As you are aware from reading this blog that EBV is strongly associated with MS and some of us believe that there is now enough evidence to accept EBV as the cause of MS. One of the reasons for thinking this is that if you are EBV seronegative, i.e. you have never been infected with the virus your chances of getting MS are close to zero. The latest meta-analysis we did showed that when you use two robust assays to assess EBV seronegativity your risk is in fact zero.
Pakpoor et al. The risk of developing multiple sclerosis in individuals seronegative for Epstein-Barr virus: a meta-analysis.
Mult Scler. 2012 Jun 11.
It is also apparent that you have to be infected with EBV before you develop MS; this is the correct sequence of events to prove causation. As you have gathered causation theory is complex and you need to fulfill many criteria; one of these criteria is experimental evidence. In other words if you stop people becoming infected with EBV you should prevent them from developing MS.
The grand challenge is to develop a vaccine against EBV that prevents wild-type infection and to set-up a study to test this hypothesis, i.e. to take a group of children who are at high risk of developing MS because one or both of their parents have MS, and to vaccinate half of them against EBV and the other half against another virus or with a placebo vaccine, and to then follow them up to see if those vaccinated with the active vaccine have a reduced incidence of MS. The follow-up for this study will have to be for 30-40 years as the average age of onset of MS is 30. To do this experiment we would first need to develop a safe and effective vaccine against EBV. The current vaccines that have been developed are not that effective; they provide some immunity against EBV but not enough to prevent wild-type infection.
Our other grand challenges:
27 Aug 2012
Grand Challenges in MS (4): month of birth effect. Why does the month you are born in affect your risk of MS? I assume you are aware that month of birth is a risk factor for MS. In the Northern hemisphere, if you are born in May …
26 Jul 2012
Grand Challenges in MS (3): changing sex ratio. Why is the incidence of MS increasing amongst woman? To prove that MS is caused by a single factor or the interaction of several factors it has to explain everything we know …
06 Jul 2012
Grand Challenges in MS (2): early aggressive therapy. In response to yesterday’s discussion on whether or not … That is another story, possibly another grand challenge.” “I hope this post in not confusing; if it is I will try and …
02 Jul 2012
Grand Challenges in MS (1): education. It appears that the grandest of all challenges in MS research is education; i.e. getting Researchers and MSers to agree on the unmet needs in the field across all stages of the disease.