MS in South Asians in England: early disease onset and novel pattern of myelin autoimmunity.
BACKGROUND
Epidemiological studies describe a latitude gradient for increased MS prevalence and a preponderance of disease in Caucasian individuals. However, individuals from other ethnic backgrounds and low-risk regions can acquire a raised risk through migration. Nearly a fifth of the London population is of Asian/Asian-British origin and a significant proportion of referrals are from this group.


METHODS
We investigated whether there were differences in timing, presentation, severity, and immunology of disease (with respect to CD4 myelin epitope recognition) between individuals in London with MS who were either of S. Asian or Caucasian origin. Individuals of S. Asian origin with MS were compared with healthy S. Asian controls, individuals with MS and of Caucasian origin and Caucasian controls.


RESULTS
Age at MS onset is significantly lower in the S. Asian group, attributable to earlier onset specifically in UK-born individuals, though clinical presentation is similar. Analysis of CD4 autoimmunity to myelin antigens shows disease in S. Asian individuals to encompass recognition of novel epitopes; immunity to MBP116-130 in S. Asian individuals was highly disease-specific.


CONCLUSIONS
These findings emphasize the need to define disease profiles across ethnicities and identify environmental triggers conferring acquired risk. Such findings must inform choices for immunotherapeutic interventions suitable for all, across ethnicities.
Department of Clinical Neurosciences, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK. r.nicholas@imperial.ac.uk.
Richard S
RS
Nicholas
Department of Medicine, Imperial College, Du Cane Road, London, W12 0NN, UK. vkostadima@yahoo.com.|Department of Clinical Neurosciences, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK. vkostadima@yahoo.com.
Vassiliki
V
Kostadima
Department of Clinical Neurosciences, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK. mah83@cam.ac.uk.
Maya
M
Hanspal
Department of Medicine, Imperial College, Du Cane Road, London, W12 0NN, UK. benwakerley@fastmail.fm.|Department of Neurology, John Radcliffe Hospital, Oxford, OX3 9DU, UK. benwakerley@fastmail.fm.
Benjamin R
BR
Wakerley
H & I Laboratory, Hammersmith Hospital Imperial College NHS trust, Du Cane Road, W12 0HS, London, UK. Ruhena.Sergeant@imperial.nhs.uk.
Ruhena
R
Sergeant
Telethon Kids Institute, PO Box 855, West Perth, Western Australia, Australia. sdecuypere@ichr.uwa.edu.au.
Saskia
S
Decuypere
Department of Clinical Neurosciences, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK. malikomar@hotmail.com.
Omar
O
Malik
Department of Medicine, Imperial College, Du Cane Road, London, W12 0NN, UK. r.boyton@ic.ac.uk.
Rosemary J
RJ
Boyton
Department of Medicine, Imperial College, Du Cane Road, London, W12 0NN, UK. d.altmann@ic.ac.uk.
Daniel M
DM
Altmann
D000328:Adult; D017668:Age of Onset; D015551:Autoimmunity / Q000276:immunology*; D001459:Bangladesh / Q000208:ethnology; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D008131:London / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000208:ethnology* / Q000276:immunology*; D009186:Myelin Sheath / Q000276:immunology*; D010154:Pakistan / Q000208:ethnology; D013188:Sri Lanka / Q000208:ethnology