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Study defines multiple-sclerosis risk for relatives
SCIENCE AND MEDICINE
Study defines multiple-sclerosis risk for relatives study published in the March of Neurology shows that multiple sclerosis (MS) susceptibility within families can be more accurately determined from the age of disease onset and sex of affected siblings, and parental disease status. Dessa Sadovnik, professor of medical genetics at the University of British Columbia, Vancouver, Canada, and colleagues studied 1896 white Canadian patients with MS and 8878 of their first-degree relatives. Brothers of male patients were found to have a higher unadjusted rate of MS (1.5%) than brothers of female patients (0.6%), whereas sisters of male patients had a similar rate of MS (2.3%) to sisters of female patients (2.7%). An earlier onset age also affected lifetime risk, so that siblings of a patient who had developed MS at age 20 or younger were almost 5 times more likely to develop MS than siblings of patients whose onset age was more than 40 years. A substantially increased MS rate was seen in siblings who also had an affected parent. For brothers with no
A,ssue
affected parent, the age-unadjusted rate was 0.8% but 3.4% with an affected parent; for sisters, the rates were 2.4% and 8.1% respectively. These rates also varied with the sex of the affected parent and sibling. Overall, the lifetime risk for sisters was about 2.5 times that of brothers, and the risk for siblings with an affected parent was about four-fold that of those with unaffected parents. Sadovnik remarks that, “despite these increased risks, the actual lifetime risks are still low-well under 5%-for these siblings”. The lifetime risk for the general population is 0.2%. The study’s findings are relevant, write its authors, because they provide specific age-adjusted figures for MS susceptibility, which will allow more precise genetic counselling. Jack Burks, president of The MS Alliance (Denver, COYUSA) shares this optimism. “The findings will enable us to provide patient information more accurately and specifically than we’ve done in the past.” Angela Pirisi
Has Lyme disease crossed the Pacific Ocean? 45-year old man living in northThe investigators from the ern Taiwan has been diagnosed National Defence Medical Centre, Taipei, Taiwan, point out that no with Lyme disease. This is the first laboratory-confirmed case of Lyme assessment has been made of the disease affecting incidence of human infection, but an - human beings in unpublished surthat country. vey has indicated The disease is that 12-28% of caused by Borrelia rodents in rural burgdotfen’, spiralTaiwan are shaped bacteria infected. which are camed by ticks whose 2* The team suggest that the disadult stages feed t ease is emerging in predominantly on f human beings, but deer. The disease 1 Sarah Randolph, is most commonlv repofled in north- The guilty party remains at large tick ecolog&t, eastern USA and (University of Europe with up to 12 000 cases Oxford, UK) notes that even though Lyme disease was identified only 20 recorded each year. The Datient attended a clinic with a years ago, it is well established throughout the northern hemisphere. characteristic itchy skin lesion-ery“Anything as widespread as that has thema chronicum migrans-and got to be a very old disease”, says recurrent attacks of asymmetrical Randolph. “There is a lot of strain swelling and pain in his left knee diversity ‘and the strains vary geoClin Microbiol 1998; 36: 807-08). graphically. Each strain is associated Diagnosis was made from raised antiwith a different pathology, so it will body titres to B burgdotfen’. A 3-week be important to assess each region’s course of treatment with oral doxycyendemic situation using strain-specline 100 mg twice daily alleviated cific DNA probes.’’ symptoms, and blood tests 3 months later showed that specific antibody Peter Moore titres had fallen.
A
THE LANCET * Vol351 March 28,1998
Predicting the fate of transplanted kidneys ejection of an organ even years
R a t 3er transplant surgery is a constant fear. Now, a new study of renal-transplant patients has identified early clinical and pathological signs that can be used to predict renal function 24 months post-transplant. This early assessment could be useful when testing future immunosuppressive protocols. In the study, 71 renal-transplant patients were followed up for 2 years. Renal biopsies were done 1,2, 3, 6, and 12 months post-transplant and results were compared with serum creatinine values at 24 months (excellent renal function was defined as creatinine el30 pmon). High chronic biopsy scores, late acute rejection (in months 4-6), low cyclosporine concentrations in months 1-2, and delayed graft function post-transplant all correlated with serum creatinine values above 130 p m o n at 24 months (IA m Soc Nephml1998; 9: 482-87). The results highlight the importance of treating patients with appropriate doses of cyclosporine in the first 3 months. Also, explain investigators Peter Nickerson and David Rush (University of Manitoba, Winnipeg, Canada), there are benefits to knowing as early as 6 months what will happen to renal graft function. Current patients and those in future treatment trials will have an early marker for success. “In the future, I think people will have to find reasons for not doing the protocol biopsies”, comments Rush. Others are not quite so enthusiastic, worrying that even at 24 months it is hard to tell what the outcome will be. “I think this is a really hard subject)’, says Nicholas T h e y (Harvard Medical School, Boston, MA, USA). “We probably need more of the same with longer followup to know what is going on.” Hannah Wunsch
963
Study defines multiple-sclerosis risk for relatives study published in the March of Neurology shows that multiple sclerosis (MS) susceptibility within families can be more accurately determined from the age of disease onset and sex of affected siblings, and parental disease status. Dessa Sadovnik, professor of medical genetics at the University of British Columbia, Vancouver, Canada, and colleagues studied 1896 white Canadian patients with MS and 8878 of their first-degree relatives. Brothers of male patients were found to have a higher unadjusted rate of MS (1.5%) than brothers of female patients (0.6%), whereas sisters of male patients had a similar rate of MS (2.3%) to sisters of female patients (2.7%). An earlier onset age also affected lifetime risk, so that siblings of a patient who had developed MS at age 20 or younger were almost 5 times more likely to develop MS than siblings of patients whose onset age was more than 40 years. A substantially increased MS rate was seen in siblings who also had an affected parent. For brothers with no
A,ssue
affected parent, the age-unadjusted rate was 0.8% but 3.4% with an affected parent; for sisters, the rates were 2.4% and 8.1% respectively. These rates also varied with the sex of the affected parent and sibling. Overall, the lifetime risk for sisters was about 2.5 times that of brothers, and the risk for siblings with an affected parent was about four-fold that of those with unaffected parents. Sadovnik remarks that, “despite these increased risks, the actual lifetime risks are still low-well under 5%-for these siblings”. The lifetime risk for the general population is 0.2%. The study’s findings are relevant, write its authors, because they provide specific age-adjusted figures for MS susceptibility, which will allow more precise genetic counselling. Jack Burks, president of The MS Alliance (Denver, COYUSA) shares this optimism. “The findings will enable us to provide patient information more accurately and specifically than we’ve done in the past.” Angela Pirisi
Has Lyme disease crossed the Pacific Ocean? 45-year old man living in northThe investigators from the ern Taiwan has been diagnosed National Defence Medical Centre, Taipei, Taiwan, point out that no with Lyme disease. This is the first laboratory-confirmed case of Lyme assessment has been made of the disease affecting incidence of human infection, but an - human beings in unpublished surthat country. vey has indicated The disease is that 12-28% of caused by Borrelia rodents in rural burgdotfen’, spiralTaiwan are shaped bacteria infected. which are camed by ticks whose 2* The team suggest that the disadult stages feed t ease is emerging in predominantly on f human beings, but deer. The disease 1 Sarah Randolph, is most commonlv repofled in north- The guilty party remains at large tick ecolog&t, eastern USA and (University of Europe with up to 12 000 cases Oxford, UK) notes that even though Lyme disease was identified only 20 recorded each year. The Datient attended a clinic with a years ago, it is well established throughout the northern hemisphere. characteristic itchy skin lesion-ery“Anything as widespread as that has thema chronicum migrans-and got to be a very old disease”, says recurrent attacks of asymmetrical Randolph. “There is a lot of strain swelling and pain in his left knee diversity ‘and the strains vary geoClin Microbiol 1998; 36: 807-08). graphically. Each strain is associated Diagnosis was made from raised antiwith a different pathology, so it will body titres to B burgdotfen’. A 3-week be important to assess each region’s course of treatment with oral doxycyendemic situation using strain-specline 100 mg twice daily alleviated cific DNA probes.’’ symptoms, and blood tests 3 months later showed that specific antibody Peter Moore titres had fallen.
A
THE LANCET * Vol351 March 28,1998
Predicting the fate of transplanted kidneys ejection of an organ even years
R a t 3er transplant surgery is a constant fear. Now, a new study of renal-transplant patients has identified early clinical and pathological signs that can be used to predict renal function 24 months post-transplant. This early assessment could be useful when testing future immunosuppressive protocols. In the study, 71 renal-transplant patients were followed up for 2 years. Renal biopsies were done 1,2, 3, 6, and 12 months post-transplant and results were compared with serum creatinine values at 24 months (excellent renal function was defined as creatinine el30 pmon). High chronic biopsy scores, late acute rejection (in months 4-6), low cyclosporine concentrations in months 1-2, and delayed graft function post-transplant all correlated with serum creatinine values above 130 p m o n at 24 months (IA m Soc Nephml1998; 9: 482-87). The results highlight the importance of treating patients with appropriate doses of cyclosporine in the first 3 months. Also, explain investigators Peter Nickerson and David Rush (University of Manitoba, Winnipeg, Canada), there are benefits to knowing as early as 6 months what will happen to renal graft function. Current patients and those in future treatment trials will have an early marker for success. “In the future, I think people will have to find reasons for not doing the protocol biopsies”, comments Rush. Others are not quite so enthusiastic, worrying that even at 24 months it is hard to tell what the outcome will be. “I think this is a really hard subject)’, says Nicholas T h e y (Harvard Medical School, Boston, MA, USA). “We probably need more of the same with longer followup to know what is going on.” Hannah Wunsch
963