A Retrospective Analysis of ALS Clusters Near Algae Blooms in North Carolina (P5-11.019)

To examine clinical differences between individuals with amyotrophic lateral sclerosis (ALS) who live near and far from harmful algal blooms (HABs) in North Carolina. While 10% of ALS cases are associated with genetic mutations, the rest may have environmental causes. Higher than expected numbers of ALS cases have been identified near HABs in North Carolina using data from death certificates between 1999 and 2020 (unpublished). It is not clear why there might be more ALS cases near HABs. Blue-green algae produce toxins, such as β-methylamino-L-alanine, which are associated with neurotoxicity and ALS. We hypothesize that there might be clinical differences in HAB-associated ALS and non-HAB-associated ALS, which may help to understand why this correlation exists and better manage HAB-associated ALS. We will perform two retrospective cohort analyses comparing individuals with ALS who live far from HABs (more than 50 miles) and individuals with ALS who live near HABs (less than 50 miles). We will first analyze differences in demographics, genetic testing, and symptom onset using an existing RedCap database. We will analyze ALS progression using ALS Functional Rating Scale scores, forced vital capacity, and weight over time. For the second analysis using the Duke electronic medical record, we will examine the percentage of patients with ALS in each region and compare family history, comorbidities, medications, and socioeconomic status. Preliminary results reveal that 16. 3% of patients with ALS who live far from HABs have a family history of ALS or dementia, compared with 11. 8% of those living near HABs. This association suggests that higher than expected rates of ALS near HABs are not caused by genetic mutations. Additional analyses are underway which we hope will shed light on the etiology of HAB-associated ALS and eventually lead to new treatments and methods of prevention. Disclosure: Ms. Linares has nothing to disclose. Dr. Li has nothing to disclose. Dr. Satterwhite has nothing to disclose. Dr. Sun has nothing to disclose. Dr. Bedlack has received personal compensation in the range of 10, 000-49, 999 for serving as a Consultant for Guidepoint Global. Dr. Bedlack has received personal compensation in the range of 5, 000-9, 999 for serving as a Consultant for New Biotic. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for Woolsey Pharma. Dr. Bedlack has received personal compensation in the range of 5, 000-9, 999 for serving as a Consultant for Amylyx. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for ITF Pharma. Dr. Bedlack has received personal compensation in the range of 5, 000-9, 999 for serving as a Consultant for Mitsubishi Tanabe America. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for Orphazyme. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for AB Scicence. Dr. Bedlack has received personal compensation in the range of 100, 000-499, 999 for serving as a Consultant for ALS Association. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for Adept Field Solutions. Dr. Bedlack has received personal compensation in the range of 5, 000-9, 999 for serving as a Consultant for Apellis. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for Black Swan. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for Clarivate. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for Clearview. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for Clean. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for CM Group. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for Corcept. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for Cytokinetics. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for Health Advances. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for MT Pharma America. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for MJH Healthcare. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for Maple Health Care. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for National Association of Managed Care Physicians. Dr. Bedlack has received personal compensation in the range of 5, 000-9, 999 for serving as a Consultant for Projects in Knowledge. Dr. Bedlack has received personal compensation in the range of 10, 000-49, 999 for serving as a Consultant for Shinkei Pharma. Dr. Bedlack has received personal compensation in the range of 5, 000-9, 999 for serving as a Consultant for Webb MD/Medscape. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving as a Consultant for UCB Pharma. Dr. Bedlack has received personal compensation in the range of 10, 000-49, 999 for serving on a Scientific Advisory or Data Safety Monitoring board for Brainstorm Cell. Dr. Bedlack has received personal compensation in the range of 5, 000-9, 999 for serving on a Scientific Advisory or Data Safety Monitoring board for Mallinkrodt. Dr. Bedlack has received personal compensation in the range of 5, 000-9, 999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurosense. Dr. Bedlack has received personal compensation in the range of 500-4, 999 for serving on a Scientific Advisory or Data Safety Monitoring board for PTC Therapeutics. Dr. Bedlack has received personal compensation in the range of 10, 000-49, 999 for serving on a Speakers Bureau for Amylyx. Dr. Bedlack has received personal compensation in the range of 10, 000-49, 999 for serving as an officer or member of the Board of Directors for GenieUS. The institution of Dr. Bedlack has received research support from Cytokinetics. The institution of Dr. Bedlack has received research support from Orion. The institution of Dr. Bedlack has received research support from Ultragenyx. The institution of Dr. Bedlack has received research support from MediciNova. The institution of Dr. Bedlack has received research support from Healey Center. Dr. Bedlack has received publishing royalties from a publication relating to health care.