The role of human betaherpesviruses 6A and 6B in the pathogenesis of multiple sclerosis: a modern view of the problem
https://doi.org/10.22625/2072-6732-2026-18-2-17-29
Abstract
The role of human herpes virus 6A and human herpes virus 6B in the pathogenesis of multiple sclerosis remains a matter of debate, largely due to the multifactorial nature of the neurological disease. This review systematizes data on the potential effect of human herpes viruses 6A and 6B on the occurrence and/or development of multiple sclerosis. The facts of the detection of laboratory diagnostic markers of beta-herpesviruses in patients with multiple sclerosis are highlighted. Hypothetical mechanisms of the pathogenesis of multiple sclerosis involving human herpes viruses 6A and 6B (molecular mimicry, incorporation of host cell proteins), including as part of a mixed infection with other viruses, are described. The mechanisms of activation of the immune system and the development of neuroinflammation under the influence of these beta-herpesviruses are considered. The main problems, unresolved issues and directions for future research in the context of the role of human herpes viruses 6A and 6B in multiple sclerosis are described.
About the Authors
N. A. SuslovRussian Federation
Nizhny Novgorod
Competing Interests:
none
A. E. Hrulev
Russian Federation
Nizhny Novgorod
Competing Interests:
none
E. N. Filatova
Russian Federation
Nizhny Novgorod
Competing Interests:
none
N. Zajceva
Russian Federation
Nizhny Novgorod
Competing Interests:
none
I. N. Vaneev
Russian Federation
Nizhny Novgorod
Competing Interests:
none
O. V. Utkin
Russian Federation
Nizhny Novgorod
Competing Interests:
none
References
1. Popkova MI., Utkin OV., Bryzgalova DA. Comparative characteristics of human betaherpesviruses 6A and 6B. A modern view on the problem. Journal Infectology. 2021;13(3):5-18. (In Russian) doi:10.22625/2072-6732-2021-13-3-5-18
2. Yamanishi K, Okuno T, Shiraki K, et al. Identification of human herpesvirus-6 as a causal agent for exanthem subitum. Lancet. 1988;1(8594):1065-1067. doi:10.1016/s01406736(88)91893-4.
3. Lundström W, Gustafsson R. Human Herpesvirus 6A Is a Risk Factor for Multiple Sclerosis. Frontiers in Immunology. 2022;13:840753. doi:10.3389/fimmu.2022.840753.
4. Sadovnichuk EA, Topuzova MP, Malko VA, Shcherbakova OA, Bisaga GN. Multiple sclerosis: mechanisms of neurodegeneration. Instrumental markers of neurodegeneration. Rossiiskii neirokhirurgicheskii zhurnal imeni professora A.L. Polenova. 2023;15(3):158-163. (In Russian) doi:10.56618/2071–2693_2023_15_3_158
5. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology. 1996;46(4):907-911. doi:10.1212/wnl.46.4.907.
6. Park D.J. A unifying model for multiple sclerosis. Clinical and Experimental Medicine. 2025;25(1):133. doi:10.1007/s10238-025-01666-3.4.
7. Prokaeva AI, Arkhipov IE, Dorchinets EE, Korobko DS, Malkova NA. Multiple sclerosis: modern diagnostic markers and prognostic factors of disease progression. Siberian Scientific Medical Journal. 2024;44(1):39-51. (In Russian) doi:10.18699/sSMJ20240105
8. Komaroff AL, Pellett PE, Jacobson S. Human Herpesviruses 6A and 6B in Brain Diseases: Association versus Causation. Clinical Microbiology Reviews. 2020;34(1):e00143-20. doi:10.1128/CMR.00143-20.
9. Challoner PB, Smith KT, Parker JD, et al. Plaque-associated expression of human herpesvirus 6 in multiple sclerosis. Proceedings of the National Academy of Sciences of the United States of America. 1995;92(16):7440-7444. doi:10.1073/pnas.92.16.7440.
10. Goodman AD, Mock DJ, Powers JM, Baker JV, Blumberg BM. Human herpesvirus 6 genome and antigen in acute multiple sclerosis lesions. J Infect Dis. 2003;187(9):1365-1376. doi:10.1086/368172.
11. Cermelli C, Berti R, Soldan SS, et al. High frequency of human herpesvirus 6 DNA in multiple sclerosis plaques isolated by laser microdissection. J Infect Dis. 2003;187(9):1377-1387. doi:10.1086/368166.
12. Opsahl ML, Kennedy PG. Early and late HHV-6 gene transcripts in multiple sclerosis lesions and normal appearing white matter. Brain. 2005;128(3):516-527. doi:10.1093/brain/awh390.
13. Gustafsson R, Reitsma R, Strålfors A, Lindholm A, Press R, Fogdell-Hahn A. Incidence of human herpesvirus 6 in clinical samples from Swedish patients with demyelinating diseases. J Microbiol Immunol Infect. 2014;47(5):418-421. doi:10.1016/j.jmii.2013.03.009.
14. Tejada-Simon MV, Zang YC, Hong J, Rivera VM, Killian JM, Zhang JZ. Detection of viral DNA and immune responses to the human herpesvirus 6 101-kilodalton virion protein in patients with multiple sclerosis and in controls. J Virol. 2002;76(12):6147-6154. doi:10.1128/jvi.76.12.6147-6154.2002.
15. Alvarez-Lafuente R, Garc a-Montojo M, De Las Heras V, et al. Herpesviruses and human endogenous retroviral sequences in the cerebrospinal fluid of multiple sclerosis patients. Mult Scler. 2008;14(5):595-601. doi:10.1177/1352458507086425.
16. Franciotta D, Bestetti A, Sala S, et al. Broad screening for human herpesviridae DNA in multiple sclerosis cerebrospinal fluid and serum. Acta Neurol Belg. 2009;109(4):277-282.
17. Derfuss T, Hohlfeld R, Meinl E. Intrathecal antibody (IgG) production against human herpesvirus type 6 occurs in about 20% of multiple sclerosis patients and might be linked to a polyspecific B-cell response. J Neurol. 2005;252(8):968-971. doi:10.1007/s00415-005-0794-z.
18. Ablashi DV, Lapps W, Kaplan M, Whitman JE, Richert JR, Pearson GR. Human Herpesvirus-6 (HHV-6) infection in multiple sclerosis: a preliminary report. Mult Scler. 1998;4(6):490-496. doi:10.1177/135245859800400606.
19. Virtanen JO, Wohler J, Fenton K, Reich DS, Jacobson S. Oligoclonal bands in multiple sclerosis reactive against two herpesviruses and association with magnetic resonance imaging findings. Mult Scler. 2014;20(1):27-34. doi:10.1177/1352458513490545.
20. Leibovitch EC, Jacobson S. Evidence linking HHV-6 with multiple sclerosis: an update. Curr Opin Virol. 2014 Dec;9:127-33. doi:10.1016/j.coviro.2014.09.016.
21. Alvarez-Lafuente R, Garcia-Montojo M, De Las Heras V, Dominguez-Mozo MI, Bartolome M, Arroyo R. CD46 expression and HHV-6 infection in patients with multiple sclerosis. Acta Neurol Scand. 2009;120(4):246-250. doi:10.1111/j.16000404.2009.01163.x.
22. Ben-Fredj N, Ben-Selma W, Rotola A, et al. Prevalence of human herpesvirus U94/REP antibodies and DNA in Tunisian multiple sclerosis patients. J Neurovirol. 2013;19(1):42-47. doi:10.1007/s13365-012-0138-6.
23. Ramroodi N, Sanadgol N, Ganjali Z, Niazi AA, Sarabandi V, Moghtaderi A. Monitoring of active human herpes virus 6 infection in Iranian patients with different subtypes of multiple sclerosis. J Pathog. 2013;2013:194932. doi:10.1155/2013/194932.
24. Nejati A, Shoja Z, Farahmand M, et al. Human herpes virus 6 status in relapsing-remitting multiple sclerosis patients. Intern Med J. 2017;47(3):339-341. doi:10.1111/imj.13363.
25. Akhyani N, Berti R, Brennan MB, et al. Tissue distribution and variant characterization of human herpesvirus (HHV)-6: increased prevalence of HHV-6A in patients with multiple sclerosis. J Infect Dis. 2000;182(5):1321-1325. doi:10.1086/315893.
26. Simpson S Jr, Taylor B, Dwyer DE, et al. AntiHHV-6 IgG titer significantly predicts subsequent relapse risk in multiple sclerosis. Mult Scler. 2012;18(6):799-806. doi:10.1177/1352458511428081.
27. Ortega-Madueño I, Garcia-Montojo M, Dominguez-Mozo MI, et al. Anti-human herpesvirus 6A/B IgG correlates with relapses and progression in multiple sclerosis. PLoS One. 2014;9(8):e104836. doi:10.1371/journal.pone.0104836.
28. Khaki M, Ghazavi A, Ghasami K, et al. Evaluation of viral antibodies in Iranian multiple sclerosis patients. Neurosciences (Riyadh). 2011;16(3):224-228.
29. Engdahl E, Gustafsson R, Huang J, et al. Increased Serological Response Against Human Herpesvirus 6A Is Associated With Risk for Multiple Sclerosis. Front Immunol. 2019;10:2715. doi:10.3389/fimmu.2019.02715.
30. Comabella M, Montalban X, Horga A, et al. Antiviral immune response in patients with multiple sclerosis and healthy siblings. Mult Scler. 2010;16(3):355-358. doi:10.1177/1352458509357066.
31. Voumvourakis KI, Kitsos DK, Tsiodras S, Petrikkos G, Stamboulis E. Human herpesvirus 6 infection as a trigger of multiple sclerosis. Mayo Clin Proc. 2010;85(11):1023-1030. doi:10.4065/mcp.2010.0350.
32. Voumvourakis KI, Fragkou PC, Kitsos DK, Foska K, Chondrogianni M, Tsiodras S. Human herpesvirus 6 infection as a trigger of multiple sclerosis: an update of recent literature. BMC Neurol. 2022;22(1):57. doi:10.1186/s12883-022-02568-7.
33. Pormohammad A, Azimi T, Falah F, Faghihloo E. Relationship of human herpes virus 6 and multiple sclerosis: A systematic review and meta-analysis. J Cell Physiol. 2018;233(4):2850-2862. doi:10.1002/jcp.26000.
34. Khalesi Z, Tamrchi V, Razizadeh MH, et al. Association between human herpesviruses and multiple sclerosis: A systematic review and meta-analysis. Microb Pathog. 2023;177:106031. doi:10.1016/j.micpath.2023.106031.
35. Vitturi BK, Cellerino M, Boccia D, et al. Environmental risk factors for multiple sclerosis: a comprehensive systematic review and meta-analysis. J Neurol. 2025;272(8):513. doi:10.1007/s00415-025-13248-0.
36. Tejada-Simon MV, Zang YC, Hong J, Rivera VM, Zhang JZ. Cross-reactivity with myelin basic protein and human herpesvirus-6 in multiple sclerosis. Ann Neurol. 2003;53(2):189-197. doi:10.1002/ana.10425.
37. Cheng W, Ma Y, Gong F, et al. Cross-reactivity of autoreactive T cells with MBP and viral antigens in patients with MS. Front Biosci (Landmark Ed). 2012;17(5):1648-1658. doi:10.2741/4010.
38. Dunn N, Kharlamova N, Fogdell-Hahn A. The role of herpesvirus 6A and 6B in multiple sclerosis and epilepsy. Scand J Immunol. 2020;92(6):e12984. doi:10.1111/sji.12984.
39. Mechelli R, Romano C, Reniè R, et al. Viruses and neuroinflammation in multiple sclerosis. Neuroimmunol Neuroinflammation. 2021;8:269-83. doi:10.20517/2347-8659.2021.01.
40. Mock DJ, Strathmann F, Blumberg BM, Mayer-Proschel M. Infection of murine oligodendroglial precursor cells with Human Herpesvirus 6 (HHV-6)--establishment of a murine in vitro model. J Clin Virol. 2006;37(1):17-23. doi:10.1016/S13866532(06)70006-3.
41. Sedighi S, Gholizadeh O, Yasamineh S, et al. Comprehensive Investigations Relationship Between Viral Infections and Multiple Sclerosis Pathogenesis. Curr Microbiol. 2022;80(1):15. doi:10.1007/s00284-022-03112-z.
42. Donati D. Viral infections and multiple sclerosis. Drug Discov Today Dis Models. 2020;32:27-33. doi:10.1016/j.ddmod.2020.02.003.
43. Reynaud JM, J gou JF, Welsch JC, Horvat B. Human herpesvirus 6A infection in CD46 transgenic mice: viral persistence in the brain and increased production of proinflammatory chemokines via Toll-like receptor 9. J Virol. 2014;88(10):54215436. doi:10.1128/JVI.03763-13.
44. Leibovitch E, Wohler JE, Cummings Macri SM, et al. Novel marmoset (Callithrix jacchus) model of human Herpesvirus 6A and 6B infections: immunologic, virologic and radiologic characterization. PLoS Pathog. 2013;9(1):e1003138. doi:10.1371/journal.ppat.1003138.
45. Yao K, Graham J, Akahata Y, Oh U, Jacobson S. Mechanism of neuroinflammation: enhanced cytotoxicity and IL-17 production via CD46 binding. J Neuroimmune Pharmacol. 2010;5(3):469-478. doi:10.1007/s11481-010-9232-9.
46. Keyvani H, Zahednasab H, Aljanabi HAA, et al. The role of human herpesvirus-6 and inflammatory markers in the pathogenesis of multiple sclerosis. J Neuroimmunol. 2020;346:577313. doi:10.1016/j.jneuroim.2020.577313.
47. Meeuwsen S, Persoon-Deen C, Bsibsi M, et al. Modulation of the cytokine network in human adult astrocytes by human herpesvirus-6A. J Neuroimmunol. 2005;164(1-2):37-47. doi:10.1016/j.jneuroim.2005.03.013.
48. Soldan SS, Fogdell-Hahn A, Brennan MB, et al. Elevated serum and cerebrospinal fluid levels of soluble human herpesvirus type 6 cellular receptor, membrane cofactor protein, in patients with multiple sclerosis. Ann Neurol. 2001;50(4):486-493. doi:10.1002/ana.1135.
49. Fogdell-Hahn A, Soldan SS, Shue S, et al. Co-purification of soluble membrane cofactor protein (CD46) and human herpesvirus 6 variant A genome in serum from multiple sclerosis patients. Virus Res. 2005;110(1-2):57-63. doi:10.1016/j.virusres.2005.01.005.
50. Wuest SC, Mexhitaj I, Chai NR, et al. A complex role of herpes viruses in the disease process of multiple sclerosis. PLoS One. 2014;9(8):e105434. doi:10.1371/journal.pone.0105434.
51. Soldan SS, Leist TP, Juhng KN, McFarland HF, Jacobson S. Increased lymphoproliferative response to human herpesvirus type 6A variant in multiple sclerosis patients. Ann Neurol. 2000;47(3):306-313.
52. Fotheringham J, Williams EL, Akhyani N, Jacobson S. Human herpesvirus 6 (HHV-6) induces dysregulation of glutamate uptake and transporter expression in astrocytes. J Neuroimmune Pharmacol. 2008;3(2):105-116. doi:10.1007/s11481007-9084-0.
53. Matute C, Alberdi E, Domercq M, Pérez-Cerdá F, Pérez-Samartín A, Sánchez-Gómez MV. The link between excitotoxic oligodendroglial death and demyelinating diseases. Trends Neurosci. 2001;24(4):224-230. doi:10.1016/s01662236(00)01746-x.
54. Campbell A, Hogestyn JM, Folts CJ, et al. Expression of the Human Herpesvirus 6A Latency-Associated Transcript U94A Disrupts Human Oligodendrocyte Progenitor Migration. Sci Rep. 2017;7(1):3978. doi:10.1038/s41598-017-04432-y.
55. Kong H, Baerbig Q, Duncan L, Shepel N, Mayne M. Human herpesvirus type 6 indirectly enhances oligodendrocyte cell death. J Neurovirol. 2003;9(5):539-550. doi:10.1080/13550280390241241.
56. Gardell JL, Dazin P, Islar J, Menge T, Genain CP, Lalive PH. Apoptotic effects of Human Herpesvirus-6A on glia and neurons as potential triggers for central nervous system autoimmunity. J Clin Virol. 2006;37(1):11-16. doi:10.1016/S13866532(06)70005-1.
57. Gustafsson R. Human Herpesvirus 6A Induces Dendritic Cell Death and HMGB1 Release without Virus Replication. Pathogens. 2021;10(1):57. doi:10.3390/pathogens10010057.
58. Paudel YN, Angelopoulou E, C BK, Piperi C, Othman I. High mobility group box 1 (HMGB1) protein in Multiple Sclerosis (MS): Mechanisms and therapeutic potential. Life Sci. 2019;238:116924. doi:10.1016/j.lfs.2019.116924.
59. Grut V, Biström M, Salzer J, et al. Human herpesvirus 6A and axonal injury before the clinical onset of multiple sclerosis. Brain. 2024;147(1):177-185. doi:10.1093/brain/awad374.
60. Tao C, Simpson-Yap S, Taylor B, et al. Markers of Epstein-Barr virus and Human Herpesvirus-6 infection and multiple sclerosis clinical progression. Mult Scler Relat Disord. 2022;59:103561. doi:10.1016/j.msard.2022.103561.
61. Censi ST, Mariani-Costantini R, Granzotto A, Tomassini V, Sensi SL. Endogenous retroviruses in multiple sclerosis: A network-based etiopathogenic model. Ageing Res Rev. 2024;99:102392. doi:10.1016/j.arr.2024.102392.
62. Charvet B, Reynaud JM, Gourru-Lesimple G, Perron H, Marche PN, Horvat B. Induction of Proinflammatory Multiple Sclerosis-Associated Retrovirus Envelope Protein by Human Herpesvirus-6A and CD46 Receptor Engagement. Front Immunol. 2018;9:2803. doi:10.3389/fimmu.2018.02803.
63. Flamand L, Menezes J. Cyclic AMP-responsive element-dependent activation of Epstein-Barr virus zebra promoter by human herpesvirus 6. J Virol. 1996;70(3):1784-1791. doi:10.1128/JVI.70.3.1784-1791.1996.
64. Cuomo L, Angeloni A, Zompetta C, et al. Human herpesvirus 6 variant A, but not variant B, infects EBV-positive B lymphoid cells, activating the latent EBV genome through a BZLF-1-dependent mechanism. AIDS Res Hum Retroviruses. 1995;11(10):1241-1245. doi:10.1089/aid.1995.11.1241.
65. Turcanova VL, Bundgaard B, H llsberg P. Human herpesvirus-6B induces expression of the human endogenous retrovirus K18-encoded superantigen. J Clin Virol. 2009;46(1):15-19. doi:10.1016/j.jcv.2009.05.015.
66. Fierz W. Multiple sclerosis: an example of pathogenic viral interaction?. Virol J. 2017;14(1):42. doi:10.1186/s12985017-0719-3.
67. Cree BAC. Herpes viral infection and the multiple sclerosis prodrome: is HHV-6A infection a second hit?. Brain. 2024;147(1):7-9. doi:10.1093/brain/awad418.
68. Gough KL, Anderson TK, Whiley DM, Sweeney EL. The diagnostic complexities of human herpesvirus 6 (HHV6) infections. J Clin Virol. 2025;182:105905. doi: 10.1016/j.jcv.2025.105905.
69. Peddu V, Dubuc I, Gravel A, et al. Inherited Chromosomally Integrated Human Herpesvirus 6 Demonstrates Tissue-Specific RNA Expression In Vivo That Correlates with an Increased Antibody Immune Response. J Virol. 2019;94(1):e01418-19. doi:10.1128/JVI.01418-1.
70. Filatova EN, Sakharnov NA, Suslov NA, Popkova MI, Utkin OV. First data on the molecular genetic diversity of HHV6B and its impact on the clinical and laboratory course of mononucleosis-like syndrome in children. Russian Journal of Infection and Immunity. 2025;15(3):476-488. (In Russian) doi:10.15789/2220-7619-FDO-17827.
Review
For citations:
Suslov N.A., Hrulev A.E., Filatova E.N., Zajceva N., Vaneev I.N., Utkin O.V. The role of human betaherpesviruses 6A and 6B in the pathogenesis of multiple sclerosis: a modern view of the problem. Journal Infectology. 2026;18(2):17-29. (In Russ.) https://doi.org/10.22625/2072-6732-2026-18-2-17-29
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