Environmental risk factors for multiple sclerosis. Part I: The role of infection

被引:728
作者
Ascherio, Alberto
Munger, Kassandra L.
机构
[1] Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA
[2] Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA
[3] Brigham & Womens Hosp, Dept Med, Channing Lab, Boston, MA 02115 USA
[4] Harvard Univ, Sch Med, Boston, MA 02115 USA
关键词
D O I
10.1002/ana.21117
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Although genetic susceptibility explains the clustering of multiple sclerosis (MS) cases within families and the sharp decline in risk with increasing genetic distance, it cannot fully explain the geographic variations in MS frequency and the changes in risk that occur with migration. Epidemiological data provide some support for the "hygiene hypothesis," but with the additional proviso for a key role of Epstein-Barr virus (EBV) in determining MS risk. We show that whereas EBV stands out as the only infectious agent that can explain many of the key features of MS epidemiology, by itself the link between EBV and MS cannot explain the decline in risk among migrants from high to low MS prevalence areas. This decline implies that either EBV strains in low-risk areas have less propensity to cause MS, or that other infectious or noninfectious factors modify the host response to EBV or otherwise contribute to determine MS risk. The role of infectious factors is discussed here; in a companion article, we will examine the possible role of noninfectious factors and provide evidence that high levels of vitamin D may have a protective role, particularly during adolescence. The primary purpose of these reviews is to identify clues to the causes of MS and to evaluate the possibility of primary prevention.
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页码:288 / 299
页数:12
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