Does EBV cause MS?

Many thanks to Dr. Oivind Torkildsen (Univ. of Bergen) for joining me on this Medscape 10-minute video interview. Dr. Torkildsen discussed the progress over the last 40 years in linking the Epstein Barr Virus to the development of multiple sclerosis.

https://www.medscape.com/viewarticle/how-does-ebv-cause-multiple-sclerosis-hit-and-run-or-chronic-2025a1000uq8?&icd=login_success_email_match_fpf

AI Summary of Medscape Interview:

1. EBV as a Necessary Factor - Virtually all MS patients have prior EBV infection; MS appears almost never to occur without it. - Landmark Science study (Ascherio, Bjornevik et al) followed 10 million U.S. military personnel with annual blood samples, confirming the requirement of EBV infection for MS development.

2. Etiologic Theories - Hit-and-Run (Molecular Mimicry): EBV triggers an autoimmune response cross-reacting with myelin antigens, then the virus is no longer needed. - 

Chronic Driver (Continuous Activation): Latent EBV in B cells sporadically reactivates, providing ongoing antigenic stimulation that drives MS pathology. - Likely both mechanisms contribute, with growing support for the chronic-driver model.

3. Implications for Prevention - EBV vaccination could theoretically prevent MS but faces challenges: identifying target populations, determining number needed to treat, and concerns about vaccine-triggered autoimmunity. - Moderna and others have resumed EBV vaccine development; phase 2 trials are underway.

4. Therapeutic Insights - Current high-efficacy MS therapies (especially B-cell–depleting agents like rituximab) may owe part of their success to depleting the EBV reservoir in B cells. - Stem cell transplant recipients sometimes require rituximab to control EBV complications, illustrating its anti-EBV potency.

5. Ongoing and Future Research - Clinical trials of antiviral agents against EBV (e.g., tenofovir) are in progress in MS patients and controls, with results expected soon. - Multiple groups are exploring strategies to eradicate or suppress EBV lytic reactivation as a disease-modifying approach in MS.

Take-Home Message Emerging data establish EBV infection as a near-universal prerequisite for MS. Efforts are now focused on preventive vaccination, antiviral therapies, and targeting the EBV reservoir in B cells to alter disease risk and progression.

For more fascinating interviews, please check out "The Art of Medicine with Dr. Andrew Wilner" on your favorite podcast player or YouTube.

#medicine #multiplesclerosis #EBV #MS #ECTRIMS