Epstein-Barr Virus and Lupus
For years medical professionals have been conducting research and collecting data on the hypothesis that the Epstein-Barr virus (named after Professor Michael Anthony Epstein who discovered and published on the existence of the virus in 1961), may be related to the development of systemic lupus erythematosus, as well as, rheumatoid arthritis, Sjogren's syndrome, multiple sclerosis, systemic sclerosis, and other autoimmune disorders. To date, Epstein-Barr virus is the most studied infection in lupus causation, which may be surprising to some patients who have never even heard of it.
What is the Epstein-Barr virus?
Epstein-Barr virus (EBV), also known as herpesvirus 4, is one of the most common human viruses stemming from the herpes virus family. Most people become infected with EBV at some point in their lives and the virus has been identified in all parts of the world. In fact, it affects 90% of the world’s adult population.
EBV spreads most commonly through bodily fluids, usually saliva. EBV can cause infectious mononucleosis, also called “mono” and other illnesses.
Symptoms of EBV infection can include:
Swollen lymph nodes in the neck
People are infected by the Epstein-Barr virus (EBV) primarily in early childhood. It usually causes no symptoms or only a brief, mild illness. When teens or young adults become infected, it can turn into infectious mononucleosis with more prevalent manifestations of extreme fatigue, fever, sore throat, and swollen lymph nodes. These symptoms can last for two to four weeks but sometimes longer. After infection, EBV becomes dormant, and people remain infected throughout the rest of their lives usually without any symptoms. In some rare cases, people can develop chronic active Epstein–Barr virus (CAEBV) disease, a rare disorder in which the disease is progressive with markedly elevated levels of active EBV in the blood. This type of EBV is primarily reported in East Asia and Latin America, suggesting a genetic predisposition in its disease progression.
The Lupus and Epstein-Barr Connection
Dr. Thomas, who wrote the best-selling handbook on lupus The Lupus Encyclopedia mentions in his chapter on “What Causes Lupus?” that the Epstein-Barr virus (EBV) in particular may be a possible trigger of the disease based on research where children with lupus had higher levels of EBV antibodies in their blood compared to children who did not have lupus. Several other studies have shown an increased association between having high levels of EBV antibodies in the blood and developing SLE at some point after the EBV infection.
A study associated with the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) helps confirm the connection between lupus and EBV. What they discovered was the immune system, having been amped up to fight EBV, mistook part of the body for part of the virus and produced antibodies (or autoantibodies) against the body's own proteins. This phenomenon of cells attacking cells is called molecular mimicry, and has been linked to a slew of different diseases, most often rheumatic fever, where people produce antibodies to proteins in the heart valves in response to a strep bacterial infection. However, this is the first time molecular mimicry has been proven to play a role in lupus. What is fascinating is that even with all this collaborative research and undeniable data, it has not yet been 100% proven that EBV definitively triggers lupus.
Dr. Judith James, M.D., Ph.D. of the Oklahoma Medical Research Foundation in Oklahoma City, seems to think that this latest research can provide further insight into confirming the connection, treating, and possibly preventing the disease through vaccinations against EBV. She states, "If we could identify susceptible people at the right point, (perhaps) we could stop this response from happening." Talk about a potential game-changer in the world of immune regulation. How exciting to think that with this information individuals who are overly susceptible may be able to side-step one of the biggest suspected lupus catalysts.
On a personal note, the Epstein-Barr Virus I believe was my lupus catalyst. It was the virus that changed the course of my life. It was the push, the proverbial "straw" that sent my immune system into a frenzy at 11 years old. Having lived with a bleeding disorder as a child, it wasn't until I strangely contracted EBV that my health declined rapidly. A few months after developing the virus, I began to notice changes in my body that were not associated with EBV. I had developed photosensitivity, swollen joints, headaches, problems with memory, weak muscles, and extreme fatigue. I had trouble sleeping and eating and lost a significant amount of weight. My pediatrician was baffled, that is, until he finally took bloodwork. BINGO. My antinuclear antibody came back as a positive speckled titer of 1:1280. Signature antibody response of SLE.
Now did Epstein-Barr “cause” my SLE? Perhaps. However, It is difficult to know for sure. Lupus is believed to be caused by a combination of genetic and environmental factors and “wonky” immune dysregulation (that’s my non-medical professional description). There are dozens of genetic variants linked to the development of the lupus, so it is feasible to assume that if it hadn’t been for EBV, something else, at some point may have triggered my symptoms, i.e. hormones, pregnancy, or some sort of traumatic event.
Be that as it may, it does make me wonder...if we are to conclude EBV as a cause, might we be able to one day develop a vaccine that may prevent it? And in doing so, give the next child who may be prone to developing lupus more years of symptom-free life?
Let’s hope so.
Written By: Kelli (Casas) Roseta
Note: If you are a lupus patient and believe EBV played a part in the development of your lupus symptoms, please comment below. We would love to hear your story.
The Lupus Encyclopedia, Johns Hopkins Press, By. Donald E. Thomas, Jr., published 2014, page 45 referenced. www.lupusencyclopedia.com
Frontiers in Immunology, Review: Published February 3rd 2021, Dr. Judith James and Neelaskshi R. Jog
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