Cytomegalovirus and multiple sclerosis risk
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LETTER TO THE EDITORS
Cytomegalovirus and multiple sclerosis risk Julia Pakpoor • Jina Pakpoor • Giulio Disanto • Gavin Giovannoni • Sreeram V. Ramagopalan
Received: 8 March 2013 / Revised: 28 March 2013 / Accepted: 2 April 2013 / Published online: 16 April 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Dear Sirs, Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system [1]. The aetiology is unknown but gene-environment interactions are most likely to underlie this multifactorial disease [1]. Infectious agents have been long speculated to play a causal role in the pathophysiology of MS. Thus far, numerous infectious agents have been investigated and Epstein–Barr virus has been the most consistently associated with increased MS risk [2]. However, studies investigating an association between cytomegalovirus (CMV) and MS have been inconclusive due to conflicting findings of both a protective and harmful influence of CMV on MS, likely in part as a consequence of small sample sizes [2, 3]. This study therefore aimed to compare the occurrence of CMV infection in MS patients versus controls to generate an overall estimate of the relationship between CMV and MS risk. This is important in evaluating the potential role of viruses in MS aetiology and thereby also in the treatment, and ultimately prevention, of MS.
J. Pakpoor G. Disanto S. V. Ramagopalan Medical Research Council Functional Genomics Unit and Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK J. Pakpoor School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK G. Giovannoni S. V. Ramagopalan (&) Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK e-mail: [email protected]
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Pubmed and EMBASE were searched on 20/02/2013 without any limitations for the terms [‘‘multiple sclerosis’’ (MeSH terms) OR ‘‘multiple’’ (all fields) AND ‘‘sclerosis’’ (all fields) OR ‘‘multiple sclerosis’’ (all fields)] AND [‘‘cytomegalovirus’’ (MeSH terms) OR ‘‘cytomegalovirus’’ (all fields)]. References of identified studies were searched to identify further articles. Where a study was considered suitable but raw data not available, authors were contacted. Raw data for the number of MS patients and controls who were CMV seropositive was extracted. Case–control studies (including published conference abstracts) were eligible for inclusion. Exclusion criteria were as follows: if the study was not a case–control study, if the article was not available in English, if serum CMV antibodies were not measured, if controls were related to cases (note spouses as controls were acceptable), if data had been duplicated in an included study or if controls had another known neurological condition. The Mantel–Haenszel with random effects model in Review Manager 5.1 was used to calculate the overall odds ratio (OR) and 95 % confidence interval (CI). Statistical significance was p \ 0.05. Statistical
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