Relating Genetic and Environmental Risk Scores to Multiple Sclerosis Susceptibility

This study is currently recruiting participants.
Verified February 2014 by National Institutes of Health Clinical Center (CC)
Information provided by:
National Institutes of Health Clinical Center (CC) Identifier:
First received: June 8, 2012
Last updated: March 14, 2014
Last verified: February 2014

June 8, 2012
March 14, 2014
April 2012
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The primary outcome is diagnosis of MS according to the 2010 revisions to the McDonald criteria.
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Complete list of historical versions of study NCT01617395 on Archive Site
Secondary outcome measures include development of MS-like abnormalities on brain imaging studies, abnormalities on laboratory testing, and clinical symptoms and signs.
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Relating Genetic and Environmental Risk Scores to Multiple Sclerosis Susceptibility
Integrating Genetic and Environmental Risk Scores Into an Algorithm to Predict Multiple Sclerosis Susceptibility


- Research shows that both genes and the environment influence a person s risk for getting multiple sclerosis (MS). However, it is not possible to accurately predict who will develop MS. Researchers want to study people with MS and their family members. They have developed a Genetic and Environmental Risk Score for MS. This score combines information from a person's medical history and genes. It also includes environmental factors that may be related to developing MS. This study will test this risk score to see if it can help predict who will develop MS.


- To evaluate a score for genetic and environmental risk factors that may help predict whether a person will develop MS.


  • Individuals at least 18 years of age who have MS.
  • Individuals between 18 to 50 years of age who are the parent, brother, sister, or child of a person with MS.


  • People with MS will allow researchers to look at their personal and medical data. These data will have been collected in other MS-related studies.
  • Relatives of people with MS will fill out a questionnaire and give blood and saliva samples. They will fill out the questionnaire again one year later.
  • Some relatives will have additional optional testing. These tests will include a physical exam and imaging studies. There may also be other tests. These tests may be repeated every 1 to 5 years for 20 years.

Objective. The overall objective of this study is to investigate the genetic, immune, and neuroimaging profiles that may increase a person s risk of developing multiple sclerosis (MS) in order to identify and validate predictive biomarkers in populations at risk for this disorder.

Study population. There will be two study populations:

  1. Individuals at risk for developing MS As part of the Genes and Environment in Multiple Sclerosis (GEMS) study, we plan to recruit up to 1000 first-degree relatives of MS patients. GEMS is a study of 5000 individuals that is being led by our collaborators at the Brigham & Women s Hospital and Harvard University. For the purposes of this study, a first-degree relative may be a parent, sibling, or child between 18 and 50 years of age but must not carry a diagnosis of MS. The first-degree relative must have the ability to provide consent and be willing to participate in the study. Two potentially overlapping subsets of these individuals will undergo detailed testing at the NIH:

    1. The cross-sectional subcohort will consist of 100 participants with combined genetic and environmental risk scores (GERS), defined in the protocol, in the highest and lowest 5 percent of the entire study population.
    2. The longitudinal subcohort will consist of up to 100 participants, ages 18 to 40,who express willingness to be followed for 20 years at the NIH, whose GERS falls in the top 10 percent of the entire study population, and who have a first-degree relative with MS who is participating.
  2. MS patients We plan to recruit up to 1000 MS patients whose first-degree relatives are enrolled this study. These participants will be evaluated under other Neuroimmunology Branch protocols and will not undergo separate evaluation under this protocol. The purpose of including this cohort in the current study is to allow access to their clinical, biological, and imaging data for comparison with first-degree relatives.

Design. This is a prospective cohort natural-history study. All GEMS participants will complete the following study procedures, which can be performed offsite: informed consent; study questionnaire; saliva sample; and blood draw. The questionnaire will be repeated 1 year after enrollment.

There will two additional substudies conducted at NIH: a cross-sectional substudy and a longitudinal substudy. Participants in these substudies will be evaluated with clinical, radiological, and laboratory procedures. Participants in the cross-sectional cohort will undergo evaluation at the NIH at a single time point (with optional longitudinal follow up), whereas participants in the longitudinal cohort will undergo evaluation at the NIH for 20 years. There will be an interim analysis 5 years after the 50th participant is recruited to the longitudinal cohort, and the study of this cohort will be terminated if we have not observed the development of MS-related radiological or laboratory abnormalities in any of the participants. Participants with MS will provide informed consent to allow access to their own research data, but the data themselves will be (or will have already been) collected under other Neuroimmunology Branch clinical protocols.

NIH will be a unique site within the overall GEMS study, for the following reasons: (1) It will be the only site at which imaging will be performed, as part of the cross-sectional and longitudinal substudies; (2) GEMS participants seen at NIH may undergo additional procedures that are not part of the overall GEMS study; (3) The NIH substudy has a prospective design with built-in long-term follow-up on the longitudinal cohort, whereas the overall GEMS study has only one year of planned follow-up; (4) Data from participants in the NIH substudy will be directly linked to data from their own relatives with MS.

Outcome measures. For participants in the overall GEMS study, the primary outcome measure is the GERS itself, as most participants in this cohort will not undergo further testing. For participants in the cross-sectional cohort, which consists of individuals at highest and lowest risk for MS, the primary outcome measure is the presence or absence of lesions on T2-weighted brain MRI that meet the 2010 MRI criteria for dissemination in space a finding that, in this population, is likely to be related to MS. For participants in the longitudinal cohort, the study endpoint is a clinical diagnosis of MS according to the same 2010 criteria. Secondary outcome measures include: (1) The age at which participants develop MS-related abnormalities on brain imaging studies, abnormalities on laboratory testing, and clinical symptoms and signs; (2) The time lag between defined exposures (for example, infectious mononucleosis) and the appearance of MS-related radiological, laboratory, and clinical abnormalities; and (3) The time lag between the appearance of asymptomatic radiological and laboratory abnormalities and the onset of clinical symptoms.

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Multiple Sclerosis
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*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
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GEMS cohort (target n equals 1000)

  • First-degree relative (parent, sibling, or child) of a self-reported MS patient.
  • Age 18-50, inclusive, at the time of enrollment into the overall GEMS study.
  • Willingness to be contacted regarding additional follow-up procedures.
  • Cross-sectional subcohort (target n equal 100):

    • Genetic and environmental risk score (GERS) in the top or bottom 5 percent of the overall GEMS study.
  • Longitudinal subcohort (target n equal 100):

    • Ages 18-40, inclusive.
    • GERS in the top 10 percent of the overall GEMS study.
    • Willing to undergo additional study procedures at the NIH for 20 years, with planned follow-up every year for participants between ages 18 and 25, every 2 years for participants between ages 26 and 30, and every 5 years for participants between ages 31 and 40.
    • Relative enrolled in NIH study with confirmation of MS diagnosis.

MS patients

  • Co-enrolled in another Neuroimmunology Branch natural history protocol.
  • Diagnosis confirmed at NIH.
  • Age 18 or older.

Both cohorts

-Able to give informed consent.


GEMS cohort

-Diagnosis of MS.

Cross-sectional and longitudinal subcohorts

  • Contraindications to MRI scanning.
  • Diagnosis of another central nervous system disease.
18 Years to 50 Years
Contact: Rosalind Hayden, R.N. (301) 827-9002
Contact: Daniel S Reich, M.D. (301) 496-1801
United States
120122, 12-N-0122
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National Institutes of Health Clinical Center (CC)
National Institute of Neurological Disorders and Stroke (NINDS)
Principal Investigator: Daniel S Reich, M.D. National Institutes of Health Clinical Center (CC)
National Institutes of Health Clinical Center (CC)
February 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP