Can Immunotherapy for Epstein-Barr Be a Potential MS Treatment?

After you have been exposed to the Epstein-Barr virus (EBV), it will remain in your body for a lifetime. While it doesn't usually cause illness, this virus has been linked to the development of multiple sclerosis (MS) in genetically susceptible people. Infection with EBV is extremely common. In fact, approximately 90% of the world's population is infected. This is because the virus is easily spread, mostly through saliva.

The symptoms resemble those of other common viruses and most people never even realize they are infected at all. There is currently no treatment to eradicate EBV from your body. There is also no vaccine currently available to prevent EBV infection.

Background

Based on evidence that EBV may contribute to the development of MS, researchers are working to find a treatment that targets the virus. It's still not clear whether treating EBV could slow down a person's MS disease course or perhaps even prevent MS from developing in the first place.

While these goals are only emerging, one very small study showed some promise. This Australian study examined the safety and effects of EBV-targeted immunotherapy—a therapy that uses a person's own immune system to combat illness.

EBV-Targeted Immunotherapy

In the Australian study published in The Journal of Clinical Investigation, 10 patients (five with secondary progressive MS and five with primary progressive MS) were given an adoptive T-cell therapy. This is a type of immunotherapy in which the participants' EBV-specific T cells are removed from the bloodstream, regrown in a laboratory, and then infused back into their blood.

While being regrown, the T cells were stimulated to target the EBV virus with the aim of making them better able to attack and control the virus within the body.

Results

Results revealed that among the 10 participants who received the targeted EBV therapy, seven showed improvements in various MS symptoms, such as:

• Fatigue
• Balance
• Cognitive skills (such as word-finding skills, concentration, and mental clarity)
• Mood
• Manual dexterity (improvement in handwriting)
• Urinating at night
• Leg spasticity
• Sleep
• Vision acuity
• Overall quality of life

The reduction in fatigue was one of the most commonly reported clinical improvements. This is important because fatigue is one of the most prominent and disabling symptoms of both MS and acute infectious mononucleosis, also called mono—an illness caused by EBV infection.

In addition to improvements in their MS symptoms, three of the participants experienced a reduction in their Expanded Disability Status Scale (EDSS) score.

Some participants did not show any MS symptom improvement and remained stable. One participant experienced an initial MS symptom improvement but then deteriorated with an increase in their EDSS score at the end of the study.

Safety

Overall, the T cell therapy used in this study was well-tolerated and safe with no serious adverse events reported. In fact, the only treatment-related adverse event reported in the study was transient dysgeusia (impaired taste) occurring in one participant.

Study Review

It's important to note that this study is a phase 1 trial, which is the first step in a long process to examine a new therapy. In other words, the purpose of this study (and any phase one trial) is to test the waters in terms of safety and side effects.

This study only included a very small number of participants. In addition, with phase one trials, there is no control group. This means that it is difficult to determine whether any clinical improvement seen in a study was simply by chance or from actually receiving the T-cell therapy.

Moreover, as the authors of the study noted, immunotherapy is not without risk.

One possible explanation for worsening symptoms is that the T cells may mistake non-EBV antigens for EBV antigens within the brain and spinal cord—a phenomenon called cross-reactivity. Results from early studies have thus far been uncertain.

Lastly, the potential long-term benefits of this unique immunotherapy are unclear. A follow up three years later showed sustained benefit. However, it's possible that as the T cells' ability to target EBV within the body dwindles, a person's MS could worsen.

A Word From Verywell

Larger and more controlled trials are needed to see if EBV-specific T cell therapy is indeed an effective MS therapy. Regardless, this study is a good first step—and it serves as a motivator for those with MS to remain resilient and hopeful in their own MS journeys.