title: The essential role of Epstein-Barr virus in the pathogenesis of multiple sclerosis.
abstract: There is increasing evidence that infection with the Epstein-Barr virus (EBV) plays a role in the development of multiple sclerosis (MS), a chronic inflammatory demyelinating disease of the CNS. This article provides a four-tier hypothesis proposing (1) EBV infection is essential for the development of MS; (2) EBV causes MS in genetically susceptible individuals by infecting autoreactive B cells, which seed the CNS where they produce pathogenic autoantibodies and provide costimulatory survival signals to autoreactive T cells that would otherwise die in the CNS by apoptosis; (3) the susceptibility to develop MS after EBV infection is dependent on a genetically determined quantitative deficiency of the cytotoxic CD8+ T cells that normally keep EBV infection under tight control; and (4) sunlight and vitamin D protect against MS by increasing the number of CD8+ T cells available to control EBV infection. The hypothesis makes predictions that can be tested, including the prevention and successful treatment of MS by controlling EBV infection.
authors.affiliation: School of Medicine, The University of Queensland, Queensland, Australia. m.pender@uq.edu.au
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pender
mesh_terms: D001323:Autoantibodies / Q000096:biosynthesis; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000235:genetics / Q000821:virology*; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000502:physiology*; D006801:Humans; D009103:Multiple Sclerosis / Q000235:genetics / Q000473:pathology / Q000821:virology*; D016176:T-Lymphocyte Subsets / Q000473:pathology / Q000821:virology
chemical_list: D001323:Autoantibodies