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. 2020 Jan 24:10:1368.
doi: 10.3389/fneur.2019.01368. eCollection 2019.

High Levels of Epstein-Barr Virus Nuclear Antigen-1-Specific Antibodies and Infectious Mononucleosis Act Both Independently and Synergistically to Increase Multiple Sclerosis Risk

Anna Karin Hedström  1   2 , Jesse Huang  2   3 , Angelica Michel  4 , Julia Butt  4 , Nicole Brenner  4 , Jan Hillert  2   3 , Tim Waterboer  4 , Ingrid Kockum  2   3 , Tomas Olsson  2   3 , Lars Alfredsson  1
Affiliations

High Levels of Epstein-Barr Virus Nuclear Antigen-1-Specific Antibodies and Infectious Mononucleosis Act Both Independently and Synergistically to Increase Multiple Sclerosis Risk

Anna Karin Hedström et al. Front Neurol. .

Abstract

Objective: Elevated levels of anti-EBNA-1 antibodies and infectious mononucleosis (IM) history have consistently been associated with multiple sclerosis (MS) risk. We aimed to study whether these aspects of Epstein-Barr virus (EBV) infection represent separate risk factors for MS and whether they both interact with MS-associated HLA genes in disease development. Methods: Two Swedish-population-based case-control studies were used, comprising 5,316 cases and 5,431 matched controls. Subjects with different HLA alleles, EBNA-1, and IM status were compared regarding MS risk by calculating odds ratios (OR) with 95% confidence intervals (CI) employing logistic regression. Causal mediation analysis was used to assess to what extent the relationship between IM history and MS risk was mediated by high anti-EBNA-1 antibody levels and vice versa. Results: The causal mediation analysis revealed that both aspects of EBV infection mainly act directly on MS risk. The direct effect of elevated anti-EBNA-1 antibody levels on MS risk, expressed on the OR scale, was 2.8 (95% CI 2.5-3.1), and the direct effect of IM history on MS risk was 1.7 (95% CI 1.5-2.0). A significant interaction between the two aspects of EBV infection was observed (RERI 1.2, 95% CI 0.3-2.0), accounting for about 50% of the total effect. Further, both aspects of EBV infection interacted with DRB1*15:01 and absence of A*02:01. Interpretation: Elevated anti-EBNA-1 antibody levels and IM history are different risk factors for MS. The two aspects of EBV infection act synergistically to increase MS risk, indicating that they partly are involved in the same biological pathways.

Keywords: Epstein–Barr virus infection; anti-EBNA-1 antibodies; human leukocyte antigen; infectious mononucleosis; multiple sclerosis.

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Figures

Figure 1
Figure 1
Anti-EBNA-1 antibody levels among included and excluded cases and controls by the 25th, 50th, and 75th percentiles among controls.
Figure 2
Figure 2
OR of developing MS among subjects with different combinations of DRB1*15:01, A*02:01, EBNA1, and IM status.
See this image and copyright information in PMC

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