Epstein–Barr virus and multiple sclerosis: association or causation?

Abstract

Multiple sclerosis (MS) is a multifactorial disease in which both genetic and environmental factors and their interactions underlie causation. The current evidence base supports a strong association between Epstein–Barr virus (EBV) and MS, but potential causality remains strongly debated. It is not possible to exclude the possibility that an abnormal response to EBV infection is a consequence, rather than a cause, of the underlying pathophysiology of MS, or indeed that the association may be a reflection of a similar underlying disease mechanism. Substantial experimental progress is necessary to achieve consistency of molecular findings to complement the strong epidemiological association between EBV and MS, which cannot alone show causation. Collectively, the strength of the association between EBV and MS warrants careful development and trial of anti-EBV drugs to observe any effect on MS disease course.

Keywords::

• Epstein–Barr nuclear antigen
• Epstein–Barr virus
• infectious mononucleosis
• latitude
• multiple sclerosis
• seroprevalence
• temporality

Financial & competing interests disclosure

G Giovannoni serves on scientific advisory boards for Merck Serono, Biogen Idec and Vertex Pharmaceuticals; has served on the editorial board of Multiple Sclerosis; has received speakers honoraria from Bayer Schering Pharma, Merck Serono, Biogen Idec, Pfizer Inc., Teva Pharmaceutical Industries Ltd, Sanofi-Aventis, Vertex Pharmaceuticals, Genzyme Corporation, Ironwood and Novartis; has served as a consultant for Bayer Schering Pharma, Biogen Idec, GlaxoSmithKline, Merck Serono, Protein Discovery Laboratories, Teva Pharmaceutical Industries Ltd, Sanofi-Aventis, UCB, Vertex Pharmaceuticals, GW Pharma, Novartis and FivePrime; serves on the speakers bureau for Merck Serono; and has received research support from Bayer Schering Pharma, Biogen Idec, Merck Serono, Novartis, UCB, Merz Pharmaceuticals, LLC, Teva Pharmaceutical Industries Ltd, Sanofi-Aventis, GW Pharma and Ironwood. SV Ramagopalan receives research support from the Multiple Sclerosis Society of Canada Scientific Research Foundation and the Multiple Sclerosis Society of the United Kingdom. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.