Epstein-Barr virus may cause Multiple Sclerosis through involvement of the venous
system.
Steven R Brenner, Neurologist
St. Louis VA Medical Center and Dept Neurology and Psychiatry at St. Louis University
Dear Editor,
I read the article by Zivadinov (1) with reference to the association of Epstein-Barr
virus (EBV) to gray matter atrophy in multiple sclerosis (MS) patients.
Accumulation of EBV infected B cells in meninges and perivascular regions of MS
lesions in 21 or 22 patients with MS (2) was noted as well, indicating direct involvement
of the brain and perivascular spaces by EBV in MS patients..
A recent study has indicated chronic cerebrospinal venous insufficiency with multiple
extracranial venous strictures in MS patients (3).
EBV appears to infect endothelial cells (4), and may be important in the pathology
of EBV virus.
EBV virus has been found to cause deep venous thrombosis in a patient with hereditary
thrombophilia (5).
EBV may infect the venous endothelium causing venous thromboses and strictures in
the cranial and spinal venous drainage system and perivascular regions of MS lesions
in patients with MS.
Such venous involvement may be implicated in MS disease involvement.
Chronic EBV infection may involve the venous system with secondary effects on the
brain and spinal cord in MS.
References
- Zivadinov R, Zorzon M, Weinstock-Guttman B, Serafin M, Bosco A, Bratina A, et al.
Epstein-Barr virus is associated with grey matter atrophy in multiple sclerosis
J Neurol Neurosurg Psychiatry 2009; 80: 620 -625.
- Serafani B, Rosicarelli B, Franciotta D, et al. Dysregulated Epstein-Barr virus
infection in the multiple sclerosis brain. J Exp Med 2007; 204:2899-2912.
- Zamboni P, Galeotti P, Menegatti E, Malagoni AM, Tacconi G, et al. Chronic cerebrospinal
venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry
2009: 80: 392-398.
- Jones K, Rivera C, Sgadari C, Franklin J, Max EE, et al. Infection of human endothelial
cells with Epstein-Barr virus. J Exp Med. 1995; 182: 1213-1221.
- Mashav N, Saar N, Chundadze T, Steinvil. Epstein-Barr virus associated thromboembolism:
A case report and review of the literature. Thromb Res. 2008; 122: 570-571.
No conflict of interest.
Bron: jnnp.bmj.com (e-letter)
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