Interactions of serum cholesterol with anti-herpesvirus responses affect disease progression in clinically isolated syndromes

•Cholesterol measured in pre-treatment serum from 118 high-risk CIS patients•Antibody responses to EBV EBNA-1 are associated with cholesterol levels.•Interactions of cholesterol with anti-CMV positivity are associated with disease progression.•Interactions of cholesterol with anti-EBV VCA antibodies are associated with MRI lesions.

ObjectivesTo investigate whether anti-herpesvirus antibodies are associated with serum cholesterol profiles in clinically isolated syndromes (CIS).MethodsPre-treatment serum samples from 118 high-risk CIS patients were analyzed for IgG antibodies against cytomegalovirus (anti-CMV), Epstein Barr virus (EBV) viral capsid antigen (VCA) and EBV nuclear antigen-1 (EBNA-1). A lipid profile consisting of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) was obtained. Clinical and MRI assessments were obtained at baseline, 6, 12, and 24 months after start of interferon-beta treatment.ResultsThe study included 118 CIS patients (77 females, 41 males, 65.3% female; mean age: 28.1 ± SD 8.1 years). Anti-EBV EBNA-1 antibody levels were associated with LDL-C (p = 0.009) and TC (p = 0.008) levels. Anti-CMV positivity status was associated with reduced time to relapse (p = 0.006) and the greater number of relapses (p = 0.009) in patients with high HDL-C. Anti-EBV VCA antibody levels were associated with greater number of new T2 lesions (p = 0.002) and with increased brain atrophy (p < 0.001) in patients with high LDL-C.ConclusionsOur results indicate that higher levels of anti-EBV EBNA-1 antibodies are associated with higher LDL-C and TC levels. Anti-CMV positive individuals have greater disease progression in the presence of higher HDL-C levels. Individuals with higher levels of anti-EBV VCA antibodies have greater progression on MRI measures in the presence of higher LDL-C.