The Nature of Genetic Susceptibility to Multiple Sclerosis

OBJECTIVE: To explore the nature of MS-susceptibility and, by extension, other complex-genetic diseases. BACKGROUND Basic-epidemiological parameters of MS (e.g., prevalence, recurrence-risks for siblings and twins, time-dependent changes in sex-ratio, etc.) are well-established. Moreover, >200 genetic-loci are unequivocally MS-associated, especially the HLA-DRB1*15:01~HLA-DQB1*06:02~a1 haplotype-association. DESIGN/METHODS: We define the genetically-susceptible subset-(G) to include everyone with any non-zero life-time chance of developing MS. We analyze, mathematically, the implications that these epidemiological observations have regarding genetic susceptibility. In addition, we use the sex-ratio change (observed over a 35-year interval), to derive the relationship between MS-probability and an increasing likelihood of a suitable environmental-exposure. RESULTS: We demonstrate that genetic-susceptibitly is restricted to less than 4.7% of populations across Europe and North America. Among carriers of the HLA-DRB1*15:01~HLA-DQB1*06:02~a1 haplotype, fewer than 20% are even in the subset-(G). Women are less likely to be susceptible than men although their MS-penetrance is considerably greater. Response-curves for MS-probability increase with an increasing likelihood of a suitable environmental-exposure, especially among women. These environmental response-curves plateau at under 50% for women and at a significantly lower level for men. CONCLUSIONS: MS is fundamentally a genetic disorder. Despite this, a suitable environmental-exposure is also critical for disease-pathogenesis. Genetic-susceptibility requires specific combinations of non-additive genetic risk-factors. For example, the HLA-DRB1*15:01~HLA-DQB1*06:02~a1 haplotype, by itself, poses no MS-risk. Moreover, the fact that environmental-response-curves plateau below 50%, indicates that disease-pathogenesis is partly stochastic. By extension, other diseases for which monozygotic-twin recurrence-risks greatly exceed disease-prevalence (e.g., rheumatoid arthritis, diabetes, and celiac disease), must have a similar genetic basis.