Rare variation in neurological disease genes and its role in multiple sclerosis mimicry and phenotype

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Abstract Background Multiple sclerosis (MS) diagnosis relies on identifying disease episodes disseminated in space and time, and excluding other disease explanations. MS is a genetically complex autoimmune and neurodegenerative disorder that shares features with some monogenic progressive neurological conditions. The extent to which people diagnosed with MS have an alternate diagnosis (MS mimic), or genetic multimorbidity is unknown. Additionally, the burden of rare variation associated with MS risk and severity in monogenic neurological disease genes has not been evaluated. We investigated the prevalence of disease-causing variants in progressive neurological disease genes, and their contribution to MS risk and severity, in 4,340 MS cases diagnosed in sub-speciality clinics in Australia and New Zealand, and in 2,861 local controls. Methods Exome sequencing and array-based genotyping data were analysed for 1,680 genes with pathogenic or likely pathogenic variants reported in ClinVar. Clinical history reviews of MS cases with putative disease-causing variants were conducted. We specifically examined the contribution of rare, likely deleterious variants in a subset of 30 hereditary spastic paraplegia (HSP) genes in 421 individuals with progressive onset MS (POMS). Gene-based association tests with MS risk and severity were performed for all genes in the cohort. Results We identified 166 MS cases (3.82%) with variants prompting clinical history reviews, and of 75 cases reviewed, four (0.13% of all cases) had either genetic multimorbidity in addition to MS or a potential misdiagnosis. In contrast to previous findings we observed no enrichment of likely deleterious variants in HSP genes in POMS, nor did we find significant associations between neurological disease genes and MS risk or severity. Conclusions Our findings suggest that rare deleterious genetic variation in progressive neurological disease genes does not play a substantive role in MS risk or severity, and that misdiagnosis is exceedingly rare in this cohort. Consequently, among individuals diagnosed with MS by a specialist, a very small proportion may benefit from clinical genomic testing to inform MS diagnosis or an alternate diagnosis, which could have implications for healthcare management.

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External Organisations
University of Tasmania; University of Melbourne; Griffith University; Alfred Health; Monash University (Australia); Murdoch University; John Hunter Hospital; University of Newcastle; University of Sydney; Murdoch University; Florey Institute of Neuroscience and Mental Health; Royal Melbourne Hospital

Associated Persons
Nicholas B. Blackburn (Creator); Bennet J. McComish (Creator); Allan Motyer (Creator); James C. Slimmer (Creator); Stephen J. Leslie (Creator); Simon A Broadley (Creator); Vilija G. Jokubaitis (Creator); Anneke Van Der Walt (Creator); Jeannette Lechner-Scott (Creator); Grant P. Parnell (Creator); Rodney J. Scott (Creator); Stacey Jackson (Creator); Vicki Elizabeth Maltby (Creator); Jac C. Charlesworth (Creator); Kathryn P. Burdon (Creator); Bruce V. Taylor (Creator); Trevor J. Kilpatrick (Creator); Justin P. Rubio (Creator)