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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Increased tissue damage and lesion volumes in African Americans with multiple sclerosis
B Weinstock-Guttman1, M Ramanathan, K Hashmi
1The Jacobs Neurological Institute, Baird Multiple Sclerosis Center, Department of Neurology, State University of New York, E2 Buffalo General Hospital, Buffalo, NY 14203, USA. BWeinstock-Guttman@Kaleidahealth.Org
Background:
African American (AA) patients with multiple sclerosis (MS) have more rapid disease progression and poorer responses to disease-modifying therapies than white American (WA) patients with MS.
Objectives:
To investigate brain MRI characteristics in AA compared to WA in a cohort of consecutive patients with MS.
Methods:
We studied 567 patients with MS (age: 45.1 +/- SD 9.8 years, disease duration: 13.4 +/- 8.6 years), comprised of 488 WA and 79 AA. All patients obtained clinical and quantitative MRI evaluation. The majority of patients, 96% of AA and 94% of WA, were on disease-modifying therapies. The MRI measures included T1-, T2-, and gadolinium contrast-enhancing (CE) lesion volumes (LV) and CE number, global and tissue-specific brain atrophy, and magnetization transfer ratio (MTR) in lesions and normal-appearing gray matter (NAGM) and white matter (NAWM). The associations between race and clinical and MRI measurements were assessed in regression analysis.
Results:
The MTR values in lesions and in NAGM and NAWM were significantly lower in AA compared to WA. The AA group had 31% greater T2-LV and 101% greater T1-LV compared to WA. The MS Severity Score for AA (mean +/- SD = 4.3 +/- 2.9) was greater than for WA (3.8 +/- 2.5), despite a shorter disease duration in AA, indicating more aggressive clinical disease.
Conclusions:
African American patients showed increased tissue damage, as measured by magnetization transfer ratio, and presented higher lesion volumes compared to white Americans. The greater tissue damage and faster lesion volume accumulation may explain the rapid clinical progression in African American patients.
Insights
African American multiple sclerosis (MS) patients exhibit greater brain tissue damage and higher lesion volumes compared to White Americans, potentially explaining more rapid disease progression in this demographic.
Area of Science:
- Neuroimmunology
- Radiology
- Clinical Neurology
Background:
- African American (AA) patients with multiple sclerosis (MS) experience more aggressive disease progression and reduced treatment efficacy compared to White American (WA) patients.
- Understanding the underlying biological differences is crucial for improving patient outcomes.
Purpose of the Study:
- To compare brain magnetic resonance imaging (MRI) characteristics between AA and WA patients diagnosed with MS.
- To identify potential imaging biomarkers associated with racial disparities in MS progression.
Main Methods:
- A cohort of 567 MS patients (79 AA, 488 WA) underwent comprehensive clinical and quantitative MRI assessments.
- MRI metrics included lesion volumes (T1, T2, gadolinium-enhancing), brain atrophy, and magnetization transfer ratio (MTR) in various brain tissues.
- Regression analyses were performed to evaluate associations between race and MRI findings.
Main Results:
- AA patients demonstrated significantly lower MTR values in lesions and normal-appearing gray and white matter compared to WA patients.
- The AA group exhibited substantially larger T2 lesion volumes (31% greater) and T1 lesion volumes (101% greater) than the WA group.
- Despite shorter disease duration, AA patients had a higher MS Severity Score, indicating more severe clinical disease.
Conclusions:
- African American MS patients present with increased brain tissue damage (evidenced by lower MTR) and higher lesion volumes compared to White Americans.
- These imaging findings suggest that greater tissue damage and accelerated lesion accumulation contribute to the observed rapid clinical progression in AA individuals with MS.
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