title: HLA-DRB1 15:01 and Epstein-Barr virus in a multiple sclerosis patient with psoriasis, nasopharyngeal and breast cancers. Lessons for possible hidden links for autoimmunity and cancer.
abstract: BACKGROUND
  Multiple sclerosis (MS) patients have a low general cancer risk and cases of neoplastic comorbidity are attributed by many researchers in chance, or therapeutical side-effects. Human leucocyte antigen (HLA) class II allele DRB1 15:01 is considered the main genetic factor independently associated with increased susceptibility for MS in Caucasians. Epstein-Barr virus (EBV) has also been proven to be a core triggering factor in MS initiation and progress, mainly in HLA-DRB1 15:01 positive MS patients.
  
  
  METHODS
  We present an exceptional case of a Greek-origin woman, carrying a distinct immunogenetic profile (HLA-A 26:01-Cw 06:02-DRB1 15:01), which gradually developed psoriasis, nasopharyngeal carcinoma (NPC), MS, breast cancer, uterine leiomyoma and other neoplasms.
  
  
  CONCLUSIONS
  EBV plays a fundamental role in the pathogenesis of both autoimmunity (i.e. MS) and cancer (i.e. NPC). Our patient's immunogenetic profile included HLA alleles which are associated with psoriasis (Cw 06:02), NPC (A 26:01), MS (DRB1 15:01) and increased risk of MS, in patients carrying EBV (DRB1 15:01). We made a targeted review of the literature finding data supporting an EBV-HLA interaction mechanism behind our patient's unique combination of disorders, suggesting that beyond the standard role of each factor, their combination could act as the hidden link, in initiation or/and comorbidity of autoimmunity and cancer.
authors.affiliation: Dept of Neurology, Medical School, National and Kapodistrian University, Aeginition Hospital, Athens, Greece; Immunogenetics Lab., Dept of Neurology, Aeginition Hospital, Athens, Greece. Electronic address: managnost@med.uoa.gr.
authors.forename: Maria
authors.initials: M
authors.lastname: Anagnostouli
authors.affiliation: Intensive Care Unit, "Henry Dunant" Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Anagnostoulis
authors.affiliation: Dept of Neurology, Medical School, National and Kapodistrian University, Aeginition Hospital, Athens, Greece; Immunogenetics Lab., Dept of Neurology, Aeginition Hospital, Athens, Greece.
authors.forename: Serafeim
authors.initials: S
authors.lastname: Katsavos
authors.affiliation: Dept of Neurology, Medical School, National and Kapodistrian University, Aeginition Hospital, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Panagiotou
authors.affiliation: Dept of Neurology, Medical School, National and Kapodistrian University, Aeginition Hospital, Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Kararizou
authors.affiliation: Dept of Neurology, Medical School, National and Kapodistrian University, Aeginition Hospital, Athens, Greece.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Davaki
mesh_terms: D015551:Autoimmunity / Q000276:immunology; D001943:Breast Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000276:immunology; D002277:Carcinoma; D005260:Female; D005500:Follow-Up Studies; D059811:HLA-DRB1 Chains / Q000097:blood*; D004854:Herpesvirus 4, Human / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000097:blood* / Q000175:diagnosis / Q000276:immunology; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000276:immunology; D011565:Psoriasis / Q000097:blood* / Q000175:diagnosis / Q000276:immunology
chemical_list: D059811:HLA-DRB1 Chains; C489631:HLA-DRB1*15:01 antigen
keywords: Breast cancer; Epstein–Barr Virus; Human leucocyte antigens; Multiple sclerosis; Nasopharyngeal carcinoma; Psoriasis