Re: Correlation between Mono and PSC? Maybe?

[Guest guest]

Hi Darryl;

The only way I can possibly link mononucleosis (caused by the Epstein-

Barr virus) to PSC is via autoimmune hepatitis:

Epstein-Bar virus ----> Autoimmune hepatitis ---> PSC

as described in these two abstracts:

_____________

Lancet. 1995 Sep 2;346(8975):608-9.

Epstein-Barr virus as a trigger for autoimmune hepatitis in susceptible

individuals.

Vento S, Guella L, Mirandola F, Cainelli F, Di Perri G, Solbiati M,

Ferraro T, Concia E

Department of Infectious Diseases, University of Verona, Borgo Trento

Hospital, Italy.

During follow-up of healthy relatives of 13 patients with autoimmune

hepatitis, seven cases of infectious mononucleosis due to Epstein-Barr

virus (EBV) occurred. In two of these seven, before EBV infection,

there was a defect in suppressor-inducer T lymphocytes specifically

controlling immune responses to the asialoglycoprotein receptor, an

antigen expressed on the hepatocyte surface. In these two, antibodies

to this autoantigen persisted and increased after infectious

mononucleosis, and autoimmune hepatitis developed within 4 months. In

susceptible individuals, EBV is a trigger for autoimmune hepatitis.

PMID: 7651006.

_____________________

Hepatology. 2002 Dec;36(6):1393-9.

Evolution of autoimmune hepatitis to primary sclerosing cholangitis: A

sequential syndrome.

Abdo AA, Bain VG, Kichian K, Lee SS

Liver Unit, Division of Gastroenterology, University of Calgary,

Calgary, Alberta, Canada.

Recently, the autoimmune hepatitis (AIH)/primary sclerosing cholangitis

(PSC) overlap syndrome has been reported increasingly. In this

syndrome, patients present with features of both AIH and PSC. It has

been suggested that the 2 diseases may be sequential in their

occurrence, whereby patients have features of AIH and then after a

number of years develop features of PSC, but clear confirmation of

evolution has not been documented in adults. We describe 6 adult cases

in which PSC was diagnosed many years after well-established AIH. Six

patients are described in whom AIH definitely was diagnosed at

presentation. No evidence of biliary disease was noted on the initial

liver biopsy or endoscopic retrograde cholangiography (ERCP). All

patients responded well to immunosuppressive therapy. After an average

duration of follow-up of 4.6 years they became resistant to

immunosuppression, and developed clear features of PSC, which was

confirmed by ERCP in all patients. The average age of the patients at

first presentation was 31.3 years, 2 were women and 4 were men, and 3

had ulcerative colitis. We found no specific features at presentation

that could predict this evolutionary outcome. In conclusion, patients

with well-established AIH can, after variable duration of follow-up,

develop PSC. In patients with AIH who become resistant to

immunosuppression or develop significant cholestasis, PSC should be

ruled out by ERCP. PMID: 12447864.

_____________________

Best regards,

Dave

(father of (22); PSC 07/03; UC 08/03)

>

> Is there any known correlation between PSC and mono?

>

[Guest guest]

I'd like to see a poll done as to how many PSCers also had mono. I've

had a suspicion for years that the two may be slightly related. Maybe

not blood brothers, but perhaps second cousins? Fred had mono at age 30,

right after we got married. (He slept through the honeymoon.) Fred also

had tularemia, or rabbit fever, as a teen. It's a serious disease caused

by coming in contact with infected rabbits, affecting multiple organs,

including the liver. It makes sense that if there are enough of these

" hits " to the body in susceptible individuals, the immune system goes

whacko..My daughter had mono at 21, and of course I worry about my kids

inheriting some of the autoimmune stuff. But if any group can make

great progress and fund/find a cure, this group can! I'm amazed by so

many of you and your tireless pursuit in fighting this battle.

Wife of Fred, PSC 03/04, UC 03/06, CWC 09/07 (Getting ready to Cruise

the Western Caribbean with my " FunShip Freddie " on Carnival- Ain't We

Got Fun?)

[Guest guest]

I was diagnosed with PSC in 1988 which I was told probably started in

85. I had mono late in 1984. Which was a big deal for me because I

was 17 and it was the first time I ever had a health problem.

[Guest guest]

Bill was diagnosed in 04 with PSC/UC at age 21. Last March he was hospitalized with mono at 24 years old.LeeI'd like to see a poll done as to how many PSCers also had mono. I've had a suspicion for years that the two may be slightly related. Maybe not blood brothers, but perhaps second cousins?

[Guest guest]

Interesting. I had mono when I was 15 and my health went immediately

downhill (stomach ulcers, drug induced hepatitis, gallstone attacks,

chronic bladder infections, etc.) They found PSC when they removed

CBD stones, which they did via open surgery because the duct was very

narrow and the stones very large.

Lori in Alaska

PSC '07

> I'd like to see a poll done as to how many PSCers also had mono.

[Guest guest]

This paper discusses evidence for association of Epstein-Barr virus

infection with a large number of autoimmune diseases:

Ann. N.Y. Acad. Sci. 1108: 567-577 (2007)

Epstein-Barr virus and cytomegalovirus in autoimmune diseases. Are

they truly notorious? A preliminary report.

Barzilai O, Sherer Y, Ram M, Izahaky D, Anaya JM, Shoenfeld Y

Address for correspondence: Yehuda Shoenfeld, M.D., F.R.C.P.,

Department of Medicine B and Center for Autoimmune Diseases, Chaim

Sheba Medical Center, Tel-Hashomer 52621, Israel.

shoenfel@...

ABSTRACT: To date, it is believed that the origin of autoimmune

diseases is one of a multifactorial background. A genetic

predisposition, an immune system malfunction or even backfire,

hormonal regulation, and environmental factors all play important

roles in the pathogenesis of autoimmune diseases. Among these

environmental factors, the role of infection is known to be a major

one. Epstein-Barr virus (EBV) and cytomegalovirus (CMV) are

considered to be notorious as they are consistently associated with

multiple autoimmune diseases. A cohort of 1595 serum samples, of 23

different autoimmune disease groups, was screened for evidence of

prior infection with EBV and CMV. All samples were screened for

antibodies against EBV nuclear antigen-1 (IgG), EBV viral

capsid antigen (IgG and IgM), EBV early antigen (IgG), EBV

heterophile antibody, and CMV (IgG and IgM) antibodies using Bio-

Rad's BioPlex 2200. A new association is proposed between EBV and

polymyositis, as results show a significant increase in titers of

various EBV target analytes when compared with healthy controls. Our

results also support prior information suggesting the association

between EBV and multiple autoimmune diseases, including SLE,

antiphospholipid syndrome, rheumatoid arthritis, multiple sclerosis,

pemphigus vulgaris, giant cell arthritis, Wegener's granulomatosis,

and polyarteritis nodosa (PAN). Elevated CMV IgG titers were observed

in sera of SLE patients. Our data support the theory that EBV is

notoriously associated with many autoimmune diseases. CMV appears to

be associated to autoimmune diseases as well, yet establishing this

theory requires further investigation.

KEYWORDS: autoimmunity; EBV; cytomegalovirus; autoimmunity;

multiplexed assay

I'll post the full paper shortly ...

Best regards,

Dave R.

[Guest guest]

Thanks Dave.I have heard different opinions as to whether you can have mono more than once, and depending on if you can or not, I don't think Bill had it before his PSC.I know that my other son had it when he was 3 and was 6. At the time , did not seem to catch it from his brother.But he sure had a good case of it last March!So, who knows how the mono may or may not have changed things. I do know that from the time Bill was born he already had allergy problems, to milk and things I ate as well as eczema.I guess the real problem might be with the immune system not functioning properly to begin with and thus opening the door to all these other problems.I sure would like to know how to shut the door.LeeThis paper discusses evidence for association of Epstein-Barr virus infection with a large number of autoimmune diseases:Ann. N.Y. Acad. Sci. 1108: 567-577 (2007)Epstein-Barr virus and cytomegalovirus in autoimmune diseases. Are they truly notorious? A preliminary report..