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EBV and ME/CFS – what can we learn from multiple sclerosis?

Epstein-Barr virus (EBV) is extremely common and affects most people at some time over their lives. It has long been suggested as a trigger for ME/CFS, and we are currently funding research from Dr Nuno Sepúlveda and Prof. Carmen Scheibenbogen looking at this area.

There is also considerable evidence suggesting that EBV is a causative factor in the development of autoimmune diseases including multiple sclerosis (MS). Prof. Alberto Ascherio is professor of epidemiology and nutrition at Harvard Chan School of Public Health and senior author of a recent study lending further support to this idea. He says:

The hypothesis that EBV causes MS has been investigated by our group and others for several years, but this is the first study providing compelling evidence of causality… 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.

Press release, Harvard TH Chan of Public Health

This study was followed by news that Moderna is starting human trials of an mRNA vaccine against EBV. All of which has renewed interest in the role of EBV in ME/CFS. A letter to the editor of Nature, co-authored by Prof. Leonard Jason, points out that other potentially preventable post-viral diseases should also receive attention, specifically ME/CFS. Nearly all cases of infectious mononucleosis (IM, also known as glandular fever) are caused by EBV, and up to 13% of individuals do not fully recover from IM and meet criteria for ME/CFS 6 months following onset.

While studying the effects of EBV vaccines and antivirals on reducing the risk or preventing MS is challenging, we must consider research to prevent ME/CFS. Such trials are feasible given that post-infection symptoms of IM typically present shortly after the acute infection and last for months or years. The successful experience of the Human Papilloma Virus (HPV) vaccination program that helps to protect against cervical cancer, should inform the public health approach to incorporate EBV vaccination to reduce the risk of ME/CFS.

Nature, 2022; 603:784–6

EBV was featured in our “Viruses make a comeback” article last year and, as mentioned above, is the subject of current ME Research UK-funded research.

However, EBV and ME/CFS has a complicated history. In fact, the late Prof. Blomberg’s ME Research UK-funded research looked for serological evidence of past herpesvirus infection/reactivation (including EBV) in several cohorts of ME/CFS patients (all diagnosed using the Canadian criteria), but found only subtle differences in antibody responses to these viruses in ME/CFS samples, suggesting that the immune system of patients may interact with these viruses in an abnormal way.