Epstein-Barr Virus Infection in Lung Cancer: Insights and Perspectives

Our plain-English summary of Epstein-Barr Virus Infection in Lung Cancer: Insights and Perspectives, by J.C. Osorio, R. Blanco, A.H. Corvalán, et al (Pathogens, 2022).

The study

• Authors: J.C. Osorio, R. Blanco, A.H. Corvalán, J.P. Muñoz, G.M. Calaf, F. Aguayo
• Journal: Pathogens
• Published: 2022;11(2)
• Type of article: Review
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Lung cancer (LC) is the leading cause of cancer death worldwide. Tobacco smoke is the most frequent risk factor etiologically associated with LC, although exposures to other environmental factors such as arsenic, radon or asbestos are also involved. Additionally, the involvement of some viral infections such as high-risk human papillomaviruses (HR-HPVs), Merkel cell polyomavirus (MCPyV), Jaagsiekte Sheep Retrovirus (JSRV), John Cunningham Virus (JCV), and Epstein-Barr virus (EBV) has been suggested in LC, though an etiological relationship has not yet been established. EBV is a ubiquitous gamma herpesvirus causing persistent infections and some lymphoid and epithelial tumors. Since EBV is heterogeneously detected in LCs from different parts of the world, in this review we address the epidemiological and experimental evidence of a potential role of EBV. Considering this evidence, we propose mechanisms potentially involved in EBV-associated lung carcinogenesis. Additional studies are warranted to dissect the role of EBV in this very frequent malignancy.

In plain English

This article is a review, not a new study of patients. The authors gathered published epidemiological and laboratory evidence on whether Epstein–Barr virus (EBV) plays a role in lung cancer. Asbestos was mentioned only briefly, with arsenic and radon, as an environmental risk factor for lung cancer; the review did not examine it. In the studies reviewed, EBV was found in lung cancer specimens at highly variable frequencies. These ranged from none (for example, 118 cases in France) to all cases in some series of pulmonary lymphoepithelioma-like carcinoma, a rare type. The authors also analysed public gene-expression (RNA-sequencing) data on 1325 lung cancer samples and compared them with normal tissue. They reported that CD21, a molecule that helps EBV enter cells, was expressed 1.8-fold more in lung tumors than in normal tissue. They concluded that a causal role for EBV has not been established and that it may be involved in a very restricted subset of cases. They suggested it could cooperate with tobacco smoke, noting that further studies are needed to confirm this.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published epidemiological and experimental studies, plus the authors' own bioinformatic analysis of public gene-expression data (TCGA)
• Who was studied: Published studies of EBV detection in lung cancer specimens from several countries, summarized in Table 1. The authors' own analysis used 1325 lung cancer samples from The Cancer Genome Atlas (1323 primary tumors and two recurrences), compared with normal tissue; the number of normal samples is not stated.
• Exposure: Epstein–Barr virus infection, with tobacco smoke and other environmental contaminants discussed as possible cofactors. Asbestos was only listed as a known lung cancer risk factor and was not examined.
• Main results:
  • Across the reviewed studies, EBV was detected in lung cancer specimens at highly variable frequencies
  • Studies from China and Taiwan found EBV in 100% of pulmonary lymphoepithelioma-like carcinomas, and EBV presence was significantly higher in this tumor type than in other lung cancers
  • Some studies found no EBV, for example 118 lung cancers in France and 110 lung adenocarcinomas in Singapore
  • In the authors' own analysis of public RNA-sequencing data, CD21 expression was 1.8-fold higher in malignant lung tumors than in normal tissue, and 1.3-fold higher in lung adenocarcinoma than in lung squamous cell carcinoma (p less than 0.001)
• The authors' conclusion: The authors concluded that an etiological role for EBV in lung cancer has not been established and that it may be involved in a very restricted subset of cases. They suggested that EBV can cooperate with tobacco smoke at different levels in lung carcinogenesis.
• Limitations the authors state:
  • Differences in EBV detection between studies may reflect sociodemographic factors, specimen type, histological type and the sensitivity and specificity of the detection methods
  • The CD21 finding only suggests a possibility and needs experimental confirmation
  • The proposed mechanisms linking tobacco smoke, environmental factors and EBV require further experimental and epidemiological studies

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Carcinogenesis.

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