Carl
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Fernando Boria
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Marina Stukova
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Cristina Rubi
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
| | - Angel Chinea
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
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18
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Amezcua L, Beecham AH, Delgado SR, Chinea A, Burnett M, Manrique CP, Gomez R, Comabella M, Montalban X, Ortega M, Tornes L, Lund BT, Islam T, Conti D, Oksenberg JR, McCauley JL. Native ancestry is associated with optic neuritis and age of onset in hispanics with multiple sclerosis. Ann Clin Transl Neurol 2018; 5:1362-1371. [PMID: 30480030 PMCID: PMC6243381 DOI: 10.1002/acn3.646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/19/2018] [Accepted: 08/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background and Objective Hispanics with multiple sclerosis (MS) present younger and more often with optic neuritis (ON) as compared to Whites in the western United States. Regional differences related to Hispanic genetic admixture could be responsible. We investigated the association between global genetic ancestry and ON and age at onset of MS in Hispanics. Methods Data were obtained for 1033 self‐identified Hispanics with MS from four MS‐based registries from four academic institutions across the United States January 2016–April 2017. Multivariate regression models, utilizing genetic ancestry estimates for Native American (NA), African, and European ancestry, were used to assess the relationship between genetic ancestry and ON presentation and age of MS onset, defined as age at first symptom. Results Genetic ancestry and ON proportions varied by region where NA ancestry and ON proportions were highest among Hispanics in the southwestern United States (40% vs. 19% overall for NA and 38% vs. 25% overall for ON). A strong inverse correlation was observed between NA and European ancestry (r = −0.83). ON presentation was associated with younger age of onset (OR: 0.98; 95% CI: 0.96–0.99; P = 7.80 × 10−03) and increased NA ancestry (OR: 2.35 for the highest versus the lowest quartile of NA ancestry; 95% CI: 1.35–4.10; P = 2.60 × 10−03). Younger age of onset was found to be associated with a higher proportion NA (Beta: −5.58; P = 3.49 × 10−02) and African ancestry (Beta: −10.07; P = 1.39 × 10−03). Interpretation Ethnic differences associated with genetic admixture could influence clinical presentation in Hispanics with MS; underscoring the importance of considering genetic substructure in future clinical, genetic, and epigenetic studies in Hispanics.
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Affiliation(s)
- Lilyana Amezcua
- Department of Neurology Keck School of Medicine University of Southern California Los Angeles California
| | - Ashley H Beecham
- Dr. John T. Macdonald Department of Human Genetics Miller School of Medicine University of Miami Miami Florida.,John P. Hussman Institute of Human Genomics Miller School of Medicine University of Miami Miami Florida
| | - Silvia R Delgado
- Multiple Sclerosis Division Department of Neurology Miller School of Medicine University of Miami Miami Florida
| | - Angel Chinea
- San Juan Multiple Sclerosis Center San Juan Puerto Rico
| | - Margaret Burnett
- Department of Neurology Keck School of Medicine University of Southern California Los Angeles California
| | - Clara Patricia Manrique
- John P. Hussman Institute of Human Genomics Miller School of Medicine University of Miami Miami Florida
| | - Refujia Gomez
- Department of Preventive Medicine Keck School of Medicine University of Southern California Los Angeles California
| | - Manuel Comabella
- Department of Neurology University of San Francisco School of Medicine Los Angeles California
| | - Xavier Montalban
- Department of Neurology University of San Francisco School of Medicine Los Angeles California
| | - Melissa Ortega
- Multiple Sclerosis Division Department of Neurology Miller School of Medicine University of Miami Miami Florida
| | - Leticia Tornes
- Multiple Sclerosis Division Department of Neurology Miller School of Medicine University of Miami Miami Florida
| | - Brett T Lund
- Department of Neurology Keck School of Medicine University of Southern California Los Angeles California
| | - Talat Islam
- Department de Neurología-Neuroinmunología Centre d'Esclerosi Múltiple de Catalunya (Cemcat) Institut de Recerca Vall d'Hebron Hospital Universitari Vall d'Hebron Universitat Autònoma de Barcelona Barcelona Spain
| | - David Conti
- Department de Neurología-Neuroinmunología Centre d'Esclerosi Múltiple de Catalunya (Cemcat) Institut de Recerca Vall d'Hebron Hospital Universitari Vall d'Hebron Universitat Autònoma de Barcelona Barcelona Spain
| | - Jorge R Oksenberg
- Department of Preventive Medicine Keck School of Medicine University of Southern California Los Angeles California
| | - Jacob L McCauley
- Dr. John T. Macdonald Department of Human Genetics Miller School of Medicine University of Miami Miami Florida.,John P. Hussman Institute of Human Genomics Miller School of Medicine University of Miami Miami Florida
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19
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Mokin M, Chinea A, Primiani CT, Ren Z, Kan P, Srinivasan VM, Hanel R, Aguilar-Salinas P, Turk AS, Turner RD, Chaudry MI, Ringer AJ, Welch BG, Mendes Pereira V, Renieri L, Piano M, Elijovich L, Arthur AS, Cheema A, Lopes DK, Saied A, Baxter BW, Hawk H, Puri AS, Wakhloo AK, Shallwani H, Levy EI, Siddiqui AH, Dabus G, Linfante I. Treatment of blood blister aneurysms of the internal carotid artery with flow diversion. J Neurointerv Surg 2018; 10:1074-1078. [DOI: 10.1136/neurintsurg-2017-013701] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 11/03/2022]
Abstract
BackgroundBlood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective.ObjectiveTo report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA).MethodsConsecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis.Results49 patients with 51 BBA of the ICA treated with devices to achieve the flow diversion effect were identified. 43 patients with 45 BBA of the ICA were treated with the pipeline embolization device and were included in the final analysis. Angiographic follow-up data were available for 30 patients (32 aneurysms in total); 87.5% of aneurysms (28/32) showed complete obliteration, 9.4% (3/32) showed reduced filling, and 3.1% (1/32) persistent filling. There was no difference between the size of aneurysm (≤2 mm vs >2 mm) or the use of adjunct coiling and complete occlusion of the aneurysm on follow-up (P=0.354 and P=0.865, respectively). Clinical follow-up data were available for 38 of 43 patients. 68% of patients (26/38) had a good clinical outcome (modified Rankin scale score of 0–2) at 3 months. There were 7 (16%) immediate procedural and 2 (5%) delayed complications, with 1 case of fatal delayed re-rupture after the initial treatment.ConclusionsOur data support the use of a flow diversion technique as a safe and effective therapeutic modality for BBA of the supraclinoid ICA.
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20
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Chinea A, Ríos-Bedoya CF, Vicente I, Rubí C, García G, Rivera A, Díaz A, Romero EE, Hernández Silvestrini Y, Díaz Y. Increasing Incidence and Prevalence of Multiple Sclerosis in Puerto Rico (2013-2016). Neuroepidemiology 2017; 49:106-112. [PMID: 29136613 DOI: 10.1159/000484090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/07/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence of multiple sclerosis (MS) has been increasing worldwide over the past decades. However, this upward trend has not been examined at the country level in Latin America and the Caribbean (LAC). The aims of this study are to examine trends of MS incidence over 4 years and to provide age- and gender-standardized incidence rate estimates for a Caribbean island. METHODS Data from the Puerto Rico (PR) MS Foundation's registry was used to identify all newly diagnosed MS cases between 2013 and 2016. MS patients were 18 years and older and met the 2010 revised McDonald criteria. Age- and gender-standardized incidence rates were estimated. RESULTS A total of 583 new MS cases were diagnosed in PR from 2013 to 2016. The age- and gender-standardized MS incidence rate for PR increased from 6.1/100,000 in 2013 to 6.7/100,000 in 2016. The annual age-standardized MS incidence rates for females rose from 8.4/100,000 in 2013 to 9.8/100,000 in 2016 and were higher than males, which remained around 3.7/100,000. CONCLUSION Incidence estimates for PR were higher than other LAC countries but consistent with MS increases in other world regions. Our findings tend to rule out several prior potential environmental explanations for high MS incidence rates.
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Affiliation(s)
- Angel Chinea
- San Juan MS Center, Guaynabo, Puerto Rico, San Juan Bautista School of Medicine, Caguas, Puerto Rico
| | | | - Ivonne Vicente
- San Juan MS Center, Guaynabo, Puerto Rico, San Juan Bautista School of Medicine, Caguas, Puerto Rico
| | | | | | - Ana Rivera
- San Juan MS Center, Guaynabo, Puerto Rico
| | | | - Eduardo Estades Romero
- San Juan MS Center, Guaynabo, Puerto Rico, Christiana Care Health System, Diagnostic Radiology, Newark, New Jersey, USA
| | - Yatzka Hernández Silvestrini
- San Juan MS Center, Guaynabo, Puerto Rico, University of Delaware, College of Health Science and Behavioral Health and Nutrition, Newark, New Jersey, USA
| | - Yaritza Díaz
- San Juan Bautista School of Medicine, Caguas, Puerto Rico
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21
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Celis K, Feliciano‐Astacio BE, Deon Adams L, Bussies P, Sierra C, Hamilton‐Nelson KL, Rajabli F, Acosta H, Chinea A, McCauley JL, Vance JM, Cuccaro ML, Beecham GW, Pericak‐Vance MA. [P2–124]: THE PUERTO RICAN ALZHEIMER DISEASE INITIATIVE (PRADI): INITIAL CLINICAL FINDINGS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | - Farid Rajabli
- University of Miami Miller School of MedicineMiamiFLUSA
| | | | - Angel Chinea
- Universidad Central del CaribeBayamonPRPuerto Rico
| | | | | | | | - Gary W. Beecham
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of MedicineMiamiFLUSA
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22
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Rajabli F, Hamilton‐Nelson KL, Feliciano‐Astacio BE, Celis K, Deon Adams L, Bussies P, Sierra C, Chinea A, Acosta H, McCauley JL, Vance JM, Cuccaro ML, Haines JL, Bush WS, Beecham GW, Pericak‐Vance MA. [P2–113]: THE RELEVANCE OF APOE4 TO ALZHEIMER's DISEASE IN THE PRESENCE OF LOCAL ANCESTRY DIFFERENCES. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Farid Rajabli
- University of Miami Miller School of MedicineMiamiFLUSA
| | - Kara L. Hamilton‐Nelson
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of MedicineMiamiFLUSA
| | | | | | | | | | | | - Angel Chinea
- Universidad Central del CaribeBayamonPRPuerto Rico
| | | | | | | | | | | | - William S. Bush
- Case Western Reserve University School of MedicineClevelandOHUSA
| | - Gary W. Beecham
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of MedicineMiamiFLUSA
| | - Margaret A. Pericak‐Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of MedicineMiamiFLUSA
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23
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Feliciano‐Astacio BE, Celis K, Deon Adams L, Hamilton‐Nelson KL, Bussies P, Sierra C, Feliciano N, Chinea A, Acosta H, McCauley JL, Vance JM, Cuccaro ML, Beecham GW, Pericak‐Vance MA. [P2–102]: THE PUERTO RICO ALZHEIMER DISEASE INITIATIVE (PRADI): A MULTISOURCE ASCERTAINMENT APPROACH. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Angel Chinea
- Universidad Central del CaribeBayamonPRPuerto Rico
| | | | | | | | | | - Gary W. Beecham
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of MedicineMiamiFLUSA
| | - Margaret A. Pericak‐Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of MedicineMiamiFLUSA
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24
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Chinea A, Ríos-Bedoya CF, Rubi C, Vicente I, Estades ER, Hernandez-Silvestrini YG. Incidence of Multiple Sclerosis in Puerto Rico, 2014: A Population-Based Study. Neuroepidemiology 2017; 48:55-60. [PMID: 28334724 DOI: 10.1159/000468989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/07/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) affects millions of people worldwide. The estimates for MS incidence are difficult to obtain but are important for understanding MS etiology, developing prevention strategies, and service planning. This study is aimed at estimating the 2014 incidence of MS in Puerto Rico (PR). METHODS The PR MS Foundation's registry was used as the data source. Neurologists, specialty pharmacies, MRI centers, health insurance companies, and the PR Department of Health identified MS cases missed by the registry. MS patients were 18 years and older and met the 2010 revised McDonald criteria. Age-standardized MS incidence rates and their corresponding 95% CIs were computed. RESULTS A total of 144 new MS cases were diagnosed in 2014. The age-standardized MS incidence rate was 5.1/100,000 (95% CI 4.3-5.9). The incidence rate was 7.1/100,000 (95% CI 5.7-8.5) for females and 2.9/100,000 (95% CI 2.0-3.8) for males. MS cases were mostly females (72.9%) with a mean age of 41.0 years (±1.0). CONCLUSION According to the country estimates, PR has a higher MS incidence than other Caribbean and Latin American countries, but a lower incidence compared to countries at higher latitudes. Our findings provide insights into the MS etiology in the Hispanic population that require additional research.
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Affiliation(s)
- Angel Chinea
- San Juan Multiple Sclerosis Center, Guaynabo, Puerto Rico
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25
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Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF, Pagani W, Lodin D, Orozco G, Chinea A. A comprehensive review of amyotrophic lateral sclerosis. Surg Neurol Int 2015; 6:171. [PMID: 26629397 PMCID: PMC4653353 DOI: 10.4103/2152-7806.169561] [Citation(s) in RCA: 370] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/12/2015] [Indexed: 12/20/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a late-onset fatal neurodegenerative disease affecting motor neurons with an incidence of about 1/100,000. Most ALS cases are sporadic, but 5–10% of the cases are familial ALS. Both sporadic and familial ALS (FALS) are associated with degeneration of cortical and spinal motor neurons. The etiology of ALS remains unknown. However, mutations of superoxide dismutase 1 have been known as the most common cause of FALS. In this study, we provide a comprehensive review of ALS. We cover all aspects of the disease including epidemiology, comorbidities, environmental risk factor, molecular mechanism, genetic factors, symptoms, diagnostic, treatment, and even the available supplement and management of ALS. This will provide the reader with an advantage of receiving a broad range of information about the disease.
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Affiliation(s)
- Sara Zarei
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Karen Carr
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Luz Reiley
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Kelvin Diaz
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Orleiquis Guerra
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | | | - Wilfredo Pagani
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Daud Lodin
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Gloria Orozco
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Angel Chinea
- Neurologist, Caribbean Neurological Center, Caguas, USA
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26
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Silva MR, Chinea A, Aberman Z, Colwell N, Gonzalez-Arias S, Chambers J. CBIO-07COMBINED BH3 AND METABOLIC PROFILING AS A METHOD TO DEFINE THERAPEUTIC RESPONSE AND RESISTANCE IN GRADE IV ASTROCYTOMAS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov209.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Calbacho M, Gómez-Rojas S, Saavedra I, Chinea A, Herrera P, López-Jiménez J. P-303 Stem cell transplantation for therapy-related myeloid neoplasm: Importance of pre-transplantation risk factors. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70350-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Meers MB, Chinea A. Evolution of Phenotypic Responses Characterizing Fetal Alcohol Spectrum Disorders (FASD) Among Vertebrate Model Organisms. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.743.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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29
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Miranda MT, Suárez E, Abbas M, Chinea A, Tosado R, Mejías IA, Boukli N, Dunston GM. HLA class I & II alleles in multiple sclerosis patients from Puerto Rico. Bol Asoc Med P R 2013; 105:18-23. [PMID: 23767380 PMCID: PMC4573578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Multiple Sclerosis (MS) is a complex disease where genetic and environmental factors have been implicated. The onset of symptoms occurs in individuals from twenty to fifty years of age, producing a progressive impairment of motor, sensory and cognitive functions. MS is more frequent in females than in males with a ratio of 4:1. The prevalence of the MS varies among ethnics groups such as Europeans, Africans and Caucasians. The estimated prevalence of MS in Puerto Rico is 42 for each 100,000 habitants, which is more than the prevalence reported for Central America and the Caribbean. In spite of this prevalence, the genetic component of MS has not been explored in order to know the alleles' expression of Puerto Rican MS patients and compare it with the allele expression in other ethnic groups. Thirty-five patients and 31 control subjects were genotyped. The allele frequencies expressed in this sample were similar to those expressed for Puerto Ricans in the National Marrow Donor Program Registry (n = 3,149). The most prevalent alleles for MS patients were HLA-DRB1*01 and *03. HLA-DQB1*04 was the most frequent in the control group and HLA-A*30, in MS patients. These findings are in agreement with published data. HLA-DQB1*04 was a marginal protector in this sample and this role has not been described before. The accuracy of the results is limited due to the sample size. After performing a statistical power analysis it showed that by increasing the sample the values would be significant.
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Affiliation(s)
- María T Miranda
- School of Medical Technology, Inter American University of Puerto Rico, Metropolitan Campus, San Juan, Puerto Rico.
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Chinea A, Pérez N, Perez-Canabal A, Rojas F, Torres J, Poser C. The Puerto Rico study for the prevalence of multiple sclerosis. Bol Asoc Med P R 2012; 104:4-9. [PMID: 23763216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article review the results of a study conducted by the Puerto Rico Multiple Sclerosis Foundation. It presents the results of the first continuous patient registry of the Puerto Rico Multiple Sclerosis (MS) Foundation in the Island between the years 2003 and 2008. It describes the profile of patients with MS and the estimated prevalence. Based on the database of the registry, the estimated prevalence at the present time is estimated to be 52 of 100,000. This population-based study analyzed data of 698 surveyed individuals diagnosed with MS. This study examines demographic factors (age distribution, gender and age at onset), other MS related variables such as the most common symptoms at the onset and after the onset of MS, psychological manifestations, family history, most common treatments, comorbid medical conditions, childhood diseases, use of assistive equipment and patients needs. MS is a chronic demyelinating disease affecting the Central Nervous System, typically manifesting itself in patients between the ages of 30 and 40 years old, causing considerable disability in a significant proportion of afflicted individuals. To date, there has only been one study conducted on the condition of the disease in Puerto Rico.
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Affiliation(s)
- Angel Chinea
- San Juan Multiple Sclerosis Center, San Juan, Puerto Rico.
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García Gutiérrez JV, González García C, Fleta B, Sánchez-Ortega I, Herrera P, Chinea A, López J, Ramos L, Ramos RP, Duarte R, Odriozola J. [Histopathological findings and biomarker analysis in cutaneous graft-versus-host disease ]. Methods Find Exp Clin Pharmacol 2010; 32 Suppl A:19-23. [PMID: 21381284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Graft-versus-host disease (GVHD) remains the greatest source of morbidity-mortality in allogenic transplant patients. Although in most cases the more easily obtainable clinical and laboratory test parameters suffice to confirm the diagnosis and establish the stage of the disease biopsies of the affected organ are sometimes needed. At present there is great Interest in the study of factors allowing a prognosis of the course and type of response to treatment in patients with CVHD. In this sense, It would be necessary to objectively Identify and validate biomarkers capable of predicting biological or pathological processes in patients with cVHD. To this effect we have performed serial analyses of skin tissue using peripheral blood and tissue biomarkers in a prospective observational study conducted in three transplant centers. The still preliminary results Indicate that certain histopathological findings classically attributed to CVHD ore also seen in patients not clinically affected by the disease--this probably being related to other physiopathological phenomena occurring during transplantation. The study of these findings, combined with biomarker analysis, will allow improved understanding of the underlying etiopathogenesis, as well as the definition of new diagnostic, prognostic and response-evaluating criteria.
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César JM, Candela A, Tenorio MT, Chinea A, Sáiz R, Liaño F. [Management of heparin-induced thrombocytopenia in a patient on hemodialysis complicated with thrombosis in the extracorporeal circuit]. Nefrologia 2008; 28:462-463. [PMID: 18662159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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