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Pumphrey CM, Scarcella JF, Price DL. Acute Presentation of Newly Diagnosed Multiple Sclerosis Associated With Polymerase Chain Reaction-Proven Human Herpesvirus 6 Central Nervous System Infection. Cureus 2022; 14:e24319. [PMID: 35607553 PMCID: PMC9122541 DOI: 10.7759/cureus.24319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/21/2022] Open
Abstract
We present the case of a 26-year-old male who was found to have human herpesvirus 6 (HHV-6) in his cerebrospinal fluid (CSF) during acute presentation of multiple sclerosis (MS). Paresthesia of the lower extremities was his only symptom during the initial presentation, and workup for MS was not included during this evaluation. A single dose of IV steroids failed to improve his condition, and symptoms became more severe. Upon secondary evaluation, MRI revealed white-matter disease with plaques at multiple levels of the cervical spine and central nervous system (CNS). Lumbar puncture was obtained, and CSF analysis was positive for HHV-6 DNA. After five days of oral steroid treatment and physical therapy for three weeks, his symptoms continued to worsen. MRI at this time demonstrated an increase in the size of previous plaques and new foci of white matter disease. Repeat CSF analysis was negative for HHV-6. The virus’ association with relapse of MS has been investigated by many studies. However, there is a lack of literature investigating its role in causing MS disease. In this case report, we highlight the need for further research aimed at determining if HHV-6 is an environmental trigger for MS disease onset.
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Voumvourakis KI, Fragkou PC, Kitsos DK, Foska K, Chondrogianni M, Tsiodras S. Human herpesvirus 6 infection as a trigger of multiple sclerosis: an update of recent literature. BMC Neurol 2022; 22:57. [PMID: 35168545 PMCID: PMC8845292 DOI: 10.1186/s12883-022-02568-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/22/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This is an update on the existing evidence regarding a relationship between infection with human herpesvirus 6 (HHV-6) and multiple sclerosis (MS) in order to contribute on the attempt to define the nature and strength of that relationship. RESULTS Study quality was assessed using the criteria proposed by Moore and Wolfson and by the classification criteria used by the Canadian Task Force on the Periodic Health Examination. Studies were categorized both by experimental technique and by quality (high [A], intermediate [B], and low [C]) as determined by the Moore and Wolfson criteria. Overall, 27 (90%) of 30 studies, 18 (86%) of which were classified as A quality, reached a statistically significant result. According to the Canadian Task Force classification, all studies were categorized as evidence of qualityII-1. Limitations of the available experimental techniques and perspectives for future research are discussed. CONCLUSIONS The current review continues to emphasize the need for further, objective, evidence-based examination of the relationship between HHV-6 infection and multiple sclerosis.
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Affiliation(s)
- K I Voumvourakis
- 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - P C Fragkou
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - D K Kitsos
- 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - K Foska
- 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - M Chondrogianni
- 2nd Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - S Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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3
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Markers of Epstein-Barr virus and Human Herpesvirus-6 infection and multiple sclerosis clinical progression. Mult Scler Relat Disord 2022; 59:103561. [DOI: 10.1016/j.msard.2022.103561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/09/2022] [Accepted: 01/23/2022] [Indexed: 11/17/2022]
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4
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Evasion of the Host Immune Response by Betaherpesviruses. Int J Mol Sci 2021; 22:ijms22147503. [PMID: 34299120 PMCID: PMC8306455 DOI: 10.3390/ijms22147503] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 02/07/2023] Open
Abstract
The human immune system boasts a diverse array of strategies for recognizing and eradicating invading pathogens. Human betaherpesviruses, a highly prevalent subfamily of viruses, include human cytomegalovirus (HCMV), human herpesvirus (HHV) 6A, HHV-6B, and HHV-7. These viruses have evolved numerous mechanisms for evading the host response. In this review, we will highlight the complex interplay between betaherpesviruses and the human immune response, focusing on protein function. We will explore methods by which the immune system first responds to betaherpesvirus infection as well as mechanisms by which viruses subvert normal cellular functions to evade the immune system and facilitate viral latency, persistence, and reactivation. Lastly, we will briefly discuss recent advances in vaccine technology targeting betaherpesviruses. This review aims to further elucidate the dynamic interactions between betaherpesviruses and the human immune system.
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5
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Jakhmola S, Upadhyay A, Jain K, Mishra A, Jha HC. Herpesviruses and the hidden links to Multiple Sclerosis neuropathology. J Neuroimmunol 2021; 358:577636. [PMID: 34174587 DOI: 10.1016/j.jneuroim.2021.577636] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
Herpesviruses like Epstein-Barr virus, human herpesvirus (HHV)-6, HHV-1, VZV, and human endogenous retroviruses, have an age-old clinical association with multiple sclerosis (MS). MS is an autoimmune disease of the nervous system wherein the myelin sheath deteriorates. The most popular mode of virus mediated immune system manipulation is molecular mimicry. Numerous herpesvirus antigens are similar to myelin proteins. Other mechanisms described here include the activity of cytokines and autoantibodies produced by the autoreactive T and B cells, respectively, viral déjà vu, epitope spreading, CD46 receptor engagement, impaired remyelination etc. Overall, this review addresses the host-parasite association of viruses with MS.
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Affiliation(s)
- Shweta Jakhmola
- Infection Bioengineering Group, Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, India
| | - Arun Upadhyay
- Cellular and Molecular Neurobiology Unit, Indian Institute of Technology, Jodhpur, India
| | - Khushboo Jain
- Infection Bioengineering Group, Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, India
| | - Amit Mishra
- Cellular and Molecular Neurobiology Unit, Indian Institute of Technology, Jodhpur, India
| | - Hem Chandra Jha
- Infection Bioengineering Group, Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, India.
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6
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Teymoori-Rad M, Sahraian MA, Mokhtariazad T, Nejati A, Mozdabadi RSK, Amiri MM, Shokri F, Marashi SM. Illuminating the in vitro effects of Epstein-Barr virus and vitamin D on immune response in multiple sclerosis patients. J Neurovirol 2021; 27:260-271. [PMID: 33666884 DOI: 10.1007/s13365-021-00951-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/12/2021] [Accepted: 01/20/2021] [Indexed: 11/25/2022]
Abstract
Given the complexity of immune complex diseases including multiple sclerosis (MS) and the plausible interactions between different risk factors, delineating the interplay between them would be imperative. The current study aimed to evaluate the in vitro effects of Epstein-Barr virus (EBV) and vitamin D on immune response in MS patients and healthy controls. The status of vitamin D and EBV load was evaluated using multiple techniques. In vitro EBV-infected peripheral blood mononuclear cells (PBMCs), in the presence or absence of vitamin D, were checked for IL-10, IFN-γ, and vitamin D receptor. MS patients showed significantly higher plasma levels of 1,25-(OH)2D but not 25-OHD, increased EBV load, and lower levels of vitamin D receptor (VDR) expression compared with healthy controls. Interestingly, an inverse correlation was observed between VDR expression and EBV load in PBMCs. Indeed, the levels of IFN-γ and IL-10 production were significantly higher in supernatant collected from in vitro EBV-infected PBMCs in MS patients compared with controls. While all vitamin D-treated PBMCs showed reduced levels of IFN-γ production, in vitro treatment of vitamin D showed no influence in IL-10 production. EBV and vitamin D were found to exert opposite in vitro effects on immune dysregulation in these patients. Our results highlight the complex interactions of different risk factors with immune system.
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Affiliation(s)
- Majid Teymoori-Rad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Centre, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtariazad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Nejati
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Mehdi Amiri
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fazel Shokri
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Mahdi Marashi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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7
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Ruprecht K. The role of Epstein-Barr virus in the etiology of multiple sclerosis: a current review. Expert Rev Clin Immunol 2020; 16:1143-1157. [PMID: 33152255 DOI: 10.1080/1744666x.2021.1847642] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. While its exact etiology is unknown, it is generally believed that MS is caused by environmental triggers in genetically predisposed individuals. Strong and consistent evidence suggests a key role of Epstein-Barr virus (EBV), a B lymphotropic human gammaherpesvirus, in the etiology of MS. Areas covered: This review summarizes recent developments in the field of EBV and MS with a focus on potential mechanisms underlying the role of EBV in MS. PubMed was searched for the terms 'Epstein-Barr virus' and 'multiple sclerosis'. Expert opinion: The current evidence is compatible with the working hypothesis that MS is a rare complication of EBV infection. Under the premise of a causative role of EBV in MS, it needs to be postulated that EBV causes a specific, and likely persistent, change(s) that is necessarily required for the development of MS. However, although progress has been made, the nature of that change and thus the precise mechanism explaining the role of EBV in MS remain elusive. The mechanism of EBV in MS therefore is a pressing question, whose clarification may substantially advance the pathophysiological understanding, rational therapies, and prevention of MS.
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Affiliation(s)
- Klemens Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin, Germany
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8
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Komaroff AL, Pellett PE, Jacobson S. Human Herpesviruses 6A and 6B in Brain Diseases: Association versus Causation. Clin Microbiol Rev 2020; 34:e00143-20. [PMID: 33177186 PMCID: PMC7667666 DOI: 10.1128/cmr.00143-20] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Human herpesvirus 6A (HHV-6A) and human herpesvirus 6B (HHV-6B), collectively termed HHV-6A/B, are neurotropic viruses that permanently infect most humans from an early age. Although most people infected with these viruses appear to suffer no ill effects, the viruses are a well-established cause of encephalitis in immunocompromised patients. In this review, we summarize the evidence that the viruses may also be one trigger for febrile seizures (including febrile status epilepticus) in immunocompetent infants and children, mesial temporal lobe epilepsy, multiple sclerosis (MS), and, possibly, Alzheimer's disease. We propose criteria for linking ubiquitous infectious agents capable of producing lifelong infection to any neurologic disease, and then we examine to what extent these criteria have been met for these viruses and these diseases.
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Affiliation(s)
- Anthony L Komaroff
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip E Pellett
- Department of Microbiology and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Steven Jacobson
- Virology/Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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9
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Tarlinton RE, Martynova E, Rizvanov AA, Khaiboullina S, Verma S. Role of Viruses in the Pathogenesis of Multiple Sclerosis. Viruses 2020; 12:E643. [PMID: 32545816 PMCID: PMC7354629 DOI: 10.3390/v12060643] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022] Open
Abstract
Multiple sclerosis (MS) is an immune inflammatory disease, where the underlying etiological cause remains elusive. Multiple triggering factors have been suggested, including environmental, genetic and gender components. However, underlying infectious triggers to the disease are also suspected. There is an increasing abundance of evidence supporting a viral etiology to MS, including the efficacy of interferon therapy and over-detection of viral antibodies and nucleic acids when compared with healthy patients. Several viruses have been proposed as potential triggering agents, including Epstein-Barr virus, human herpesvirus 6, varicella-zoster virus, cytomegalovirus, John Cunningham virus and human endogenous retroviruses. These viruses are all near ubiquitous and have a high prevalence in adult populations (or in the case of the retroviruses are actually part of the genome). They can establish lifelong infections with periods of reactivation, which may be linked to the relapsing nature of MS. In this review, the evidence for a role for viral infection in MS will be discussed with an emphasis on immune system activation related to MS disease pathogenesis.
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Affiliation(s)
- Rachael E. Tarlinton
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough LE12 5RD, UK;
| | - Ekaterina Martynova
- Insititute of Fundamental Medicine and Biology Kazan Federal University, 420008 Kazan, Russia; (E.M.); (A.A.R.)
| | - Albert A. Rizvanov
- Insititute of Fundamental Medicine and Biology Kazan Federal University, 420008 Kazan, Russia; (E.M.); (A.A.R.)
| | | | - Subhash Verma
- School of Medicine, University of Nevada, Reno, NV 89557, USA;
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10
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Hussein HM, Rahal EA. The role of viral infections in the development of autoimmune diseases. Crit Rev Microbiol 2019; 45:394-412. [PMID: 31145640 DOI: 10.1080/1040841x.2019.1614904] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The exact aetiology of most autoimmune diseases remains unknown, nonetheless, several factors contributing to the induction or exacerbation of autoimmune reactions have been suggested. These include the genetic profile and lifestyle of the affected individual in addition to environmental triggers such as bacterial, parasitic, fungal and viral infections. Infections caused by viruses usually trigger a potent immune response that is necessary for the containment of the infection; however, in some cases, a failure in the regulation of this immune response may lead to harmful immune reactions directed against the host's antigens. The autoimmune attack can be carried out by different arms and components of the immune system and through different possible mechanisms including molecular mimicry, bystander activation, and epitope spreading among others. In this review, we examine the data available for the involvement of viral infections in triggering or exacerbating autoimmune diseases in addition to discussing the mechanisms by which these viral infections and the immune pathways they trigger possibly contribute to the development of autoimmunity.
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Affiliation(s)
- Hadi M Hussein
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut , Beirut , Lebanon.,Center for Infectious Diseases Research (CIDR), American University of Beirut , Beirut , Lebanon
| | - Elias A Rahal
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut , Beirut , Lebanon.,Center for Infectious Diseases Research (CIDR), American University of Beirut , Beirut , Lebanon
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11
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Banerjee PP, Pang L, Soldan SS, Miah SM, Eisenberg A, Maru S, Waldman A, Smith EA, Rosenberg-Hasson Y, Hirschberg D, Smith A, Ablashi DV, Campbell KS, Orange JS. KIR2DL4-HLAG interaction at human NK cell-oligodendrocyte interfaces regulates IFN-γ-mediated effects. Mol Immunol 2018; 115:39-55. [PMID: 30482463 DOI: 10.1016/j.molimm.2018.09.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 09/11/2018] [Accepted: 09/30/2018] [Indexed: 12/12/2022]
Abstract
Interactions between germline-encoded natural killer (NK) cell receptors and their respective ligands on tumorigenic or virus-infected cells determine NK cell cytotoxic activity and/or cytokine secretion. NK cell cytokine responses can be augmented in and can potentially contribute to multiple sclerosis (MS), an inflammatory disease of the central nervous system focused upon the oligodendrocytes (OLs). To investigate mechanisms by which NK cells may contribute to MS pathogenesis, we developed an in vitro human model of OL-NK cell interaction. We found that activated, but not resting human NK cells form conjugates with, and mediate cytotoxicity against, human oligodendrocytes. NK cells, when in conjugate with OLs, rapidly synthesize and polarize IFN-γ toward the OLs. IFN-γ is capable of reducing myelin oligodendrocyte and myelin associated glycoproteins (MOG and MAG) content. This activity is independent of MHC class-I mediated inhibition via KIR2DL1, but dependent upon the interaction between NK cell-expressed KIR2DL4 and its oligodendrocyte-expressed ligand, HLA-G. NK cells from patients with MS express higher levels of IFN-γ following conjugation to OLs, more actively promote in vitro reduction of MOG and MAG and have higher frequencies of the KIR2DL4 positive population. These data collectively suggest a mechanism by which NK cells can promote pathogenic effects upon OLs.
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Affiliation(s)
- P P Banerjee
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX-77030, USA; Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates St, Houston, TX, 77030, USA.
| | - L Pang
- Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates St, Houston, TX, 77030, USA
| | - S S Soldan
- The Wistar Institute, 3601 Spruce St., Philadelphia, PA 19104, USA
| | - S M Miah
- Blood Cell Development and Function Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - A Eisenberg
- The Children's Hospital of Philadelphia Research Institute, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - S Maru
- The Children's Hospital of Philadelphia Research Institute, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - A Waldman
- The Children's Hospital of Philadelphia Research Institute, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - E A Smith
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX-77030, USA; Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates St, Houston, TX, 77030, USA
| | - Y Rosenberg-Hasson
- Human Immune Monitoring Center, Stanford School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - D Hirschberg
- Human Immune Monitoring Center, Stanford School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - A Smith
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX-77030, USA; Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates St, Houston, TX, 77030, USA
| | - D V Ablashi
- Human Herpes Virus 6 Foundation, 1482 East Valley Road, Suite 619 Santa Barbara, CA 93108, USA
| | - K S Campbell
- Blood Cell Development and Function Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
| | - J S Orange
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX-77030, USA; Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates St, Houston, TX, 77030, USA
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12
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Mentis AFA, Dardiotis E, Grigoriadis N, Petinaki E, Hadjigeorgiou GM. Viruses and endogenous retroviruses in multiple sclerosis: From correlation to causation. Acta Neurol Scand 2017; 136:606-616. [PMID: 28542724 PMCID: PMC7159535 DOI: 10.1111/ane.12775] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 12/28/2022]
Abstract
Multiple sclerosis is an immune-mediated disease with an environmental component. According to a long-standing but unproven hypothesis dating to initial descriptions of multiple sclerosis (MS) at the end of the 19th century, viruses are either directly or indirectly implicated in MS pathogenesis. Whether viruses in MS are principally causal or simply contributory remains to be proven, but many viruses or viral elements-predominantly Epstein-Barr virus, human endogenous retroviruses (HERVs) and human herpesvirus 6 (HHV-6) but also less common viruses such as Saffold and measles viruses-are associated with MS. Here, we present an up-to-date and comprehensive review of the main candidate viruses implicated in MS pathogenesis and summarize how these viruses might cause or lead to the hallmark demyelinating and inflammatory lesions of MS. We review data from epidemiological, animal and in vitro studies and in doing so offer a transdisciplinary approach to the topic. We argue that it is crucially important not to interpret "absence of evidence" as "evidence of absence" and that future studies need to focus on distinguishing correlative from causative associations. Progress in the MS-virus field is expected to arise from an increasing body of knowledge on the interplay between viruses and HERVs in MS. Such interactions suggest common HERV-mediated pathways downstream of viral infection that cause both neuroinflammation and neurodegeneration. We also comment on the limitations of existing studies and provide future research directions for the field.
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Affiliation(s)
- A.-F. A. Mentis
- Department of Microbiology; University Hospital of Larissa; University of Thessaly; Larissa Greece
- The Johns Hopkins University, AAP; Baltimore MD USA
| | - E. Dardiotis
- Department of Neurology; University Hospital of Larissa; University of Thessaly; Larissa Greece
| | - N. Grigoriadis
- Laboratory of Experimental Neurology and Neuroimmunology; B’ Department of Neurology; AHEPA University Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - E. Petinaki
- Department of Microbiology; University Hospital of Larissa; University of Thessaly; Larissa Greece
| | - G. M. Hadjigeorgiou
- Department of Neurology; University Hospital of Larissa; University of Thessaly; Larissa Greece
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13
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Pormohammad A, Azimi T, Falah F, Faghihloo E. Relationship of human herpes virus 6 and multiple sclerosis: A systematic review and meta-analysis. J Cell Physiol 2017. [PMID: 28631829 DOI: 10.1002/jcp.26000] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infection with human herpes viruses has been suggested to contribute to multiple sclerosis (MS), while interaction between human herpes 6 (HHV6) and MS remain unclear yet. Here, we conducted a meta-analysis on the relationship of HHV6 infection and MS. All related studies were collected from major databases. The analyses were performed by STATA 14 and Comprehensive Meta-Analysis V2.0 softwares. Pooled odds ratios (ORs) and 95%CIs were calculated from the raw data of the including studies by the random effects models when I2 > 50% and fix model when I2 < 50%. Thirty nine studies were included in the meta-analysis that 34 studies used molecular assays and 7 studies used serological assays for diagnosis of HHV6 infected cases. The relationship of HHV6 and MS was significant in healthy control group by yielding a summary OR of (2.23 [1.5-3.3], p = 0.06). A significant HHV6 association with MS were in the studies with >6 score that used serum/blood sample with OR of (6.7 [95%CI 4.8-8.6], p < 0.00001) and in serological studies, IgM positive titer in other neurological diseases (OND) control group was significant with OR of (8.3 [95%CI 3-24.07], p < 0.00001). This study has been showed that there were significant relationship between MS and HHV6 infection.
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Affiliation(s)
- Ali Pormohammad
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taher Azimi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fateme Falah
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Faghihloo
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Gieß RM, Pfuhl C, Behrens JR, Rasche L, Freitag E, Khalighy N, Otto C, Wuerfel J, Brandt AU, Hofmann J, Eberspächer B, Bellmann-Strobl J, Paul F, Ruprecht K. Epstein-Barr virus antibodies in serum and DNA load in saliva are not associated with radiological or clinical disease activity in patients with early multiple sclerosis. PLoS One 2017; 12:e0175279. [PMID: 28388676 PMCID: PMC5384756 DOI: 10.1371/journal.pone.0175279] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/23/2017] [Indexed: 12/29/2022] Open
Abstract
Objective To investigate the association of Epstein-Barr virus (EBV) nuclear antigen-1 (EBNA-1) and viral capsid antigen (VCA) immunoglobulin (Ig)G antibodies in serum as well as EBV DNA load in saliva with radiological and clinical disease activity in patients with clinically isolated syndrome (CIS) and early relapsing-remitting MS (RRMS). Methods EBNA-1 and VCA immunoglobulin (Ig)G antibodies were determined in serum of 100 patients with CIS/early RRMS and 60 healthy controls. EBV DNA load was measured in saliva of 48 patients and 50 controls. Patients underwent clinical assessment with the Expanded Disability Status Scale (EDSS) and 3 Tesla magnetic resonance imaging at baseline and after a median of 20 months of follow-up (n = 63 for MRI, n = 71 for EDSS). The association of EBV parameters with occurrence of a second relapse, indicating conversion to clinically definite MS (CDMS), was evaluated over a median of 35 months of follow-up after the first clinical event (n = 89). Results EBNA-1 IgG antibody frequency (p = 0.00005) and EBNA-1 and VCA IgG antibody levels (p<0.0001 for both) were higher in patients than in controls. EBV DNA load in saliva did not differ between groups. Neither EBV antibody levels nor DNA load in saliva were associated with baseline or follow-up number or volume of T2-weighted (T2w) or contrast enhancing lesions, number of Barkhof criteria or the EDSS, or with the number of new T2w lesions, T2w lesion volume change or EDSS change on follow-up. Likewise, levels of EBV IgG antibodies in serum and DNA load in saliva were not associated with conversion to CDMS. Conclusions While these findings confirm the association of EBV infection with early MS, neither EBNA-1 nor VCA IgG antibodies in serum nor EBV DNA load in saliva were associated with radiological or clinical disease activity in patients with CIS/early RRMS. These data are compatible with the concept that EBV may be a trigger for MS acting very early during the development of the disease.
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Affiliation(s)
- René M. Gieß
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Catherina Pfuhl
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Janina R. Behrens
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ludwig Rasche
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Erik Freitag
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nima Khalighy
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jens Wuerfel
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- MIAC AG and Dep. for Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Alexander U. Brandt
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jörg Hofmann
- Labor Berlin Charité-Vivantes GmbH, Berlin, Germany
- Institute of Medical Virology, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Bettina Eberspächer
- Labor Berlin Charité-Vivantes GmbH, Berlin, Germany
- Vivantes Klinikum Neukölln, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany
| | - Friedemann Paul
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin-Buch, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
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15
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Skuja S, Zieda A, Ravina K, Chapenko S, Roga S, Teteris O, Groma V, Murovska M. Structural and Ultrastructural Alterations in Human Olfactory Pathways and Possible Associations with Herpesvirus 6 Infection. PLoS One 2017; 12:e0170071. [PMID: 28072884 PMCID: PMC5224992 DOI: 10.1371/journal.pone.0170071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 12/28/2016] [Indexed: 12/11/2022] Open
Abstract
Structural and ultrastructural alterations in human olfactory pathways and putative associations with human herpesvirus 6 (HHV-6) infection were studied. The olfactory bulb/tract samples from 20 subjects with an unspecified encephalopathy determined by pathomorphological examination of the brain autopsy, 17 healthy age-matched and 16 younger controls were used. HHV-6 DNA was detected in 60, 29, and 19% of cases in these groups, respectively. In the whole encephalopathy group, significantly more HHV-6 positive neurons and oligodendrocytes were found in the gray matter, whereas, significantly more HHV-6 positive astrocytes, oligodendrocytes, microglia/macrophages and endothelial cells were found in the white matter. Additionally, significantly more HHV-6 positive astrocytes and, in particular, oligodendrocytes were found in the white matter when compared to the gray matter. Furthermore, when only HHV-6 PCR+ encephalopathy cases were studied, we observed similar but stronger associations between HHV-6 positive oligodendrocytes and CD68 positive cells in the white matter. Cellular alterations were additionally evidenced by anti-S100 immunostaining, demonstrating a significantly higher number of S100 positive cells in the gray matter of the whole encephalopathy group when compared to the young controls, and in the white matter when compared to both control groups. In spite the decreased S100 expression in the PCR+ encephalopathy group when compared to PCR- cases and controls, groups demonstrated significantly higher number of S100 positive cells in the white compared to the gray matter. Ultrastructural changes confirming the damage of myelin included irregularity of membranes and ballooning of paranodal loops. This study shows that among the cellular targets of the nervous system, HHV-6 most severely affects oligodendrocytes and the myelin made by them.
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Affiliation(s)
- Sandra Skuja
- Institute of Anatomy and Anthropology, Riga Stradins University, Riga, Latvia
- * E-mail:
| | - Anete Zieda
- Institute of Anatomy and Anthropology, Riga Stradins University, Riga, Latvia
| | - Kristine Ravina
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Svetlana Chapenko
- A. Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia
| | - Silvija Roga
- Department of Pathology, Riga 1st Hospital, Riga, Latvia
| | - Ojars Teteris
- Latvian State Centre for Forensic Medical Examination, Riga, Latvia
| | - Valerija Groma
- Institute of Anatomy and Anthropology, Riga Stradins University, Riga, Latvia
| | - Modra Murovska
- A. Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia
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16
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Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) characterized by loss of motor and sensory function that results from immune-mediated inflammation, demyelination, and subsequent axonal damage. Clinically, most MS patients experience recurrent episodes (relapses) of neurological impairment, but in most cases (60–80%) the course of the disease eventually becomes chronic and progressive, leading to cumulative motor, sensory, and visual disability, and cognitive deficits. The course of the disease is largely unpredictable and its clinical presentation is variable, but its predilection for certain parts of the CNS, which includes the optic nerves, the brain stem, cerebellum, and cervical spinal cord, provides a characteristic constellation of signs and symptoms. Several variants of MS have been nowadays defined with variable immunopathogenesis, course and prognosis. Many new treatments targeting the immune system have shown efficacy in preventing the relapses of MS and have been introduced to its management during the last decade.
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17
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Tao C, Simpson S, Taylor BV, van der Mei I. Association between human herpesvirus & human endogenous retrovirus and MS onset & progression. J Neurol Sci 2016; 372:239-249. [PMID: 28017222 DOI: 10.1016/j.jns.2016.11.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/02/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
This review discusses the role of Epstein-Barr virus (EBV), human herpesvirus 6 (HHV6) and human endogenous retroviruses (HERVs) in the onset and progression of multiple sclerosis (MS). Although EBV has been established as one of the causal factors in MS onset, its role in MS progression is still uncertain. Moreover, interactions between EBV and other risk factor on MS development still need more investment. With less consistent evidence than EBV, HHV6 has also been implicated in the pathogenesis of MS; moreover, it showed a closer connection with the disease activity. Recent studies found that HERVs were associated with the development and progression of MS. Some antiviral treatments have shown promise for clinical interventions in the future. Future studies are yet needed to fully clarify the role of these agents in MS onset and disease course and the modes by which they realise these effects.
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Affiliation(s)
- Chunrong Tao
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Australia.
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18
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Grytten N, Torkildsen Ø, Myhr K. Time trends in the incidence and prevalence of multiple sclerosis in Norway during eight decades. Acta Neurol Scand 2016; 132:29-36. [PMID: 26046556 PMCID: PMC4657466 DOI: 10.1111/ane.12428] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 11/28/2022]
Abstract
Norway has been subjected to numerous epidemiological investigations on the prevalence and incidence of multiple sclerosis (MS), dating back to 1935. The objective of this study was to review the studies on the prevalence and incidence of MS in Norway, provide an update on the prevalence of MS in Norway, and describe the time trends in the prevalence and incidence of MS in relation to risk factors, case ascertainment, and data. We performed a systematic search on PubMed and MEDLINE up to November 2014 using the search string ‘multiple sclerosis prevalence in Norway’ or ‘multiple sclerosis incidence in Norway’. In addition, we scrutinized the reference lists of the publications identified for relevant citations. We retrieved data on the distribution of MS in Norway on December 31, 2013 from the Norwegian Multiple Sclerosis Registry and Biobank and the Norwegian Patient Registry. We identified 29 articles. From 1961 to 2014, the reported prevalence of MS increased from 20 to 203 per 100,000 inhabitants, and the incidence increased from 1.9 to 8.0 per 100,000. The nationwide crude prevalence in Norway, based on the Norwegian Patient Registry, was 208 per 100,000 on December 31, 2013. The reported prevalence of MS in Norway has increased 10-fold, with several possible causes. During eight decades, neurological health services have generally become more accessible to the population, and transforming diagnostic criteria has made the diagnosis of MS more precise and valid. There have also been changes in lifestyle behavior and known risk factors, such as vitamin D and smoking, that might have contributed to the increased incidence of MS. A possible role of increased survival in MS needs to be examined further. This article is commented on by Berg-Hansen et al, published in 132: 364–367 (DOI: 10.1111/ane.12489).
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Affiliation(s)
- N. Grytten
- KG Jebsen MS Research Centre Department of Clinical Medicine University of Bergen Bergen Norway
- Norwegian Multiple Sclerosis Competence Centre Department of Neurology Haukeland University Hospital Bergen Norway
| | - Ø. Torkildsen
- KG Jebsen MS Research Centre Department of Clinical Medicine University of Bergen Bergen Norway
- Norwegian Multiple Sclerosis Competence Centre Department of Neurology Haukeland University Hospital Bergen Norway
| | - K.‐M. Myhr
- KG Jebsen MS Research Centre Department of Clinical Medicine University of Bergen Bergen Norway
- Norwegian Multiple Sclerosis Registry and Biobank Department of Neurology Haukeland University Hospital Bergen Norway
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19
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Reiss CS. Virus-Induced Demyelination: The Case for Virus(es) in Multiple Sclerosis. NEUROTROPIC VIRAL INFECTIONS 2016. [PMCID: PMC7122906 DOI: 10.1007/978-3-319-33189-8_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Multiple Sclerosis (MS) is the most common demyelinating disease of man with over 400,000 cases in the United States and over 2.5 million cases worldwide. There are over 64,000 citations in Pubmed dating back as far as 1887. Much has been learned over the past 129 years with a recent burst in therapeutic options (mostly anti-inflammatory) with newer medications in development that are neuroprotective and/or neuroreparative. However, with all these advancements the cause of MS remains elusive. There is a clear interplay of genetic, immunologic, and environmental factors that influences both the development and progression of this disorder. This chapter will give a brief overview of the history and pathogenesis of MS with attention to how host immune responses in genetically susceptible individuals contribute to the MS disease process. In addition, we will explore the role of infectious agents in MS as potential “triggers” of disease. Models of virus-induced demyelination will be discussed, with an emphasis on the recent interest in human herpesviruses and the role they may play in MS disease pathogenesis. Although we remain circumspect as to the role of any microbial pathogen in MS, we suggest that only through well-controlled serological, cellular immune, molecular, and animal studies we will be able to identify candidate agents. Ultimately, clinical interventional trials that either target a specific pathogen or class of pathogens will be required to make definitive links between the suspected agent and MS.
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Affiliation(s)
- Carol Shoshkes Reiss
- Departments of Biology and Neural Science, New York University, New York, New York USA
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20
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Latham LB, Lee MJ, Lincoln JA, Ji N, Forsthuber TG, Lindsey JW. Antivirus immune activity in multiple sclerosis correlates with MRI activity. Acta Neurol Scand 2016; 133:17-24. [PMID: 25939660 DOI: 10.1111/ane.12417] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this study was to determine whether reactivation of Epstein-Barr (EBV) or activation of the anti-EBV immune response correlates with MS disease activity on MR imaging. METHODS Subjects with early, active relapsing-remitting MS were studied for 16 weeks with blood and saliva samples collected every 2 weeks and brain MRI performed every 4 weeks. We isolated peripheral blood mononuclear cells from each blood sample and tested the immune response to EBV, autologous EBV-infected lymphoblastoid cell lines (LCL), human herpesvirus 6 (HHV6), varicella zoster virus (VZV), tetanus, and mitogens. We measured the proliferative response and the number of interferon-γ secreting cells with ELISPOT. We measured the amounts of EBV, HHV6, and VZV DNA in blood and saliva with quantitative PCR. On MRI, we measured number and volume of contrast enhancing and T2 lesions. We tested for correlation between the immunologic assays and the MRI results, assessing different time intervals between the MRI and immunologic assays. RESULTS We studied 20 subjects. Ten had enhancing lesions on one or more MRI scans and one had new T2 lesions without enhancement. The most significant correlation was between proliferation to autologous LCL and the number of combined unique active lesions on MRI 4 weeks later. Both proliferation and number of cells secreting interferon-γ in response to LCL correlated with the number of enhancing lesions 8 weeks later. CONCLUSIONS We find evidence for correlation of antiviral immune responses in the blood with subsequent disease activity on MRI scans.
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Affiliation(s)
- L. B. Latham
- Department of Neurology; University of Texas Health Science Center at Houston; Houston TX USA
| | - M. J. Lee
- Clinical and Translational Sciences; University of Texas Health Science Center at Houston; Houston TX USA
| | - J. A. Lincoln
- Department of Neurology; University of Texas Health Science Center at Houston; Houston TX USA
| | - N. Ji
- Department of Biology; University of Texas San Antonio; San Antonio TX USA
| | - T. G. Forsthuber
- Department of Biology; University of Texas San Antonio; San Antonio TX USA
| | - J. W. Lindsey
- Department of Neurology; University of Texas Health Science Center at Houston; Houston TX USA
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21
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Steelman AJ. Infection as an Environmental Trigger of Multiple Sclerosis Disease Exacerbation. Front Immunol 2015; 6:520. [PMID: 26539193 PMCID: PMC4609887 DOI: 10.3389/fimmu.2015.00520] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/24/2015] [Indexed: 01/19/2023] Open
Abstract
Over the past several decades, significant advances have been made in identifying factors that contribute to the pathogenesis of multiple sclerosis (MS) and have culminated in the approval of some effective therapeutic strategies for disease intervention. However, the mechanisms by which environmental factors, such as infection, contribute to the pathogenesis and/or symptom exacerbation remain to be fully elucidated. Relapse frequency in MS patients contributes to neurological impairment and, in the initial phases of disease, serves as a predictor of poor disease prognosis. The purpose of this review is to examine the evidence that supports a role for peripheral infection in modulating the natural history of this disease. Evidence supporting a role for infection in promoting exacerbation in animal models of MS is also reviewed. Finally, a few mechanisms by which infection may exacerbate symptoms of MS and other neurological diseases are discussed. Those who comprise the majority of MS patients acquire approximately two upper-respiratory infections per year; furthermore, this type of infection doubles the risk for MS relapse, underscoring the contribution of this relationship as being potentially important and particularly detrimental.
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Affiliation(s)
- Andrew J Steelman
- Department of Animal Sciences, College of Agricultural, Consumer and Environmental Sciences, University of Illinois Urbana-Champaign , Urbana, IL , USA ; Neuroscience Program, University of Illinois Urbana-Champaign , Urbana, IL , USA ; Division of Nutritional Sciences, University of Illinois Urbana-Champaign , Urbana, IL , USA
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22
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Munger KL, Fitzgerald KC, Freedman MS, Hartung HP, Miller DH, Montalbán X, Edan G, Barkhof F, Suarez G, Radue EW, Sandbrink R, Kappos L, Pohl C, Ascherio A. No association of multiple sclerosis activity and progression with EBV or tobacco use in BENEFIT. Neurology 2015; 85:1694-701. [PMID: 26453645 DOI: 10.1212/wnl.0000000000002099] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/13/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate whether Epstein-Barr virus (EBV) immunoglobulin G (IgG) antibody levels or tobacco use were associated with conversion to multiple sclerosis (MS) or MS progression/activity in patients presenting with clinically isolated syndrome (CIS). METHODS In this prospective, longitudinal study, we measured EBV IgG antibody and cotinine (biomarker of tobacco use) levels at up to 4 time points (baseline, months 6, 12, and 24) among 468 participants with CIS enrolled in the BENEFIT (Betaferon/Betaseron in Newly Emerging Multiple Sclerosis for Initial Treatment) clinical trial. Outcomes included time to conversion to clinically definite or McDonald MS, number of relapses, Expanded Disability Status Scale (EDSS) changes, brain and T2 lesion volume changes, and number of new active lesions over 5 years. Analyses were adjusted for age, sex, treatment allocation, baseline serum 25-hydroxyvitamin D level, number of T2 lesions, body mass index, EDSS, steroid treatment, and CIS onset type. RESULTS We found no associations between any EBV IgG antibody or cotinine levels with conversion from CIS to MS or MS progression as measured by EDSS or activity clinically or on MRI. The relative risk of conversion from CIS to clinically definite MS was 1.14 (95% confidence interval 0.76-1.72) for the highest vs the lowest quintile of EBNA-1 IgG levels, and 0.96 (95% confidence interval 0.71-1.31) for cotinine levels >25 ng/mL vs <10. CONCLUSIONS Neither increased levels of EBV IgG antibodies, including against EBNA-1, nor elevated cotinine levels indicative of tobacco use, were associated with an increased risk of CIS conversion to MS, or MS activity or progression over a 5-year follow-up.
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Affiliation(s)
- Kassandra L Munger
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany.
| | - Kathryn C Fitzgerald
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Mark S Freedman
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Hans-Peter Hartung
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - David H Miller
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Xavier Montalbán
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Gilles Edan
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Frederik Barkhof
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Gustavo Suarez
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Ernst-Wilhelm Radue
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Rupert Sandbrink
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Ludwig Kappos
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Christoph Pohl
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
| | - Alberto Ascherio
- From the Departments of Nutrition (K.L.M., K.C.F., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Ottawa Hospital Research Institute (M.S.F.), Canada; Heinrich-Heine Universität (H.-P.H., R.S.), Düsseldorf, Germany; UCL Institute of Neurology (D.H.M.), London, UK; Hospital Universitari Vall d'Hebron (X.M.), Barcelona, Spain; CHU-Hôpital Pontchaillou (G.E.), Rennes, France; VU University Medical Center (F.B.), Amsterdam, the Netherlands; Bayer HealthCare Pharmaceuticals (G.S.), Montville, NJ; Medical Image Analysis Center (E.-W.R.), and Neurology, Departments of Medicine, Clinical Research and Biomedicine (L.K., C.P.), University Hospital Basel, Switzerland; Bayer HealthCare (R.S.), Berlin; and Department of Neurology (C.P.), University Hospital of Bonn, Germany
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Mouhieddine TH, Darwish H, Fawaz L, Yamout B, Tamim H, Khoury SJ. Risk factors for multiple sclerosis and associations with anti-EBV antibody titers. Clin Immunol 2015; 158:59-66. [DOI: 10.1016/j.clim.2015.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 12/18/2022]
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Leibovitch EC, Jacobson S. Evidence linking HHV-6 with multiple sclerosis: an update. Curr Opin Virol 2014; 9:127-33. [PMID: 25462444 PMCID: PMC4269240 DOI: 10.1016/j.coviro.2014.09.016] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022]
Abstract
Following reports of elevated antiviral antibodies in MS patient sera and viral DNA detection in MS plaques nearly two decades ago, the neurovirology community has actively explored how herpesviruses such as HHV-6 might be involved in MS disease pathogenesis. Though findings across the field are non-uniform, an emerging consensus of viral correlates with disease course and evidence of HHV-6-specific immune responses in the CNS provide compelling evidence for a role, direct or indirect, of this virus in MS. Ultimately, the only way to demonstrate the involvement, or lack thereof, of HHV-6 or other herpesviruses in this disease is through a controlled clinical trial of an efficacious antiviral drug.
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Affiliation(s)
- Emily C Leibovitch
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Institute for Biomedical Sciences, School of Medicine and Health Sciences of The George Washington University, Washington, DC, USA
| | - Steven Jacobson
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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