Thread by @DrEricDing

💡HUGE—We now have evidence that Multiple Sclerosis is likely caused by an infection—notably, the Epstein-Barr virus increased risk of developing MS by a whopping **32-fold***—via Harvard epidemiology team. ➡️ Hopeful because EBV vaccine coming soon. 🧵
statnews.com/2022/01/13/str…

2) “Our data strongly suggest Epstein-Barr virus is the leading cause of multiple sclerosis,” said Kjetil Bjornevik, a research scientist at Harvard and the study’s lead author. “It was a really dramatic increase in risk that would be very hard to explain any other way.”

3) More than a decade ago, his Harvard colleague, epidemiologist Alberto Ascherio (my friend) had a hunch that the answer to what initiates MS might be frozen somewhere on the campus of the Walter Reed Army Institute of Research.

4) Since 1985, scientists collecting, screening, and storing (at -30 degrees C) blood drawn from every member of the U.S. military every few years. With >62 million samples from over 10 million members, the DoD Serum Repository is the largest collection of its kind in the world.

5) For biomedical researchers, the Serum Repository is their Hubble Telescope. It allows them to look not just deep into people’s bodies, but also back in time, to moments before the diseases they’re interested in took hold.

6) That’s particularly important for MS, because it’s most often diagnosed in people in their 20s and 30s. In order to capture people prior to disease onset, you have to start sampling when they’re in their teens — like, say, when most military recruits sign up for service.

7) There are many vaccines under development against Epstein Barr virus.

“EBV infects more than 95% of the human population, causes IM in 70% of adolescents and young adults in developed countries.
frontiersin.org/articles/10.33…

8) “An EBV prophylactic vaccine holds great promise for prevention of EBV associated cancers such as BL, HL, PTLD, NPC, and GC, and would also be the most cost-effective approach for the management of IM as well as EBV associated autoimmune disease such as MS”.

9) Notably there is a promising candidate for **sterilizing immunity against EBV**—“These data suggest that the combination of EBV gH/gL, gB and gp350 could be an ideal EBV prophylactic vaccine that can elicit markedly high EBV neutralizing activity…”

10) “with the potential to induce sterilizing immunization, prevent primary EBV infection and therefore prevent EBV associated cancers as well IM and MS.” 👀

11) Epidemiology sidenote — these “nested case control” studies with bio banked specimen samples from decades ago are amazing — they allow epidemiologists to “time travel” back decades to find the root cause / risk factor for something. It costs a lot of $ though but worth it.

12) Also, while correlation isn’t always causation, every causation is a correlation. And a relative risk = 32 is literally OFF THE CHARTS! My original thesis paper had a RR=20 (0.05 inverted), which was already a record—➡️ but 32 is almost unheard of strong—very likely causal!

13) there is a lot of good hopeful news on the horizon for MS — exactly last year — BioNTech says it was successful on a potential vaccine against MS in mice 🐁 using their mRNA vaccine technology. Hopeful!

https://twitter.com/drericding/status/1348912741562667008