title: Gender influence in EBV antibody response in multiple sclerosis patients from Kuwait.
abstract: BACKGROUND
  Epstein-Barr virus (EBV) infection is implicated with multiple sclerosis (MS) risk, exacerbation, and progression. The HLA-DRB1*1501 haplotype is a strong MS risk factor consistently documented in MS populations. There are no studies of EBV infections and HLA-DRB1*1501 haplotype associating with MS from Kuwait where MS prevalence has increased significantly.
  
  
  OBJECTIVE
  To determine the association of EBV infection with MS incidence, and to investigate HLA-DRB1*1501 as a potential genetic risk factor for MS in Kuwait.
  
  
  METHODS
  This is a case-control study involving 141 MS patients and 40 healthy controls. Antibody titers against EBV antigens' viral capsid antigen (VCA) and Epstein-Barr nuclear antigen 1 (EBNA1) were measured using enzyme-linked immunosorbent assays. HLA-DRB1*1501 haplotype assessment was done using rs3135005 TaqMan genotyping assay.
  
  
  RESULTS
  Antibody titers against EBV were significantly elevated in MS patients compared to healthy controls (anti-EBNA1, p=0.008; anti-VCA, p=0.028). MS males had higher antibody titers to EBNA1 than healthy male controls (p=0.005) and female MS patients (p=0.03). HLA-DRB1*1501 haplotype genotypes failed to generate a risk association with MS or EBV antibody titers (p=0.6).
  
  
  CONCLUSIONS
  An increased immune response to EBV infection is associated with MS incidence influenced by the type of antigen and sex. HLA-DRB1*1501 haplotype is not associated with MS risk in our Kuwaiti MS cohort.
authors.affiliation: Human Genetics Unit, Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait. Electronic address: rabeah@hsc.edu.kw.
authors.forename: Rabeah
authors.initials: R
authors.lastname: Al-Temaimi
authors.affiliation: Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait, Kuwait; Neurology Clinic, Department of Medicine, Dasman Diabetes Institute, Kuwait.
authors.forename: Raed
authors.initials: R
authors.lastname: Alroughani
authors.affiliation: Molecular Pathology Unit, Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait.
authors.forename: Sindhu
authors.initials: S
authors.lastname: Jacob
authors.affiliation: Molecular Pathology Unit, Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait.
authors.forename: Fahd
authors.initials: F
authors.lastname: Al-Mulla
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000276:immunology*; D016022:Case-Control Studies; D005260:Female; D059811:HLA-DRB1 Chains / Q000235:genetics / Q000276:immunology*; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology*; D007730:Kuwait / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology*; D012727:Sex Characteristics; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D059811:HLA-DRB1 Chains; C489631:HLA-DRB1*15:01 antigen
keywords: EBNA1; Epstein–Barr virus; HLA-DRB1*1501; Kuwait; Multiple sclerosis; VCA