Thursday, 14 January 2016

CrowdSpeak & ResearchSpeak: EBV and the genetic risk of MS

Could EBV interact with genes that predispose you to getting MS? #MSResearch #CrowdSpeak #CrowdacureMS

"I would like to thank those of you who donated money to our Crowdfunding project; it is much appreciated. If you haven't donated yet please consider doing it. The research we are doing will allow us finalise the power calculations to find the correct dose of anti-EBV drug we plan to use in the ARTEMIS study. If you recall you helped design and name this study and some of you recommended we use crowdfunding to get this project off the ground. We therefore view this experiment, the fund raising and the ARTEMIS study, as enabling the crowd."

Click here to find out more!

"We refer to MS as being a complex disease; i.e. a disease that occurs due to an interaction between your genes and the environment. This doesn't exclude one environmental factor as being pivotal in the causal pathway, in other words if that factor is absent you won't get MS. This is why the observation that MS does not occur in people who don't have EBV is so important. There are some studies who have described a small number of pwMS who are EBV negative, however, most of these studies have used simple antibody, or serological, assays to assess EBV positivity. When you limit the analysis to studies using more than one technique to assess EBV infection positivity rates are 100%. This is why many of us in the field are very keen to get an EBV vaccination study off the ground to  test whether by preventing EBV infection we can prevent MS. Unfortunately, we don't have a protective EBV vaccine at present. I am hopeful this will change in the near future. I am aware that the NIH are working on a new EBV vaccine."

"Could EBV be associated with MS by interacting with the main genetic MS susceptibility genes? The meta-analysis below looks at the interaction between EBV infection and the presence of the main susceptibility gene (HLA-DRB1*1501). The authors find that there is a minor interaction between them; in statistical speak this interaction is additive and not multiplicative. My problem with this meta-analysis is that it includes data from studies that have determined the presence, or absence, of EBV infection with simple serological studies. In other words the pwMS who are EBV-negative in these studies are likely to be EBV-positive if they were tested using more sensitive techniques."

"Another obvious question to ask is: could the link between infectious mononucleosis (IM) and MS be explained by genetic factors, in other words do the genes that increase your susceptibility to getting MS simply increase your chances of getting IM? We looked at this several years ago and excluded this possibility in relation to the main genetic risk factor HLA. Therefore it looks as if the link between IM and MS cannot simply be explained by a common genetic factor."

"Based on these and other observation we hypothesise that there must be something specific to the biology of EBV that will explain how it triggers and/or drives MS. This is the main reason why we set-up the Charcot Project." 


Xiao et al. A meta-analysis of interaction between Epstein-Barr virus and HLA-DRB1*1501 on risk of multiple sclerosis. Sci Rep. 2015 Dec 11;5:18083. doi: 10.1038/srep18083.

Background: Infection with Epstein-Barr virus (EBV) and HLA-DRB1*1501-positivity is a risk factor for multiple sclerosis (MS), but whether an interaction between these two factors causes MS is unclear. 

Objective: We therefore conducted a meta-analysis on the effect of the interaction between HLA-DRB1*1501 and EBV infection on MS. 

Methods: Searches of PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and the Wanfan databases through February 2015 yielded 5 studies that met the criteria for inclusion in the meta-analysis. EBV infection and HLA-DRB1*1501-positivity were dichotomized. The additive (S) and multiplicative interaction indexes (OR) between EBV infection and HLA-DRB1*1501 and their 95% confidence intervals (95%CI) were calculated for each study and then combined in a meta-analysis. 

Results: EBV infection was significantly associated with MS (OR = 2.60; 95%CI, 1.48-4.59). HLA-DRB1*1501 was associated with a significantly increased risk of MS (OR, 3.06; 95%CI, 2.30-4.08). An interaction effect between EBV infection and HLA-DRB1*1501 on MS was observed on the additive scale (S, 1.43; 95%CI, 1.05-1.95, P = 0.023), but no interaction effect was observed on the multiplicative scale (OR, 0.86, 95%CI, 0.59-1.26). 

Conclusion: This meta-analysis provides strong evidence that EBV alone, HLA-DRB1*1501 alone or their interaction is associated with an elevated risks of MS.

CoI: Team G will be recipients of a grant from Crowdacure to perform this research

6 comments:

  1. how can you use the study to identify the dose of drug when you are not even testing the drug? please share some info on the effect of the drug on ebv shedding.

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    1. Re: "how can you use the study to identify the dose of drug when you are not even testing the drug? please share some info on the effect of the drug on ebv shedding."

      The results of this study will be used to power the anti-viral dose finding study. Please see my previous post that explains it.

      http://multiple-sclerosis-research.blogspot.com/2016/01/crowdspeak-power-calculations-for.html

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  2. Autoimmune diseases tend to run in families.

    How does the EBV-hypothesis explain this?

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    1. It cannot just be the virus, otherwise everyone would get MS who got the virus. Epstein Barr causes at least one type of Hodgkin's Lymphoma but very few who get the virus develop the cancer. It is the interaction of the virus with the immune system, and for some reason the age you catch the virus. So it can run in families but the causal agent is the virus.

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  3. Oh Thank Prof. G of this text!!!
    That was one of the difficulties I faced (and still I face) to try to bring more donors for Charcot II study design. Many tell me "oh but I tested for all viruses and all were negative", or "ah so remember never had mono", or "ah to explain why this hypothesis I have MS and my uncle".
    I have told them all these questions may well be answered within 02, 03 years maybe (I don't know the duration for which it was drawn up Charcot 2) if the project get off the ground, and for this we need to donate!
    We will not know the answers to the clinical trial is realized. There to study all trying to find a correlation with EM "vitamin D, genes, cats, stress, red meat, bacteria, vaccines, processed foods, mercury, cigarette, etc.".
    I think this time I have been following what has been and what is being done to find the causation of MS I've seen everything. And every time delves into the genome another gene enters the susceptibility role for the disease, soon we will have about 300 genes, so why not look at what the EBV can tell us about MS? ...

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  4. Prof G. dutch researchers verified the existence of a "secret communication" to the white blood cells, via exosomes, and in people with disordered immune mechanism saves just run away with chronic infections as a result. They are looking for this mechanism in the LES, but seems to be more a study that supports the idea of ​​the existence of Charcot 2 ...

    "White blood cells infected with the Epstein Barr virus (such as glandular fever), activate immune cells so that the virus does not predominate, and the person remains healthy.

    This is done with a secret message that are transmitted through tiny vesicles (exosomes) from one cell to another. In people with disordered immune mechanism saves just runaway with chronic infections as a result. Unraveling the mechanism may contribute to a better treatment of autoimmune diseases but also cancer. VUmc researcher Pegtel and his colleagues published here this week in the prestigious journal PNAS.

    Almost every human being has the Epstein Barr Virus (EBV) in a very small percentage of their white blood cells. However, the virus is inactive (latent) and most people will never notice. Until now it was thought that the virus was invisible to the immune system, but that turns out not to be so. "In fact, the virus appears to send a message via exosomes - tiny sacs - the white blood cells to immune cells," said research molecular biologist Michael Pegtel. This mechanism maintains the delicate balance between man and virus in position whereby man remains healthy. In people with a defective EBV, however, the immune system can expand so that there is more than exosomes normally circulate in the blood. The message spread exosomes do store special alarm cells of the immune system haywire and so may produce inflammation. The researchers show that this is possible in the skin of people with the autoimmune disease lupus erythematosus (SLE, also known as Lupus) is done.

    Same mechanism in cancer
    Exosomes frequently also circulate in the blood of patients with cancer. The results of research Pegtels very similar to vanAmerikaans onderzoekdat showed that cells under stress similar messages spread via exosomes, and thus resistance to anti-cancer therapy work in hand. Pegtel is enthusiastic: "If we can further understand and unravel this mechanism, it offers many opportunities for the treatment of several disorders. I think of the autoimmune disease Lupus, but also on where cancer exosomes play a role in therapy resistance and metastasis. This investigation is also established through an intensive collaboration between doctors and scientists from many departments such as pathology, oncology, rheumatology, dermatology and neuro-oncology at VU University Medical Centre, Utrecht and America. "Meanwhile, the VU University Medical Center research team has started the development of new methods to allow the unraveling of this ingenious communication mechanism".

    http://zorgkrant.zorgportaal.nl/index.php/bericht/8940-virus-zendt-lgeheimer-boodschap-tussen-menselijke-cellen.html

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