Lilyana Amezcua's guest appearances

Lilyana Amezcua

Multiple Sclerosis Discovery: The Podcast of the MS Discovery Forum

RealTalk MS

Alan Alda

Tim Kennedy

Richard Cohen

David Baker

Jeffrey Cohen

Michael Levy

Alan Thompson

David Holtzman

Oscar Fernandez

Paul Matthews

Raj Kapoor

Adam Kaplin

Bruce Cree

Daniel Hartung

John Hart

OwlTail

Welcome to the 300th episode of RealTalk MS! Yikes! In last week's episode of the podcast, Dr. Bruce Bebo walked us through the latest research on the prevalence of MS in the United States, and the data serves as a clear reminder that anyone can get MS.  However, not everyone with MS receives the same quality of care. My guest today is clinician-researcher Dr. Lilyana Amezcua, and we're discussing her work in exploring healthcare disparities among minority populations.  In addition to celebrating our 300th episode, we're also celebrating World MS Day! We'll let you know where you can join the virtual festivities. And, as our RealTalk MS Listener Survey ends, we're announcing the winner of a $100 Amazon Gift Card. Can Do MS is hosting a day-long in-person and virtual More About MS program this Friday, June 2. We'll give you the details and tell you how you can register for this free event. And the International Progressive MS Alliance has announced a large-scale research program focused on developing solutions to some of the most challenging symptoms that people living with progressive MS face. We're sharing the details. We have a lot to talk about! Are you ready for RealTalk MS??! Welcome to our 300th episode!  :25 It's World MS Day!  1:55 Congratulations to the winner of a $100 Amazon gift card!  2:56 Details and registration info for the Can Do MS More About MS Program  3:43 The International Progressive MS Alliance announces a large-scale research program  5:17 Dr. Lilyana Amezcua discusses healthcare disparities among minority communities   7:51 Share this episode  32:12 Thanks for listening, and here's to the next 300!!  32:32 SHARE THIS EPISODE OF REALTALK MS Just copy this link &amp; paste it into your text or email: https://realtalkms.com/300 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com World MS Day on the Web https://worldmsday.org World MS Day on Facebook https://facebook.com/worldmsday REGISTER for the Can Do MS More About MS Program https://cando-ms.org/more-about-ms-registration  Prioritizing Progressive MS Rehabilitation Research: A Call from the International Progressive MS Alliance https://journals.sagepub.com/doi/pdf/10.1177/1352458521999970  Join the RealTalk MS Facebook Group https://facebook.com/groups/realtalkms Download the RealTalk MS App for iOS Devices https://itunes.apple.com/us/app/realtalk-ms/id1436917200 Download the RealTalk MS App for Android Deviceshttps://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 300 Guests: Dr. Lilyana Amezcua Tags: MS, MultipleSclerosis, MSResearch, MSSociety, RealTalkMS Privacy Policy

Welcome to the 300th episode of RealTalk MS! Yikes! In last week's episode of the podcast, Dr. Bruce Bebo walked us through the latest research on the prevalence of MS in the United States, and the data serves as a clear reminder that anyone can get MS.  However, not everyone with MS receives the same quality of care. My guest today is clinician-researcher Dr. Lilyana Amezcua, and we're discussing her work in exploring healthcare disparities among minority populations. In addition to celebrating our 300th episode, we're also celebrating World MS Day! We'll let you know where you can join the virtual festivities. And, as our RealTalk MS Listener Survey ends, we're announcing the winner of a $100 Amazon Gift Card. Can Do MS is hosting a day-long in-person and virtual More About MS program this Friday, June 2. We'll give you the details and tell you how you can register for this free event. And the International Progressive MS Alliance has announced a large-scale research program focused on developing solutions to some of the most challenging symptoms that people living with progressive MS face. We're sharing the details. We have a lot to talk about! Are you ready for RealTalk MS??! Welcome to our 300th episode!  :25 It's World MS Day!  1:55 Congratulations to the winner of a $100 Amazon gift card!  2:56 Details and registration info for the Can Do MS More About MS Program  3:43 The International Progressive MS Alliance announces a large-scale research program  5:17 Dr. Lilyana Amezcua discusses healthcare disparities among minority communities   7:51 Share this episode  32:12 Thanks for listening, and here's to the next 300!!  32:32 SHARE THIS EPISODE OF REALTALK MS Just copy this link &amp; paste it into your text or email: <a href="https://realtalkms.com/300" rel="noopener nofollow" target="_blank">https://realtalkms.com/300</a> ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: <a href="mailto:jon@realtalkms..com" rel="noopener noreferrer">jon@realtalkms.com</a> Phone: (310) 526-2283 And don't forget to join us in the <a href="https://facebook.com/groups/realtalkms" rel="nofollow" target="_blank">RealTalk MS Facebook group</a>! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the <a href="https://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk" rel="noopener noreferrer nofollow" target="_blank">RealTalk MS app</a> or at <a href="http://www.realtalkms.com/" rel="noopener noreferrer nofollow" target="_blank">www.RealTalkMS.com</a> World MS Day on the Web <a href="https://worldmsday.org" rel="noopener nofollow" target="_blank">https://worldmsday.org</a> World MS Day on Facebook <a href="https://facebook.com/worldmsday" rel="noopener nofollow" target="_blank">https://facebook.com/worldmsday</a> REGISTER for the Can Do MS More About MS Program <a href="https://cando-ms.org/more-about-ms-registration" rel="noopener nofollow" target="_blank">https://cando-ms.org/more-about-ms-registration</a> Prioritizing Progressive MS Rehabilitation Research: A Call from the International Progressive MS Alliance <a href="https://journals.sagepub.com/doi/pdf/10.1177/1352458521999970" rel="noopener nofollow" target="_blank">https://journals.sagepub.com/doi/pdf/10.1177/1352458521999970</a> Join the RealTalk MS Facebook Group <a href="https://facebook.com/groups/realtalkms" rel="noopener nofollow" target="_blank">https://facebook.com/groups/realtalkms</a> Download the RealTalk MS App for iOS Devices <a href="https://itunes.apple.com/us/app/realtalk-ms/id1436917200" rel="nofollow" target="_blank">https://itunes.apple.com/us/app/realtalk-ms/id1436917200</a> Download the RealTalk MS App for Android Devices<a href="https://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk" rel="noopener nofollow" target="_blank">https://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk</a> Give RealTalk MS a rating and review <a href="https://realtalkms.com/review" rel="noopener nofollow" target="_blank">http://www.realtalkms.com/review</a> Follow RealTalk MS on Twitter, <a href="https://twitter.com/RealTalkMS_jon" rel="noopener noreferrer nofollow" target="_blank">@RealTalkMS_jon</a>, and subscribe to our newsletter at our website, <a href="https://www.realtalkms.com/" rel="noopener noreferrer nofollow" target="_blank">RealTalkMS.com</a>. RealTalk MS Episode 300 Guests: Dr. Lilyana Amezcua Tags: MS, MultipleSclerosis, MSResearch, MSSociety, RealTalkMS <a href="https://realtalkms.com/privacy-policy" rel="noopener noreferrer nofollow" target="_blank">Privacy Policy</a>

Episode 300: Healthcare Disparities Among Minority Populations with Dr. Lilyana Amezcua

[intro music]   Host — Dan Keller Hello, and welcome to Episode Ninety-three of Multiple Sclerosis Discovery, the podcast of the MS Discovery Forum. I’m Dan Keller.   Today's interview features Dr. Lilyana Amezcua, an assistant professor of neurology at the University of Southern California in Los Angeles. Part of her work focuses on defining racial disparities in MS, particularly among the Hispanic community. When we met, she said the prevalence of MS among Hispanics in Latin America has been increasing over the past 20 years, and their clinical characteristics are different from those of whites. As Hispanic Americans constitute one of the largest minorities in the U.S. population, she looked into their clinical picture, as well.   Interviewee – Lilyana Amezcua And so we initially did a first observation in 2011 noting when we examined close to 200 MS patients of Hispanic background self-identified that they were at twice the risk of presenting with optic neuritis and spinal cord problems compared to whites. There is some literature indicating throughout Latin America that these observations could be related to an Asian background. And so when we think about a Hispanic, we think about an umbrella that is related to an intermixing of European, African, and Asian derived background or Native American. So that diversity along with the cultural diversity could have some implications in the way that MS behaves and including risk. And that is one of the theories going around that that's why they don't get MS that much because of an Asian background. However, again, like I mentioned, in the last 20 years more cases have been reported.   Interviewer – Dan Keller Haven't Asians been reported to have this opticospinal sort of MS? So would that feed into this optic neuritis finding with the Hispanics?   Dr. Amezcua That is correct, and actually a second study of ours that we did several years ago was to actually specifically look for that definition of opticospinal MS. And so what we found within 200 or so patients was that indeed when we applied that definition, very few met that criteria. But irrespective of that, and we made sure that every case was negative for aquaporin 4, which is an antibody that you commonly find in more of the NMO spectrum disorders, that these individuals did not have this aquaporin 4, but yet close to 20% looked like they had spinal cord lesions that could be associated with opticospinal.   So that observation, of course, led us to think, well, okay, we should look further. If we do think that Asian ancestry could be important, would some of those clinical characteristics be associated with that type of global ancestry? And in fact today we have a poster related to taking the population that we just presented and looking at their genetic variants, which are mostly noting that the European genetic variants are also found in the Hispanic, but now going forward and looking at, well, what about global ancestry and their clinical characteristics? And in that poster, that abstract, we find that the higher proportion of Asian background you have, the higher risk of presenting with let's say, an optic neuritis. Now that doesn't necessarily say that this is just specific for optic neuritis, but it could going forward let us know about the mechanism behind optic neuritis, which is also found in MS, also found in NMO, and these optical spinal forms of MS.   MSDF How did you go about looking at the genetics of the population?   Dr. Amezcua Going about the genetics actually went back to the fact that when I would say, I'm studying Hispanics, people would ask, what is a Hispanic? And it is true…Hispanic…and so it is defined, you know, when you define it it's well, you can be from Cuba, you can be from Mexico, you can be from the US. But really what links us is…and I say linked us because I'm one of them…is the fact that there is a genetic background that is shared. And there's also cultural aspects that are shared. The cultural aspect is probably going to be important when we start examining the environmental aspects of MS.   MSDF What did you find?   Dr. Amezcua We just started basically with vitamin D. We looked at vitamin D levels in Hispanics with MS compared to whites with MS, and we found that significantly lower levels were among the Hispanics. This is not surprising. This is expected, actually, because of the skin coloration and sun exposure probably differences, but it's also widely known that Hispanics would have lower vitamin D levels. Of course, that doesn't answer, well, if they have lower vitamin D levels, if their risk of MS is less, it doesn't give us any explanation. But we know that their vitamin D levels are low.   Other aspects that we have looked at is just examining differences by migration. So we know in MS that migration, usually, depending on when you move from one place to the other and looking at the risk of MS in the underlying country, that will be modified depending on the age of migration. And so of course Hispanics in the US, again, along with their diversity, they're diverse in the fact that there are many that are US born and there are many that are immigrants. So we looked at differences by this, and we found tremendous amount of differences. One was that the US born appears to have an increased risk of developing MS at a younger age. And this again is just validating some of that information that we know about MS in the past, right, coming from a lower prevalent region and being born in a place of higher risk.   But the second was that, which we were surprised, was that the immigrant, despite being here, let's say 25 years, they developed MS after they had emigrated from their country, on average, 15 years later. So that's interesting. That's again calling for us to investigate, what environmental encounters might have they had when coming to this country? And the third was that respective of this, of, you know, disease duration, there was an independent risk factor for the immigrant to develop ambulatory disability at a shorter time. So that's telling us that, again, well, one is differential environmental exposures. But could the immigrant and the US-born also just be two different populations in terms of, again, what does Hispanic mean? That's where we are.   MSDF In that sense, could you correlate vitamin D levels or anything else with the amount of European background or indigenous Central and South American background they had?   Dr. Amezcua I think that's an excellent idea. You know, I think that could be done, to look at the US-born versus the immigrant. Now there is a large study conducted by Dr. Langer-Gould that's examining the risk of MS within Hispanics, whites, and African Americans in relationship to vitamin D and their HLA. So that will give us information on vitamin D. But absolutely we know that within Hispanics, we're going to have to separate groups because it's just such a big umbrella.   MSDF It's also a big umbrella in terms of cultural background. It's not uniform culture whether you're from the Caribbean or Mexico or born in the US.   Dr. Amezcua Absolutely. So culturally we're going to have to tease that out. And it's simply starts by learning about, well, what are those cultural differences? Which could be from simple perceptions and their access and utilization of care, which needs to be first addressed, or to go forward and then say, well, let's see if there's biological differences. First, I think, you know, between the US-born and the immigrant, the differences could be explained also by sociocultural factors. And those need to be teased out. And then from there look to see, well, is this really a health disparity? Or is it an inherent biological difference of the disease, which we also expect to find.   MSDF Do you think that the results you find in this population is going to be more generalizable or relatable and give you some clues into what's going on with anyone who is getting MS or not?   Dr. Amezcua Absolutely. That is the goal. While that diversity is complex, it's also a positive aspect because it will allow you to tease out a lot of those factors. And so within the admixture, of the genetic admixture, one can say, well, you have less European background. But what about that Asian component that is not found in your general European? It doesn't mean that it's not going to be found. Instead of looking for, I guess, a needle in a haystack, you will just be looking it in a block and maybe find something new or lead us to understanding of mechanisms, again, from the optic neuritis and the global ancestry. We are hoping that this is beyond just understanding one population, but understanding MS, which is the target population.   MSDF Have we missed anything important?   Dr. Amezcua There is definitely a lot to do, and I think it's an effort that cannot be done alone. And so combining it with different centers that have the same interests and population is what the goal is, is to create a network of centers that are interested in defining this population, to move faster.   MSDF Great. Thank you.   Dr. Amezcua Great. Thank you.   [transition music]   MSDF Thank you for listening to Episode Ninety-three of Multiple Sclerosis Discovery. This podcast was produced by the MS Discovery Forum, MSDF, the premier source of independent news and information on MS research. Msdiscovery.org is part of the nonprofit Accelerated Cure Project for Multiple Sclerosis. Robert McBurney is our President and CEO, and Hollie Schmidt is Vice President of Scientific Operations.   Msdiscovery.org aims to focus attention on what is known and not yet known about the causes of MS and related conditions, their pathological mechanisms, and potential ways to intervene. By communicating this information in a way that builds bridges among different disciplines, we hope to open new routes toward significant clinical advances.   [outro music]   We’re interested in your opinions. Please join the discussion on one of our online forums or send comments, criticisms, and suggestions to editor@msdiscovery.org.   For Multiple Sclerosis Discovery, I'm Dan Keller.

[intro music] Host — Dan Keller Hello, and welcome to Episode Ninety-three of Multiple Sclerosis Discovery, the podcast of the MS Discovery Forum. I’m Dan Keller. Today's interview features Dr. Lilyana Amezcua, an assistant professor of neurology at the University of Southern California in Los Angeles. Part of her work focuses on defining racial disparities in MS, particularly among the Hispanic community. When we met, she said the prevalence of MS among Hispanics in Latin America has been increasing over the past 20 years, and their clinical characteristics are different from those of whites. As Hispanic Americans constitute one of the largest minorities in the U.S. population, she looked into their clinical picture, as well. Interviewee – Lilyana Amezcua And so we initially did a first observation in 2011 noting when we examined close to 200 MS patients of Hispanic background self-identified that they were at twice the risk of presenting with optic neuritis and spinal cord problems compared to whites. There is some literature indicating throughout Latin America that these observations could be related to an Asian background. And so when we think about a Hispanic, we think about an umbrella that is related to an intermixing of European, African, and Asian derived background or Native American. So that diversity along with the cultural diversity could have some implications in the way that MS behaves and including risk. And that is one of the theories going around that that's why they don't get MS that much because of an Asian background. However, again, like I mentioned, in the last 20 years more cases have been reported. Interviewer – Dan Keller Haven't Asians been reported to have this opticospinal sort of MS? So would that feed into this optic neuritis finding with the Hispanics? Dr. Amezcua That is correct, and actually a second study of ours that we did several years ago was to actually specifically look for that definition of opticospinal MS. And so what we found within 200 or so patients was that indeed when we applied that definition, very few met that criteria. But irrespective of that, and we made sure that every case was negative for aquaporin 4, which is an antibody that you commonly find in more of the NMO spectrum disorders, that these individuals did not have this aquaporin 4, but yet close to 20% looked like they had spinal cord lesions that could be associated with opticospinal. So that observation, of course, led us to think, well, okay, we should look further. If we do think that Asian ancestry could be important, would some of those clinical characteristics be associated with that type of global ancestry? And in fact today we have a poster related to taking the population that we just presented and looking at their genetic variants, which are mostly noting that the European genetic variants are also found in the Hispanic, but now going forward and looking at, well, what about global ancestry and their clinical characteristics? And in that poster, that abstract, we find that the higher proportion of Asian background you have, the higher risk of presenting with let's say, an optic neuritis. Now that doesn't necessarily say that this is just specific for optic neuritis, but it could going forward let us know about the mechanism behind optic neuritis, which is also found in MS, also found in NMO, and these optical spinal forms of MS. MSDF How did you go about looking at the genetics of the population? Dr. Amezcua Going about the genetics actually went back to the fact that when I would say, I'm studying Hispanics, people would ask, what is a Hispanic? And it is true…Hispanic…and so it is defined, you know, when you define it it's well, you can be from Cuba, you can be from Mexico, you can be from the US. But really what links us is…and I say linked us because I'm one of them…is the fact that there is a genetic background that is shared. And there's also cultural aspects that are shared. The cultural aspect is probably going to be important when we start examining the environmental aspects of MS. MSDF What did you find? Dr. Amezcua We just started basically with vitamin D. We looked at vitamin D levels in Hispanics with MS compared to whites with MS, and we found that significantly lower levels were among the Hispanics. This is not surprising. This is expected, actually, because of the skin coloration and sun exposure probably differences, but it's also widely known that Hispanics would have lower vitamin D levels. Of course, that doesn't answer, well, if they have lower vitamin D levels, if their risk of MS is less, it doesn't give us any explanation. But we know that their vitamin D levels are low. Other aspects that we have looked at is just examining differences by migration. So we know in MS that migration, usually, depending on when you move from one place to the other and looking at the risk of MS in the underlying country, that will be modified depending on the age of migration. And so of course Hispanics in the US, again, along with their diversity, they're diverse in the fact that there are many that are US born and there are many that are immigrants. So we looked at differences by this, and we found tremendous amount of differences. One was that the US born appears to have an increased risk of developing MS at a younger age. And this again is just validating some of that information that we know about MS in the past, right, coming from a lower prevalent region and being born in a place of higher risk. But the second was that, which we were surprised, was that the immigrant, despite being here, let's say 25 years, they developed MS after they had emigrated from their country, on average, 15 years later. So that's interesting. That's again calling for us to investigate, what environmental encounters might have they had when coming to this country? And the third was that respective of this, of, you know, disease duration, there was an independent risk factor for the immigrant to develop ambulatory disability at a shorter time. So that's telling us that, again, well, one is differential environmental exposures. But could the immigrant and the US-born also just be two different populations in terms of, again, what does Hispanic mean? That's where we are. MSDF In that sense, could you correlate vitamin D levels or anything else with the amount of European background or indigenous Central and South American background they had? Dr. Amezcua I think that's an excellent idea. You know, I think that could be done, to look at the US-born versus the immigrant. Now there is a large study conducted by Dr. Langer-Gould that's examining the risk of MS within Hispanics, whites, and African Americans in relationship to vitamin D and their HLA. So that will give us information on vitamin D. But absolutely we know that within Hispanics, we're going to have to separate groups because it's just such a big umbrella. MSDF It's also a big umbrella in terms of cultural background. It's not uniform culture whether you're from the Caribbean or Mexico or born in the US. Dr. Amezcua Absolutely. So culturally we're going to have to tease that out. And it's simply starts by learning about, well, what are those cultural differences? Which could be from simple perceptions and their access and utilization of care, which needs to be first addressed, or to go forward and then say, well, let's see if there's biological differences. First, I think, you know, between the US-born and the immigrant, the differences could be explained also by sociocultural factors. And those need to be teased out. And then from there look to see, well, is this really a health disparity? Or is it an inherent biological difference of the disease, which we also expect to find. MSDF Do you think that the results you find in this population is going to be more generalizable or relatable and give you some clues into what's going on with anyone who is getting MS or not? Dr. Amezcua Absolutely. That is the goal. While that diversity is complex, it's also a positive aspect because it will allow you to tease out a lot of those factors. And so within the admixture, of the genetic admixture, one can say, well, you have less European background. But what about that Asian component that is not found in your general European? It doesn't mean that it's not going to be found. Instead of looking for, I guess, a needle in a haystack, you will just be looking it in a block and maybe find something new or lead us to understanding of mechanisms, again, from the optic neuritis and the global ancestry. We are hoping that this is beyond just understanding one population, but understanding MS, which is the target population. MSDF Have we missed anything important? Dr. Amezcua There is definitely a lot to do, and I think it's an effort that cannot be done alone. And so combining it with different centers that have the same interests and population is what the goal is, is to create a network of centers that are interested in defining this population, to move faster. MSDF Great. Thank you. Dr. Amezcua Great. Thank you. [transition music] MSDF Thank you for listening to Episode Ninety-three of Multiple Sclerosis Discovery. This podcast was produced by the MS Discovery Forum, MSDF, the premier source of independent news and information on MS research. <a href="http://Msdiscovery.org" rel="nofollow" target="_blank">Msdiscovery.org</a> is part of the nonprofit Accelerated Cure Project for Multiple Sclerosis. Robert McBurney is our President and CEO, and Hollie Schmidt is Vice President of Scientific Operations. <a href="http://Msdiscovery.org" rel="nofollow" target="_blank">Msdiscovery.org</a> aims to focus attention on what is known and not yet known about the causes of MS and related conditions, their pathological mechanisms, and potential ways to intervene. By communicating this information in a way that builds bridges among different disciplines, we hope to open new routes toward significant clinical advances. [outro music] We’re interested in your opinions. Please join the discussion on one of our online forums or send comments, criticisms, and suggestions to <a href="mailto:editor@msdiscovery.org">editor@msdiscovery.org</a>. For Multiple Sclerosis Discovery, I'm Dan Keller.

Multiple Sclerosis Discovery  --  Episode 93 with Dr. Lilyana Amezcua