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How to and should we target EBV in MS?
Svetlana Eckert1, Dejan Jakimovski1,2, Robert Zivadinov2,3
1Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Introduction:
The etiology of multiple sclerosis (MS) remains unknown. Pathogenesis likely relies on a complex interaction between multiple environmental, genetic, and behavioral risk factors. However, a growing body of literature supports the role of a preceding Epstein-Barr virus (EBV) infection in the majority of cases.
Areas Covered:
In this narrative review, we summarize the latest findings regarding the potential role of EBV as a predisposing event inducing new onset of MS. EBV interactions with the genetic background and other infectious agents such as human endogenous retrovirus are explored. Additional data regarding the role of EBV regarding the rate of mid- and long-term disease progression is also discussed. Lastly, the effect of currently approved disease-modifying therapies (DMT) for MS treatment on the EBV-based molecular mechanisms and the development of new EBV-specific therapies are further reviewed.
Expert Opinion:
Recent strong epidemiological findings support that EBV may be the primary inducing event in certain individuals that shortly thereafter develop MS. More studies are needed in order to better understand the significant variability in susceptibility based on environmental factors such as EBV exposure. Future investigations should focus on determining the specific EBV-related risk antigen(s) and phenotyping people with likely EBV-induced MS. Targeting EBV via several different avenues, including development of an EBV vaccine, may become the mainstay of MS treatment in the future.
Insights
Epstein-Barr virus (EBV) infection may be a primary trigger for multiple sclerosis (MS) in susceptible individuals. Further research into EBV
Area of Science:
- Neuroimmunology
- Infectious Disease Epidemiology
Background:
- The precise cause of multiple sclerosis (MS) remains elusive, though it involves genetic, environmental, and behavioral factors.
- A significant body of research suggests a link between Epstein-Barr virus (EBV) infection and the development of MS.
Purpose of the Study:
- To review current evidence on Epstein-Barr virus (EBV) as a potential trigger for multiple sclerosis (MS) onset.
- To explore EBV's interaction with genetic predispositions and other infections in MS pathogenesis.
- To examine EBV's role in MS disease progression and the impact of disease-modifying therapies (DMTs).
Main Methods:
- Narrative review of recent epidemiological and molecular findings.
- Exploration of EBV's interaction with host genetics and co-infections.
- Analysis of EBV's influence on MS progression and treatment responses.
Main Results:
- Strong epidemiological data indicate EBV may be the initiating event for MS in some individuals.
- Variability in susceptibility to EBV-induced MS is influenced by environmental factors.
- Current DMTs' effects on EBV-related mechanisms and potential EBV-specific therapies are discussed.
Conclusions:
- EBV is increasingly recognized as a critical factor in MS etiology for certain populations.
- Future research should identify EBV-specific risk factors and phenotypes.
- EBV-targeted strategies, including vaccination, may offer future therapeutic avenues for MS.
