The influence of environmental risk factors in the development of ALS in the Mediterranean Island of Cyprus

Ellie Mitsi; Christiana C Christodoulou; Paschalis Nicolaou; Kyproula Christodoulou; Eleni Zamba-Papanicolaou

doi:10.3389/fneur.2023.1264743

The influence of environmental risk factors in the development of ALS in the Mediterranean Island of Cyprus

Front Neurol. 2023 Nov 23:14:1264743. doi: 10.3389/fneur.2023.1264743. eCollection 2023.

Authors

Ellie Mitsi^{1

2}, Christiana C Christodoulou², Paschalis Nicolaou¹, Kyproula Christodoulou¹, Eleni Zamba-Papanicolaou²

Affiliations

¹ Neurogenetics Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
² Neuroepidemiology Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.

Abstract

Introduction: Amyotrophic lateral sclerosis (ALS) is a devastating, uniformly lethal degenerative disease of motor neurons, presenting with relentlessly progressive muscle atrophy and weakness. The etiology of ALS remains unexplained for over 85% of all cases, suggesting that besides the genetic basis of the disease, various environmental factors are implicated in the pathogenesis of ALS. This study aimed to investigate the contribution of known environmental risk factors of ALS in the Cypriot population.

Methods: We conducted a case-control study with a total of 56 ALS cases and 56 healthy gender/age-matched controls of Cypriot nationality. Demographic, lifestyle characteristics, medical conditions, and environmental exposures were collected through the use of a detailed questionnaire. Statistical analyses using the R programming language examined the association between the above environmental factors and ALS.

Results: A chi-square test analysis revealed a statistically significant (p = 0.000461) difference in smoking status between the two groups. In addition, univariate logistic regression analysis showed a statistically significant association between ALS cases for head trauma/injury (p = 0.0398) and exposure to chemicals (p = 0.00128), compared to controls.

Conclusion: This case-control investigation has shed some light on the epidemiological data of ALS in Cyprus, by identifying environmental determinants of ALS, such as smoking, head trauma, and chemical exposure, in the Cypriot population.

Keywords: Cypriot population; Mediterranean Island; amyotrophic lateral sclerosis; case–control study; environmental factors; epidemiology.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study consumables and direct expenses were funded by the Cyprus Institute of Neurology and Genetics. EM received funding from Telethon, Cyprus. EM received funding from Telethon, Cyprus (no. 73234).