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The role of Epstein-Barr virus in multiple sclerosis: from molecular pathophysiology to in vivo imaging
Yi Guan1, Dejan Jakimovski1, Murali Ramanathan2
1Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Abstract:
Multiple sclerosis (MS) is a disease of the central nervous system characterized by inflammation, demyelination, and neuronal damage. Environmental and genetic factors are associated with the risk of developing MS, but the exact cause still remains unidentified. Epstein-Barr virus (EBV), vitamin D, and smoking are among the most well-established environmental risk factors in MS. Infectious mononucleosis, which is caused by delayed primary EBV infection, increases the risk of developing MS. EBV may also contribute to MS pathogenesis indirectly by activating silent human endogenous retrovirus-W. The emerging B-cell depleting therapies, particularly anti-CD20 agents such as rituximab, ocrelizumab, as well as the fully human ofatumumab, have shown promising clinical and magnetic resonance imaging benefit. One potential effect of these therapies is the depletion of memory B-cells, the primary reservoir site where EBV latency occurs. In addition, EBV potentially interacts with both genetic and other environmental factors to increase susceptibility and disease severity of MS. This review examines the role of EBV in MS pathophysiology and summarizes the recent clinical and radiological findings, with a focus on B-cells and in vivo imaging. Addressing the potential link between EBV and MS allows the better understanding of MS pathogenesis and helps to identify additional disease biomarkers that may be responsive to B-cell depleting intervention.
Insights
Epstein-Barr virus (EBV) infection is linked to multiple sclerosis (MS) risk. Therapies targeting B-cells, which harbor EBV, show promise for MS treatment and understanding disease mechanisms.
Area of Science:
- Neuroimmunology
- Virology
- Epidemiology
Background:
- Multiple sclerosis (MS) is a central nervous system disorder with unknown etiology, influenced by genetic and environmental factors.
- Epstein-Barr virus (EBV), vitamin D, and smoking are key environmental risk factors implicated in MS development.
- EBV infection, particularly infectious mononucleosis, is strongly associated with an increased risk of MS.
Purpose of the Study:
- To review the role of Epstein-Barr virus (EBV) in the pathophysiology of multiple sclerosis (MS).
- To summarize recent clinical and radiological findings concerning EBV and MS, focusing on B-cells and in vivo imaging.
- To explore how understanding the EBV-MS link can improve MS pathogenesis knowledge and identify therapeutic biomarkers.
Main Methods:
- Literature review of studies investigating EBV's role in MS.
- Analysis of clinical and magnetic resonance imaging (MRI) data related to MS patients and EBV status.
- Examination of the impact of B-cell depleting therapies on MS and EBV latency.
Main Results:
- EBV may contribute to MS pathogenesis by activating human endogenous retrovirus-W and potentially interacting with genetic factors.
- B-cell depleting therapies (e.g., anti-CD20 agents) demonstrate clinical and radiological benefits in MS.
- These therapies deplete memory B-cells, the primary reservoir for latent EBV, suggesting a mechanism for therapeutic efficacy.
Conclusions:
- EBV is a significant factor in MS pathophysiology, interacting with host genetics and environment.
- B-cell targeting therapies offer a promising avenue for MS treatment by addressing EBV reservoirs.
- Further research into the EBV-MS connection can yield novel biomarkers and therapeutic strategies.
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