Epstein-Barr Virus as a Trigger of Autoimmune Liver Diseases

Abstract

The pathogenesis of autoimmune diseases includes a combination of genetic factors and environmental exposures including infectious agents. Infectious triggers are commonly indicated as being involved in the induction of autoimmune disease, with Epstein-Barr virus (EBV) being implicated in several autoimmune disorders. EBV is appealing in the pathogenesis of autoimmune disease, due to its high prevalence worldwide, its persistency throughout life in the host's B lymphocytes, and its ability to alter the host's immune response and to inhibit apoptosis. However, the evidence in support of EBV in the pathogenesis varies among diseases. Autoimmune liver diseases (AiLDs), including autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC), have a potential causative link with EBV. The data surrounding EBV and AiLD are scarce. The lack of evidence surrounding EBV in AiLD may also be reflective of the rarity of these conditions. EBV infection has also been linked to other autoimmune conditions, which are often found to be concomitant with AiLD. This paper will critically examine the literature surrounding the link between EBV infection and AiLD development. The current evidence is far from being conclusive of the theory of a link between EBV and AiLD.

Pathogen Infection as a Possible Cause for Autoimmune Hepatitis

“…Admittedly, many case studies demonstrate a strict temporal relation between pathogen infection and the development of acceleration of AIH. In particular, HAV, HCV, and EBV have been discussed to play a role in AIH [65,113]. However, in contrast to other autoimmune diseases (see reviews in this special issue of IRI) the data for an involvement of pathogens are rare and firm evidence from large cohorts is missing.…”

“…Another prominent candidate is Epstein-Barr virus (EBV), a pathogen that has been very frequently associated with the development of several autoimmune diseases, including systemic lupus erythematosus (SLE), multiple sclerosis (MS), autoimmune forms of thyroiditis (Grave's disease and Hashimoto's disease), rheumatoid arthritis (RA), inflammatory bowel disease (IBD), type 1 diabetes (T1D), Sjögren's syndrome (SjS), and myasthenia gravis (MG) as well as autoimmune liver diseases [65]. In the present review, we will focus on the role of EBV in AIH, and refer to a recent review by Rigopoulpu et al for an excellent overview on the role of EBV in autoimmune liver diseases, such as PBC and PSC [65].…”

“…In the present review, we will focus on the role of EBV in AIH, and refer to a recent review by Rigopoulpu et al for an excellent overview on the role of EBV in autoimmune liver diseases, such as PBC and PSC [65].…”

De-Novo Autoimmune Hepatitis with Consecutive Acute Liver Failure Induced by Hepatitis E Infection: A Case Report

“…HEV is a leading cause of acute hepatitis in developing countries and an emerging causative agent of acute and chronic hepatitis in Europe (4)(5)(6). A recent study from the Robert Koch Institute found an anti-HEV prevalence of 16.8% in the adult population in Germany (7,8).…”

A Case of Ulcerative Colitis Following Acute Hepatitis Induced by Epstein-Barr Virus Infection

“…Chronic EBV infection is a possible triggering factor for not only IBD but for other autoimmune diseases including autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis. 2,3,18 The pathogenesis of autoimmune disease related to EBV infection is not clear. Autoimmunity may develop because of molecular mimicry, which is defined as immunological cross-reactivity between EBV and self-antigens.…”