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Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination

Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination

Published on: September 12, 2016

The association between various viral infections and multiple sclerosis: An umbrella review on systematic review and

Arash Bakhshi¹, Narges Eslami², Naeim Norouzi²

¹Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Reviews in Medical Virology

|November 27, 2023

Abstract:

Multiple Sclerosis (MS) is one of the immune-mediated demyelinating disorders. Multiple components, including the environment and genetics, are possible factors in the pathogenesis of MS. Also, it can be said that infections are a key component of the host's response to MS development. Finally, we evaluated the relationship between different pathogens and MS disease in this umbrella research. We systematically collected and analysed multiple meta-analyses focused on one particular topic. We utilised the Scopus, PubMed, and Web of Science databases starting with inception until 30 May 2023. The methodological quality of the analysed meta-analysis has been determined based on Assessing the Methodological Quality of Systematic Reviews 2 and Grade, and graph construction and statistical analysis were conducted using Comprehensive Meta-Analysis. The Confidence Interval of effect size was 95% in meta-analyses, and p < 0.05 indicated a statistically meaningful relationship. The included studies evaluated the association between MS and 12 viruses containing SARS-CoV-2, Epstein-Barr virus (EBV), Hepatitis B virus, varicella-zoster virus (VZV), human herpesvirus 6 (HHV-6), HHV-7, HHV-8, HSV-1, HSV-2, Cytomegalovirus, Human Papillomavirus, and influenza. SARS-CoV-2, with a 3.74 odds ratio, has a significantly more potent negative effect on MS among viral infections. After that, EBV, HHV-6, HSV-2, and VZV, respectively, with 3.33, 2.81, 1.76, and 1.72 odds ratios, had a significantly negative relationship with MS (p < 0.05). Although the theoretical evidence mostly indicates that EBV has the greatest effect on MS, recent epidemiological studies have challenged this conclusion and put forward possibilities that SARS-CoV-2 is the culprit. Hence, it was necessary to investigate the effects of SARS-CoV-2 and EBV on MS.

Insights

This study found SARS-CoV-2 and Epstein-Barr virus (EBV) significantly increase the risk of Multiple Sclerosis (MS). SARS-CoV-2 showed a stronger association than EBV, challenging previous assumptions about MS pathogenesis.

Area of Science:

Neuroimmunology
Infectious Diseases
Epidemiology

Background:

Multiple Sclerosis (MS) is an immune-mediated demyelinating disorder with complex etiology.
Environmental factors, genetics, and infections are implicated in MS pathogenesis.
The role of specific viral infections in MS development requires further clarification.

Purpose of the Study:

To conduct an umbrella review evaluating the association between various pathogens and Multiple Sclerosis (MS).
To specifically investigate the impact of SARS-CoV-2 and Epstein-Barr virus (EBV) on MS risk, given conflicting evidence.
To synthesize findings from multiple meta-analyses on viral associations with MS.

Main Methods:

Systematic collection and analysis of meta-analyses from Scopus, PubMed, and Web of Science databases until May 2023.
Methodological quality assessed using Assessing the Methodological Quality of Systematic Reviews 2 and GRADE criteria.
Statistical analysis performed using Comprehensive Meta-Analysis with a 95% confidence interval and p < 0.05 significance level.

Main Results:

Twelve viruses were evaluated for their association with MS.
SARS-CoV-2 demonstrated the strongest negative association with MS (Odds Ratio: 3.74).
Epstein-Barr virus (EBV) (OR: 3.33), Human Herpesvirus 6 (HHV-6) (OR: 2.81), Herpes Simplex Virus 2 (HSV-2) (OR: 1.76), and Varicella-Zoster Virus (VZV) (OR: 1.72) also showed significant negative relationships with MS.

Conclusions:

Recent epidemiological data suggest SARS-CoV-2 may have a more significant impact on MS than previously thought, challenging the established role of EBV.
Multiple viral infections are significantly associated with an increased risk of developing Multiple Sclerosis.
Further research is warranted to elucidate the precise mechanisms by which these viruses contribute to MS pathogenesis.

Read full analysis

Keywords:

multiple sclerosis umbrella review viral infection

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