The elusive link: EBV in MS

INTRODUCTION: The link between the risk of developing Multiple Sclerosis (MS) and Epstein-Barr Virus (EBV) infection has been confirmed. However, the mechanisms by which EBV influences MS remain unclear, likely due to the complex interplay among the EBV subtype, the host's immune response, and viral and environmental exposures. AREAS COVERED: In this review, we explore some of those complexities and the evidence on how EBV may contribute, at the molecular level, to MS pathogenesis across the spectrum of MS disease, both relapsing-remitting and progressive. For this review, we searched PubMed and Medline entries using a combination of terms related to 'Epstein-Barr Virus,' 'Multiple Sclerosis,' 'disease-modifying therapies,' and 'EBV activity.' Those search results were then used to address how EBV relates to MS pathophysiology and how the effects of MS risk factors and the efficacy of disease-modifying therapies may be explained by their effects on EBV. EXPERT OPINION: We posit that addressing EBV infection and viral replication is vital to the discovery of a cure for MS. Given that multiple genetic factors are involved, targeting EBV within cellular reservoirs and suppressing EBV protein expression is likely to provide the greatest benefit in preventing MS disease activity, progression, and immune-mediated neurodegeneration.