TRACE ELEMENTS IN HIGH INCIDENCE AREAS OF MULTIPLE SCLEROSIS: A ROLE OF VOLCANOGENIC ASHES?

Abstract

Objective: To study the blood levels of selected trace elements (TE) in Multiple Sclerosis (MS) patients living in high-incidence cluster areas in the Etna volcano region. Methods: MS patients living in the province of Catania have been retrospectively enrolled among those followed by the Neurologic Clinic of the AOU Policlinico “G. Rodolico-San Marco” who had the disease onset between 2005 and 2020.Aserumsample was used for the determination of TE levels (As,Cd, Cr, Cu, Fe, Mg, Mn, Ni, Se, Zn). All the analyses have been conducted with an ICPMS with the standard addition technique, previous digestion of the samples with nitric acid. MS patients living the high incidence clusters were frequency matched with MS patients living outside the clusters. Comparisons of TE across the groups were conducted using the Mann-Whitney test. Results: A total of 86 (48 women; 55.8%) MS patients was recruited, with a mean age of 41.6±13.1 years, a mean disease duration of 2.0±2.6 years and a mean Expanded Disability Status Scale of 2.3±1.7. Of these patients, 40 belonged to high incidence clusters and 46 were outside the clusters. No differences were found in demographic characteristics between the groups. Concerning TE, we found a significant higher concentration of Mn in incluster patients (6.7±16.6 μg/L vs 2.5±5.9 μg/L). Discussion: Several environmental factors may modulate the pathogenesis of the disease, and among them TE play an important role. Our findings suggest that Manganese, which has several toxic effects, might contribute to the higher incidence of MS previously observed in a cluster of communalities in the south-eastern flank of the Etna volcano, where volcanic ashes rich in TE usually fall due to the prevailing winds. Conclusions: Exposition to high levels of Mn could be a cofactor in the pathogenesis of MS.