MedicineIs EBV one of the main “triggers” of multiple sclerosis?
For decades, the primary cause of multiple sclerosis (MS) has remained one of the biggest questions in neurology. Now, a number of studies are placing the Epstein–Barr virus (EBV) at the center of a powerful hypothesis: EBV may act as a kind of “trigger” that initiates the immunological process that, years later, can manifest as multiple sclerosis.
EBV is an extremely common virus. Over 90 percent of adults become infected with it during their lifetime and, after infection, the virus does not completely leave the body. It can remain in a latent state, especially within the B cells of the immune system.
This does not mean that EBV infection automatically causes MS. The overwhelming majority of infected people never develop the disease. However, data indicate that EBV may be a very important link in the chain leading to it.
What did the study with over 10 million people show?
One of the most powerful pieces of evidence came from a study published in Science in 2022. The researchers analyzed a cohort of more than 10 million members of the U.S. military, using blood samples collected over the years.
During the follow‑up, 955 individuals were diagnosed with MS. The analysis showed that the risk of MS increased about 32‑fold after EBV infection. A similar association was not found with cytomegalovirus, another virus transmitted in a similar way. (PubMed)
In the blood samples, the level of light neurofilament (NfL) – a biomarker of neuroaxonal damage – began to rise only after EBV infection. This creates an important sequence of events:
EBV infection can be followed by biological changes that precede the clinical manifestation of multiple sclerosis. Studies have shown that after infection there can be an increase in biomarkers of neuroaxonal damage, suggesting a possible sequence of events where EBV infection precedes nerve damage and, later, the onset of MS.
How could EBV “trigger” the process?
One of the most interesting explanations is called molecular mimicry.
The immune system creates antibodies against EBV proteins. But some parts of a viral protein called EBNA1 share similarity with proteins of the nervous system.
A study in Nature discovered that some antibodies produced against EBNA1 can also recognize GlialCAM, a protein of the central nervous system. In other words, the immune system that has been trained to recognize the virus can, in some individuals, begin to recognize the body’s own structures.
The immune system’s battle against the virus can, in some predisposed individuals, lead to a misdirected immune response, where the response initially directed against EBV also begins to recognize the body’s own structures. This process can promote the development of autoimmunity and, subsequently, the inflammation and damage to myelin and nerve structures that characterize multiple sclerosis.
But molecular mimicry may not be the only mechanism. EBV specifically infects B cells, which have a central role in MS. The virus can remain latent in B cells and potentially influence how these cells present antigens and activate T cells.
A spark, not the whole fire
The most accurate way to conceptualize EBV is not as a virus that infects the brain and immediately causes MS.
EBV can act as an initial “trigger” by infecting B cells and remaining in them in a latent state. This long‑term presence can affect how the immune system responds, favoring in some individuals immune responses that mistakenly also recognize nervous system proteins. Over time, this reaction can contribute to the development of chronic autoimmunity, inflammation in the nervous system, and myelin damage, processes that characterize multiple sclerosis.
Even the newest literature continues to describe EBV infection as potentially necessary, but not sufficient, for the development of MS. Genetic factors and other biological and environmental factors appear to determine in which individual this “spark” ultimately turns into disease.
This changes the main question of scientific research. Instead of only asking how to curb inflammation once MS has developed, researchers are trying to understand what happens between EBV infection and the onset of autoimmunity.
If this link is fully defined, it may become possible in the future to intervene precisely at the disease’s “trigger” before the autoimmune process progresses to cause nerve damage.