Could the virus behind glandular fever trigger MS?

When I was diagnosed with MS, I didn’t think a virus could be partly to blame. 

The Epstein Barr Virus - or EBV - triggered the interest of Dr Kassandra Munger 20 years ago. Kassandra’s relationship with MS began when her mother was diagnosed, sparking her passion for studying MS.

What is EBV?

EBV is a very common virus - by adulthood around 96% of people have been infected. Most people acquire EBV in early childhood, usually passed through saliva. Most people won’t be aware they’ve been infected with EBV but some will experience symptoms as glandular fever. 

EBV and MS

"Unlike other viruses we may encounter, EBV stays in our bodies for life" says Kassandra. You can see evidence of an earlier EBV infection by looking for antibodies. Antibodies are immune cells our bodies create to fight viruses. By measuring the levels of EBV antibodies in someone’s blood, Kassandra can see if they’ve ever been infected with EBV and how severely.  

Lots of different research studies have found associations between EBV antibodies and MS. People without antibodies almost never have MS. And people with higher levels of antibodies are more likely to have MS than people with lower levels.

A study of the US military

"Because you’re seeing the same patterns everywhere you look" Kassandra says, "we think EBV must actually play a role in causing MS". But we also need to know the infection occurred before MS developed. So Kassandra’s been analysing EBV antibody levels in yearly blood samples taken from the US military over a long period of time. 

The data show those who were originally EBV-negative (they hadn’t yet been infected with EBV) but later developed EBV antibodies, had a much higher risk of MS than individuals who remained negative. "The risk of MS increases around 27-fold after EBV infection" she says, "the pattern is very striking".  

But most studies on EBV and MS have involved White populations and there are still relatively few cases of MS amongst Black people in the US military. So she now plans to study a broader group to understand whether the effects are true for everyone.

Could an EBV vaccine lower the risk of MS? 

Raising this vital question with Kassandra, she told me "it’s proving very difficult to develop a vaccine for EBV". Currently, scientists are focusing on a vaccine to prevent people who become infected with EBV experiencing it as glandular fever. But she cautions "even if this was successful, the impact on MS is not completely clear, because many people with MS didn’t have any symptoms of glandular fever when they got EBV". 

She also tells me "we know EBV on its own isn’t enough to cause MS". What happens to someone on top of that matters too. So we need to know how EBV interacts with other risk factors like vitamin D and your genetics

There’s more work to do, but great scientists like Kassandra have devoted their whole careers to figuring out “What causes MS?” One day I believe we’ll be able to stop anyone from developing it.

This blog first appeared as an article in our MS Matters magazine. You can download the full issue of MS Matters for free. To get a copy by post please contact [email protected] to subscribe.