Epstein-Barr virus (EBV) is one of the most common and successful human viruses, infecting more than 90% of the world’s adult
population. Despite its strong tumorigenic potential, most virus carriers remain healthy due to maintenance of a delicate
balance between the host’s immune system, which limits production of virus particles, and the virus, which persists for the
duration of the host’s life. New data show that this balance is altered on a subtle level in patients with multiple sclerosis
(MS) and other autoimmune diseases who show enhanced as well as less restricted T-cell and antibody responses to EBV-encoded
antigens. Such quantitatively and qualitatively distinct immune responses and the virus’ unique ability to immortalize B cells
as well as to continuously stimulate strong T-cell responses during persistent infection suggest a possible role for EBV in
the initiation and progression of symptomatic autoimmunity. We hypothesize that EBV promotes both autoimmune B and T-cell
responses. EBV gene products might stimulate cross-reactive autoimmune B cells directly or increase their survival after infection.
In addition, autoimmune T cells could be maintained via molecular mimicry between autoantigens and EBV antigens, and via the
Th1 polarizing cytokine milieu of protective antiviral T-cell immunity. A better understanding of how EBV and EBV-specific
immune control mechanisms interfere with the evolution of autoimmunity may generate a rationale for novel EBV-targeting therapeutic
strategies aimed at the prevention and more efficient treatment of autoimmune diseases.