The genetic architecture of multiple sclerosis (MS) is similar to that of coeliac disease, with human leukocyte antigen (HLA) being the greatest genetic determinant in both diseases. Furthermore, similar to the involvement of gluten in coeliac disease, Epstein–Barr virus (EBV) infection is now widely considered to be an important environmental factor in MS. The molecular basis for the HLA association in coeliac disease is well defined, and B cells have a clear role in antigen presentation to gluten-specific CD4⁺ T cells. By contrast, the mechanisms underlying the HLA association of MS are unknown but accumulating evidence indicates a similar role of B cells acting as antigen-presenting cells. The growing parallels suggest that much could be learned about the mechanisms of MS by using coeliac disease as a model. In this Perspective article, we discuss the insights that could be gained from these parallels and consider the possibility of antiviral treatment against EBV as a therapy for MS that is analogous to the gluten-free diet in coeliac disease.

多发性硬化症 （MS） 的遗传结构与乳糜泻相似，人类白细胞抗原 （HLA） 是这两种疾病中最大的遗传决定因素。此外，与麸质在乳糜泻中的参与类似，EB 病毒 （EBV） 感染现在被广泛认为是 MS 的重要环境因素。乳糜泻中 HLA 关联的分子基础已明确，B 细胞在抗原呈递至麸质特异性 CD4⁺ T 细胞中起着明确的作用。相比之下，MS 的 HLA 关联的机制尚不清楚，但越来越多的证据表明 B 细胞作为抗原呈递细胞具有类似的作用。越来越多的相似之处表明，通过使用乳糜泻作为模型，可以了解很多关于 MS 机制的知识。在这篇 Perspective 文章中，我们讨论了可以从这些相似之处中获得的见解，并考虑了针对 EBV 的抗病毒治疗作为 MS 疗法的可能性，这类似于乳糜泻中的无麸质饮食。