New study suggests hope on the horizon for people with multiple sclerosis
Sharon Ní Chonchúir is cautiously optimistic about new research from the Harvard School of Public Health linking MS to the Epstein-Barr Virus. Picture: Domnick Walsh
In 2010, I became one of the 9,000 or so people in Ireland with MS. I also had a bad bout of glandular fever in my teens. Researchers now say there is a link between the two. According to a team at the Harvard School of Public Health, Epstein-Barr Virus (EBV), the pathogen that can cause glandular fever, is also a cause for MS.
“Our study is the first that provides definitive evidence that MS is a rare complication of EBV infection,” says Professor Alberto Ascherio, one of the study authors. “This is a big step because it suggests that most MS cases could be prevented by stopping EBV infection and that targeting EBV could lead to the discovery of a cure for MS.”
EBV is a common herpes virus. According to Ascherio, approximately 95% of people are infected by the virus by adulthood. Most display no symptoms, but some go on to develop glandular fever. Ascherio’s research now shows that a proportion of those people later develop MS.
He and his team looked at the medical records of more than 10m US military members. They identified 955 people who were diagnosed with MS during their period of service. Because EBV remains in our bodies for life and the US army stores blood samples from soldiers, they could screen the blood for EBV and explore the relationship between EBV infection and the onset of MS in later life.
“We found that the risk of MS increased 32-fold after EBV infection but was unchanged after infection with any other virus,” says Ascherio.
Kingston Mills, a professor of experimental immunology at Trinity College Dublin, is cautiously optimistic about this research. “It’s very strong data,” he says. “A lot more is needed before it’s proven beyond doubt that EBV causes MS, but this is a significant first step.”
Dr Brian Sweeney, a consultant neurologist at Cork University Hospital, is cautious too, highlighting two potential problems. “The number of people involved in this study was huge,” he says. “But it was mostly male, whereas MS is more common in women. And they were all on active duty, so perhaps they didn’t represent a sample of the general population.”
Dr Sweeney explains MS as “a chronic inflammatory disease of the brain and spinal cord (central nervous system) that people usually live with over many decades. It usually presents at age 30.”
Symptoms vary from one person to the next. In my case, pins and needles down my right side were the first sign that something was wrong. This was followed by convulsions of pain. Then my body stopped doing what I asked of it. I couldn’t drive. I was always dropping things and my fingers constantly missed the keys as I typed articles for work.
Aoife Kirwan is research, information, and advocacy officer with the MS Society of Ireland. “Common symptoms experienced by our members include fatigue, sensory issues, pins and needles, numbness, visual disturbance, pain, balance issues, mobility issues, problems with speech and swallowing, bladder and bowel problems, cognitive dysfunction, and sexual dysfunction,” she says. “Some 60% of people living with MS experience anxiety and depression too.”
When I started medication in 2010, options were limited and the drug I was prescribed had so many unpleasant side effects I eventually stopped taking it.
Things had improved by 2019 when I began taking a disease-modifying drug called Fingolimod, one of a dozen such drug therapies now on the market. I take it daily with no side effects.
According to Professor Mills, the drug works by targeting T and B cells in the immune system. Typically, these cells kill viruses and bacteria that get into the body. In people with MS, these cells go rogue, attacking the myelin sheath that protects nerve cells in the brain and spinal cord.
“Fingolimod prevents the migration of T and B cells from the lymph nodes where they are made to the brain where they precipitate the damage,” says Mills.
I found another glimmer of hope when I discovered the Overcoming MS Programme in 2013. This recommends high doses of vitamin D, a diet low in saturated fat, exercise, and stress management to minimise the immune response in MS. I’ve followed this programme ever since and believe it has helped me maintain my health.
These days, I have no symptoms and it's only at times when I get very tired or especially stressed that I experience mild pain. This usually subsides if I can get some rest and succeed in managing my stress levels.
This new study is a further cause for hope. “I believe a vaccine preventing EBV infection would prevent MS,” says Ascherio. “And because EBV persists in the body for a lifetime and keeps providing stimulation to the immune system, it’s likely it contributes to MS activity and progression. Antiviral drugs against EBV could provide a better treatment for MS than current immunosuppressive drugs.”
There are still a lot of unknowns, but this could be possible, agrees Professor Mills. “If a link is definitively proven between EBV and MS and if a vaccine is developed, that could have an impact on the incidence of MS decades from now,” he says.
Dr Sweeney agrees. “There is a debate as to whether EBV vaccines could be given to children in the future,” he says. “This might reduce the incidence of MS and cancers associated with EBV. We know that such a vaccine strategy is already working to reduce the risk of HPV-associated cancers in young women and men.”
In January of this year, Moderna announced that it had just launched a Phase 1 trial into just such an EBV vaccine. It may be too soon to tell, but this is one area of research that I and others living with MS will be watching with great interest.
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