Friday, 23 June 2017

You can be EBV negative and still have MS

Some one asked if we were too embarrassed to discuss the paper below. ProfG argues that EBV is the cause of multiple sclerosis, so EBV negative individuals would burst the bubble

Dobson R, Kuhle J, Middeldorp J, Giovannoni G. Epstein-Barr-negative MS: a true phenomenon? Neurol Neuroimmunol Neuroinflamm. 2017;4(2):e318. Epstein-Barr virus (EBV) infection is associated with MS; up to 3.3% people with MS are EBV nuclear antigen-1 (EBNA1)-seronegative compared with 6.0% controls. EBV serology is complex, and multiple antigens are required to assess seropositive status.We examined a cohort of seemingly EBV-negative patients with clinically isolated syndrome (CIS). The size of the population enrolled in the International CIS study allowed us to examine the largest population of seemingly EBV-negative patients with CIS gathered to date.

Yesterday someone mentioned this paper and implied we were frightened to bring it up.

There are EBV negative pwMS. Does this mean the idea is wrong. 

In fact only 1 of 1,047 pwMS (<0.01%) was truly EBV-negative. Those that were negative were more likely to not make oligoclonal bands.

I haven't seen ProfG crying in his soup, so I am guessing that he can live with the occasional negative pwMS.

Detection is only as good as you look, they tried a few ways but didn't succeed to detect EBV in everyone

JC virus causes PML so if you are JC virus negative and taking natalizumab. Why is the risk of PML 1 in 10,000 and not never?

One suggestion is EBV is a transactivator and it make HERV (endogenous retro virus) to become active as the target. We all have HERV its 7% of our genome.


12 comments:

  1. I'm EBV negative and have MS.

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  2. "I'm EBV negative and have MS."

    Really..hmm..what test type was done ?

    https://www.ncbi.nlm.nih.gov/pubmed/22740437

    CONCLUSION:
    The sensitivity and specificity of the assay used to measure EBV antibody titres have an influence on the association between MS and EBV. Looking at studies where two independent methods are used and therefore are likely to be the most robust, EBV appears to be present in 100% of MS patients. This has implications for future studies of EBV in MS. MS patients without EBV infection, if they truly exist, should be studied in more detail.

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    Replies
    1. I will look for the results at home. My neurologist about fours years ago requested the test.

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    2. Found the report, here is what it states:.
      Epstein-Barr virus serology- (jd)- Normal- No Action
      EPSTEIN -BARR VIRUS VCA IGM
      Not detected.

      Delete
  3. I am the 'someone' ! You have missed my point. The routinely tested 'negatives' in this paper were subjected to additional (in house) methods to try to detect antibody. This rather extraordinary manipulation (perfectly justified of course) should have been controlled with a comparable group of non-MS EBV negatives. Another point, not discussed is that it is not unusual to find low-affinity cross reactivity with other antigens when 'scraping the barrel' in this way. The MS patients may well have antibody to MBP, which is known to share epitopes with EBV.

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    Replies
    1. I wonder if the one truly EBV negative subject might be positive if a PCR was run for EBV?

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    2. I wondered the same thing. I'm positive EBV, and I have positive oligoclonal bands as well. First outbreak of MS about 6 months after relapse of a strong MI.

      If there are more than 100 antigens involved in the immune response to EBV, why only 3 antigens are used to diagnose EBV infection? In this case PCR would be the most appropriate test to do.

      I had positive EBV after a PCR...

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  4. Does any medication in the world actually treat these apparent EBV controlled memory B-cells in follicles in the brain? If EBV is thought by many to cause MS, why has the attention not shifted to a vaccine that has been invented already? Aren't all current B-cell therapies just treated downstream to the actual cause of MS if it is these EBV controlled memory b-cells in the brain?

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  5. The reported CNS penetration of thiotepa and busulfan is both >80%

    http://www.nature.com/bmt/journal/v31/n8/full/1703917a.html#bib24

    ReplyDelete

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