New research undertaken at St Vincent's to identify possible causes of Multiple Sclerosis

What is Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic, incurable disease of the brain and spinal cord, where the immune system attacks and degenerates the protective myelin sheath around nerves, leading to disruption in brain signals to the rest of the body. It affects more than 33,000 people in Australia alone and can result in a range of disabling symptoms, including loss of mobility, fatigue, incontinence, and changes to vision.

What’s the correlation between Epstein Barr Virus (EBV) and MS?

There is evidence to suggest that infection with the Epstein-Barr Virus (EBV) is necessary but not sufficient to cause multiple sclerosis (MS). A consortium ‘The Open Coast-to-Coast Australian Multiple Sclerosis’ (OCCAMS) where world-class interdisciplinary team of clinicians, scientists and consumers working in hospitals will study the variability in an individual’s immune response to EBV that may contribute to MS pathogenesis.

What is EBV?

EBV is one of the most common human viruses. Most people are exposed to the virus at some point in their lives and most people are infected during childhood. The virus spreads mostly through bodily fluids like saliva and causes fatigue, fever, sore throat, inflamed lymph nodes, swollen liver, enlarged spleen, and rash. After infection, the virus becomes dormant in the body and in some cases can reactivate.

What does this study involve?

OCCAMS, along with its industry partners and the use of state-of-the-art technologies will determine why some individuals infected with EBV develop MS. In Australia, EBV infects more than 90 per cent of the healthy adult population and yet MS only occurs in less than 1 in 1,000 individuals. This suggests that EBV infection may be necessary but not sufficient to cause MS. This study will seek to improve understanding of how immune responses to viruses vary across individuals to inform disease prediction and treatment pathways. Machine learning will be used to predict an individual’s risk and form the basis for future primary prevention studies.

Three studies will take place where:

Protocol 1

Does an individual’s genetic disposition trigger an immune response to EBV and thus develop MS?

Mapping studies of the immune response to EBV by comparing unrelated individuals who are EBV-negative without MS, EBV-positive without MS and EBV-positive with MS.

Protocol 2

Is an individual’s predisposition to MS triggered by an immune response to EBV?

This will determine how variability in immune responses to EBV may trigger MS in predisposed individuals. The studied groups include those who presented with their first demyelinating episode (FDE), and a control cohort.

Protocol 3

Can at-risk individuals be identified for developing MS after an EBV infection?

A preventative risk model using machine learning will be developed to assess the probability of those at risk of developing MS prior to and after EBV exposure.

What are the role of T cells and B cells in this study?

 Both cells are called lymphocytes. The B cells produce antibodies used to attack invading bacteria, viruses and toxins. The T cells destroy the body’s own already infected cells that have been taken over by virus or bacteria or become cancerous.

T cells and B cells respond differently to fighting EBV in MS. This study seeks to identify the difference in immune responses by T cells and B cells on EBV and how this response correlates to individuals developing MS.

This study is possible through the collaboration of Dr Jennifer Massey, Clinical Lead and staff specialist neurologist at St Vincent’s Clinic and Prof Tri Phan, Scientific Lead at the Garvan Institute of Medical Research.