What is the link between Epstein-Barr virus and lupus?
In autoimmune research, it is known that the Epstein-Barr (EBV) virus is a strong risk factor for triggering multiple sclerosis (MS). EBV is a herpes virus that is spread mainly through saliva and can cause infectious mononucleosis in teens and young adults. Unfortunately, this virus is the most common human virus worldwide, yet there is no vaccine to protect individuals against EBV infection. In a new study by Stanford Medicine, researchers have found compelling evidence that EBV is a direct driver of systemic lupus erythematosus (SLE), the most common type of lupus.
Although EBV infects roughly 95% of adults and typically remains dormant, the study shows that in lupus patients, the virus awakens a tiny subset of B cells (immune cells responsible for producing antibodies and presenting antigens), triggering them to activate large networks of autoreactive immune cells. Using an advanced high-precision sequencing technique, the researchers identified how EBV exerts its influence at the cellular level.
In healthy individuals, fewer than 1 in 10,000 B cells harbor latent EBV, but in lupus patients, this rises to about 1 in 400. The key culprit appears to be EBNA2, a viral protein occasionally produced by latent EBV. EBNA2 acts as a molecular switch that "turns on" numerous inflammatory genes within the infected B cell. This transforms the cell into a highly active antigen-presenting “driver” that awakens helper T cells and recruits vast numbers of antinuclear B and killer T cells—immune cells that mistakenly attack the body—leading to the tissue damage characteristic of lupus.
The findings also raise broader questions about EBV’s potential role in other autoimmune conditions, where hints of similar mechanisms have been observed. But the question remains: if almost everyone carries EBV, why do only some develop autoimmunity? One hypothesis is that only certain viral strains trigger this dangerous immune cascade. As multiple companies pursue an EBV vaccine, researchers note that such a vaccine would need to be given in early childhood, as it cannot eliminate the virus once it is latent. This study is crucial in the understanding of lupus and opens new doors for prevention and treatment.
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