Research: Imaging African Americans a case for immunomodulation

Howard et al. MRI correlates of disability in african-americans with multiple sclerosis. PLoS One. 2012;7(8) :e43061. Epub 2012.

OBJECTIVES: Multiple sclerosis (MS) in African-Americans (AAs) is characterized by more rapid disease progression and poorer response to treatment than in Caucasian-Americans (CAs). MRI provides useful and non-invasive tools to investigate the pathological substrate of clinical progression. The aim of our study was to compare MRI measures of brain damage between AAs and CAs with MS.

METHODS: Retrospective analysis of 97 AAs and 97 CAs with MS matched for age, gender, disease duration and age at MRI examination.
 
RESULTS: AA patients had significantly greater T2- (pā€Š=ā€Š0.001) and T1-weighted (pā€Š=ā€Š0.0003) lesion volumes compared to CA patients. In contrast, measurements of global and regional brain volume did not significantly differ between the two ethnic groups (p>0.1).

CONCLUSIONS: By studying a quite large sample of well demographically and clinically matched CA and AA patients with a homogeneous MRI protocol we showed that higher lesion accumulation, rather than pronounced brain volume decrease might explain the early progress to ambulatory assistance of AAs with MS.



This study suggests that African Americans may have a a larger lesion number, which accounts for a more rapid disease progression than white Americans, which may occur. This would suggest that more aggressive immunomodulation  may be a useful approach to treatment. More aggressive disease is related to more aggressive MRI lesion load no matter what the skin colour or ethnic origin so the study is self-fulfilling. It does not tell us anything about why there is a higher lesion load.

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