Multiple Sclerosis : what are the exact causes and the future outlooks to treat this disease?

Published on 10 February 2023 Read 25 min

Multiple sclerosis (MS) is a disease which involves an immune-mediated process, patients’ bodies’ immune systems show an abnormal response against their central nervous system made up of the spinal cord, the brain and optic nerves. Despite many years of research, the exact cause of MS has not been identified. However, recently a study was published that examined the relationship between the Epstein-Barr virus and multiple sclerosis. In this article, Alcimed dives into the topic and address MS symptoms, current treatment options, and potential causes of the disease.

What do Multiple Sclerosis patients experience?

Common MS symptoms include fatigue, vision disorders, numbness and tingling, muscle spasms, mobility problems and pain.

The estimated number of people with MS worldwide has been increasing in every world region since 2013. In 2020, MS prevalence was 35.0 per 100.000 people. The rising prevalence is most likely based on earlier multiple sclerosis diagnosis, improved ascertainment, and longer survival of MS patients. It seems like females are more likely to have MS as males, as current numbers show them to be twice as likely to develop MS with a ratio as high as 4 to 1 in some countries.

The development of multiple sclerosis is highly unpredictable and affects each patient differently. Common MS symptoms include fatigue, vision disorders, numbness and tingling, muscle spasms, mobility problems and pain.

About 85% of the patients are initially diagnosed with a relapsing-remitting course of the disease (RRMS). MS patients experience neurological disorders, over a short time period, after which a symptom-free period will follow. Patients with relapsing remitting MS (RRMS) typically experience full or partial recovery between episodes. Other types of MS include primary progressive MS (PPMS) and secondary progressive MS (SPMS). Primary progressive multiple sclerosis is less common and accounts for about 10 to 15 percent of all MS patients. The patient’s neurological function is impaired and gets worse as the disease progresses. MS patients may experience some minor improvements, but no relapses. Secondary progressive multiple sclerosis is described as the next stage of RRMS. Numbers show that around 50% of all patients with RRMS will develop SPMS within 10 years.

MS cannot be cured. However, without MS treatment, most patients with this disease will experience gradually worsening MS symptoms over time. Current multiple sclerosis treatment is mainly focusing on increasing the quality of life of patients by reducing symptoms of MS and the treatment of relapses or MS cures focusing on immunomodulation and thereby reducing the disease’s progress.

Potential causes of Multiple Sclerosis: could the Epstein-Barr virus be responsible?

Researchers have identified more than 230 genes that may contribute to the MS risk. Furthermore, it is suggested that MS might be related to or caused by certain viruses.

It is not completely clear what cause MS. Researchers think it might be partly genetic and partly environmental factors. Examples of risk factors that might be related to MS are a lack of sunlight or vitamin D, smoking, and teenage obesity. Researchers have identified more than 230 genes that may contribute to the MS risk. Furthermore, it is suggested that MS might be related to or caused by certain viruses.

In February 2022, a large study was presented that explored whether there is a link between multiple sclerosis and the Epstein-Barr virus (EBV). The researchers analyzed blood samples taken from soldiers between 1993 and 2013. The study showed that people who were infected with EBV were 32 times as likely to develop MS when compared to people who were uninfected with EBV. It is important to note EBV in itself is not sufficient to trigger MS. 9 out of 10 people will contract the Epstein-Barr virus in their lives, most infections don’t cause any symptoms and only a very few of them develop MS disease.

The study published in February 2022 found a link between EBV and MS epidemiologically, but the pathological role of Epstein-Barr virus remained unclear. However, researchers might have a first explanation for the relation between EBV and MS. During an Epstein-Barr virus infection, the B-cells of the human immune system starts to produce antibodies called EBNA1. This protein has some structural similarities with a protein in the central nervous system (GlialCAM). Some of the B-cells could potentially start making antibodies that bind to both EBNA1 and GlialCAM, which might trigger an attack on the neurons. Studies found that about 1 in 4 MS patients carry these particular antibodies. This explanation provides us with a mechanistic link for the association between MS and EBV, and could thereby serve as a guide for the development of new MS treatments.

Can we vaccinate against Epstein-Barr virus?

There are currently three EBV vaccines in the pipeline.

With this knowledge in mind, many people might ask themselves: Can we vaccinate against Epstein-Barr virus? As EBV is also known to be related to certain cancers, researchers have been interested in the development of a vaccine for a long time. However, it seemed not economically acceptable to develop one as research and development costs were too high. The development of the first mRNA vaccines for Covid-19 might boost the current activities. After years of very little progress, there are currently three EBV vaccines in the pipeline. For example, Moderna, is currently in phase 1 of clinical trials of an mRNA vaccine for Epstein-Barr virus.

Challenges and future outlook

It is not expected that vaccination will soon be administered to all children to prevent multiple sclerosis as almost all of us contract EBV in our lives, and only a few of us develop MS. An important barrier is the fact that it will take a large and long-term study to demonstrate the efficacy of the EBV vaccine against multiple sclerosis. Furthermore, more research is needed to figure out whether the vaccine needs to provide sterilizing immunity (so that the virus will not bind to any human cells) or if limiting the severity of the infection will be enough to reduce the risk of developing multiple sclerosis. Alcimed is closely following the rapid developments in the rare diseases field and is ready to support you on these topics! Don’t hesitate to contact our team!

About the author,

Hannah, Consultant in the Alcimed’s Healthcare in team in Germany

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