First of all I would like to thank Nigel for providing a link to a copy of Paul's paper which I have read with interest. I congratulate Paul on doing a nice summary of some of the important MS literature going back 150 years. This is somewhat deja vu for me because C. pneumone as the cause of MS burst on the scene in 1998, only 3 years after I had begun my quest to identify as many causal factors as possible.
Paul references a number of studies which found C. pneumonia in PwMS but failed to list all the studies which did not, and there are lots of them. The most convincing study that C.pneumonia is NOT a key causal factor of MS is the Munger et al, 2004 study which looked at the blood samples of people who later developed MS. It is critical to note that these samples were collectected after the time MS is established (>18) and before MS was diagnosed. To quote the authors, "Seropositivity for Cpn was not significantly associated with risk of MS". This seriously downgrades the C.pneumonia hypothesis because the cause must come before the disease.
I might also note that Paul did not address the genetics of MS and the strong HLA evidence. This also downgrades an infective hypothesis. It should also be noted that immunosuppressants have some, albeit relatively minor, benefit for MS and they should have the opposite effect if MS is primarily an infectious disease as Paul proposes. I would also mention that it appears CCSVI is relatively common (at least 10% of healthy controls) whereas MS is rare (~.1% of population). Thus only one person in 100 with CCSVI gets MS. The bottom line is CCSVI is most important for MS to happen but there are other rarer factors which are also causal factors. The evidence for EBV in MS is extremely strong. A similar Harvard study to the Munger one on C.pneumomia found that everyone who got MS had an EBV infection before diagnosis.
Of course the pediatric studies also leave little doubt that EBV is a key player in MS. I expect CCSVI is caused by a variety of factors perhaps including C.pneumone. To me all the data for MS are best explained by MS being caused by the presence of CCSVI (variety of causes and quite common) in concert with a dysregulated immune system most likely due to genetics (rare), and an EBV infection during vitamin D deficiency (common). Finally I would note the geography of MS is readily explained by vitamin D supply and genetics and in no way points to an infectious cause for MS.
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