Could population of Orkney hold the key to finding a vaccine for MS?
Islanders fall ill at TEN TIMES the global average... and scientists say a common virus may be partly to blame
ScIEnTISTS have long been puzzled by why the Orkney Islands have the highest rates of multiple sclerosis in the world. At least 80 people on the islands are living with the condition that can cause serious disability affecting movement and vision.
This equates to 402 per 100,000 people, more than ten times the world average of 35.9.
Experts believe there are genetic factors at play within the islanders’ DnA but now researchers hope to shed new light on whether a common virus could also be playing a role.
And an exciting clinical trial in the United States could pave the way for a vaccine for the virus and the health problems thought to be associated with it.
MS is a condition that can affect the brain and spinal cord, causing a range of potential symptoms, including problems with vision, arm or leg movement, sensation or balance.
Those with MS include Anne Rowling, mother of Harry Potter author JK Rowling, who died in 1990 from complications of the condition, and US actresses christina Applegate and Selma Blair.
There is no cure for MS but treatments and specialists can help manage the condition and its symptoms.
new research has established people who have been infected with the common EpsteinBarr virus (EBV) have a 32 times higher risk of developing MS. EBV is best known as the cause of glandular fever, also called infectious mononucleosis. Once someone is infected, it remains in the body for life. Glandular fever is spread through bodily fluids, primarily saliva.
When younger children are infected, they can have a mild, brief illness but if someone is infected later in life –such as in adolescence – it can be more serious, with a fever and sore throat that can last for several weeks, even leading to chronic fatigue syndrome in some cases.
Approximately 1 per cent of all EBV-infected individuals develop serious complications, including hepatitis, neurological problems or severe blood abnormalities.
EBV has also been linked to conditions including stomach and nasopharyngeal cancers, Hodgkin and Burkitt lymphomas, as well as autoimmune diseases such as systemic lupus erythematosus. This causes inflammation in connective tissues, such as cartilage and the lining of blood vessels.
REcEnT research has found a history of EBV is common in MS patients. A study published in January of ten million soldiers’ historical blood samples over a 20-year period showed that those who had not been infected with the Epstein-Barr virus ‘virtually never’ get MS.
Out of 801 people who developed the condition, only one never tested positive for EBV during the study. Other viruses looked at did not show a link with MS.
A separate study has shown EBV cells reside within the brain lesions of MS patients, suggesting the virus is playing a role in the way MS damages brain cells.
An unpublished Orkney and Shetland study found that of the people with MS on the islands who were also tested for a previous EBV infection, all got a positive result.
Lack of vitamin D has also been linked to MS, but Orcadians have not been found to have unusually low levels of it. The leading geneticist working to unlock the mysteries of why Orkney has MS hotspots has said he believes a combination of factors, including DnA and EBV are significant.
Jim Flett Wilson, professor of human genetics at Edinburgh University, said: ‘We actually did a small piece of work on EBV a long time ago, although it was never published. Every sample from Orkney or Shetland we had with MS which was tested for EBV was positive, just like in all the other much larger studies, so it’s definitely part of the picture.’
He added: ‘I have not done a survey of whether EBV is more common in the general population of Orkney, which is what would be needed to understand if EBV is part of the reason for the excess.’
clusters in families from certain parts of Orkney, such as the islands of South Ronaldsay, Westray and Rousay, have been documented as hotspots. There are also so-called ‘coldspots’, as people with ancestry from Deerness, on the east, very rarely develop the condition.
But it does not matter whether people have stayed on the islands or moved away, people with an Orkney heritage are more likely to be diagnosed with MS than the general population.
common genetic factors have been ruled out as the cause of the high rates. Professor Wilson said his ‘best guess’ was a link to a rare genetic variant or multiple variants shared by some people in Orkney. This could be combined with other factors such as EBV infection. He explained: ‘My thoughts on why rare genetic factors are part of it are to do with the fact certain analyses show it is partly genetic, but we excluded it was common genetic variants, so it must therefore be rare ones.’
The genetic research into MS is part of a much wider set of studies into Orkney and Shetland DnA, and how that might impact islanders’ health.
For some people, MS is characterised by periods of relapse and remission while for others it has a progressive pattern.
Most people are diagnosed between the ages of 20-40, but it can affect younger and older people too. Roughly three times as many women have MS as men.
Though EBV is a common virus it is not very well understood as it is quite complex.
AVAccInE is at the research stage and being trialled in the US but is not yet available in the UK. It uses the same mRnA technology as some covid vaccines and is focusing on preventing people infected with EBV from developing glandular fever.
The work is at an early stage but there is hope that it could be a game changer by reducing incidence of the debilitating conditions EBV is associated with.
At the trial launch this month, US national Institute of Allergy and Infectious Diseases director Dr Anthony Fauci said: ‘A vaccine that could prevent or reduce the severity of infection with EBV could reduce the incidence of infectious mononucleosis and might also reduce the incidence of EBV-associated malignancies and autoimmune diseases.’
Orkney MSP Liam McArthur has been vocal in calling for more research into MS.
He said: ‘With the highest incidence rates of MS in the world, most people in Orkney will know someone affected by MS.’
Mr McArthur added: ‘While there is a way to go in finding a cure for MS, we can take comfort from the progress made in recent years on treatment and early diagnosis. This has been spearheaded by research taking place in Scotland, which must be supported to continue.’