Detection of Epstein–Barr virus and B-cell follicles in the multiple sclerosis brain: what you find depends on how and where you look

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Sir, The research article by Willis et al. (2009) and the letter to the editor by Peferoen et al. (2010) challenge our earlier finding that infection with Epstein–Barr virus is a common feature in the multiple sclerosis brain, provided that autopsy samples containing immune infiltrates are analysed (Serafini et al., 2007). Both groups also fail to detect meningeal B-cell follicles, the structures we first found in a proportion of patients with secondary progressive multiple sclerosis (Serafini et al., 2004; Magliozzi et al., 2007; Howell et al., 2009) and then identified as main, though not unique, intracerebral sites of Epstein–Barr virus persistence and reactivation (Serafini et al., 2007). Based on their inability to find follicle-like structures in 94 multiple sclerosis brain specimens collected by the Netherlands Brain Bank and in a small number of specimens obtained from the UK Multiple Sclerosis Tissue Bank, Peferoen et al. (2010) ‘question the importance and significance of ectopic B cell follicles as a pathogenic feature of multiple sclerosis’, a scenario we proposed by showing that these structures are associated with more extensive cortical pathology and aggressive clinical course (Magliozzi et al., 2007; Howell et al., 2009). Inability to detect meningeal B-cell follicles in brain tissue of the Dutch Multiple Sclerosis cohort was recently reported also by Kooi et al. (2009) and Torkildsen et al. (2010).