The genetic diversity of multiple sclerosis risk among Hispanic and African American populations living in the United States

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.

Multiple sclerosis in Hispanics: a study of clinical disease expression

Background: Hispanics living with multiple sclerosis (MS) in the United States are not well defined.

Objective: To describe the clinical characteristics of MS among Hispanic Whites (HW) in Southern California with those of non-Hispanic Whites (NHW).

Methods: We performed a medical chart review to identify all cases of HW with MS ( n = 125) who were treated at our institution during a 1-year period. We also identified cases of NHW with MS (100 NHW) treated at those clinics. All HW patients were interviewed to ascertain ancestry including detailed migration history. Disease progression was assessed by ambulatory disability and defined as Expanded Disability Status Scale (EDSS) score ≥6.

Results: Compared with NHW, HW were more likely to have a relapsing–remitting form of MS and a younger age of onset (28.4 ± 0.97 years) with presenting symptoms of optic neuritis and transverse myelitis. However, overall ambulatory disability did not differ between HW and NHW. Migration to the US at age >15 years was associated with increased risk of disability in HW.

Conclusions: HW living in the USA may be at risk of developing MS at an earlier age compared with NHW. Migration history can play an important role in the management of HW with MS.

Peripheral blood stem cell transplantation in multiple sclerosis with busulfan and cyclophosphamide conditioning: report of toxicity and immunological monitoring

Multiple sclerosis (MS) is an immune-mediated disease that may be amenable to high-dose immunosuppression with peripheral blood stem cell transplantation (SCT) in selected patients. Five MS patients (all women, ages 39-47 years) received granulocyte colony-stimulating factor (G-CSF) for stem cell mobilization, CD34 cell selection for T-cell depletion, a preparatory regimen of busulfan (1 mg/kg x 16 doses) and cyclophosphamide (120 mg/kg), and antithymocyte globulin (10 mg/kg x 3 doses) at the time of stem cell infusion. Days required to recover absolute neutrophil count >500 were 12 to 14 and platelet count >20,000 were 17 to 58. Posttransplantation infectious complications in the first year after SCT occurred in 3 of 5 patients, and 1 patient died at day 22 after SCT from influenza A pneumonia. Neuropathologic study in this patient showed demyelinating plaques with surrounding macrophages but only rare T cells. In 2 patients, MS flared transiently with G-CSF. Magnetic resonance imaging gadolinium enhancement was present in 3 of 5 patients before transplantation and 0 of 4 after SCT. There were cerebrospinal fluid oligoclonal bands at 1 year after SCT, similar to the pretransplantation assays. Sustained suppression of peripheral blood mononuclear cell proliferative responses to myelin antigens occurred after SCT, but new responses to some myelin peptide fragments also developed after SCT. In 1 patient, enzyme-linked immunospot (ELISPOT) assays done 9 months after SCT showed a predominant T helper 2 (Th2) cytokine pattern. Neurological progression of 1 point on the extended disability status scale was seen in 1 patient 17 months after SCT. Another patient who was neurologically stable died abruptly 19 months after SCT from overwhelming S. pneumoniae sepsis. The remaining patients have had stable MS (follow-up, 18 and 30 months). In summary, our experience confirms the high-risk nature of this approach. Further studies and longer follow-up would be needed to determine the significance of new lymphocyte proliferative responses after SCT and the overall effect of this treatment on the natural history of MS.

Rinderpest virus infection in primary bovine skin fibroblasts

Rinderpest virus (RPV) replicated to a high titre in primary bovine skin fibroblasts. The course of infection was similar to that seen in established cell lines. Virulent field virus grew at a faster rate than the fully attenuated vaccine strain of the virus. Virus antigen expression, as measured by FACScan analysis, correlated with the time course of infection for the two strains in cell cultures. Wild type virus, obtained directly from cattle, infected cells at a slower rate than virus passaged even once in primary bovine skin fibroblasts. This is the first report of a productive infection of primary bovine skin fibroblasts by wild type RPV.

Multiple sclerosis flares associated with recombinant granulocyte colony-stimulating factor

Four of 10 patients who were enrolled on protocols of high-dose immunosuppression with peripheral blood stem cell rescue for MS experienced neurologic worsening while receiving recombinant human granulocyte colony-stimulating factor. There was improvement when methylprednisolone was given to three of the patients, but one patient died of respiratory failure. The mechanism of the neurologic worsening is uncertain.

Morbillivirus downregulation of CD46

There is evidence that CD46 (membrane cofactor protein) is a cellular receptor for vaccine and laboratory-passaged strains of measles virus (MV). Following infection with these MV strains, CD46 is downregulated from the cell surface, and consequent complement-mediated lysis has been shown to occur upon infection of a human monocytic cell line. The MV hemagglutinin (H) protein alone is capable of inducing this downregulation. Some wild-type strains of MV fail to downregulate CD46, despite infection being prevented by anti-CD46 antibodies. In this study we show that CD46 is also downregulated to the same extent by wild-type, vaccine, and laboratory-passaged strains of rinderpest virus (RPV), although CD46 did not appear to be the receptor for RPV. Expression of the RPV H protein by a nonreplicating adenovirus vector was also found to cause this downregulation. A vaccine strain of peste des petits ruminants virus caused slight downregulation of CD46 in infected Vero cells, while wild-type and vaccine strains of canine distemper virus and a wild-type strain of dolphin morbillivirus failed to downregulate CD46. Downregulation of CD46 can, therefore, be a function independent of the use of this protein as a virus receptor.

Antigen recognition and activation of ovine gamma delta T cells

We have investigated several aspects of gamma delta T cells in sheep. gamma delta T cells of sheep express a unique transmembrane protein termed T19 but lack the expression of particular cell-surface molecules such as CD2, CD4 and CD8 which are typically associated with alpha beta T cells. The majority of gamma delta T cells isolated from animals of all ages examined lacked the expression of CD45RA. A faster rate of activation by gamma delta T cells compared to either CD4 or CD8 T cells was seen in the time-course of IL-2 receptor alpha chain (CD25) cell-surface expression. All gamma delta T cells expressed the CD25 protein within 8 hr of activation whereas the majority of CD4 or CD8 T cells did not express CD25 until 24 hr post-concanavalin A (Con A) stimulation. This difference in the rate of expression of activation molecules was not restricted to CD25, as a similar trend was seen with cell-surface expression of major histocompatibility complex (MHC) class II molecules. We have used the distinct phenotypic profile of ovine gamma delta T cells to purify these cells by positive selection via the T19 molecule to assess their in vitro proliferative response to various antigens. Routinely, cell populations comprising more than 93% gamma delta T cells with yields of approximately 55% were obtained. Purified gamma delta T cells were capable of responding to Mycobacterium tuberculosis antigen in a primary and secondary in vitro proliferation assay and to ovalbumin in a secondary response. Ovine gamma delta T cells showed little, if any, proliferative response to allogeneic stimulator cells.

Expression of T19 (WC1) molecules by ovine lymphocytes

Workshop clusters WC1 and WC2 monoclonal antibodies (mAbs) were tested for their reactivity with ovine peripheral blood mononuclear cells (PBMC). The populations of ovine lymphocytes defined by these mAbs were found to be part of the population of T19+ (WC1+) cells, and the gamma/delta T cell receptor (TCR) (WC2) expressing T cells. The expression of cell surface WC1 antigens following mitogen stimulation of ovine PBMC was studied. Whilst the size of the WC1 populations increased during culture with concanavalin A, the changes in the ratio of WC1:gamma/delta TCR percentages observed suggested either a loss of WC1 molecules or a selective expansion of WC1- cells.

Different rates of interleukin 2 receptor expression by ovine gamma/delta and alpha/beta T cells

We have used the monoclonal antibodies IL-A111, CACT116A, to investigate the expression of interleukin 2 receptors (IL-2R) by ovine peripheral blood T cells. Monoclonal antibodies (MAbs) IL-A111 and CACT116A reacted with concanavalin A (Con A) activated ovine lymphocytes and both mAbs did so with similar FACS (fluorescence activated cell sorting) profiles and fluorescence intensity. Following activation by Con A all three major ovine T cell subsets, namely CD4+, CD8+ and gamma/delta T cells, express the IL-2R. All gamma/delta T cells express IL-2R within 12 h following activation by Con A in vitro whereas alpha/beta T cells do not express the IL-2R until 24 h after the start of culture with the mitogen. In freshly isolated peripheral blood a small percentage of lymphocytes, which are almost all CD4+, express the IL-2R.