When a Common Virus Becomes a Clue

The Link Between Epstein-Barr and Multiple Sclerosis

Epstein-Barr virus (EBV), best known for causing mononucleosis (“mono”), infects nearly everyone — about 95% of adults worldwide. For most people who get the virus, they recover without consequence. But for a small number of people, an EBV infection may set the stage for developing multiple sclerosis (MS), a debilitating disease in which the immune system attacks the brain and spinal cord.

A recent study, led by Neda Sattarnezhad Oskouei, MD, and Tobias Lanz, MD, from Stanford Medicine’s Division of Immunology and Rheumatology, brought together collaborators from across Stanford University and from the Department of Clinical Neuroscience and the Center for Molecular Medicine at the Karolinska Institutet and Karolinska University Hospital in Stockholm, Sweden.

They found that a protein in EBV, called EBNA1, looks very similar to a brain protein named GlialCAM, which helps protect nerve fibers. The immune system, trying to fight EBV, can mistake GlialCAM for the virus and attack it by accident — damaging the protective coating around nerves and causing MS symptoms.

Genetics makes this scenario more likely. The study found that people with a specific gene, HLA-DRB1*15:01, were far more likely to have these mistaken antibodies. Those with the gene and high antibody levels were up to nine times more likely to develop MS. These findings could help pinpoint who is most at risk and guide future work on vaccines or antiviral treatments.

Watch MedStory with Rebecca Handler, manager of SciComms Strategy in the Department of Medicine.

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