Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis: a longitudinal study

Abstract

On average, African Americans with multiple sclerosis demonstrate higher inflammatory disease activity, faster disability accumulation, greater visual dysfunction, more pronounced brain tissue damage and higher lesion volume loads compared to Caucasian Americans with multiple sclerosis. Neurodegeneration is an important component of multiple sclerosis, which in part accounts for the clinical heterogeneity of the disease. Brain atrophy appears to be widespread, although it is becoming increasingly recognized that regional substructure atrophy may be of greater clinical relevance. Patient race (within the limitations of self-identified ancestry) is regarded as an important contributing factor. However, there is a paucity of studies examining differences in neurodegeneration and brain substructure volumes over time in African Americans relative to Caucasian American patients. Optical coherence tomography is a non-invasive and reliable tool for measuring structural retinal changes. Recent studies support its utility for tracking neurodegeneration and disease progression in vivo in multiple sclerosis. Relative to Caucasian Americans, African American patients have been found to have greater retinal structural injury in the inner retinal layers. Increased thickness of the inner nuclear layer and the presence of microcystoid macular pathology at baseline predict clinical and radiological inflammatory activity, although whether race plays a role in these changes has not been investigated. Similarly, assessment of outer retinal changes according to race in multiple sclerosis remains incompletely characterized. Twenty-two African Americans and 60 matched Caucasian Americans with multiple sclerosis were evaluated with brain MRI, and 116 African Americans and 116 matched Caucasian Americans with multiple sclerosis were monitored with optical coherence tomography over a mean duration of 4.5 years. Mixed-effects linear regression models were used in statistical analyses. Grey matter (-0.9%/year versus-0.5%: P =0.02), white matter (-0.7%/year versus-0.3%: P =0.04) and nuclear thalamic (-1.5%/year versus-0.7%/year: P =0.02) atrophy rates were approximately twice as fast in African Americans. African Americans also exhibited higher proportions of microcystoid macular pathology (12.1% versus 0.9%, P =0.001). Retinal nerve fibre layer (-1.1% versus-0.8%: P =0.02) and ganglion cell+ inner plexiform layer (-0.7%/year versus-0.4%/year: P =0.01) atrophy rates were faster in African versus Caucasian Americans. African Americans on average exhibited more rapid neurodegeneration than Caucasian Americans and had significantly faster brain and retinal tissue loss. These results corroborate the more rapid clinical progression reported to occur, in general, in African Americans with multiple sclerosis and support the need for future studies involving African Americans in order to identify individual differences in treatment responses in multiple sclerosis.

Black African and Latino/a identity correlates with increased plasmablasts in MS

“…Over the past 16 years, 2,7,37 observational studies revealed greater clinical severity and poorer prognosis among individuals of the Black African diaspora, including those identifying within the spectrum of Latin American identity. 2,16 Both overt and indirect evidence support ethno-ancestry as a critical factor in MS. A primary role for B cells in MS pathogenesis unequivocally shown in 2008 11,38 is not only accentuated in individuals of Black African heritage 8 but parallels similar ethno-ancestry–based B cell–driven dysregulation in other conditions.…”

“…1,2 Paraclinical measures of CNS inflammation (T2 lesion accumulation and lesion volume) may be pronounced, 3,4 whereas atrophy metrics, including brain and retinal degeneration, appear accelerated among BALAwMS compared with CAwMS. 5–7 Ethno-ancestry is clearly an important consideration in MS. Unfortunately, the paradox of ethno-ancestry being simultaneously relevant in MS yet underrepresented in both clinical and translational investigation is apparent both in clinical trials and observational research.…”

Optical Coherence Tomography in Multiple Sclerosis

“…Caldito et al recently published that African Americans experience more rapid thinning of the pRNFL and the GCL/IPL than Caucasian Americans. 64 They also experienced a larger frequency of developing MME. These results correlated with greater loss of cortical gray matter, white matter, and thalamic volume in the same African American participants.…”

Association of body mass index with longitudinal rates of retinal atrophy in multiple sclerosis

“…African-American patients with MS exhibit a more aggressive disease course, including accelerated brain and retinal atrophy. 34 However, accounting for race in our analyses, we found that both African-American race and elevated BMI were independently associated with faster rates of GCIPL atrophy, suggesting that the preponderance of African-American patients in the obese cohort did not influence our findings; rather, both race and BMI have significant associations with rates of retinal atrophy. Additionally, the study lacked data in healthy controls.…”