Multiple Sclerosis is Likely Caused by a Virus, Says Study

US military study suggests that the Epstein-Barr virus may be a leading cause of Multiple Sclerosis (MS). Image courtesy of HealthCentral.

Multiple Sclerosis (MS), a debilitating autoimmune disease, may in fact be caused by a virus, suggests a new study published in Science by Harvard Medical School Researchers.

The researchers tested a cohort of more than 10 million young adults on active duty in the US military between 1993 and 2013. During this 20-year timeframe, 955 individuals were diagnosed with MS over the course of their period of service. The researchers found that the risk of MS increased 32-fold after infection with the Epstein-Barr virus, known as EBV for short.

MS is a chronic inflammatory demyelinating disease of the central nervous system. The chronic inflammation occurs when the immune system mistakenly attacks the protective sheath (myelin) that covers nerve fibers, causing communication problems between your brain and the rest of your body. According to the Mayo Clinic, the disease can eventually cause permanent damage or deterioration of the nerves. Other symptoms include vision problems, slurred speech, fatigue, dizziness, tingling or pain in parts of the body, and bowel, bladder, and sexual dysfunction.

Multiple Sclerosis and the Epstein-Barr Virus

Although the exact cause of multiple sclerosis is unknown, it has long been hypothesized that the demyelination in the brain and spinal course is triggered by a viral infection. This particular study found that serum levels of neurofilament light chain, a biomarker of neuroaxonal degeneration, increased only after EBV seroconversion, suggesting that EBV is a leading cause of MS. However, the risk of MS was not increased after infection with other viruses, such as the cytomegalovirus (CMV); the researchers had also compared samples to CMV positivity as a negative control group, and found that CMV positivity was actually associated with a lower risk of MS.

“The key finding is that MS is a complication of infection with EBV,” said Alberto Ascherio, a professor of epidemiology and nutrition at Harvard’s T.H. Chan School of Public Health. Commenting on the size and longevity of the study, Ascherio said: “There is no comparable population in the world.”

Stanford University researchers believe that molecular mimicry may be the culprit behind why those infected with Epstein-Barr have a higher risk of developing MS. Molecular mimicry occurs when immune cells targeting EBV accidentally attack myelin, due to the molecular similarities between the virus and this tissue. A 2018 study identified EBV-infected B cells in the brains of MS patients, lending support to the molecular mimicry theory.

Deficiency of vitamin D from the sun may also play a role in the development of MS. Image courtesy of Minnesota Oncology.

Multiple Sclerosis: Vitamin D Deficiency and Genetic Factors

It’s unlikely that EBV is the sole reason behind the development of MS, however. The study suggests that EBV seropositivity is necessary to develop MS, but it isn’t sufficient – otherwise, 95% of the world’s population would have MS, since the virus is prevalent worldwide. According to the UK-based Multiple Sclerosis Trust, an estimated 2.5 million people worldwide have multiple sclerosis. So why do only some people develop MS and not others?

Another theory about the development of MS is vitamin D deficiency. Vitamin D, also known as the sunshine vitamin, may be a protective compound against the development of MS; it has been found, for instance, that the distribution of MS around the world is uneven; generally, the prevalence of the disease increases as you travel further north or south from the equator. The parts of Asia, Africa and America that lie on the equator have extremely low levels of MS, while Canada and Scotland have particularly high rates. This suggests that vitamin D, particularly from the sun, is important in preventing MS, possibly due to its anti-inflammatory properties.

Other studies have shown that certain ethnic groups have a markedly lower prevalence of MS, despite living in places where the disease is more common. For example, the Sami or Lapps of northern Scandinavia, the Inuits of Canada and Greenland (Denmark), and the Maoris of New Zealand exhibit very low rates of MS, despite living in some of the northernmost and southernmost climates in the world.

The Inuit people of Canada and Greenland have very low rates of MS among their population, despite living in some of the northernmost regions of the world. Photo courtesy of The Paleo Diet.

Multiple Sclerosis and Diet

Another theory that has evolved is the relationship between Multiple Sclerosis and one’s diet. As noted above, many northernmost communities do not get sufficient vitamin D from the sun, due to their local climate. However, they make up for this by consuming a vitamin D-rich diet; for example, fish and marine mammals like seal and whale. These foods are also rich in healthy omega-3 fatty acids, which are also known to have anti-inflammatory properties and may help other autoimmune conditions beyond MS, like rheumatoid arthritis, Crohn’s disease, ulcerative colitis, and systemic lupus erythematosus.

Although considered controversial to some, Dr. Terry Wahls, who has multiple sclerosis herself, developed a dietary approach to treating autoimmune conditions with paleo principals, which she calls the Wahls Protocol.

New Ways to Treat MS

Ascherio, for his part, believes that his team’s groundbreaking research on the connection between viruses like Epstein-Barr and MS could pioneer the development of new multiple sclerosis treatments. For example, immunosuppressive therapies that deplete B cells infected by EBV.

There is also renewed interest in developing vaccines and antivirals against EBV with the objective of eradicating MS. While antivirals targeting EBV don’t yet exist, Ascherio says their development is realistic: “Once you establish the causal connection, I think it’s a question of providing sufficient rational for research on antivirals, specifically for EBV, that could help people with MS [around] the world,” he concluded.

March is Autoimmune Disease Awareness Month

According to the American Autoimmune & Related Diseases Association (AARDA), March is officially Autoimmune Disease Awareness Month (ADAM)! During this month, the organization works to raise awareness about autoimmune diseases among the general public. With increased awareness about autoimmune diseases, the AARDA says that they will be able to secure more funding for medical research, new treatment options, and improved patient diagnostics.

According to the AARDA, there are over 100 known autoimmune diseases, which are responsible for causing widespread chronic illness and pain. While many individuals have heard of at least one autoimmune disease, like rheumatoid arthritis, lupus, multiple sclerosis, type 1 diabetes, or Crohn’s disease, few members of the general public know that these conditions are autoimmune in nature, and all stem from the commonality of an overactive immune system.

There is also widespread misinformation about the term ‘autoimmune’. I once read on the Reddit forum r/autoimmune about a woman who, during a doctor’s appointment, told a nurse that she had an autoimmune disease. The nurse thought that this meant that the patient had HIV/AIDS, which is not an autoimmune disease, but rather an immunodeficiency caused by a virus. These misconceptions about autoimmune disease are another reason why it’s important to raise awareness and educate the public – and even healthcare professionals – about this cause.

While the exact number of autoimmune disease patients is unknown, it’s estimated that autoimmune conditions impact over 24 million Americans. An additional 8 million Americans have auto-antibodies, blood molecules that may predispose them to developing an autoimmune disease in the future. This isn’t counting the many individuals who go undiagnosed as a result of their symptoms being dismissed, a misdiagnosis, or due to their healthcare provider lacking knowledge about autoimmune disease.

Autoimmune diseases are also a leading cause of death and disability. Dr. Anthony Fauci, a leading allergy and disease expert, estimated back in 2001 that autoimmune disease treatment costs in the US exceeded $100 billion annually. While this may seem like a staggering figure, it’s possible that the true cost is much higher, since, as noted above, many individuals go undiagnosed or are misdiagnosed, and new autoimmune diseases are being discovered with each passing year. Furthermore, a more recent 2020 study showed that the incidence of autoimmune disease is on the rise in the US – so these cost figures (which are now 20 years old), are most likely continuing to increase.

The fact that autoimmune diseases pose an extreme burden on our healthcare system is just another reason that it’s important for the general public to be educated about these conditions, and why more resources need to be dedicated towards research and finding a cure.

So what can you do to help? If you or someone you love has an autoimmune disease, consider raising awareness (with the patient’s permission, of course), by posting about it on social media with the hashtag #ADAM for Autoimmune Disease Awareness Month. By sharing your story or the stories of others, you can raise awareness and be a voice for the millions of people suffering from autoimmune diseases worldwide.

Thanks for reading our blog! For autoimmune disease news and blog articles delivered straight to your inbox, consider subscribing to our mailing list.

Why Autoimmune Patients with COVID-19 Should Beware of the Cytokine Storm

As the SARS-CoV-2 virus responsible for the COVID-19 disease continues to infect people and claim lives across the globe, scientists and medical professionals are learning more about its impact on patients.

One interesting phenomenon that’s been observed is that some coronavirus patients experience relatively mild to moderate symptoms, while others experience severe, life-threatening problems that can land them in the ER. According to Sharp Health News, the virus itself may not be entirely to blame for this, but rather, an overreaction by the body’s immune system.

When a foreign agent, such as a virus, invades your body, your immune cells secrete cytokines, which are molecules that initiate an immune response. However, in some cases, immune cells continue to secrete cytokines, even after a sufficient immune response has been mounted. This is called a ‘cytokine storm’ and the overproduction of these molecules can cause a harmful inflammatory response in the body.

Certain people are more susceptible to cytokine storms than others; for example, there is evidence that those with genetic mutations in their immune cells are more vulnerable. According to creakyjoints.org, those with autoimmune conditions often have abnormally high levels of these cytokines, which is why autoimmune patients often take immune-suppressing medications. However, a cytokine storm isn’t the same as an autoimmune disease flare, though they can be related.

As detailed by creakyjoints.org, some autoimmune patients end up with cytokine storms unrelated to COVID-19. Dr. Randy Cron, a pediatric rheumatologist and author of the book Cytokine Storm Syndrome commented, “About 10% of patients with juvenile idiopathic arthritis will experience [a cytokine storm]; in some cases, multiple times.”

With regards to COVID-19, which is respiratory in nature, a cytokine storm can gravely impact a patient. Acute lung injury (ALI) is a common consequence of a cytokine storm occurring in the lungs, and if a lung infection is severe, the inflammation will spread to the rest of the body via one’s blood circulation and cause sepsis. In some cases, the immune response to an infection can even be deadly.

That’s why it’s important to ‘calm the storm’ and prevent a cytokine storm before it even happens. One type of treatment being explored for COVID-19 is hydroxychloroquine, which is an antiviral and immunosuppressant drug used to treat malaria and autoimmune diseases like lupus, rheumatoid arthritis (RA) and Sjogren’s. Although the medication is still undergoing clinical trials, many are hopeful that this drug will serve as a treatment to halt the progression of COVID-19.

Besides pharmaceutical therapies, Sharp Health News cites curcumin, a compound found in turmeric, as beneficial for its anti-inflammatory properties. A 2015 study states that in lab experiments, researchers found that curcumin blocked the release of the cytokines that are responsible for inflammation.

All in all, it’s important for autoimmune patients to guard against the coronavirus by adhering to strict hygiene guidelines, such as hand washing thoroughly with soap and water, avoiding close contact with others, and disinfecting surfaces routinely. Remember, prevention is the best form of treatment, and can help those with autoimmune disease to avoid a damaging cytokine storm.