Multiple sclerosis risk variants alter expression of co-stimulatory genes in B cells

The increasing evidence supporting a role for B cells in the pathogenesis of multiple sclerosis prompted us to investigate the influence of known susceptibility variants on the surface expression of co-stimulatory molecules in these cells. Using flow cytometry we measured surface expression of CD40 and CD86 in B cells from 68 patients and 162 healthy controls that were genotyped for the multiple sclerosis associated single nucleotide polymorphisms (SNP) rs4810485, which maps within the CD40 gene, and rs9282641, which maps within the CD86 gene. We found that carrying the risk allele at rs4810485*T lowers the cell-surface expression of CD40 in all tested B cells sub-types (in total B cells p ≤ 5.10 x 10-5 in patients and ≤ 4.09 x 10-6 in controls), while carrying the risk allele at rs9282641*G increased the expression of CD86, with this effect primarily seen in the naïve B cell subset (p = 0.048 in patients and 5.38 x 10-5 in controls). In concordance with these results analysis of RNA expression demonstrated that the risk allele of rs4810485*T resulted in lower total CD40 expression (p = 0.057) but with an increased proportion of alternative splice-forms leading to decoy receptors (p = 4.00 x 10-7). Finally, we also observed that the risk allele of rs4810485*T is associated with decreased levels of interleukin-10 (p = 0.020), which is considered to have an immunoregulatory function downstream of CD40. Given the importance of these co-stimulatory molecules in determining the immune reaction that appears in response to antigen our data suggest that B cells might have an important antigen presentation and immunoregulatory role in the pathogenesis of multiple sclerosis

Low Frequency Synonymous Coding Variation in CYP2R1 has Large Effects on Vitamin D Level and Risk of Multiple Sclerosis

Vitamin D insufficiency is common, correctable and influenced by genetic factors, and it has been associated with risk of several diseases. We sought to identify low-frequency genetic variants that strongly increased the risk of vitamin D insufficiency and tested their effect on risk of multiple sclerosis, a disease influenced by low vitamin D concentrations. We used whole-genome sequencing data from 2,619 individuals through the UK10K program and deep imputation data from 39,655 genome-wide genotyped individuals. Meta-analysis of the summary statistics from 19 cohorts identified a low-frequency synonymous coding p.Asp120Asp variant (rs117913124[A], minor allele frequency=2.5%) in CYP2R1 which conferred a large effect on 25-hydroxyvitamin D (25OHD) levels (-0.43 standard deviations of standardized natural log-transformed 25OHD, per A allele, P-value = 1.5 x10-88). The effect on 25OHD was four-times larger and independent of the effect of a previously described common variant near CYP2R1. By analyzing 8,711 individuals we showed that heterozygote carriers of this low-frequency variant have an increased risk of vitamin D insufficiency (OR=2.2, 95% CI 1.78-2.78, P=1.26 x 10-12). Individuals carrying one copy of this variant had also an increased odds of multiple sclerosis (OR=1.4, 95%CI 1.19-1.64, P=2.63 x 10-5) in a sample of 5,927 cases and 5,599 controls. In conclusion, we describe a low-frequency coding variant in CYP2R1, which exerts the largest effect upon 25OHD levels identified to date in the general European population and implicates vitamin D in the etiology of multiple sclerosis

No evidence of a significant role for CTLA-4 in multiple sclerosis

Variation in the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) gene plays a significant role in determining susceptibility to autoimmune thyroid disease and type 1 diabetes. Its role in multiple sclerosis is more controversial. In order to explore this logical candidate more thoroughly, we genotyped 771 multiple sclerosis trio families from the United Kingdom for the 3? untranslated region variable number tandem repeat, the CT60 single nucleotide polymorphism (SNP) and five haplotype-tagging SNPs. No individual marker or common haplotype showed evidence of association with disease. These data suggest that any effect of CTLA-4 on multiple sclerosis susceptibility is likely to be very small

Novel rheumatoid arthritis susceptibility locus at 22q12 identified in an extended UK genome-wide association study

© 2014 The Authors. Arthritis & Rheumatology is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.Peer reviewedPublisher PD

Mononeuritis multiplex: an unexpectedly frequent feature of severe COVID-19

The prolonged mechanical ventilation that is often required by patients with severe COVID-19 is expected to result in significant Intensive Care Unit – Acquired Weakness (ICUAW) in many of the survivors. However, in our post-COVID-19 follow up clinic we have found that, as well as the anticipated global weakness related to loss of muscle mass, a significant proportion of these patients also have disabling focal neurological deficits relating to multiple axonal mononeuropathies. Amongst the 69 patients with severe COVID-19 that have been discharged from the intensive care units in our hospital, we have seen 11 individuals (16%) with such a mononeuritis multiplex. In many instances, the multi-focal nature of the weakness in these patients was initially unrecognised as symptoms were wrongly assumed to relate simply to “critical illness neuromyopathy”. While mononeuropathy is well recognised as an occasional complication of intensive care, our experience suggests that such deficits are surprisingly frequent and often disabling in patients recovering from severe COVID-19.Cambridge NIHR Biomedical Reseach Centr

A whole genome screen for association with multiple sclerosis in portuguese patients

Multiple sclerosis (MS) is common in Europe affecting up to 1:500 people. In an effort to identify genes influencing susceptibility to the disease, we have performed a population-based whole genome screen for association. In this study, 6000 microsatellite markers were typed in separately pooled DNA samples from MS patients (n = 188) and matched controls (n = 188). Interpretable data was obtained from 4661 of these markers. Refining analysis of the most promising markers identified 10 showing potential evidence for association.SERONO (Portugal).Fundação para a Ciência e a Tecnologia (FCT) - grant FRH/BD/9111/2002.British Council/ICCTI.Wellcome Trust, Multiple Sclerosis Societies of the United States and Great Britain, Multiple Sclerosis International Federation - GAMES project - grant 057097

Obesity and Multiple Sclerosis: A Mendelian Randomization Study.

BACKGROUND: Observational studies have reported an association between obesity, as measured by elevated body mass index (BMI), in early adulthood and risk of multiple sclerosis (MS). However, bias potentially introduced by confounding and reverse causation may have influenced these findings. Therefore, we elected to perform Mendelian randomization (MR) analyses to evaluate whether genetically increased BMI is associated with an increased risk of MS. METHODS AND FINDINGS: Employing a two-sample MR approach, we used summary statistics from the Genetic Investigation of Anthropometric Traits (GIANT) consortium and the International MS Genetics Consortium (IMSGC), the largest genome-wide association studies for BMI and MS, respectively (GIANT: n = 322,105; IMSGC: n = 14,498 cases and 24,091 controls). Seventy single nucleotide polymorphisms (SNPs) were genome-wide significant (p < 5 x 10-8) for BMI in GIANT (n = 322,105) and were investigated for their association with MS risk in the IMSGC. The effect of each SNP on MS was weighted by its effect on BMI, and estimates were pooled to provide a summary measure for the effect of increased BMI upon risk of MS. Our results suggest that increased BMI influences MS susceptibility, where a 1 standard deviation increase in genetically determined BMI (kg/m2) increased odds of MS by 41% (odds ratio [OR]: 1.41, 95% CI 1.20-1.66, p = 2.7 x 10-5, I2 = 0%, 95% CI 0-29). Sensitivity analyses, including MR-Egger regression, and the weighted median approach provided no evidence of pleiotropic effects. The main study limitations are that, while these sensitivity analyses reduce the possibility that pleiotropy influenced our results, residual pleiotropy is difficult to exclude entirely. CONCLUSION: Genetically elevated BMI is associated with risk of MS, providing evidence for a causal role for obesity in MS etiology. While obesity has been associated with many late-life outcomes, these findings suggest an important consequence of childhood and/or early adulthood obesity.National Institute for Health Research Cambridge Biomedical Research CentreThis is the final version of the article. It first appeared from Public Library of Science via http://dx.doi.org/10.1371/journal.pmed.1002053

Accurate Liability Estimation Improves Power in Ascertained Case Control Studies

Linear mixed models (LMMs) have emerged as the method of choice for confounded genome-wide association studies. However, the performance of LMMs in non-randomly ascertained case-control studies deteriorates with increasing sample size. We propose a framework called LEAP (Liability Estimator As a Phenotype, https://github.com/omerwe/LEAP) that tests for association with estimated latent values corresponding to severity of phenotype, and demonstrate that this can lead to a substantial power increase