Wednesday, 7 December 2011

EBV serology and vD levels as risk factors for MS

Munger et al. Anti-Epstein-Barr virus antibodies as serological markers of multiple sclerosis: a prospective study among United States military personnel. Mult Scler. 2011 Oct;17(10):1185-93. 

BACKGROUND:  Elevated Epstein-Barr virus (EBV) antibody titers are risk factors for multiple sclerosis (MS), but the strength and consistency of this association are not well characterized.

OBJECTIVES:  The objectives of this study were to determine whether this association is confounded by vitamin D or modified by gender or race, and the usefulness ofEBV nuclear antigen (EBNA) antibodies as a marker for MS.

METHODS: We conducted a prospective study among US military personnel. Antibody titers against EBV antigens were measured in serum samples from 222 individuals who developed MS and 444 age, sex, and race/ethnicity matched controls. Conditional logistic regression was used to estimate relative risks.

RESULTS: MS risk increased with increasing titers of anti-EBNA complex (p < 10(-9)) and anti-EBNA-1 (p = 5.8 × 10(-9)) titers. MS risk was 36-fold higher among individuals with anti-EBNA complex IgG titers ≥320 than among those with titers <20 (95% confidence interval [CI] 9.6-136), and 8-fold higher among those with anti-EBNA-1 ≥320 than among those with anti-EBNA-1 <20 (95% CI 2.6-23). These associations were consistent across gender and race/ethnicity groups and independent from 25-hydroxyvitamin D levels. Areas under the receiver operating characteristic (ROC) curves were 0.67 for EBNA complex and 0.65 for EBNA-1.

CONCLUSIONS: Serum titers of pre-onset anti-EBNA antibodies are strong, robust markers of MS risk and could be useful in an MS risk score.


"This study suggests that the antibody levels to EBV are not linked to the levels of vitamin D. The problem with this study is that the average vD levels were not that low. In addition, vD levels are cyclical across the year being highest at the end of summer and lowest at the end of winter. Therefore I am not convinced that there is no association between these two variables. We need more data. However, if the anti-EBNA-1 levels and vD levels are truly independent of each other then we need to explain their role in the pathogenesis of MS."


3 comments:

  1. I would like to know what both MouseDoctor and you make about David Cameron’s plans to accelerate drug development for NHS patients, and what this may mean for us MS’ers (with an emphasis on progressive cases)?

    As I understand it, the idea is to share patient records with private health care companies, including some that use animals in clinical tests. This will give pharmaceutical companies more freedom to run clinical trials inside hospitals. It is hoped that this new plan will speed up the drugs pipeline which is not flowing like it used to because the number of medicines in late stage development has declined. (The dramatic decline in clinical trials in the UK has gone from 6% of the global total in 2000, to 1.4% last year.) It is also hoped that these new measures will sooth the soaring costs of conducting clinical trials.

    Do you welcome these changes or are you sceptical? It’s a fact that fewer and fewer British patients are benefiting from new therapies on clinical trials because of the shift overseas. This means those of us who are badly affected by MS are looking at a bleaker future because pharmaceutical companies are not focussing efforts on the needs of British progressive MS’ers.

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  2. Dear Awara Singh,

    The issue is not that Pharma companies don't want to go through the red tape of ethics, but more the time it takes to do this. By the time you have gone through R&D and ethics (needed in NHS) you could have set up and recruited in another country.Clinical trials bring in money to the hospitals but because it takes so long, pharma companies are looking elsewhere, so the money goes elsewhere.

    This is not about giving NHS data to private companies. It is about making the data anonymous meaning no data which can identify someone and then using that to support clinical research. Private companies will pay the NHS for this. There is a lot of ignorance about what is proposed and it is not being explained well either by government or the BBC.

    However, to play devil's advocate, it only takes one NHS memory stick to go missing and public confidence is undermined; even if the stick has nothing on it. These are important issues needing to be discussed at a national level and not just on blogs.

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  3. Will this study help to convince more people that EBV causes MS?

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