Epstein-Barr virus infection: from molecular basis of pathogenesis to personalized therapeutic strategies
TL;DR
This review analyzes modern epidemiological trends that demonstrate a pronounced socioeconomic dependence of the dynamics of seroconversion, which is manifested by the phenomenon of “delayed infection” in developed countries, associated with an increased risk of manifest forms.
Abstract
Epstein-Barr virus, which infects more than 95 % of the world's population, poses a significant threat to the health of children, being a trigger for a wide range of pathologies - from infectious mononucleosis to cancer and autoimmune diseases. This review analyzes modern epidemiological trends that demonstrate a pronounced socioeconomic dependence of the dynamics of seroconversion, which is manifested by the phenomenon of “delayed infection” in developed countries, associated with an increased risk of manifest forms. The molecular mechanisms of Epstein-Barr virus persistence and pathogenesis are covered in detail, including immune evasion strategies and manipulation of host cell signaling pathways (NF-κB, JAK/STAT, PI3K/Akt/mTOR), as well as the role of genetic predisposition in determining the outcome of infection. Particular attention is paid to modern and promising approaches to diagnostics and therapy: quantitative determination of viral load, immunophenotyping, the use of monoclonal antibodies (rituximab, brentuximab vedotin), adoptive transfer of virus-specific T-lymphocytes and inhibitors of signaling kinases (Syk, BTK, JAK, mTOR). The need to develop preventive vaccines based on modern platforms (mRNA, nanoparticles) is emphasized. An integrative personalized approach to patient care is substantiated, combining virological, immunological and genetic monitoring for risk stratification and selection of the optimal intervention strategy.