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2014 ; 33
(4
): 266-83
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Role of pathogens in multiple sclerosis
#MMPMID24266364
Libbey JE
; Cusick MF
; Fujinami RS
Int Rev Immunol
2014[Jul]; 33
(4
): 266-83
PMID24266364
show ga
Multiple sclerosis (MS) is an inflammatory demyelinating autoimmune disease of
the central nervous system (CNS). Although the etiology of MS is unknown, genetic
and environmental factors play a role. Infectious pathogens are the likely
environmental factors involved in the development of MS. Pathogens associated
with the development or exacerbation of MS include bacteria, such as Mycoplasma
pneumoniae and Chlamydia pneumoniae, the Staphylococcus aureus-produced
enterotoxins that function as superantigens, viruses of the herpes virus
(Epstein-Barr virus and human herpesvirus 6) and human endogenous retrovirus
(HERV) families and the protozoa Acanthamoeba castellanii. Evidence, from studies
with humans and animal models, supporting the association of these various
pathogens with the development and/or exacerbation of MS will be discussed along
with the potential mechanisms including molecular mimicry, epitope spreading and
bystander activation. In contrast, infection with certain parasites such as
helminthes (Schistosoma mansoni, Fasciola hepatica, Hymenolepis nana, Trichuris
trichiura, Ascaris lumbricoides, Strongyloides stercolaris, Enterobius
vermicularis) appears to protect against the development or exacerbation of MS.
Evidence supporting the ability of parasitic infections to protect against
disease will be discussed along with a brief summary of a recent Phase I clinical
trial testing the ability of Trichuris suis ova treatment to improve the clinical
course of MS. A complex interaction between the CNS (including the blood-brain
barrier), multiple infections with various infectious agents (occurring in the
periphery or within the CNS), and the immune response to those various infections
may have to be deciphered before the etiology of MS can be fully understood.
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