Amy M Lavery1, Amy T Waldman2, T Charles Casper3, Shelly Roalstad3, Meghan Candee3, John Rose3, Anita Belman4, Bianca Weinstock-Guttman5, Greg Aaen6, Jan-Mendelt Tillema7, Moses Rodriguez7, Jayne Ness8, Yolanda Harris8, Jennifer Graves9, Lauren Krupp10, Leslie Benson11, Mark Gorman11, Manikum Moodley12, Mary Rensel12, Manu Goyal13, Soe Mar13, Tanuja Chitnis14, Teri Schreiner15, Tim Lotze16, Benjamin Greenberg17, Ilana Kahn18, Jennifer Rubin19, Emmanuelle Waubant9. 1. Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States. Electronic address: laverya@email.chop.edu. 2. Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States. 3. University of Utah, Salt Lake City, UT, United States. 4. Stony Brook University, Stony Brook, NY, United States. 5. Buffalo General Hospital, State University of New York at Buffalo, Buffalo, NY, United States. 6. Loma Linda University Children's Hospital, Loma Linda, CA, United States. 7. Mayo Clinic, Rochester, MN, United States. 8. University of Alabama, Tuscaloosa, AL, United States. 9. University of California San Francisco, San Francisco, CA, United States. 10. New York University Medical Center, New York, NY, United States. 11. Boston Children's Pediatric MS Center, Boston, MA, United States. 12. Cleveland Clinic, Cleveland, OH, United States. 13. Washington University in St. Louis, St. Louis, MO, United States. 14. Massachusetts General Hospital, Harvard Medical School, Boston, MS, United Staes. 15. Denver Children's Hospital, Denver, CO, United States. 16. Texas Children's Hospital, Houston, TX, United States. 17. University of Texas Southwestern Medical Center, Dallas, TX, United States. 18. Children's National Medical Center, Washington, DC, United States. 19. Lurie Children's Hospital, Chicago, IL, United States.
Abstract
BACKGROUND: Multiple sclerosis (MS) is a presumed autoimmune disease caused by genetic and environmental factors. It is hypothesized that environmental exposures (such as air and water quality) trigger the innate immune response thereby activating a pro-inflammatory cascade. OBJECTIVE: To examine potential environmental factors in pediatric MS using geographic information systems (GIS). METHODS: Pediatric MS cases and healthy controls were identified as part of an ongoing multicenter case-control study. Subjects' geographic locations were mapped by county centroid to compare to an Environmental Quality Index (EQI). The EQI examines 5 individual environmental components (air, land, water, social, built factors). A composite EQI score and individual scores were compared between cases and controls, stratified by median proximity to enrollment centers (residence <20 or ≥20 miles from the recruiting center), using logistic regression. RESULTS: Of the 287 MS cases and 445 controls, 46% and 49% respectively live in areas where the total EQI is the highest (worst environmental quality). Total EQI was not significantly associated with the odds for MS (p = 0.90 < 20 miles from center; p = 0.43 ≥ 20 miles); however, worsening air quality significantly impacted the odds for MS in those living near a referral center (OR = 2.83; 95%CI 1.5, 5.4) and those who reside ≥ 20 miles from a referral center (OR = 1.61; 95%CI 1.2, 2.3). CONCLUSION: Among environmental factors, air quality may contribute to the odds of developing MS in a pediatric population. Future studies will examine specific air constituents and other location-based air exposures and explore potential mechanisms for immune activation by these exposures.
BACKGROUND:Multiple sclerosis (MS) is a presumed autoimmune disease caused by genetic and environmental factors. It is hypothesized that environmental exposures (such as air and water quality) trigger the innate immune response thereby activating a pro-inflammatory cascade. OBJECTIVE: To examine potential environmental factors in pediatric MS using geographic information systems (GIS). METHODS: Pediatric MS cases and healthy controls were identified as part of an ongoing multicenter case-control study. Subjects' geographic locations were mapped by county centroid to compare to an Environmental Quality Index (EQI). The EQI examines 5 individual environmental components (air, land, water, social, built factors). A composite EQI score and individual scores were compared between cases and controls, stratified by median proximity to enrollment centers (residence <20 or ≥20 miles from the recruiting center), using logistic regression. RESULTS: Of the 287 MS cases and 445 controls, 46% and 49% respectively live in areas where the total EQI is the highest (worst environmental quality). Total EQI was not significantly associated with the odds for MS (p = 0.90 < 20 miles from center; p = 0.43 ≥ 20 miles); however, worsening air quality significantly impacted the odds for MS in those living near a referral center (OR = 2.83; 95%CI 1.5, 5.4) and those who reside ≥ 20 miles from a referral center (OR = 1.61; 95%CI 1.2, 2.3). CONCLUSION: Among environmental factors, air quality may contribute to the odds of developing MS in a pediatric population. Future studies will examine specific air constituents and other location-based air exposures and explore potential mechanisms for immune activation by these exposures.
Authors: Ulrike Gehring; Alet H Wijga; Gerard Hoek; Tom Bellander; Dietrich Berdel; Irene Brüske; Elaine Fuertes; Olena Gruzieva; Joachim Heinrich; Barbara Hoffmann; Johan C de Jongste; Claudia Klümper; Gerard H Koppelman; Michal Korek; Ursula Krämer; Dieter Maier; Erik Melén; Göran Pershagen; Dirkje S Postma; Marie Standl; Andrea von Berg; Josep M Anto; Jean Bousquet; Thomas Keil; Henriette A Smit; Bert Brunekreef Journal: Lancet Respir Med Date: 2015-12 Impact factor: 30.700
Authors: Marcus Koch; Geeta S M Ramsaransing; Alexander V Arutjunyan; Michael Stepanov; Albert Teelken; Dorothea J Heersema; Jacques De Keyser Journal: J Neurol Date: 2005-11-14 Impact factor: 4.849
Authors: V Calabrese; G Scapagnini; A Ravagna; R Bella; D A Butterfield; M Calvani; G Pennisi; A M Giuffrida Stella Journal: Neurochem Res Date: 2003-09 Impact factor: 3.996
Authors: Anna Mölter; Angela Simpson; Dietrich Berdel; Bert Brunekreef; Adnan Custovic; Josef Cyrys; Johan de Jongste; Frank de Vocht; Elaine Fuertes; Ulrike Gehring; Olena Gruzieva; Joachim Heinrich; Gerard Hoek; Barbara Hoffmann; Claudia Klümper; Michal Korek; Thomas A J Kuhlbusch; Sarah Lindley; Dirkje Postma; Christina Tischer; Alet Wijga; Göran Pershagen; Raymond Agius Journal: Eur Respir J Date: 2014-10-16 Impact factor: 16.671
Authors: Christine L Gray; Danelle T Lobdell; Kristen M Rappazzo; Yun Jian; Jyotsna S Jagai; Lynne C Messer; Achal P Patel; Stephanie A DeFlorio-Barker; Christopher Lyttle; Julian Solway; Andrey Rzhetsky Journal: Environ Res Date: 2018-06-27 Impact factor: 6.498
Authors: Amin Ziaei; Amy M Lavery; Xiaorong Ma Shao; Cameron Adams; T Charles Casper; John Rose; Meghan Candee; Bianca Weinstock-Guttman; Greg Aaen; Yolanda Harris; Jennifer Graves; Leslie Benson; Mark Gorman; Mary Rensel; Soe Mar; Tim Lotze; Benjamin Greenberg; Tanuja Chitnis; Janace Hart; Amy T Waldman; Lisa F Barcellos; Emmanuelle Waubant Journal: Mult Scler Date: 2022-01-08 Impact factor: 5.855
Authors: Emmanuelle Waubant; Robyn Lucas; Ellen Mowry; Jennifer Graves; Tomas Olsson; Lars Alfredsson; Annette Langer-Gould Journal: Ann Clin Transl Neurol Date: 2019-08-07 Impact factor: 4.511
Authors: Amy M Lavery; Emmanuelle Waubant; T Charles Casper; Shelly Roalstad; Meghan Candee; John Rose; Anita Belman; Bianca Weinstock-Guttman; Greg Aaen; Jan-Mendelt Tillema; Moses Rodriguez; Jayne Ness; Yolanda Harris; Jennifer Graves; Lauren Krupp; Leigh Charvet; Leslie Benson; Mark Gorman; Manikum Moodley; Mary Rensel; Manu Goyal; Soe Mar; Tanuja Chitnis; Teri Schreiner; Tim Lotze; Benjamin Greenberg; Ilana Kahn; Jennifer Rubin; Amy T Waldman Journal: Ann Clin Transl Neurol Date: 2018-09-27 Impact factor: 4.511
Authors: Mariana Oliveira; André Padrão; André Ramalho; Mariana Lobo; Ana Cláudia Teodoro; Hernâni Gonçalves; Alberto Freitas Journal: Int J Environ Res Public Health Date: 2020-11-13 Impact factor: 3.390