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It also occurs in healthy blood relatives of patients with autoimmune diseases, suggesting it is genetically determined. Here it is proposed that this CD8+ T-cell deficiency underlies the development of chronic autoimmune diseases by impairing CD8+ T-cell control of Epstein-Barr virus (EBV) infection, with the result that EBV-infected autoreactive B cells accumulate in the target organ where they produce pathogenic autoantibodies and provide costimulatory survival signals to autoreactive T cells which would otherwise die in the target organ by activation-induced apoptosis. Autoimmunity is postulated to evolve in the following steps: (1) CD8+ T-cell deficiency, (2) primary EBV infection, (3) decreased CD8+ T-cell control of EBV, (4) increased EBV load and increased anti-EBV antibodies, (5) EBV infection in the target organ, (6) clonal expansion of EBV-infected autoreactive B cells in the target organ, (7) infiltration of autoreactive T cells into the target organ, and (8) development of ectopic lymphoid follicles in the target organ. It is also proposed that deprivation of sunlight and vitamin D at higher latitudes facilitates the development of autoimmune diseases by aggravating the CD8+ T-cell deficiency and thereby further impairing control of EBV. The hypothesis makes predictions which can be tested, including the prevention and successful treatment of chronic autoimmune diseases by controlling EBV infection.<\/jats:p>","DOI":"10.1155\/2012\/189096","type":"journal-article","created":{"date-parts":[[2012,1,24]],"date-time":"2012-01-24T21:00:53Z","timestamp":1327438853000},"page":"1-16","source":"Crossref","is-referenced-by-count":72,"title":["CD8+ T-Cell Deficiency, Epstein-Barr Virus Infection, Vitamin D Deficiency, and Steps to Autoimmunity: A Unifying Hypothesis"],"prefix":"10.1155","volume":"2012","author":[{"given":"Michael P.","family":"Pender","sequence":"first","affiliation":[{"name":"School of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia"},{"name":"Department of Neurology, Royal Brisbane and Women\u2019s Hospital, Brisbane, QLD 4029, 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