4 ms·

Cause is still not well explained. EBV is such an ubiquitous virus, more than 90% of all adults worldwide have been infected with it. Most will never know. Why

Cause is still not well explained. EBV is such an ubiquitous virus, more than 90% of all adults worldwide have been infected with it. Most will never know. Why is that just a tiny percentage develop MS?

killjoywashere 5y ago
EBV is associated with a lot of things that involve a tiny percentage of the population. Nasopharyngeal carcinoma, Hodgkin's lymphoma. Non-Hodgkin's lymphomas. Post-transplant lymphoproliferative disease. Burkitt's lymphoma. Oral hairy leukoplakia. Related viruses are associated with other diseases, e.g. HHV-8 and Kaposi's Sarcoma, primary effusion lymphoma, and Castleman's disease.
- jessriedel 5y ago
  Is there an estimate anywhere of the total health burden of EBV, making reasonable assumptions about causality for the diseases you describe? Would be very interesting to know so you could compare it to the risk of a future EBV vaccine.
  - Metacelsus 5y ago
    I calculated it on my blog a few months ago: Every year, it causes the loss of 4.6 million disability-adjusted life years due to cancers alone, and another ~2 million to autoimmune diseases like multiple sclerosis. https://denovo.substack.com/p/epstein-barr-virus-more-maladies https://denovo.substack.com/p/epstein-barr-virus-more-maladi...
  - throwawaylinux 5y ago
    What are the reasonable assumptions about causality?
jessriedel 5y ago
This question, though very worthwhile, doesn't necessarily need to be answered. Vaccines for EBV are under development. If we stop most EBV infections, we can stop most MS.
- sonicggg 5y ago
  Vaccine is no guarantee though, just look at Covid. DW was recently covering breakthrough cases that led to Long Covid. You're speculating now.
  - boondaburrah 5y ago
    Right but when was the last time anyone you know got polio? Vaccines aren't 100% effective but if we can get the average susceptibility to the virus in the population down far enough (even though it'll never be complete) there's a threshold where the virus can have a hard enough time hopping that it really makes a difference.
  - bagacrap 5y ago
    I don't see where gp assumed a vaccine will be effective. Note "if".
- Metacelsus 5y ago
  Yeah, but will the vaccines be effective? EBV is amazingly good at immune evasion. Prior antibodies don't protect against re-infection.
- lamontcg 5y ago
  Doesn't help you if you've already got a persistent EBV infection though, and the host immune response to EBV may be something that you want to avoid stimulating if you've already got it in you and can't get it out. Something like CRISPR/Cas9 editing may be the way to treat persistent EBV and other herpesvirus infections.
  - bluGill 5y ago
    Maybe, though it appears that covid vaccines help clear long covid, so maybe not. Until we have a vaccine we cannot study this to see how or if it works.
    - lamontcg 5y ago
malloc2048 5y ago
Good question, if I am correct there is also a higher chance to develop MS if you are a woman and if you live in the northern hemisphere and some parts of Australia and New Zealand. Also if you are of Northern European descent the risk is higher if I remember correctly. Possibly it's a mix of many things and you have to be one of the unlucky people where that mix triggers something in the immune system and the disease develops. I am very unlucky in that regard. According to my doctors the number of autoimmune diseases I have is rare in a single person. I have a sysmetic autoimmune disease (Rheumatoid Artritis) and autoimmune diseases in my kidneys, liver,thyroid, skin and mouth. So somehow multipe times there were events in my life where a mix of things caused my immune system to turn against me. A little off-topic, but to give an impression of how that works out in daily life, in case you are also diagnosed with an autoimmune disease. If you are lucky, there is good medication and you will hardly notice you're ill, except for the checkups with your doctor I also know some autoimmune diseases can (become) pretty aggressive, but n=1, most people I know with autoimmune diseases have a decent quality of life. Fortunately, in my case also for each disease there is medication that either supresses the inflammation or the protects my body against the effects of the auto-immune response. So I take my pills and a bi-weekly injection with a biological and I can continue to live with a decent quality of life. Except for one important thing, my main remaining symptom is that I have a lot less energy than most people and need much more sleep. Despite that all inflammation parameters in my blood show no signs of inflammation or activity of the disease, my body somehow loses energy to something. This seems to be a complaint of many autoimmune illness sufferers, no signs of activity of the ilness, but more tired than before the disease came into their life. Hopefully there will soon be more developments in this area of medicine.
- supperburg 5y ago
  Yes, inflammatory signals can and do pull metabolic levers, something that is criminally under appreciated, and this can manifest as feeling tired somehow. There is absolutely a connection.
- someotherperson 5y ago
  > if I am correct there is also a higher chance to develop MS if you are a woman and if you live in the northern hemisphere and some parts of Australia and New Zealand. Also if you are of Northern European descent the risk is higher if I remember correctly. I believe this has been largely disregarded. The higher incidence rate in Europe/Anglosphere was a consequence of higher testing and accurate diagnoses, coupled with the ability to provide treatment.
rewgs 5y ago
Welcome to the immune system :p Most people don't develop food allergies. Especially most adults if they don't have a family history of it/didn't have any food allergies as children. Those that do typically only develop 1 or 2. I can't imagine how infinitesimally small the odds of this happening to me are, and yet here I am, at age 31, with nearly 30 food allergies that all activated about a year ago, seemingly overnight. No known cause, and after a year of researching the immune system and just how depressingly little medical science knows about it, I doubt I'll ever know, let alone receive a treatment that will allow me to eat like a normal person again. And that's just one way in which the immune system can go haywire. There's MS and all the dozens of other (auto)immune issues -- so many that some don't even have a name. It is truly baffling, but the immune system has gotta be one of the single most complex systems known to man. There's a whole lot of ways something like that can break.
- dd36 5y ago
  Pardon my ignorance, does this mean you won’t have allergies if you take an immunosuppressive drug?
scotty79 5y ago
Why only a small percentage of those who contracted polio got paralysis? Interesting, but for now let's settle on eradicating ebv to hell

killjoywashere 5y ago

EBV is associated with a lot of things that involve a tiny percentage of the population. Nasopharyngeal carcinoma, Hodgkin's lymphoma. Non-Hodgkin's lymphomas. Post-transplant lymphoproliferative disease. Burkitt's lymphoma. Oral hairy leukoplakia. Related viruses are associated with other diseases, e.g. HHV-8 and Kaposi's Sarcoma, primary effusion lymphoma, and Castleman's disease.

jessriedel 5y ago
Is there an estimate anywhere of the total health burden of EBV, making reasonable assumptions about causality for the diseases you describe? Would be very interesting to know so you could compare it to the risk of a future EBV vaccine.
- Metacelsus 5y ago
  I calculated it on my blog a few months ago: Every year, it causes the loss of 4.6 million disability-adjusted life years due to cancers alone, and another ~2 million to autoimmune diseases like multiple sclerosis. https://denovo.substack.com/p/epstein-barr-virus-more-maladies https://denovo.substack.com/p/epstein-barr-virus-more-maladi...
- throwawaylinux 5y ago
  What are the reasonable assumptions about causality?

jessriedel 5y ago

This question, though very worthwhile, doesn't necessarily need to be answered. Vaccines for EBV are under development. If we stop most EBV infections, we can stop most MS.

sonicggg 5y ago
Vaccine is no guarantee though, just look at Covid. DW was recently covering breakthrough cases that led to Long Covid. You're speculating now.
- boondaburrah 5y ago
  Right but when was the last time anyone you know got polio? Vaccines aren't 100% effective but if we can get the average susceptibility to the virus in the population down far enough (even though it'll never be complete) there's a threshold where the virus can have a hard enough time hopping that it really makes a difference.
- bagacrap 5y ago
  I don't see where gp assumed a vaccine will be effective. Note "if".
Metacelsus 5y ago
Yeah, but will the vaccines be effective? EBV is amazingly good at immune evasion. Prior antibodies don't protect against re-infection.
lamontcg 5y ago
Doesn't help you if you've already got a persistent EBV infection though, and the host immune response to EBV may be something that you want to avoid stimulating if you've already got it in you and can't get it out. Something like CRISPR/Cas9 editing may be the way to treat persistent EBV and other herpesvirus infections.
- bluGill 5y ago
  Maybe, though it appears that covid vaccines help clear long covid, so maybe not. Until we have a vaccine we cannot study this to see how or if it works.
  - lamontcg 5y ago

malloc2048 5y ago

Good question, if I am correct there is also a higher chance to develop MS if you are a woman and if you live in the northern hemisphere and some parts of Australia and New Zealand. Also if you are of Northern European descent the risk is higher if I remember correctly. Possibly it's a mix of many things and you have to be one of the unlucky people where that mix triggers something in the immune system and the disease develops. I am very unlucky in that regard. According to my doctors the number of autoimmune diseases I have is rare in a single person. I have a sysmetic autoimmune disease (Rheumatoid Artritis) and autoimmune diseases in my kidneys, liver,thyroid, skin and mouth. So somehow multipe times there were events in my life where a mix of things caused my immune system to turn against me. A little off-topic, but to give an impression of how that works out in daily life, in case you are also diagnosed with an autoimmune disease. If you are lucky, there is good medication and you will hardly notice you're ill, except for the checkups with your doctor I also know some autoimmune diseases can (become) pretty aggressive, but n=1, most people I know with autoimmune diseases have a decent quality of life. Fortunately, in my case also for each disease there is medication that either supresses the inflammation or the protects my body against the effects of the auto-immune response. So I take my pills and a bi-weekly injection with a biological and I can continue to live with a decent quality of life. Except for one important thing, my main remaining symptom is that I have a lot less energy than most people and need much more sleep. Despite that all inflammation parameters in my blood show no signs of inflammation or activity of the disease, my body somehow loses energy to something. This seems to be a complaint of many autoimmune illness sufferers, no signs of activity of the ilness, but more tired than before the disease came into their life. Hopefully there will soon be more developments in this area of medicine.

supperburg 5y ago
Yes, inflammatory signals can and do pull metabolic levers, something that is criminally under appreciated, and this can manifest as feeling tired somehow. There is absolutely a connection.
someotherperson 5y ago
> if I am correct there is also a higher chance to develop MS if you are a woman and if you live in the northern hemisphere and some parts of Australia and New Zealand. Also if you are of Northern European descent the risk is higher if I remember correctly. I believe this has been largely disregarded. The higher incidence rate in Europe/Anglosphere was a consequence of higher testing and accurate diagnoses, coupled with the ability to provide treatment.

rewgs 5y ago

Welcome to the immune system :p Most people don't develop food allergies. Especially most adults if they don't have a family history of it/didn't have any food allergies as children. Those that do typically only develop 1 or 2. I can't imagine how infinitesimally small the odds of this happening to me are, and yet here I am, at age 31, with nearly 30 food allergies that all activated about a year ago, seemingly overnight. No known cause, and after a year of researching the immune system and just how depressingly little medical science knows about it, I doubt I'll ever know, let alone receive a treatment that will allow me to eat like a normal person again. And that's just one way in which the immune system can go haywire. There's MS and all the dozens of other (auto)immune issues -- so many that some don't even have a name. It is truly baffling, but the immune system has gotta be one of the single most complex systems known to man. There's a whole lot of ways something like that can break.

dd36 5y ago
Pardon my ignorance, does this mean you won’t have allergies if you take an immunosuppressive drug?

scotty79 5y ago

Why only a small percentage of those who contracted polio got paralysis? Interesting, but for now let's settle on eradicating ebv to hell