Other Factors
But the complete, complex relationship between EBV and SLE risk may also involve other factors, the researchers conclude. Future research in this area will include preventive trials, as well as pursuing additional natural history studies. Dr. James poses the question of whether early detection of disease could help identify appropriate target populations for research and intervention.
She is one of the researchers, along with principal investigators Nancy Olsen, MD, and David Karp, MD, PhD, in the promising, NIH-funded Study of Anti-Malarials in Incomplete Lupus Erythematosus (SMILE). This double-blind, multi-center trial will examine patients with incomplete lupus receiving hydroxychloroquine, compared with placebo, to see if it could prevent them from acquiring additional clinical and immunological factors that define lupus.2
Dr. James
Researchers are also looking for associations of other infections with lupus—and other patient groups that aren’t related to a lupus patient. Another recent study conducted at Cincinnati Children’s Hospital Medical Center (CCHMC) and published last year in the journal Nature Genetics found associations between EBV-related transcription factors and six other medical conditions along with SLE.3 That study found EBV is associated with an increased risk of developing SLE, multiple sclerosis, rheumatoid arthritis, juvenile idiopathic arthritis, inflammatory bowel disease, celiac disease and type 1 diabetes—which together affect nearly 8 million people in the U.S. The study also found that a protein produced by EBV binds to multiple locations along the human genome associated with these seven conditions.
One of the leaders of that study, John B. Harley, MD, PhD, professor and director of the Center for Autoimmune Genomics and Etiology at CCHMC, says lupus is the signal disease in this research—“the one we start with.” Recent studies are convincing researchers that EBV is an important etiologic agent in the progression of SLE, and Dr. James’ research “is another step in the direction of trying to figure it out, consistent with the possibility EBV causes lupus,” Dr. Harley tells The Rheumatologist.
