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Research paper
Genetic variation in the gene LRP2 increases relapse risk in multiple sclerosis
  1. Yuan Zhou1,
  2. Jennifer S Graves2,
  3. Steve Simpson Jr.1,3,
  4. Jac C Charlesworth1,
  5. Ingrid van der Mei1,
  6. Emmanuelle Waubant2,
  7. Lisa F Barcellos4,
  8. Anita Belman5,
  9. Lauren Krupp6,
  10. Robyn Lucas7,
  11. Anne-Louise Ponsonby8,
  12. Bruce V Taylor1
  13. Ausimmmune/AusLong investigators group
  1. 1 Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
  2. 2 Department of Neurology, University of California, San Francisco, USA
  3. 3 Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia
  4. 4 Division of Epidemiology, School of Public Health, University of California, Berkeley, USA
  5. 5 Stonybrook University, Stonybrook, New York, USA
  6. 6 New York University, New York, USA
  7. 7 National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
  8. 8 Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
  1. Correspondence to Professor Bruce V Taylor, Menzies Research Institue University of Tasmania, Hobart, Tasmania 7001 Australia; bruce.taylor{at}


Background Due to the lack of prospective studies with longitudinal data on relapse, past genetic studies have not attempted to identify genetic factors that predict relapse risk (the primary endpoint of many pivotal clinical trials testing the efficacy of multiple sclerosis (MS) disease-modifying drugs) at a genome-wide scale.

Methods We conducted a genome-wide association analysis (GWAS) to identify genetic variants that predict MS relapse risk, using a three-stage approach. First, GWAS was conducted using the southern Tasmania MS Longitudinal Study with 141 cases followed prospectively for a mean of 2.3 years. Second, GWAS was conducted using the Ausimmune Longitudinal Study with 127 cases having a classic first demyelinating event followed for 5 years from onset. Third, the top hits with p<5.0×10−6 from the first two stages were combined with a longitudinal US paediatric MS cohort with 181 cases followed for 5 years after onset. Predictors of time to relapse were evaluated by a mixed effects Cox model. An inverse variance fixed effects model was then used to undertake a meta-analysis.

Results In the pooled results, using these three unique longitudinal MS cohorts, we discovered one novel locus (LRP2; most significant single nucleotide polymorphism rs12988804) that reached genome-wide significance in predicting relapse risk (HR=2.18, p=3.30×10−8). LRP2 is expressed on the surface of many central nervous system cells including neurons and oligodendrocytes and is a critical receptor in axonal guidance.

Conclusions The finding of a genetic locus that has extensive effects on neuronal development and repair is of interest as a potential modulator of MS disease course.

  • multiple sclerosis
  • LRP2
  • CNS
  • disease progression
  • relapse risk

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  • Contributors YZ, JSG and SSJ did the statistical analysis and interpretation and wrote and revised the manuscript. JCC, IVDM, EW, LFB, AB, LK, RL, ALP and BVT conceived and designed the study and revised the manuscript.

  • Competing interests Dr Graves reports grants from Biogen, Genentech, S3 group, outside the submitted work.

  • Patient consent Obtained.

  • Ethics approval All the studies obtained the ethics approvals.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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