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NEUROLOGY 2007;69:68-72
© 2007 American Academy of Neurology

Higher IgG index found in African Americans versus Caucasians with multiple sclerosis

John R. Rinker, II, MD, Kathryn Trinkaus, PhD, Robert T. Naismith, MD and Anne H. Cross, MD

From the Department of Neurology and Neurosurgery, Washington University School of Medicine, St. Louis, MO.

Address correspondence and reprints requests to Dr. John R. Rinker II, Campus Box 8111, 660 S. Euclid Avenue, St. Louis, MO 63110 rinkerj{at}neuro.wustl.edu

Background: African Americans (AAs) experience greater disability from multiple sclerosis (MS) compared with Caucasian Americans (CAs). Interethnic immunologic differences in MS and their relationship to disease-related disability have not been described.

Objective: To compare measures of CSF humoral immunity between AAs and CAs with MS.

Methods: Using a case–control design, all AA MS patients with CSF immune studies at the Washington University MS center were compared with randomly selected CAs with MS. Two CA controls were selected for every AA case. Immunoglobulin G (IgG) index and synthesis rates, oligoclonal band positivity, white blood cell count, and CSF protein were compared between groups. Survival analysis was conducted to compare times to ambulatory assistance.

Results: Sixty-six AA cases and 132 CA controls were identified. Measures of CSF humoral activity were all higher in the AA group. The mean IgG index of AAs was 1.35 (SD 0.62), and that of CAs was 1.05 (SD 0.55), for a mean difference of 0.30 (p = 0.001). The median IgG synthesis rate was also higher among AAs (13.55 vs 8.20 mg/day), for a median difference of 5.35 mg/day (p = 0.010). Survival analysis confirmed previous reports of earlier ambulatory assistance requirement among AAs. Despite differences in both humoral immune response and times to ambulatory assistance, Cox proportional hazards modeling did not show IgG index as predictive of earlier ambulatory assistance.

Conclusions: The CSF humoral immune response is more active among African Americans (AAs) than among Caucasian Americans (CAs) with multiple sclerosis. AAs also progress to ambulatory assistance earlier than CAs, but high immunoglobulin G index does not predict earlier progression to the disability endpoint.

Dr. Rinker was supported by the Washington University Department of Neurology NIH-Sponsored Post-Doctoral Training Grant (T32 NS007205) and by the 2006–2007 Serono-Pfizer Clinical Fellowship of the National Multiple Sclerosis Society. Dr. Naismith is supported by a K12 award from the NIH and administered by Washington University School of Medicine. Dr. Cross was supported by NIH K24RR017100-02 and the Manny and Rosalyn Rosenthal-Dr. John L. Trotter Chair in Neuroimmunology.

Disclosure: Dr. Rinker is supported by the 2006–2007 Serono-Pfizer Clinical Fellowship of the National Multiple Sclerosis Society. Dr. Trinkaus has nothing to disclose. Dr. Naismith is supported by an NIH K12 award administered by Washington University School of Medicine. Dr. Cross was supported in part by the Manny and Rosalyn Rosenthal-Dr. John L. Trotter Chair in Neuroimmunology.

Received December 4, 2006. Accepted in final form February 14, 2007.




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