What should we do about it?
I gave the Charcot lecture earlier this year at the NIH. In the lecture, I made the point that the epidemiology and biology of MS are coming together around the B-cell and EBV and that it is looking increasingly likely that EBV is the cause of MS.
Although my slides tell the story it is important to stress that proving causation is a complex process and the only way to prove that EBV is the cause of MS is to prevent EBV infection and see what happens to the incidence and prevalence of MS over time. This hypothesis is based on many epidemiological studies, but the most compelling piece of data is the observation that people who are EBV negative are protected from getting MS. Yes, protected from getting MS.
One hurdle we have at the moment is that we don’t yet have a good sterilising vaccine to prevent EBV infection. The latter is a technological challenge and there are very good vaccinologists working on bivalent and trivalent vaccines as we speak. Let’s hope they are safe and effective.
Some of you may know that I now wear two hats. My new hat is that I am a co-director of the Preventive Neurology Unit within the Wolfson Institute of Preventive Medicine and one of the diseases we are focusing on is MS. This is one of the main reasons I left Queen Square to move to Barts and The London; I wanted to work on EBV and MS.
In October 2016 we held a task force meeting on EBV as a cause of MS (see PDF below). The conclusions of the meeting was a unanimous yes; we need to go ahead and design and perform EBV vaccination trials to try and prevent MS. The latter is easier said than done, but that is our direction of travel, with ‘many miles to go before we sleep’.
There will be a lot of naysayers along the way but to quote Arthur Schopenhauer, ‘All truth passes through three stages; first, it is ridiculed, then it is violently opposed and finally, it is accepted as self-evident’.