Targeting Epstein-Barr virus infection as an intervention against multiple sclerosis

Jons, Daniel; Sundström, Peter; Andersen, Oluf

doi:10.1111/ane.12294

Cited by 18 publications

(16 citation statements)

References 117 publications

(134 reference statements)

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“…In contrast, the increasing frequency of overweight among young people seems to increase MS risk [26][27][28]. EpsteinBarr virus is another important immunogenetic factor suggested to contribute to MS susceptibility [29][30][31]. Moreover, direct and passive smoking was found to increase the risk of MS [32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Multiple Sclerosis Incidence and Prevalence Trends in the Province of Padua, Northeast Italy, 1965–2018

et al. 2018

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Background: Previous studies, dating back to the 1960s disclosed a progressive increase in multiple sclerosis (MS) incidence and prevalence in the Province of Padua. To further analyze whether this trend is the effect of the improved diagnostic procedures or is primarily related to a real increase risk of MS, we analyzed MS incidence and prevalence of the 5-year period 2011–2015. Methods: Patients with a diagnosis of MS or clinically isolated syndrome highly suggestive of MS were included in the study. All available sources of clinical and administrative information were evaluated. Mean annual incidence in the 5-year period 2011–2015 and the prevalence on December 31, 2015 were calculated. Results: The 2011–2015 mean incidence was 6.5/100,000/year, 7.9 for females, 4.1 for males. The overall prevalence was 182/100,000, 241 for females, 116 for males. Compared to the 2000–2009 period, mean age at onset, onset-diagnosis delay and F/M ratio did not significantly change. Since the 1960s, incidence and prevalence of MS linearly increased with no interposed plateau periods. Conclusions: MS incidence and prevalence further and significantly increased in the period 2011–2015. Our 1965–2015 data indicate a real increased risk of MS and stress a role of exogenous factors in MS susceptibility.

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Section: Discussionmentioning

confidence: 99%

Multiple Sclerosis Incidence and Prevalence Trends in the Province of Padua, Northeast Italy, 1965–2018

et al. 2018

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“…Human herpesviruses have since long been implicated, and EBV is now regarded as an established risk factor for MS. 1,10 The etiological link between EBV and MS is based on several observations such as the association between infectious mononucleosis (IM) and MS, serological data including from presymptomatic samples, and several studies…”

Section: Epstein-barr Virusmentioning

confidence: 99%

Managing Epstein-Barr virus and other risk factors in MS-Future perspectives

Sundström

2017

Acta Neurol Scand

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Funding information NoneHere, we discuss the rationale and feasibility of treatment directed against the modifiable risk factors in multiple sclerosis. The established environmental risk factors vitamin D insufficiency, cigarette smoke exposure, adolescence overweight, and Epstein-Barr virus infection are reviewed. Already available measures to target these risk factors are discussed. K E Y W O R D SEpstein-Barr virus, multiple sclerosis, smoking, treatment, vitamin D | INTRODUCTIONManagement of the modifiable environmental risk factors in MS may be regarded as a plausible and logical way to treat a patient with MS.An important premise is that if a factor is involved in the etiology of a disease then it is most probably also involved in the mechanisms responsible for disease activity. Even if this is the case, other constraints (medico-legal or lack of scientific evidence from large phase III randomized controlled trials) may hinder such actions.The recognized risk factors that we can manage and do something about are the modifiable environmental risk factors: insufficiency of vitamin D/UVB radiation, cigarette smoke exposure, adolescent overweight, and human herpesvirus infection, most certainly with EpsteinBarr virus (EBV). 1-3 | VITAMIN D AND UV EXPOSUREVitamin D status depends mostly on sun exposure. Traditionally, the sun represents something positive. In the Western world, one usually says that the weather is great if it is a sunny day. The sun, the light, and the daytime symbolize the good side, while darkness and the nighttime represent evil and fear. But in the last decades, we have learned, from authorities such as the European Union Commission, that sunshine is harmful. Because of the risk for skin cancer, we should avoid being outdoors around noon, wear protective clothing, and use sunscreen.However, in the most recent years, data have been published that suggest that we, at least in Sweden, should reconsider these advices.For example, a Swedish study showed a doubled mortality in those avoiding the sun compared to those with the highest sun exposure.

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“…Overall, the observations described above suggest EBV infection is a strong risk factor favoring MS development. Prevention of EVB infection may therefore reduce the risk of disease .…”

Section: Epstein–barr Virus Infectionmentioning

confidence: 99%

Multiple sclerosis and environmental factors: the role of vitamin D, parasites, and Epstein-Barr virus infection

Correale

Gaitán

2015

Acta Neurol Scand

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Pathogenic mechanisms underlying multiple sclerosis development have yet to be clearly identified, but considerable evidence indicates that autoimmunity plays an important role in the etiology of the disease. It is generally accepted that autoimmune diseases like MS arise from complex interactions between genetic susceptibility and environmental factors. Although environmental factors unequivocally influencing MS development have yet to be established, accumulating evidence singles out several candidates, including sunlight–UV exposure or vitamin D deficiency, viral infections, hygiene, and cigarette smoking. Vitamin D deficiency has been associated with different autoimmune diseases. Several investigations indicate 125 (OH)2 vitamin D plays a critical role in shaping T‐cell response and inducing T cells with immunosuppressive properties. Likewise, helminth infections represent another potential environmental factor exerting immunomodulatory properties. Both epidemiological and experimental data provide evidence to support autoimmune down‐regulation secondary to parasite infections in patients with MS, through regulatory T‐ and B‐cell action, with effects extending beyond simple response to an infectious agent. Finally, different epidemiological studies have demonstrated that Epstein–Barr virus infection confers added risk of developing MS. Proposed mechanisms responsible for this association include activation and expansion of self‐reactive T and B cells, lower threshold for self‐tolerance breakdown, and enhanced autoreactive B‐cell survival, all to be discussed in this review. Understanding environmental factors influencing propensity to MS will lead to new and more effective approaches to prevent and treat the disease.

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Targeting Epstein-Barr virus infection as an intervention against multiple sclerosis

Cited by 18 publications

References 117 publications

Multiple Sclerosis Incidence and Prevalence Trends in the Province of Padua, Northeast Italy, 1965–2018

Multiple Sclerosis Incidence and Prevalence Trends in the Province of Padua, Northeast Italy, 1965–2018

Managing Epstein-Barr virus and other risk factors in MS-Future perspectives

Multiple sclerosis and environmental factors: the role of vitamin D, parasites, and Epstein-Barr virus infection

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