Multiple Sclerosis Immunity

Environment plus genetics equals disease could be included in nearly every autoimmune condition that patients face today.  This is not new news.  For example, an genetic variant of the immune gene HLA-DR15 has been known as a risk factor for multiple sclerosis for almost 50 years.  The environment plays an important role in the disease as not everyone with this genetic variant get the disease.  One in four of healthy adults has an HLA DR15 variant yet multiple sclerosis only affects about 1 in a 1000 on average.  Scientists estimate that 60 percent of a person’s risk for multiple sclerosis is due to the genetic variant, but they also recognized that almost 100 percent of the patients have evidence of Epstein-Barr virus infection.  This virus increases multiple sclerosis risk 15 times higher.

The research study in focus looked about the interplay between HLA DR15 and this common virus.  How could a virus that infects over 90 percent of the population by age 30 also trigger a deadly autoimmune disease in some but not others.   They found that two variants of DR15 called DR1a and DR2b seem to alter how immune T cells present antigens from the EBV virus.  This seems to increase the risk of the T cells reacting to self-peptides in brain tissue.  When the T cells cross-react with the brain tissue, they trigger an inappropriate immune response and damage brain cells.  They also found the common intestinal bacteria called Akkermansia mucinophila could trigger a similar cross reaction.

One should then ask if treating EBV could lower the risk of multiple sclerosis.  This research neither addresses that directly or even asks the question.  In fact, they believe that the HLA DR15 variant actually creates a stronger response to EBV infection, yet that same improvement seems to lead to more cross reactivity with brain tissue.  While functional medicine strives to apply as much basic research findings to current practice, we still have to move slow enough to think through implications.  At our office, we do treat chronic EBV infections in chronic fatigue patients when labs indicate the need.  We can’t yet say for sure that treating EBV could prevent multiple sclerosis nor treat already present disease.  In preparing for 2020 and beyond, we anxiously await further findings from studies like these linking common infections to deadly diseases with the hope of finding cures and preventive strategies.

Original Article:

Jian Wang, Ivan Jelcic, Lena Mühlenbruch, Veronika Haunerdinger, Nora C. Toussaint, Yingdong Zhao, Carolina Cruciani, Wolfgang Faigle, Reza Naghavian, Magdalena Foege, Thomas M.C. Binder, Thomas Eiermann, Lennart Opitz, Laura Fuentes-Font, Richard Reynolds, William W. Kwok, Julie T. Nguyen, Jar-How Lee, Andreas Lutterotti, Christian Münz, Hans-Georg Rammensee, Mathias Hauri-Hohl, Mireia Sospedra, Stefan Stevanovic, Roland Martin. HLA-DR15 Molecules Jointly Shape an Autoreactive T Cell Repertoire in Multiple Sclerosis. Cell, 2020; DOI: 10.1016/j.cell.2020.09.054

Thanks to Science Daily:

University of Zurich. “Multiple sclerosis as the flip side of immune fitness.” ScienceDaily. ScienceDaily, 22 October 2020. <www.sciencedaily.com/releases/2020/10/201022112554.htm>.