Training the immune system to fight the virus responsible for glandular fever 鈥� also known as infectious mononucleosis or 鈥渕ono鈥� 鈥� leads to聽improvements in multiple sclerosis symptoms,聽 a small clinical trial has concluded.
The Epstein-Barr virus has long been suspected as a possible cause of MS, after researchers noticed that people with a past history of glandular fever were more likely to develop the neurodegenerative condition. Multiple studies have now confirmed that almost every MS patient carries the virus and that non-carriers almost never develop the disease.
After most glandular fever episodes, the virus lies dormant in a group of immune cells called B cells without causing any further problems, says at QIMR Berghofer Medical Research Institute in Australia. But growing evidence suggests that problems with some people鈥檚 immune聽systems聽allow the聽virus-infected B cells to invade their brain and spine, he says.
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These infected immune cells may then go rogue, attacking the protective coating around the nerves, leading to the hallmark damage seen in MS, says Khanna. In support of this idea, his team has previously found .
Immune boost
Based on these clues, Khanna and his colleagues wondered if they could help people with MS by encouraging their immune systems to control the Epstein-Barr virus. The hope was that doing so would improve the people鈥檚 symptoms, which commonly include fatigue and problems with vision, balance and muscle control.
In 2013, they tested this idea for the first time in a 42-year-old Australian man with MS. They extracted a subset of his immune cells called T cells, trained them to recognise and destroy the Epstein-Barr virus, then re-injected them back into his bloodstream. Afterwards, he reported feeling less tired and having fewer painful leg spasms, better hand function, and increased productivity at work.
To follow up on this promising result, Khanna鈥檚 team recently tested the same approach in 10 people with progressive MS 鈥� a form of the disease in which symptoms are constant and get steadily worse. Unlike relapsing MS, which has periods of symptom relief, there are few treatments available for progressive MS.
Seven of the people reported improvements, including increased energy and the ability to do everyday activities, as well as better concentration, mental clarity, vision, and balance. In four people, levels of an MS-associated protein called immunoglobulin G also went down. None of the people in the study reported serious side-effects.
The findings strengthen the idea that the Epstein-Barr virus plays a role in MS, says at MS Research Australia. However, it remains a mystery why only a small percentage of virus carriers go on to develop the condition, he says. There may be genetic reasons why some people鈥檚 immune systems are better at managing the virus than others, he says.
The clinical results are exciting so far, says Khanna, but the treatment still needs to be compared against a placebo in larger groups of patients to confirm that it works. His team is currently planning a bigger trial in Australia and the US that is due to start in the first half of 2019.
JCI Insight
