EBV and MS: is EBV the cause?

Yet another meta-analysis on EBV and MS. Is EBV the cause of MS? #MSBlog #MSResearch

Almohmeed et al. Systematic Review and Meta-Analysis of the Sero-Epidemiological Association between Epstein Barr Virus and Multiple Sclerosis. PLoS One. 2013 Apr 9;8(4):e61110. doi: 10.1371/journal.pone.0061110. Print 2013.

BACKGROUND: A role for Epstein Barr virus (EBV) in MS has been postulated. Previous systematic reviews found higher prevalences of anti-EBV antibodies in MSers compared to controls, but many studies have since been published, and there is a need to apply more rigorous systematic review methods.

METHODOLOGY & PRINCIPAL FINDINGS: They examined the link between EBV and MS by conducting a systematic review and meta-analysis of case-control and cohort studies that examined the prevalence of anti-EBV antibodies in the serum of cases and controls. They searched Medline and Embase databases from 1960 to 2012, with no language restriction. The odds ratios (OR) for anti-EBV antibodies sero-positivity were calculated, and meta-analysis conducted. Quality assessment was performed. 39 studies were included. Quality assessment found most studies reported acceptable selection and comparability of cases and controls. However the majority had poor reporting of ascertainment of exposure. Most studies found a higher sero-prevalence of anti-EBNA IgG and anti-VCA IgG in cases compared to controls. The results for anti-EA IgG were mixed with only half the studies finding a higher sero-prevalence in cases. The meta-analysis showed a significant OR for sero-positivity to anti-EBNA IgG and anti-VCA IgG in MS cases (4.5 [95% confidence interval (CI) 3.3 to 6.6, p<0.00001] and 4.5 [95% CI 2.8 to 7.2, p<0.00001] respectively). However, funnel plot examination suggested publication bias for the reporting of the anti-EBNA IgG. No significant difference in the OR for sero-positivity to anti-EA IgG was found (1.4 [95% CI 0.9 to 2.1, pā€Š=ā€Š0.09]).

CONCLUSION & SIGNIFICANCE: These findings support previous systematic reviews, however publication bias cannot be excluded. The methodological conduct of studies could be improved, particularly with regard to reporting and conduct of laboratory analyses.

"These findings are in keeping with our recent meta-analysis. It seems that many groups are repeating similar work. Thankfully the results are consistent. EBV infection and an antibody response to certain EBV proteins or antigens, in particular EBNA-1 (EBV nuclear antigen-1) is strongly associated with MS. Is this association causal? I think it is. How do you prove it? You target EBV with specific anti-viral drugs and see what happens to MS. This hypothesis is the core hypothesis that underpins The Charcot Project."

"The following video from our 4th MS Research Day is an update on the Charcot Project."



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Pakpoor et al. The risk of developing multiple sclerosis in individuals seronegative for Epstein-Barr virus: a meta-analysis. Mult Scler. 2012 Jun 11. It is also apparent that you have to be infected with EBV before you develop ...

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