title: Aboriginals with multiple sclerosis: HLA types and predominance of neuromyelitis optica.
abstract: BACKGROUND
  MS is common in people of northern European ethnicity who live in northern geographic areas; however, MS is rarely identified among aboriginal peoples living in the same areas.
  
  
  OBJECTIVE
  To determine the prevalence, clinical features, HLA type, and viral infections associated with MS among aboriginals in Manitoba, Canada.
  
  
  METHODS
  A retrospective study was performed in which the clinical features of all aboriginal patients with MS together with HLA type and human herpesvirus-6, HIV-1, human T-cell lymphotropic virus-1, and endogenous retrovirus associated with MS (MSRV) infections were analyzed and compared with results from nonaboriginal patients with MS.
  
  
  RESULTS
  Seven aboriginals with MS were identified with a period prevalence among aboriginals of 40:100,000. Clinical features included relapsing-remitting (n = 6) or primary progressive (n = 1) phenotypes with aggressive disease courses and frequent involvement of optic nerves and spinal cord (n = 5) compared with nonaboriginal patients. Autopsy of one patient showed necrosis and eosinophil infiltrates in a cervical spinal cord lesion and a demyelinated optic nerve. Analysis of HLA alleles at the DRB1 and DQB1 loci indicated that the HLA types detected were common in aboriginals, but there were no HLA alleles previously associated with the development of MS. Analysis of the copy number of MSRV did not show differences among aboriginals and nonaboriginals with or without MS.
  
  
  CONCLUSIONS
  Aboriginals of Algonkian background are at increased risk for an aggressive type of MS, resembling neuromyelitis optica, which is resistant to conventional MS treatments and occurs independently of HLA alleles previously associated with MS.
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
authors.forename: S M
authors.initials: SM
authors.lastname: Mirsattari
authors.forename: J B
authors.initials: JB
authors.lastname: Johnston
authors.forename: R
authors.initials: R
authors.lastname: McKenna
authors.forename: M R
authors.initials: MR
authors.lastname: Del Bigio
authors.forename: P
authors.initials: P
authors.lastname: Orr
authors.forename: R T
authors.initials: RT
authors.lastname: Ross
authors.forename: C
authors.initials: C
authors.lastname: Power
mesh_terms: D000328:Adult; D044467:American Indian or Alaska Native; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology*; D009471:Neuromyelitis Optica / Q000503:physiopathology*