Celia Oreja-Guevara
Head of the Neurology Section and coordinator of the Multiple Sclerosis Unit at the Hospital Clínico San Carlos.
The article confirms the clear involvement of the Epstein-Barr virus in the pathogenesis of multiple sclerosis. This article reaffirms that the Epstein-Barr virus is a trigger for the disease and that other viruses, such as CMV and VZV, are not. The results obtained in cell-based assays have been validated in cohorts of healthy individuals and those with multiple sclerosis, as well as in treated and untreated patients.
This article is an in-depth analysis of data from the first author, who published work years ago demonstrating the involvement of the Epstein-Barr virus. Demonstrating that it is the antigens on the viral particles that elicit the immune response opens up new therapeutic avenues, such as developing more specific vaccines against the Epstein-Barr virus, seeking more targeted antivirals, and identifying therapies that could cure the disease at an early stage.
The limitations of this study are that it has only examined the peripheral immune response to the virus, rather than the response of the central nervous system, and that the findings have only been demonstrated in saliva. Furthermore, not all possible treatments have been tested, and the response to the Epstein-Barr virus has not been correlated with clinical improvement. The response to treatment with natalizumab is difficult to explain because, in clinical practice, patients receiving this treatment remain relapse-free for many years.