PULMONOLOGY / BASIC RESEARCH
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Previous studies have suggested an association between herpesvirus infections and idiopathic pulmonary fibrosis (IPF), but the causal relationship remains largely unclear. We used bidirectional Mendelian randomization (MR) to investigate the associations between genetically predicted antibody responses to herpesviruses and IPF risk.

Material and methods:
The data for different antibodies against herpes simplex virus (HSV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) were obtained from the IEU GWAS database (https://gwas.mrcieu.ac.uk/datasets/), and the data for IPF were obtained from the FinnGen GWAS database (https://r7.finngen.fi/). We selected eligible single nucleotide polymorphisms (SNPs) from summary-level data of GWAS as instrumental variables. The generalized summary data-based MR (GSMR) method was used as the main analysis method, complemented by inverse-variance weighted (IVW), MR-Egger, and weighted median analyses. Sensitivity analyses were conducted to check the robustness of the MR results, and reverse MR analyses were performed to assess potential reverse causation.

Results:
Genetically predicted antibody responses to EBV viral capsid antigen (VCA) p18 were associated with IPF risk. However, GSMR and IVW results indicated that anti-EBV IgG levels were significantly negatively associated with IPF. Sensitivity analyses suggested limited influence of horizontal pleiotropy.

Conclusions:
Genetically predicted EBV-related immune responses show heterogeneous associations with IPF risk. These findings suggest a potential role of EBV-related immune mechanisms in IPF, although causal interpretation should be made cautiously. Further studies are needed to clarify underlying biological mechanisms.
REFERENCES (48)
1.
Richeldi L, Collard HR, Jones MG. Idiopathic pulmonary fibrosis. Lancet 2017; 389: 1941-52.
 
2.
Neumark N, Cosme C Jr, Rose KA, Kaminski N. The idiopathic pulmonary fibrosis cell atlas. Am J Physiol Lung Cell Mol Physiol 2020; 319: L887-93.
 
3.
Cottin V, Hirani NA, Hotchkin DL, et al. Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases. Eur Respir Rev 2018; 27: 180076.
 
4.
Raghu G, Chen SY, Yeh WS, et al. Idiopathic pulmonary fibrosis in US Medicare beneficiaries aged 65 years and older: incidence, prevalence, and survival, 2001-11. Lancet Respir Med 2014; 2: 566-72.
 
5.
Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011; 183: 788-824.
 
6.
King TE Jr, Bradford WZ, Castro-Bernardini S, et al. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med 2014; 370: 2083-92.
 
7.
Richeldi L, Cottin V, du Bois RM, et al. Nintedanib in patients with idiopathic pulmonary fibrosis: combined evidence from the TOMORROW and INPULSIS(®) trials. Respir Med 2016; 113: 74-9.
 
8.
Moss BJ, Ryter SW, Rosas IO. Pathogenic mechanisms underlying idiopathic pulmonary fibrosis. Annu Rev Pathol 2022; 17: 515-46.
 
9.
Sheng G, Chen P, Wei Y, et al. Viral infection increases the risk of idiopathic pulmonary fibrosis: a meta-analysis. Chest 2020; 157: 1175-87.
 
10.
Roizmann B, Desrosiers RC, Fleckenstein B, Lopez C, Minson AC, Studdert MJ. The family Herpesviridae: an update. The Herpesvirus Study Group of the International Committee on Taxonomy of Viruses. Arch Virol 1992; 123: 425-49.
 
11.
Duckworth A, Longhurst HJ, Paxton JK, Scotton CJ. The role of Herpes viruses in pulmonary fibrosis. Front Med 2021; 8: 704222.
 
12.
Lok SS, Haider Y, Howell D, Stewart JP, Hasleton PS, Egan JJ. Murine gammaherpes virus as a cofactor in the development of pulmonary fibrosis in bleomycin resistant mice. Eur Respir J 2002; 20: 1228-32.
 
13.
Yonemaru M, Kasuga I, Kusumoto H, et al. Elevation of antibodies to cytomegalovirus and other herpes viruses in pulmonary fibrosis. Eur Respir J 1997; 10: 2040-5.
 
14.
Kropski JA, Pritchett JM, Zoz DF, et al. Extensive phenotyping of individuals at risk for familial interstitial pneumonia reveals clues to the pathogenesis of interstitial lung disease. Am J Respir Crit Care Med 2015; 191:417-26.
 
15.
Sekula P, Del Greco MF, Pattaro C, Köttgen A. Mendelian randomization as an approach to assess causality using observational data. J Am Soc Nephrol 2016; 27: 3253-65.
 
16.
Davey Smith G, Hemani G. Mendelian randomization: genetic anchors for causal inference in epidemiological studies. Hum Mol Genet 2014; 23: R89-98.
 
17.
Emdin CA, Khera AV, Kathiresan S. Mendelian randomization. JAMA 2017; 318: 1925-6.
 
18.
Choi KW, Chen CY, Stein MB, et al. Assessment of bidirectional relationships between physical activity and depression among adults: a 2-sample mendelian randomization study. JAMA Psychiatry 2019; 76: 399-408.
 
19.
Walker VM, Zheng J, Gaunt TR, Smith GD. Phenotypic causal inference using genome-wide association study data: mendelian randomization and beyond. Annu Rev Biomed Data Sci 2022; 5: 1-17.
 
20.
Lin BD, Alkema A, Peters T, et al. Assessing causal links between metabolic traits, inflammation and schizophrenia: a univariable and multivariable, bidirectional Mendelian-randomization study. Int J Epidemiol 2019; 48: 1505-14.
 
21.
Butler-Laporte G, Kreuzer D, Nakanishi T, Harroud A, Forgetta V, Richards JB. Genetic determinants of antibody-mediated immune responses to infectious diseases agents: a genome-wide and HLA association study. Open Forum Infect Dis 2020; 7: ofaa450.
 
22.
Abecasis GR, Altshuler D, Auton A, et al. A map of human genome variation from population-scale sequencing. Nature 2010; 467: 1061-73.
 
23.
He Q, Wang W, Xu D, et al. Causal association of iron status with functional outcome after ischemic stroke. Stroke 2024; 55: 423-31.
 
24.
Zhu Z, Zheng Z, Zhang F, et al. Causal associations between risk factors and common diseases inferred from GWAS summary data. Nat Commun 2018; 9: 224.
 
25.
Burgess S, Bowden J, Fall T, Ingelsson E, Thompson SG. Sensitivity analyses for robust causal inference from mendelian randomization analyses with multiple genetic variants. Epidemiology 2017; 28: 30-42.
 
26.
Bowden J, Davey Smith G, Burgess S. Mendelian randomization with invalid instruments: effect estimation and bias detection through Egger regression. Int J Epidemiol 2015; 44: 512-25.
 
27.
Mostafaei S, Sayad B, Azar MEF, et al. The role of viral and bacterial infections in the pathogenesis of IPF: a systematic review and meta-analysis. Respir Res 2021; 22: 53.
 
28.
Moore BB, Moore TA. Viruses in idiopathic pulmonary fibrosis. Etiology and exacerbation. Ann Am Thorac Soc 2015; 12 Suppl 2: S186-92.
 
29.
Tang YW, Johnson JE, Browning PJ, et al. Herpesvirus DNA is consistently detected in lungs of patients with idiopathic pulmonary fibrosis. J Clin Microbiol 2003; 41: 2633-40.
 
30.
Seibold MA, Wise AL, Speer MC, et al. A common MUC5B promoter polymorphism and pulmonary fibrosis. N Engl J Med 2011; 364: 1503-12.
 
31.
Cheng C, Bao X, Zheng L, et al. Causal relationship between carotene levels and male erectile dysfunction: a sex-stratified Mendelian randomization study. Arch Med Sci 2025; 21: 1069-72.
 
32.
Zhu L, Gao Q, Guo X, Xu Z, Zhang J. Causal relationship between sleep traits and erectile dysfunction: evidence from Mendelian randomization analysis. Arch Med Sci 2025; 21: 597-604.
 
33.
Feng K, Yuan J, Wei Y, Li M. Association between type 1 diabetes mellitus and esophageal varices: a Mendelian randomization study. Arch Med Sci 2025; 21: 605-16.
 
34.
Zhao P, Chen K, Yang L, et al. Clinical and functional characterization of a novel TNFRSF9 variant causing immune dysregulation with predisposition to EBV-driven lymphomagenesis. Front Immunol 2025; 16: 1605221.
 
35.
Morawiec N, Adamczyk B, Spyra A, et al. The role of Epstein-Barr virus in the pathogenesis of autoimmune diseases. Medicina 2025; 61: 1148.
 
36.
Tsukamoto K, Hayakawa H, Sato A, Chida K, Nakamura H, Miura K. Involvement of Epstein-Barr virus latent membrane protein 1 in disease progression in patients with idiopathic pulmonary fibrosis. Thorax 2000; 55: 958-61.
 
37.
Stewart JP, Egan JJ, Ross AJ, et al. The detection of Epstein-Barr virus DNA in lung tissue from patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 1999; 159: 1336-41.
 
38.
Erre GL, Mameli G, Cossu D, et al. Increased Epstein-Barr virus DNA load and antibodies against EBNA1 and EA in Sardinian patients with rheumatoid arthritis. Viral Immunol 2015; 28: 385-90.
 
39.
Westergaard MW, Draborg AH, Troelsen L, Jacobsen S, Houen G. Isotypes of Epstein-Barr virus antibodies in rheumatoid arthritis: association with rheumatoid factors and citrulline-dependent antibodies. Biomed Res Int 2015; 2015: 472174.
 
40.
Manika K, Alexiou-Daniel S, Papakosta D, et al. Epstein-Barr virus DNA in bronchoalveolar lavage fluid from patients with idiopathic pulmonary fibrosis. Sarcoidosis Vasc Diffuse Lung Dis 2007; 24: 134-40.
 
41.
Sides MD, Klingsberg RC, Shan B, et al. The Epstein-Barr virus latent membrane protein 1 and transforming growth factor--β1 synergistically induce epithelial--mesenchymal transition in lung epithelial cells. Am J Respir Cell Mol Biol 2011; 44: 852-62.
 
42.
Yan H, Zhu C, Jin X, Feng G. Mendelian randomization reveals no correlations between herpesvirus infection and idiopathic pulmonary fibrosis. PLoS One 2023; 18: e0295082.
 
43.
Hsu FM, Mohanty RP, Rubbi L, et al. An epigenetic human cytomegalovirus infection score predicts viremia risk in seropositive lung transplant recipients. Epigenetics 2024; 19: 2408843.
 
44.
Lasithiotaki I, Antoniou KM, Vlahava VM, et al. Detection of herpes simplex virus type-1 in patients with fibrotic lung diseases. PLoS One 2011; 6: e27800.
 
45.
Zhang M, Qiu J, Wang R. Mendelian randomization study on the causal effect of herpes simplex virus infection on idiopathic pulmonary fibrosis. Expert Rev Respir Med 2024; 18: 341-7.
 
46.
Costa P, Rusconi S, Mavilio D, et al. Differential disappearance of inhibitory natural killer cell receptors during HAART and possible impairment of HIV-1-specific CD8 cytotoxic T lymphocytes. AIDS 2001; 15: 965-74.
 
47.
Murdaca G, Colombo BM, Puppo F. The role of Th17 lymphocytes in the autoimmune and chronic inflammatory diseases. Intern Emerg Med 2011; 6: 487-95.
 
48.
Egan JJ, Adamali HI, Lok SS, Stewart JP, Woodcock AA. Ganciclovir antiviral therapy in advanced idiopathic pulmonary fibrosis: an open pilot study. Pulm Med 2011; 2011: 240805.
 
eISSN:1896-9151
ISSN:1734-1922
Journals System - logo
Scroll to top