Polygenicity of Comorbid Depression in Multiple Sclerosis.


Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
01 08 2023
Historique:
received: 12 08 2022
accepted: 13 04 2023
medline: 2 8 2023
pubmed: 9 6 2023
entrez: 8 6 2023
Statut: ppublish

Résumé

Depression is common in multiple sclerosis (MS) and is associated with faster disability progression. The etiology of comorbid depression in MS remains poorly understood. Identification of individuals with a high risk of depression, through polygenic scores (PGS), may facilitate earlier identification. Previous genetic studies of depression considered depression as a primary disorder, not a comorbidity, and thus, findings may not generalize to MS. Body mass index (BMI) is a risk factor of both MS and depression, and its association may highlight differences in depression in MS. To improve the understanding of comorbid depression in MS, we will investigate PGS in people with MS, with the hypothesis that a higher depression PGS is associated with increased odds for comorbid depression in MS. Samples from 3 sources (Canada, UK Biobank, and the United States) were used. Individuals were grouped into cases (MS/comorbid depression) and compared with 3 control groups: MS/no depression, depression/no immune disease, and healthy persons. We used 3 depression definitions: lifetime clinical diagnoses, self-reported diagnoses, and depressive symptoms. The PGS were tested in association with depression using regression. A total of 106,682 individuals of European genetic ancestry were used: Canada (n = 370; 213 with MS), UK Biobank (n = 105,734; 1,390 with MS), and the United States (n = 578 with MS). Meta-analyses revealed individuals with MS and depression had a higher depression PGS compared with both individuals with MS without depression (odds ratio range per SD 1.29-1.38, A higher depression genetic burden was associated with approximately 30%-40% increased odds of depression in European genetic ancestry participants with MS compared with those without depression and was no different compared with those with depression and no comorbid immune disease. This study paves the way for further investigations into the possible use of PGS for assessing psychiatric disorder risk in MS and its application to non-European genetic ancestries.

Sections du résumé

BACKGROUND AND OBJECTIVES
Depression is common in multiple sclerosis (MS) and is associated with faster disability progression. The etiology of comorbid depression in MS remains poorly understood. Identification of individuals with a high risk of depression, through polygenic scores (PGS), may facilitate earlier identification. Previous genetic studies of depression considered depression as a primary disorder, not a comorbidity, and thus, findings may not generalize to MS. Body mass index (BMI) is a risk factor of both MS and depression, and its association may highlight differences in depression in MS. To improve the understanding of comorbid depression in MS, we will investigate PGS in people with MS, with the hypothesis that a higher depression PGS is associated with increased odds for comorbid depression in MS.
METHODS
Samples from 3 sources (Canada, UK Biobank, and the United States) were used. Individuals were grouped into cases (MS/comorbid depression) and compared with 3 control groups: MS/no depression, depression/no immune disease, and healthy persons. We used 3 depression definitions: lifetime clinical diagnoses, self-reported diagnoses, and depressive symptoms. The PGS were tested in association with depression using regression.
RESULTS
A total of 106,682 individuals of European genetic ancestry were used: Canada (n = 370; 213 with MS), UK Biobank (n = 105,734; 1,390 with MS), and the United States (n = 578 with MS). Meta-analyses revealed individuals with MS and depression had a higher depression PGS compared with both individuals with MS without depression (odds ratio range per SD 1.29-1.38,
DISCUSSION
A higher depression genetic burden was associated with approximately 30%-40% increased odds of depression in European genetic ancestry participants with MS compared with those without depression and was no different compared with those with depression and no comorbid immune disease. This study paves the way for further investigations into the possible use of PGS for assessing psychiatric disorder risk in MS and its application to non-European genetic ancestries.

Identifiants

pubmed: 37290970
pii: WNL.0000000000207457
doi: 10.1212/WNL.0000000000207457
pmc: PMC10401690
doi:

Types de publication

Journal Article Meta-Analysis Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

e522-e532

Subventions

Organisme : CIHR
ID : THC-135234
Pays : Canada

Informations de copyright

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

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Auteurs

Kaarina Kowalec (K)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston. kaarina.kowalec@gmail.com.

Kathryn C Fitzgerald (KC)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Amber Salter (A)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Casandra Dolovich (C)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Arvid Harder (A)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Charles N Bernstein (CN)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

James Bolton (J)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Gary R Cutter (GR)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Lesley A Graff (LA)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Sara Hägg (S)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Carol A Hitchon (CA)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Yi Lu (Y)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Fred Lublin (F)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Kyla A McKay (KA)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Scott B Patten (SB)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Amit Patki (A)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Hemant K Tiwari (HK)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Jerry S Wolinsky (JS)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

Ruth Ann Marrie (RA)

From the College of Pharmacy (K.K.), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Medical Epidemiology & Biostatistics (K.K., A.H., S.H., Y.L.), Karolinska Institutet, Stockholm, Sweden; Department of Neurology (K.C.F.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (A.S.), UT Southwestern, Dallas, TX; Department of Internal Medicine (C.D., C.N.B., R.A.M.), Department of Psychiatry (J.B.), and Department of Community Health Sciences (J.B., R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Biostatistics (G.R.C., A.P., H.K.T.), University of Alabama at Birmingham; Department of Clinical Health Psychology (L.A.G.), and Department of Rheumatology (C.A.H.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Icahn School of Medicine at Mount Sinai (F.L.), New York, NY; Department of Clinical Neuroscience (K.A.M.), Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences (S.B.P.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston.

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