Not just myeloma

First bit of news: I’ve had absolutely no pain in my heel. It’s as good as new. I have to admit I’m still stunned…and I wonder if a more conventional doctor, let’s say a physiotherapist, would have made the connection between my relatively new eyeglass prescription and my heel pain. I doubt it.

This makes me wonder how many similar cases there are, of people who think they have plantar fasciitis or tendonitis or, sorry for the mention! 😉 , heel spurs, but whose pain actually originated in a different part of the body, an easy-to-fix part of the body. Mind-blowing, eh?

But the reason I’m writing today is that EBV, that is, the Epstein-Barr virus, is in the news again.

I wrote a few posts about the EBV connection to MGUS (and, therefore, to SMM and MM) back in October of 2017 when I came across an Italian study on this very topic, and then another bunch of posts in December and January, as I recall. To find and read these posts, all you have to do is put the acronym “EBV” in my blog’s “Search” box.

But now we have a more recent EBV study (which a dear SMM friend, thanks!!!, brought to my attention), conducted by a team at the Cincinnati Children’s Hospital Medical Center, showing that this terrible virus is linked to SEVEN OTHER diseases, as follows: lupus, MS, RA, inflammatory bowel disease, juvenile idiopathic arthritis, celiac disease, and type 1 diabetes. (!!!)

Here’s the link to the Science Daily article:

It’s a very interesting, easy-to-read article…a highly recommended read. As my friend commented, EBV has reached the mainstream now.

Here’s a food-for-thought excerpt from the SD article: “When viral and bacterial infections strike, our bodies respond by commanding B cells within our immune systems to crank out antibodies to battle the invaders. However, when EBV infections occur, something unusual happens. The EBV virus invades the B cells themselves, re-programs them, and takes over control of their functions.”

Given all the possibly dire consequences of an EBV infection, and given the fact that more than 90% of adults all over the world are antibody positive by the time they are 35 years old (freaky fact), we must take action. So, while we wait for an EBV vaccine to be developed (see article for more info), we need to build up our immune systems and, more importantly, those of our kids. How do we do that? Well, by looking up all the natural ways to block EBV…Curcumin would be at the top of my list: it prevents B cells infected with EBV from becoming immortal, etc. etc. etc. (check PubMed…I even found a study published back in 1998 about how curcumin affects EBV!)…There is lots we can do…

Oh how I wish I’d known all this stuff when I was in grad school, BEFORE I contracted this bloody virus, which, I just read, is an ancient fellow, perhaps 100 million years old…another freaky fact!!!

Anyway, it’s too late for me now…But it might NOT be late for you, so…get going! PREVENTION IS KEY!!! 🙂

EBV and myeloma stem cells. Chapter 3

Back to the Ph.D. thesis. Dr. Biswas tells us, on page 28, “that the tiny percentage of cells that harbor virus are [sic] stably maintained over months or years.” Years?

Could it be maintained for decades, too? Hmmm. At my request, I was tested a few years ago for EBV, but the only thing we found was that I had some anti-EBV antibodies…nothing at all useful…

Anyway, here’s something interesting on page 31: “EBV infects B cells both in vitro and in vivo.” In vitro, EBV makes these B cells immortal. What happens in vivo, however, isn’t that clear. In people who aren’t affected long-term by EBV, as mentioned previously, the virus doesn’t cause any real harm. What triggers it to wake up and initiate the development of different types of cancer?

On page 46 we find “that in myeloma, EBV persists in a latent form in the 47 CD19+CD138- B-cell progenitor population and undergoes lytic reactivation in tandem as the cell becomes a CD19-CD138+ plasma cell.” So something has to happen within the B cell, the CD19 positive cell that is, in order for EBV to wake up and jump into action.

It’s actually on page 46 where my brain almost exploded. Lytic reactivation? 😯  I had absolutely no idea what that meant, so I looked for an “easy” explanation, which I found, finally (if you are interested, have a look here: ).

This study tells us there are two ways in which a virus, nothing more than a “parasite,” can infect its host cell: 1. actively, by causing “a lytic infection characterized by the release of new progeny virus particles, often upon the lysis of the host cell,” (lysis refers to the destruction of a cell, the host cell in this case), or 2. inactively, which occurs when the virus just sleeps, without reproducing itself.

Reactivation” occurs when a sleeping virus wakes up and reproduces, stimulated by internal or external factors…but that gets into too much detail, so let’s skip that part.

Here’s another clue: in order to be reactivated, EBV needs the help of a protein called Zta, as well as a transcription factor called Rta (remember NF-kappaB?). Not easy to describe a process that I barely comprehend myself, but, in a few words, a transcription factor (XBP-1) activates this pesky Zta, which then rushes over to hug its buddy Rta. The two of them, fortified by their love, then activate other genes, in what is called a “cascade.” (Phew…wiping the sweat off my brow…)

At the end of this process, EBV gets reactivated, which means it’s fully awake and ready to do its evil deeds. And in fact this is discussed in the Ph.D. thesis, too, on page 13, if you want to have a look. Yes, I’m jumping a bit back and forth, but it’s inevitable, especially when things aren’t too clear. [I just hope I’m not making any mistakes…Please correct me if I am! Thanks!]

An important aside (p. 48): EBV doesn’t become a target of T cells because it hides its “viral gene expression during latency.” Aha!!!

Another aside: the EBV myeloma lines are different from those of Burkitt lymphoma and lymphoblastoid cell lines, but are similar to chronic lymphocytic leukemia or CLL cell lines. The EBV-infected CLL B cells, however, do not become immortal and only grow for a short time. Bit of a difference there.

So, okay, back to us: in myeloma, B cells get activated and become plasma cells, thanks to the help of transcription factors (Blimp-1 and the above-mentioned XPB-1, etc.). In this process of transformation, in this cascade of events, EBV disappears. That is, it is no longer present in the newly-created plasma cell. Since plasma cells cannot reproduce themselves, it doesn’t have to be. It has already done its damage.

And now let’s get to something that I thought could be very useful, potentially at least: if you interfere with the cascade, with the process of transformation, EBV cannot reactivate itself.

This is important because, as we can see on page 93, “The investigations presented here show that although the cells that harbor EBV are only a tiny percentage of the cells in culture, EBV is an important driver for the proliferation of the cultured cell population considered as a whole.”

Margaret’s simple (simplistic) solution: we need to block the reactivation of EBV…keep it asleep, like Fluffy, the three-headed dog in Harry Potter. We need to block these transcription factors.

Shortly after I began this umpteenth EBV-MM journey (but, THIS TIME, with PROOF of the association!), I went to see our family doctor, who is a real genius. I’d sent him the main EBV-MM association studies, which we discussed briefly. Then I asked him to prescribe an anti-EBV drug for me.

My idea was:  block the EBV = block the MM.

Well (I should have known it), my doctor told me it’s not that simple. Sure, he could prescribe a cycle of acyclovir for me, but:

  1. For how long?
  2. What should the dose be?
  3. Would it work?
  4. What about the side effects?
  5. Did I really want to take the risk?

Of course I had no good answers, except to question e. (I’ve taken risks before, so, no biggie). And so I gave up, but only for the time being.

I just have to do some more research. There must be a way, a non-conventional way. Any ideas?

Hmmm, I just read that bortezomib (Velcade) kills EBV. Not that that gives me an incentive to start conventional treatments, mind you! But 1. if you are already on Velcade, AND 2. if EBV might have initiated your myeloma, well then, two birds with one stone, right?

Anyway, proteasome inhibitors in general have an effect against EBV, including, tada!, curcumin.

Food for thought.

Okay, I think I have enough fodder for a Chapter 4, then I’m done with the Ph.D. thesis. Take care, everyone! Ciao!

EBV and myeloma stem cells. Chapter 2.

One thing Dr. Biswas discovered is that the subset of EBV-positive (as opposed to the EBV-negative) myeloma cells are the blasted stem cells, which have CD19 on their surface. What does that mean? Simply that we’re not talking about plasma cells here, but about B-cells that have the ability to REPRODUCE themselves, turning into plasma cells (which do not have that ability, btw).

Confused? Well then, let’s have a look at something different.

On page 12, Dr. Biswas discusses the 90% percentage that I mentioned in my previous post. While EBV “is benign in acute stages and latent in chronic stages […], in some cases, EBV has been demonstrated to be involved in the development of many malignancies, both hematologic and epithelial.”

So EBV doesn’t normally cause any terrible mischief. but remains inactive (quiescent) once it gets inside its host cell. But, in some cases, EBV doesn’t keep sleeping like Fluffy (Harry Potter reference: Fluffy, the three-headed sleeping dog)…That is the case with myeloma, as we have seen, but it happens in other types of cancers, too, such as Burkitt lymphoma, Hodgkin and non-Hodgkin lymphomas.

Even though it’s difficult to keep up with the technical gobbledegook, what is clear is that other factors have to be present in order for EBV to initiate the development of cancer (the image in my brain is of Fluffy waking up when the music stops…the music would be the “other factors”…). Anyway, that will be fodder for my third chapter, methinks.

So, summing up: 1. in MOST cases, EBV causes no long-term harm but simply remains dormant inside its host cell; 2. In some cases, unfortunately, it is associated with the development of cancer; 3. In myeloma, EBV DNA is present only in a small subpopulation of MM cells = the myeloma stem cells; 4. EBV doesn’t cause just one type of cancer, but quite a few, and 5. As for other types of cancer, EBV is present in EVERY SINGLE tumor cell, so myeloma really stands out in this group of EBV-associated malignancies. Yaaay, we’re special! Um.  🙄

A question just popped into my head (actually, it’s been in my head for a while now): would it make a difference if you took antiviral drugs such as acyclovir as soon as you receive an EBV diagnosis? Hmmm.

When my EBV infection was diagnosed, I was given nothing, e.g. Nothing. Just told to go home and rest…

But after going through all these new EBV-myeloma studies, I wonder if I would have ended up with MGUS (more than 18 years ago!) if I had immediately taken acyclovir or something similar? And I wonder this not just for myself but for all the people who have EBV-associated cancers.

Well, perhaps it’s because there wasn’t much research on this topic back then (the EBV-MM studies are quite recent, as we have seen). Perhaps EBV is too insidious to be targeted by any existing drug on the planet…even acyclovir has its limits, I have read. Perhaps it’s because nothing can be done once the process has begun, but I can tell you that I’d have been “relieved” (with lack of a better word) to have known the cause/s of my cancer. It would have eliminated all these years of wondering where I got this thing (well, not wondering obsessively…you know what I mean).

And another thing: with all we know about EBV now, it seems absolutely astounding that everyone diagnosed with MGUS, SMM, or MM doesn’t get immediately tested for EBV. I mean, NOW (not 20 years ago).

Or am I wrong? Was anyone here tested for EBV?

Okay, enough for today. I seem to have more questions than answers…

My next chapter is going to be a bit more technical. I’m sure you can’t wait, eh! 😉 I’ll try to tone it down…  😎 

More on EBV and myeloma stem cells

A few months ago, before all the kitten chaos began in our lives (read: when I had a bit more free time!), I came across a 2013 Johns Hopkins University Ph.D. thesis titled “Persistence of EBV in the cancer stem cells fraction of multiple myeloma,” by Sunetra Biswas. [Reminder: EBV is the acronym for Epstein-Barr Virus, about which I’ve written a bunch of posts, most recently in October 2017…A connection has finally been established between EBV and MM in SOME patients.]

I began reading, and drafting a post about, Dr. Biswas’ thesis, which is very interesting but also quite technical here and there…well, okay, it’s technical everywhere 😉 Now, I might repeat some stuff, but that’s because there are some repetitions in the thesis, as you will see if you are brave enough to go have a peek. I apologize for the repetitions…I just took one out, in fact, and I’ve only re-read this post at least five times! 😉

Here’s the link:

In the abstract, Dr. Biswas states that “EBV is present in some multiple myeloma cell lines and patients and when present, it is detected in a subpopulation of cells.” This subpopulation has “a mature B cell phenotype.”

But EBV just doesn’t sit inside the cell and do nothing. Nope, it helps MM cells grow.

However, check this out: when EBV is taken out of the MM cells (using a viral inhibitor), their growth slows down. On page iii, she talks about the growth of myeloma STEM cells. Oh how I wish I’d known all this when I became infected with EBV, decades ago!!! This viral inhibitor business gets reiterated on Page 8, btw.

On Page 2 of the Introduction, she states something that I already knew (but reminders aren’t a bad thing, eh): some B-cells infected by EBV become IMMORTAL. Just like cancer cells.

On Page 8 she begins looking at multiple myeloma and at myeloma stem cells, and then states that her research “suggests that EBV persists in cancer stem cells in MM patients and in four out of seven commonly studied MM cell lines.” More than half…wow.

Further on, Dr. Biswas states what we already know: “Multiple myeloma is a neoplasm of the plasma cells that has not been previously shown to be associated with EBV.” Indeed, in the past, whenever I asked a MM expert about this possible connection, all I got were denials and eye rolls. Well, now we have more than one study showing that there IS a connection…for SOME of us, at least.

Can’t be denied now. No more eye rolls expected… 😉

Now, even though she “identified EBV in 4 out of 7 multiple myeloma cell lines, EBV wasn’t present in every single myeloma cell, but only in a subset of cells, that is, a small population of cells, which makes it different from other EBV-caused cancers. And yes, the subset of cells happen to be myeloma stem cells.

Time for a mind-boggling statistic: the B-cells of 90% of the world’s population are infected with EBV. So here’s a good question: since Epstein-Barr is such a common viral infection, why don’t more people have myeloma or other types of cancer associated with an EBV infection? Clearly something else must be going on, otherwise practically everyone in the world would have some sort of EBV-associated cancer…

There must be other factors involved for an EBV infection to lead to MGUS and so on…

I hope to find the answer to that question by the end of this post (but I may not…there may be no answer as of yet), which I am going to divide into “chapters”…although if I skip a lot of the technical stuff, and the repetitions, I might end up with less material than originally planned… 😉 …

Oh, okay, drat, Pixie and Pandora have woken up from a nice cat nap and are becoming way too interested in what I’m doing at the computer, so I have to stop for today…Meeeeow! I mean, Ciao! 🙂

“Educate your immune system”

I just finished reading a fascinating New York Times article on the immune system and thought I’d post the link. Remember my April 5 post, “The gut factor,” on the connection between gut bacteria and cancer? Well, this article provides more food for thought in that same area:

Note: toward the end of the article, there is a reference to the Epstein-Barr virus and the risk of developing multiple sclerosis. No, no mention of multiple myeloma. However, I still think it is of interest to those of us who have had EBV in the past and would like to know about any possible repercussions…

Links, links, links…

P.S. By the way, since I have received a couple of condolence notes, I thought I should mention that my mother is not only alive but is actually doing a bit better these days. She has begun eating a bit more, gaining a bit of weight, and seems more interested in interacting with others. When Stefano and I left the U.S.A. to return to our home in Florence just a few weeks ago, her situation seemed hopeless. I didn’t think she had long to live, to be honest.

But now…who knows?