Can we explain racial differences in MS?


I have copied this from the National Multiple sclerosis website

“Historically, MS was believed to primarily affect white people, particularly those of European descent. Recent research, however, indicates a higher incidence (the number of people newly diagnosed with MS within a given period of time) of MS in Black people than previously thought , consistent with the rate of MS in white people”.

“Black people with MS might also have more aggressive disease progression, greater disability and different symptoms, including more walking, balance, and coordination problems, more cognitive and visual symptoms, more frequent  relapses with poorer recovery, and earlier disability onset”.

So how do you define the biology that under pins these observations. Is it genetics or environmental? As disease has been increasing between first and second generation imigrants suggests that enviroment is important. But could there be a biology that may have some influence. A while ago we suggested that certain B cell subsets were important in driving MS, in this study they find that after about 5 months there is slower repopulation in some people identifying themselves as white. There does not seem to due to expansion of particulalar B cell subsets but it suggests b cells are important.

Faster B-cell repletion after anti-CD20 infusion in Black patients compared to white patients with neurologic diseases.Saidenberg L, Arbini AA, Silverman GJ, Lotan I, Cutter G, Kister I.Mult Scler Relat Disord. 2022 Apr 25;63:103830. doi: 10.1016/j.msard.2022.103830.

This retrospective, single-center study aimed to characterize and compare the kinetics of B-cell reemergence following anti-CD20 infusion (anti-CD20i) in African American (AA) and white patients with MS or NMOSD. In a logistic regression model that included race, time since anti-CD20i, body mass index, and diagnosis, only AA race (p=0.01) and time since anti-CD20i (p=0.0003) were significant predictors of B-cell repletion. However, B-cell subset composition was similar between AA and white patients with detectable CD19+ B-cell counts. These findings highlight the importance of including a diverse study population in future studies of anti-CD20 therapies.

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  • Don’t forget there are a significant amount of “white genes” in people who identify themselves as black, stemming from slavery. Don’t know what that significance level is, but I suspect more than a “wee bit”.

      • Normally and unfortunately black communities have less access to health

        resources and diagnostics tools

        Is that metrics increasing ? and as a consequence the cases seen?

      • Question posed is, Is it genetics or environment? My comment eludes to the difficulty in sorting out a biological, or “genetic” link. Sure seems like the environmental side of things to me, I would guess.

  • I would like to know possible explainations why Asian pwMS have more spinal cord involvement and less brain involvement. This can’t be explained by b-cell repopulation etc.

    • One example could be the expression of the targets..for example there is more myelin oligodendrocyte glycoprotein in spinal cord (and optic nerve) than the brain, genetics etc, etc

      • I understand – if this is the case we kind of assuming molecular mimicry is the cause of MS?

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