Targeting Epstein Barr Virus (EBV) : A novel treatment for Multiple Sclerosis (MS)
To cure or not to cure MS, that is the question. I claim MS is a curable disease because of what I have seen happen to some of my patients who have been treated early with Cladribine or AHSCT . There is a growing recognition among the scientific community that deals exclusively with MS that Epstein Barr Virus is the potential cause of Multiple Sclerosis. It is now clear that EBV is necessary but not sufficient for someone to develop MS.
Those of us who are interested in curing MS argue about how EBV causes MS. There are currently three leading EBV causation theories. (1) EBV triggers autoimmunity as a hit-and-run event, and the virus doesn’t play a role in the disease after the initial triggering event. (2) EBV-infected B-cells are responsible for driving autoimmunity. (3) Active EBV infection drives MS disease activity.
CD19 is a molecular or antigenic expression on one type of lymphocytes (B cells) that plays a major role in causing and perpetuating immune- mediated damage to the central nervous system in MS.
CD19-targeted CAR T-cells could be one form of immunotherapy that would purge the body of EBV-infected B-cells. These cells are engineered to find and kill any cell expressing CD19. The advantage CAR T-cells have over B-cell targeting monoclonal antibodies (anti-CD20 or anti-CD19) is that they traffic unhindered into the CNS. It is important to scrub the central nervous system (CNS) clean of pathogenic B-cells, plasmablasts, and other hard-to-reach B-cell niches that may harbor EBV-infected B-cells.
The future may well belong to CAR-T cell therapy that aims to cure Multiple Sclerosis and not merely control or mitigate this dreadful, disabling disease.
Reference:
NEJM Article
Müller et al. CD19 CAR T-Cell Therapy in Autoimmune Disease — A Case Series with Follow-up. N Engl J Med 2024; 390:687-700.
Editorial
Isaacs. CAR T Cells — A New Horizon for Autoimmunity? N Engl J Med 2024; 390:758-759.
