The Immunological Therapeutic Strategies for Controlling Multiple Sclerosis: Considerations during the COVID-19 Pandemic

A growing body of evidence initially suggested that patients with multiple sclerosis (MS) might be more susceptible to coronavirus disease 2019 (COVID-19). Moreover, it was speculated that patients with MS treated with immunosuppressive drugs might be at risk to develop a severe diseases course after infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2). However, the recently published data have shown that MS patients do not have a higher risk for severe COVID-19. Although there is no indication that patients with MS and immunomodulatory/immunosuppressive therapy are generally at a higher risk of severe COVID-19, it is currently being emphasized that the hazards of poorly treated MS may outweigh the putative COVID-19 dangers. In this review, we discuss the challenges and considerations for MS patients in the COVID-19 pandemic.

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Multiple Sclerosis and SARS-CoV-2 Vaccination: Considerations for Immune-Depleting Therapies

Vaccines ◽

10.3390/vaccines9020099 ◽

2021 ◽

Vol 9 (2) ◽

pp. 99

Author(s):

Johann Sellner ◽

Paulus S. Rommer

Keyword(s):

Multiple Sclerosis ◽

Severe Acute Respiratory Syndrome ◽

Open Questions ◽

Immunological Effects ◽

Restricted Use

Several concerns have been raised about the use of immunodepleting agents including alemtuzumab, cladribine and CD20-depleting antibodies in people with multiple sclerosis (pwMS) during the coronavirus disease (COVID) 2019 pandemic. As the end of the pandemic is not yet in sight, vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) may be an elegant strategy to overcome the potential hazards associated with initiating and continuing treatment with immune-depleting agents. In this review, we summarize the immunological effects of immune-depleting therapy and underlying considerations for the hitherto existing recommendations that suggest a restricted use of immune-deleting therapies during the pandemic. Moreover, we critically discuss open questions regarding vaccination in general and against SARS-CoV-2 in pwMS.

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Disease-modifying therapies and SARS-CoV-2 vaccination in multiple sclerosis: an expert consensus

Journal of Neurology ◽

10.1007/s00415-021-10545-2 ◽

2021 ◽

Author(s):

Diego Centonze ◽

Maria A. Rocca ◽

Claudio Gasperini ◽

Ludwig Kappos ◽

Hans-Peter Hartung ◽

...

Keyword(s):

Multiple Sclerosis ◽

Severe Acute Respiratory Syndrome ◽

Vaccination Campaign ◽

Safety And Efficacy ◽

Chinese City ◽

Disease Modifying Therapies ◽

Global Pandemic ◽

The World ◽

Disease Modifying

AbstractCoronavirus disease (COVID-19) appeared in December 2019 in the Chinese city of Wuhan and has quickly become a global pandemic. The disease is caused by the severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2), an RNA beta coronavirus phylogenetically similar to SARS coronavirus. To date, more than 132 million cases of COVID19 have been recorded in the world, of which over 2.8 million were fatal (https://coronavirus.jhu.edu/map.html). A huge vaccination campaign has started around the world since the end of 2020. The availability of vaccines has raised some concerns among neurologists regarding the safety and efficacy of vaccination in patients with multiple sclerosis (MS) taking immunomodulatory or immunosuppressive therapies.

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Vaccination Setting of Patients with Autoimmune Diseases in Times of Severe Acute Respiratory Syndrome Coronavirus Type 2 Pandemic Using the Example of Multiple Sclerosis Patients: A Longitudinal Multicenter Study

European Neurology ◽

10.1159/000519582 ◽

2021 ◽

pp. 1-8

Author(s):

Felicita Heidler ◽

Julia Baldt ◽

Niklas Frahm ◽

Silvan Elias Langhorst ◽

Pegah Mashhadiakbar ◽

...

Keyword(s):

Multiple Sclerosis ◽

Severe Acute Respiratory Syndrome ◽

Multicenter Study ◽

Older Patients ◽

Chronically Ill ◽

Vaccination Status ◽

Younger Patients ◽

Vaccination Recommendations ◽

Multiple Sclerosis Patients

Background: Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection represents a serious health risk, especially in chronically ill people. Multiple sclerosis (MS) is the most common chronic immune-mediated neurological disease. Vaccinations play an important role in the therapeutic MS management. This study aimed at determining MS patients’ attitudes toward vaccinations and governmental measures before and during the SARS-CoV-2 pandemic, including associations with sociodemographic and clinical variables. Methods: In a longitudinal, multicenter study, 200 MS patients were investigated regarding their vaccination attitudes before and after the first wave of the SARS-CoV-2 pandemic. Data on vaccination status and burden (physical, psychological, and social) experienced as caused by the pandemic and related governmental safety measures were registered. Results: Patients with progressive MS felt significantly more pandemic-burdened than patients with relapsing-onset MS (p < 0.001). Older patients were more frequently willing to get vaccinated against SARS-CoV-2 than younger patients (p < 0.001). After the first pandemic wave, patients with pre-pandemic willingness to comply with vaccination recommendations were more likely to accept recommended standard vaccinations (60% vs. 36%) and a possible SARS-CoV-2 vaccination than pre-pandemic nonwilling patients (66.7% vs. 42.0%). Conclusions: The vaccination topic was not immediately present in many patients before the pandemic. MS patients need comprehensive and understandable education meeting their concerns using evidence-based and convincing arguments on the subject of vaccination, particularly younger patients. Older patients are already more often willing to become vaccinated. Complete vaccination status is necessary to avoid multiple infections.

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Approach to SARS-CoV-2 Vaccination in Patients With Multiple Sclerosis

Frontiers in Immunology ◽

10.3389/fimmu.2021.701752 ◽

2021 ◽

Vol 12 ◽

Author(s):

Christina Woopen ◽

Katharina Schleußner ◽

Katja Akgün ◽

Tjalf Ziemssen

Keyword(s):

Multiple Sclerosis ◽

Immune Response ◽

Severe Acute Respiratory Syndrome ◽

Cellular Immunity ◽

Cellular Responses ◽

Immunosuppressive Drugs ◽

Clinical Use ◽

Immunocompromised Patients ◽

Vaccine Response ◽

Safety And Efficacy

For more than a year now, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been causing the coronavirus disease (COVID-19) pandemic with high mortality and detrimental effects on society, economy, and individual lives. Great hopes are being placed on vaccination as one of the most potent escape strategies from the pandemic and multiple vaccines are already in clinical use. However, there is still a lot of insecurity about the safety and efficacy of vaccines in patients with autoimmune diseases like multiple sclerosis (MS), especially under treatment with immunomodulatory or immunosuppressive drugs. We propose strategic approaches to SARS-CoV-2 vaccination management in MS patients and encourage fellow physicians to measure the immune response in their patients. Notably, both humoral and cellular responses should be considered since the immunological equivalent for protection from SARS-CoV-2 after infection or vaccination still remains undefined and will most likely involve antiviral cellular immunity. It is important to gain insights into the vaccine response of immunocompromised patients in order to be able to deduce sensible strategies for vaccination in the future.

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1250-P: Lifestyle + Mindfulness Pilot Trial in Latinx Teens at Risk for Type 2 Diabetes (T2D)

Diabetes ◽

10.2337/db20-1250-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1250-P

Author(s):

NATALIA L. SANCHEZ ◽

VIRGINIA JIMENEZ ◽

MATTHEW HAEMER ◽

LAUREN B. SHOMAKER ◽

MILENA CASAMASSIMA ◽

...

Keyword(s):

Type 2 Diabetes ◽

At Risk ◽

Pilot Trial

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110-OR: Type 2 Diabetes (T2D)–Associated TCF7L2 Genetic Variants and Indices of Insulin Secretion and Sensitivity in Individuals at Risk for Type 1 Diabetes (T1D)

Diabetes ◽

10.2337/db20-110-or ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 110-OR

Author(s):

MARIA J. REDONDO ◽

MEGAN V. WARNOCK ◽

LAURA E. BOCCHINO ◽

SUSAN GEYER ◽

ALBERTO PUGLIESE ◽

...

Keyword(s):

Type 2 Diabetes ◽

At Risk ◽

Type 1 Diabetes ◽

Insulin Secretion ◽

Genetic Variants

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2397-PUB: PowerHouse: A Lifestyle Intervention for Youth at Risk for Type 2 Diabetes (T2D)

Diabetes ◽

10.2337/db19-2397-pub ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 2397-PUB

Author(s):

HALA K. EL MIKATI ◽

JULIE PIKE ◽

KATIE HABERLIN-PITTZ ◽

LISA YAZEL-SMITH ◽

BRETT M. MCKINNEY ◽

...

Keyword(s):

Type 2 Diabetes ◽

At Risk ◽

Lifestyle Intervention ◽

Youth At Risk

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Faculty Opinions recommendation of Predictors of incident herpes simplex virus type 2 infections in young women at risk for unintended pregnancy in San Francisco.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1093766.548685 ◽

2007 ◽

Author(s):

Anne Buvé

Keyword(s):

At Risk ◽

Herpes Simplex Virus ◽

Herpes Simplex ◽

San Francisco ◽

Unintended Pregnancy ◽

Virus Type ◽

Young Women ◽

Herpes Simplex Virus Type ◽

Simplex Virus

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Alpha-1-Antichymotrypsin: a Common Player for Type 2 Diabetes and Alzheimer's Disease

Current Diabetes Reviews ◽

10.2174/1573399816999201012200537 ◽

2020 ◽

Vol 16 ◽

Author(s):

Nataly Guzmán-Herrera ◽

Viridiana C. Pérez-Nájera ◽

Luis A. Salazar-Olivo

Keyword(s):

Oxidative Stress ◽

Alzheimer’S Disease ◽

Type 2 Diabetes ◽

Alzheimer's Disease ◽

Regulatory Networks ◽

Therapeutic Strategies ◽

Oxidative Stresses ◽

Bibliographic Search ◽

And Oxidative Stress

Background: Numerous studies have shown a significant association between type 2 diabetes mellitus (T2D) and Alzheimer's disease (AD), two pathologies affecting millions of people worldwide. Chronic inflammation and oxidative stress are two conditions common to these diseases also affecting the activity of the serpin alpha-1-antichymotrypsin (ACT), but a possible common role for this serpin in T2D and AD remains unclear. Objective: To explore the possible regulatory networks linking ACT to T2D and AD. Materials and Methods: A bibliographic search was carried out in PubMed, Med-line, Open-i, ScienceDirect, Scopus and SpringerLink for data indicating or suggesting association among T2D, AD, and ACT. Searched terms like “alpha-1-antichymotrypsin”, “type 2 diabetes”, “Alzheimer's disease”, “oxidative stress”, “pro-inflammatory mediators” among others were used. Moreover, common therapeutic strategies between T2D and AD as well as the use of ACT as a therapeutic target for both diseases were included. Results: ACT has been linked with development and maintenance of T2D and AD and studies suggest their participation through activation of inflammatory pathways and oxidative stress, mechanisms also associated with both diseases. Likewise, evidences indicate that diverse therapeutic approaches are common to both diseases. Conclusion: Inflammatory and oxidative stresses constitute a crossroad for T2D and AD where ACT could play an important role. In-depth research on ACT involvement in these two dysfunctions could generate new therapeutic strategies for T2D and AD.

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