Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis

A longitudinal study

Natalia Gonzalez Caldito, Shiv Saidha, Elias S. Sotirchos, Blake E. Dewey, Norah J. Cowley, Jeffrey Glaister, Kathryn C. Fitzgerald, Omar Al-Louzi, James Nguyen, Alissa Rothman, Esther Ogbuokiri, Nicholas Fioravante, Sydney Feldman, Ohemaa Kwakyi, Hunter Risher, Dorlan Kimbrough, Teresa C. Frohman, Elliot Frohman, Laura Balcer, Ciprian Crainiceanu & 7 others Peter C.M. Van Zijl, Ellen M. Mowry, Daniel S. Reich, Jiwon Oh, Dzung L. Pham, Jerry Prince, Peter A. Calabresi

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)3115-3129
Number of pages15
JournalBrain
Volume141
Issue number11
DOIs
StatePublished - Nov 1 2018
Externally publishedYes

Fingerprint

African Americans
Multiple Sclerosis
Atrophy
Longitudinal Studies
Brain
Optical Coherence Tomography
Linear Models
Pathology
Nerve Fibers
Individuality
Ganglia
Disease Progression
Wounds and Injuries

Keywords

  • African American
  • magnetic resonance imaging (MRI)
  • multiple sclerosis
  • optical coherence tomography (OCT)
  • race

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Caldito, N. G., Saidha, S., Sotirchos, E. S., Dewey, B. E., Cowley, N. J., Glaister, J., ... Calabresi, P. A. (2018). Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis: A longitudinal study. Brain, 141(11), 3115-3129. https://doi.org/10.1093/brain/awy245

Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis : A longitudinal study. / Caldito, Natalia Gonzalez; Saidha, Shiv; Sotirchos, Elias S.; Dewey, Blake E.; Cowley, Norah J.; Glaister, Jeffrey; Fitzgerald, Kathryn C.; Al-Louzi, Omar; Nguyen, James; Rothman, Alissa; Ogbuokiri, Esther; Fioravante, Nicholas; Feldman, Sydney; Kwakyi, Ohemaa; Risher, Hunter; Kimbrough, Dorlan; Frohman, Teresa C.; Frohman, Elliot; Balcer, Laura; Crainiceanu, Ciprian; Van Zijl, Peter C.M.; Mowry, Ellen M.; Reich, Daniel S.; Oh, Jiwon; Pham, Dzung L.; Prince, Jerry; Calabresi, Peter A.

In: Brain, Vol. 141, No. 11, 01.11.2018, p. 3115-3129.

Research output: Contribution to journalArticle

Caldito, NG, Saidha, S, Sotirchos, ES, Dewey, BE, Cowley, NJ, Glaister, J, Fitzgerald, KC, Al-Louzi, O, Nguyen, J, Rothman, A, Ogbuokiri, E, Fioravante, N, Feldman, S, Kwakyi, O, Risher, H, Kimbrough, D, Frohman, TC, Frohman, E, Balcer, L, Crainiceanu, C, Van Zijl, PCM, Mowry, EM, Reich, DS, Oh, J, Pham, DL, Prince, J & Calabresi, PA 2018, 'Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis: A longitudinal study', Brain, vol. 141, no. 11, pp. 3115-3129. https://doi.org/10.1093/brain/awy245
Caldito NG, Saidha S, Sotirchos ES, Dewey BE, Cowley NJ, Glaister J et al. Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis: A longitudinal study. Brain. 2018 Nov 1;141(11):3115-3129. https://doi.org/10.1093/brain/awy245
Caldito, Natalia Gonzalez ; Saidha, Shiv ; Sotirchos, Elias S. ; Dewey, Blake E. ; Cowley, Norah J. ; Glaister, Jeffrey ; Fitzgerald, Kathryn C. ; Al-Louzi, Omar ; Nguyen, James ; Rothman, Alissa ; Ogbuokiri, Esther ; Fioravante, Nicholas ; Feldman, Sydney ; Kwakyi, Ohemaa ; Risher, Hunter ; Kimbrough, Dorlan ; Frohman, Teresa C. ; Frohman, Elliot ; Balcer, Laura ; Crainiceanu, Ciprian ; Van Zijl, Peter C.M. ; Mowry, Ellen M. ; Reich, Daniel S. ; Oh, Jiwon ; Pham, Dzung L. ; Prince, Jerry ; Calabresi, Peter A. / Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis : A longitudinal study. In: Brain. 2018 ; Vol. 141, No. 11. pp. 3115-3129.
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T1 - Brain and retinal atrophy in African-Americans versus Caucasian-Americans with multiple sclerosis

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AU - Caldito, Natalia Gonzalez

AU - Saidha, Shiv

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AU - Dewey, Blake E.

AU - Cowley, Norah J.

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AU - Crainiceanu, Ciprian

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N2 - 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.

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