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Salter A, Lancia S, Cutter GR, Fox RJ, Marrie RA. Effects of COVID-19 Infection on Symptom Severity and Disability in Multiple Sclerosis. Neurology 2025; 104:e210149. [PMID: 39715473 DOI: 10.1212/wnl.0000000000210149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 10/07/2024] [Indexed: 12/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Infections, including infection with SARS-CoV-2 (COVID-19), could alter the course of multiple sclerosis (MS). Previous studies assessing the effects of COVID-19 on MS outcomes were small and had discordant findings. The study objective was to evaluate the association of COVID-19 infection with changes in the trajectory of MS symptoms and disability. METHODS We used a controlled interrupted time series (ITS), a quasiexperimental study design using longitudinal data from the North American Research Committee on Multiple Sclerosis Registry. Participants who completed at least 3 surveys before and after their index survey were identified. Exposure of interest was COVID-19 infection based on confirmed diagnosis using an at-home or laboratory test, as reported by the participant. Symptoms were measured using the SymptoMScreen (SMSS), a self-report measure of symptom severity across 12 domains common in MS. Disability was measured using PDDS. Segmented regression was used to compare changes in outcomes over time between cohorts, before and after the exposure (COVID-19 infection). RESULTS The spring 2023 survey response rate was 67.3%, and 4,787 participants completed the COVID-19 questions. Of those participants, 2,106 (44.0%) reported ever having confirmed COVID-19. The COVID-19 infection cohort included 796 participants with ≥3 surveys both before and after index survey. The uninfected cohort included 1,534 participants (32.0%) who reported never having COVID-19 nor other infections in the previous 6 months, of whom 1,336 had the requisite number of presurveys and postsurveys. After adjusting for participant characteristics, the SMSS score increased nominally over time in the COVID-19 and uninfected cohorts and this change over time did not differ between cohorts either before (0.005, 95% CI -0.025 to 0.035) or after (-0.0002, 95% CI -0.014 to 0.014) COVID-19 infection. The immediate effect of COVID-19 infection on the SMSS total score was minimal within the COVID-19 cohort and did not differ between cohorts (0.41, 95% CI -0.13 to 0.94). Findings were similar for disability. DISCUSSION Our study using an ITS design found that COVID-19 infection was not associated with immediate changes in symptom severity or disability, nor did it change the trajectories of these outcomes over a median follow-up of 18 months. Although results may not generalize to younger people with MS, these findings enhance our general understanding of the consequences of infection in people with MS.
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Affiliation(s)
- Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, University of Texas Southwestern Medical Center, Dallas
- Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas
| | - Samantha Lancia
- Department of Neurology, Section on Statistical Planning and Analysis, University of Texas Southwestern Medical Center, Dallas
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama in Birmingham
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, OH
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Cagol A, Montobbio N. Reassuring Insights Into the Effect of COVID-19 on Symptoms and Disability in People With Multiple Sclerosis: Weathering the Storm. Neurology 2025; 104:e210272. [PMID: 39715479 DOI: 10.1212/wnl.0000000000210272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 11/07/2024] [Indexed: 12/25/2024] Open
Affiliation(s)
- Alessandro Cagol
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Switzerland
- Multiple Sclerosis Centre, Departments of Neurology, Clinical Research and Biomedicine, University Hospital and University Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Switzerland; and
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
| | - Noemi Montobbio
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genoa, Italy
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3
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De Ridder D, Uppal A, Rouzinov S, Lamour J, Zaballa ME, Baysson H, Joost S, Stringhini S, Guessous I, Nehme M. SARS-CoV-2 Infection and the Risk of New Chronic Conditions: Insights from a Longitudinal Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:166. [PMID: 40003393 PMCID: PMC11855532 DOI: 10.3390/ijerph22020166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 01/09/2025] [Accepted: 01/21/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND The post-acute impact of SARS-CoV-2 infections on chronic conditions remains poorly understood, particularly in general populations. OBJECTIVES Our primary aim was to assess the association between SARS-CoV-2 infections and new diagnoses of chronic conditions. Our two secondary aims were to explore geographic variations in this association and to assess the association between SARS-CoV-2 infections and the exacerbation of pre-existing conditions. METHODS This longitudinal study used data from 8086 participants of the Specchio-COVID-19 cohort in the canton of Geneva, Switzerland (2021-2023). Mixed-effects logistic regressions and geographically weighted regressions adjusted for sociodemographic, socioeconomic, and healthcare access covariates were used to analyze self-reported SARS-CoV-2 infections, new diagnoses of chronic conditions, and the exacerbation of pre-existing ones. RESULTS Participants reporting a SARS-CoV-2 infection were more likely to be diagnosed with a new chronic condition compared to those who did not report an infection (adjusted odds ratio [aOR] = 2.15, 95% CI 1.43-3.23, adjusted p-value = 0.002). Notable geographic variations were identified in the association between SARS-CoV-2 infections and new diagnoses. While a positive association was initially observed between SARS-CoV-2 infections and exacerbation of pre-existing chronic conditions, this association did not remain significant after adjusting p-values for multiple comparisons. CONCLUSIONS These findings contribute to understanding COVID-19's post-acute impact on chronic conditions, highlighting the need for targeted health management approaches and calling for tailored public health strategies to address the pandemic's long-term effects.
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Affiliation(s)
- David De Ridder
- Geographic Information Research and Analysis in Population Health (GIRAPH) Lab, Department of Community Health and Medicine, Faculty of Medicine, 1205 Geneva, Switzerland (I.G.)
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland (M.N.)
| | - Anshu Uppal
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland (M.N.)
| | - Serguei Rouzinov
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland (M.N.)
| | - Julien Lamour
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland (M.N.)
| | - María-Eugenia Zaballa
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland (M.N.)
| | - Hélène Baysson
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland (M.N.)
| | - Stéphane Joost
- Geographic Information Research and Analysis in Population Health (GIRAPH) Lab, Department of Community Health and Medicine, Faculty of Medicine, 1205 Geneva, Switzerland (I.G.)
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland (M.N.)
- Geospatial Molecular Epidemiology (GEOME), Laboratory for Biological Geochemistry (LGB), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), 1004 Lausanne, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland (M.N.)
- School of Population and Public Health, and Edwin S.H, Leong Centre for Healthy Aging, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Idris Guessous
- Geographic Information Research and Analysis in Population Health (GIRAPH) Lab, Department of Community Health and Medicine, Faculty of Medicine, 1205 Geneva, Switzerland (I.G.)
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland (M.N.)
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Mayssam Nehme
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland (M.N.)
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Hadidchi R, Pakan R, Alamuri T, Cercizi N, Al-Ani Y, Wang SH, Henry S, Duong TQ. Long COVID-19 outcomes of patients with pre-existing dementia. J Alzheimers Dis 2025; 103:605-615. [PMID: 39686622 DOI: 10.1177/13872877241303934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2024]
Abstract
BACKGROUND Although COVID-19 has been linked to worse acute outcomes in patients with some neurodegenerative disorders, its long-term impact on dementia remains unclear. OBJECTIVE To investigate the outcomes of COVID-19 survivors with dementia. METHODS This retrospective study evaluated 9806 patients with dementia in the Montefiore Health System (January 2016 to July 2023). Comparisons were made between dementia patients with and without a positive SARS-CoV-2 polymerase-chain-reaction test who had a follow-up at least two weeks post-infection. Outcomes included all-cause mortality, major adverse cardiovascular events (MACE), new-onset dysphagia, dyspnea, fatigue, new-onset sleep disturbances, altered mental status, first-time fall, headache, new-onset depression, and new-onset anxiety. Adjusted hazard ratios (aHR) were computed adjusting for age, sex, race, ethnicity, and pre-existing comorbidities. RESULTS Dementia patients with COVID-19 were younger, more likely to be male, and had a higher prevalence of major pre-existing comorbidities compared to those without COVID-19. Patients who survived acute COVID-19 were more likely to die than non-COVID controls after adjusting for covariates (aHR = 1.65 [1.43, 1.91]). COVID-19 was significantly associated with higher risk of MACE (aHR = 1.58 [1.41, 1.78]), new-onset dysphagia (aHR = 1.64 [1.42, 1.91]), dyspnea (aHR = 1.27 [1.12, 1.44]), fatigue (aHR = 1.42 [1.22, 1.65]), new-onset sleep disturbances (aHR = 1.36 [1.15, 1.60]), altered mental status (aHR = 1.36 [1.16, 1.59]), and first-time fall (aHR = 1.34 [1.09, 1.65]). CONCLUSIONS COVID-19 increases the risk of mortality and other adverse health outcomes in dementia patients. These findings highlight the need for closer follow-up and management strategies for dementia patients post-COVID-19.
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Affiliation(s)
- Roham Hadidchi
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Rachel Pakan
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Tharun Alamuri
- Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Noel Cercizi
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Yousef Al-Ani
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Stephen H Wang
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Sonya Henry
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Tim Q Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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Pakan R, Hadidchi R, Al-Ani Y, Piskun H, Duong KS, Henry S, Wang S, Maurer CW, Duong TQ. Long-Term Outcomes of Patients with Pre-Existing Essential Tremor After SARS-CoV-2 Infection. Diagnostics (Basel) 2024; 14:2774. [PMID: 39767135 PMCID: PMC11674104 DOI: 10.3390/diagnostics14242774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 12/04/2024] [Accepted: 12/08/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND/OBJECTIVES Although COVID-19 has been linked to worse outcomes in patients with neurological disorders, its impact on those with essential tremor (ET) remains unclear. To investigate clinical outcomes of ET patients with and without COVID-19 three and a half years post-pandemic. METHODS 1074 ET patients were evaluated in this retrospective study in the Montefiore Health System from January 2016 to July 2023. Comparisons between ET patients with and without a positive SARS-CoV-2 polymerase chain reaction test were made. Outcomes included post-index date major adverse cardiovascular events (MACEs), new-onset sleep disturbances, fatigue, dyspnea, first-time fall, new-onset anxiety, new-onset depression, headache, new-onset imbalance, new-onset mild cognitive impairment, and all-cause mortality, adjusted hazard ratios (aHR) adjusting for covariates were calculated. RESULTS ET patients with COVID-19 had higher prevalence of pre-existing type-2 diabetes, depression, and anxiety compared to ET patients without COVID-19. COVID-19 was significantly associated with higher risk of MACEs, (aHR = 2.39 [1.49, 3.82]), new-onset sleep disturbance, (aHR = 2.12 [1.44, 3.13]), fatigue, (aHR = 1.83 [1.27, 2.65]), dyspnea, (aHR = 1.98 [1.40, 2.80]), first-time fall, (aHR = 4.76 [2.24, 10.14]), new-onset anxiety, (aHR = 3.66 [2.02, 6.64]), and new-onset depression, (aHR = 2.38 [1.20, 4.70]). COVID-19 was not associated with all-cause mortality. CONCLUSIONS In patients with ET, COVID-19 significantly increases the risk of several long-term adverse health outcomes, but not mortality.
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Affiliation(s)
- Rachel Pakan
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA; (R.P.); (R.H.); (Y.A.-A.); (H.P.); (K.S.D.); (S.H.); (S.W.)
| | - Roham Hadidchi
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA; (R.P.); (R.H.); (Y.A.-A.); (H.P.); (K.S.D.); (S.H.); (S.W.)
| | - Yousef Al-Ani
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA; (R.P.); (R.H.); (Y.A.-A.); (H.P.); (K.S.D.); (S.H.); (S.W.)
| | - Hannah Piskun
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA; (R.P.); (R.H.); (Y.A.-A.); (H.P.); (K.S.D.); (S.H.); (S.W.)
| | - Katie S. Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA; (R.P.); (R.H.); (Y.A.-A.); (H.P.); (K.S.D.); (S.H.); (S.W.)
| | - Sonya Henry
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA; (R.P.); (R.H.); (Y.A.-A.); (H.P.); (K.S.D.); (S.H.); (S.W.)
| | - Stephen Wang
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA; (R.P.); (R.H.); (Y.A.-A.); (H.P.); (K.S.D.); (S.H.); (S.W.)
| | - Carine W. Maurer
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Tim Q. Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA; (R.P.); (R.H.); (Y.A.-A.); (H.P.); (K.S.D.); (S.H.); (S.W.)
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Levitz D, Chao Foong Y, Sanfilippo P, Spelman T, Rath L, Roldan A, Lal A, Monif M, Jokubaitis V, Ozakbas S, Alroughani R, Boz C, Terzi M, Kalincik T, Blanco Y, Foschi M, Surcinelli A, Buzzard K, Skibina O, Laureys G, Van Hijfte L, Ramo-Tello C, Soysal A, Sanchez-Menoyo JL, Habek M, Cartechini E, Rojas JI, Karabudak R, Willekens B, Al-Harbi T, Fragoso Y, Castillo-Triviño T, Decoo D, Aragon de Vecino MC, Skromne E, Sirbu CA, Zhu C, Merlo D, Gresle M, Butzkueven H, Van Der Walt A. The impact of COVID-19 infection on multiple sclerosis disease course across 12 countries: a propensity-score-matched cohort study. Ther Adv Neurol Disord 2024; 17:17562864241278496. [PMID: 39525878 PMCID: PMC11544652 DOI: 10.1177/17562864241278496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 08/12/2024] [Indexed: 11/16/2024] Open
Abstract
Background The relationship between coronavirus disease 2019 (COVID-19) infection and multiple sclerosis (MS) relapse and disease progression remains unclear. Previous studies are limited by small sample sizes and most lack a propensity-matched control cohort. Objective To evaluate the effect of COVID-19 infection on MS disease course with a large propensity-matched cohort. Design This multi-centre cohort study analysed relapse and disability outcomes post-COVID-19 infection after balancing covariates using a propensity score matching method. The study period was from the 11th of September 2019 to the 16th of February 2023. The mean follow-up period was 1.7 years. Methods Data were retrieved from the MSBase Registry. Propensity scores were obtained based on age, sex, disease duration, baseline Expanded Disability Status Scale (EDSS), MS course, relapses pre-baseline, disease-modifying therapy (DMT) class and country. Primary outcomes were time to first relapse, annualised relapse rate (ARR) and time to confirm EDSS progression. Secondary outcomes were time to EDSS of 3, 4 or 6. Sensitivity analyses with baseline DMT classes were performed. Results The study included 2253 cases and 6441 controls. After matching, there were 2161 cases and an equal number of matched controls. Cases had a significantly higher ARR (ARR = 0.10 [95% CI 0.09-0.11]) compared to controls (ARR = 0.07 [95% CI 0.06-0.08]). Cases had a significantly greater hazard of time to first relapse compared to controls (hazard ratio (HR) = 1.54 [95% CI 1.29-1.84]). There was no association between COVID-19 infection and 24-week EDSS progression (HR = 1.18 [95% CI 0.92-1.52]), or time to EDSS of 3, 4 or 6. For patients on interferons and glatiramer acetate (BRACE), COVID-19 infection was associated with a greater hazard of time to first relapse (HR = 1.83 [95% CI 1.25-2.68]) and greater hazard of time to EDSS of 3 (HR = 2.04 [95% CI 1.06-3.90]) compared to patients on BRACE therapy without COVID-19 infection. Conclusion COVID-19 infection was associated with a significantly increased MS relapse rate and a shorter time to first relapse. There was no effect on confirmed EDSS progression over the short term. These results support ongoing COVID-19 risk minimisation strategies to protect patients with MS.
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Affiliation(s)
- David Levitz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Yi Chao Foong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Paul Sanfilippo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Louise Rath
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Angie Roldan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Anoushka Lal
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - Tomas Kalincik
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Yolanda Blanco
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Matteo Foschi
- Department of Neuroscience, Neurology Unit, S. Maria delle Croci Hospital of Ravenna, AUSL Romagna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L’Aquila, Italy
| | - Andrea Surcinelli
- Department of Neuroscience, Neurology Unit, S. Maria delle Croci Hospital of Ravenna, AUSL Romagna, Ravenna, Italy
| | - Katherine Buzzard
- Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Olga Skibina
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Guy Laureys
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | | | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Jose Luis Sanchez-Menoyo
- Hospital de Galdakao-Usansolo, Galdakao, Spain
- Instituto de Investigacion sanitario Biocruces-Bizkaia, Barakaldo, Spain
| | - Mario Habek
- Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | | | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Talal Al-Harbi
- King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Yara Fragoso
- Universidade Metropolitana de Santos, Santos, Brazil
| | | | | | | | - Eli Skromne
- Hospital Angeles de las Lomas, Instituto Mexicano de Neurociencias, Huixquilucan, Mexico
| | - Carmen-Adella Sirbu
- Central Military Emergency University Hospital, Bucharest, Romania
- Titu Maiorescu University, Bucharest, Romania
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Daniel Merlo
- Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia
| | - Melissa Gresle
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Anneke Van Der Walt
- Department of Neuroscience, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia
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Saratov GA, Belogurov AA, Kudriaeva AA. Myelin basic protein antagonizes the SARS-CoV-2 protein ORF3a-induced autophagy inhibition. Biochimie 2024; 225:1-9. [PMID: 38703943 DOI: 10.1016/j.biochi.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/06/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
Inhibition of autophagy is one of the hallmarks of the SARS-CoV-2 infection. Recently it was reported that SARS-CoV-2 protein ORF3a inhibits fusion of autophagosomes with lysosomes via interaction with VPS39 thus preventing binding of homotypic fusion and protein sorting (HOPS) complex to RAB7 GTPase. Here we report that myelin basic protein (MBP), a major structural component of the myelin sheath, binds ORF3a and is colocalized with it in mammalian cells. Co-expression of MBP with ORF3a restores autophagy in mammalian cells, inhibited by viral protein. Our data suggest that basic charge of MBP drives suppression of ORF3a-induced autophagy inhibition as its deaminated variants lost ability to bind ORF3a and counteract autophagy blockade. These results together with our recent findings, indicating that MBP interacts with structural components of the vesicle transport machinery-synaptosomal-associated protein 23 (SNAP23), vesicle-associated membrane protein 3 (VAMP3) and Sec1/Munc18-1 family members, may suggest protective role of the MBP in terms of the maintaining of protein traffic and autophagosome-lysosome fusion machinery in oligodendrocytes during SARS-CoV-2 infection. Finally, our data may indicate that deimination of MBP observed in the patients with multiple sclerosis (MS) may contribute to the previously reported worser outcomes of COVID-19 and increase of post-COVID-19 neurologic symptoms in patients with MS.
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Affiliation(s)
- George A Saratov
- Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997, Moscow, Russia; Moscow Institute of Physics and Technology (national Research University), Phystech School of Biological and Medical Physics, 141701, Dolgoprudny, Moscow Region, Russia
| | - Alexey A Belogurov
- Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997, Moscow, Russia; Russian University of Medicine, Department of Biological Chemistry, Ministry of Health of Russian Federation, 127473, Moscow, Russia.
| | - Anna A Kudriaeva
- Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997, Moscow, Russia.
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Dancy C, Heintzelman KE, Katt ME. The Glycocalyx: The Importance of Sugar Coating the Blood-Brain Barrier. Int J Mol Sci 2024; 25:8404. [PMID: 39125975 PMCID: PMC11312458 DOI: 10.3390/ijms25158404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
The endothelial glycocalyx (GCX), located on the luminal surface of vascular endothelial cells, is composed of glycoproteins, proteoglycans, and glycosaminoglycans. It plays a pivotal role in maintaining blood-brain barrier (BBB) integrity and vascular health within the central nervous system (CNS), influencing critical processes such as blood flow regulation, inflammation modulation, and vascular permeability. While the GCX is ubiquitously expressed on the surface of every cell in the body, the GCX at the BBB is highly specialized, with a distinct composition of glycans, physical structure, and surface charge when compared to GCX elsewhere in the body. There is evidence that the GCX at the BBB is disrupted and partially shed in many diseases that impact the CNS. Despite this, the GCX has yet to be a major focus of therapeutic targeting for CNS diseases. This review examines diverse model systems used in cerebrovascular GCX-related research, emphasizing the importance of selecting appropriate models to ensure clinical relevance and translational potential. This review aims to highlight the importance of the GCX in disease and how targeting the GCX at the BBB specifically may be an effective approach for brain specific targeting for therapeutics.
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Affiliation(s)
- Candis Dancy
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV 26506, USA; (C.D.); (K.E.H.)
| | - Kaitlyn E. Heintzelman
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV 26506, USA; (C.D.); (K.E.H.)
- School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Moriah E. Katt
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV 26506, USA; (C.D.); (K.E.H.)
- Department of Neuroscience, School of Medicine, West Virginia University Health Science Center, Morgantown, WV 26506, USA
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9
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Gudesblatt M, Bumstead B, Buhse M, Zarif M, Morrow SA, Nicholas JA, Hancock LM, Wilken J, Weller J, Scott N, Gocke A, Lewin JB, Kaczmarek O, Mendoza JP, Golan D. De-escalation of Disease-Modifying Therapy for People with Multiple Sclerosis Due to Safety Considerations: Characterizing 1-Year Outcomes in 25 People Who Switched from Ocrelizumab to Diroximel Fumarate. Adv Ther 2024; 41:3059-3075. [PMID: 38861218 PMCID: PMC11263251 DOI: 10.1007/s12325-024-02902-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/14/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Switching disease-modifying therapy (DMT) may be considered for relapsing-remitting multiple sclerosis (RRMS) if a patient's current therapy is no longer optimal. This was particularly important during the recent COVID-19 pandemic because of considerations around immune deficiency and impaired vaccine response associated with B cell-depleting DMTs. This real-world, single-center study aimed to evaluate change or decline in functional ability and overall disease stability in people with RRMS who were switched from B cell-depleting ocrelizumab (OCRE) to diroximel fumarate (DRF) because of safety concern related to the COVID-19 pandemic. METHODS Adults with RRMS were included if they had been clinically stable for ≥ 1 year on OCRE. Data collected at baseline and 1 year post switch included relapse rate, magnetic resonance imaging (MRI), blood work for assessment of peripheral immune parameters, the Cognitive Assessment Battery (CAB), optical coherence tomography (OCT), and patient-reported outcomes (PROs). RESULTS Participants (N = 25) had a mean (SD) age of 52 (9) years, and a mean (SD) duration of 26 (8) months' treatment with OCRE before the switch to DRF. Median washout duration since the last OCRE infusion was 7 months (range 4-18 months). No participants relapsed on DRF during follow-up, and all remained persistent on DRF after 1 year. There were no significant changes in peripheral immune parameters, other than an increase in the percentage of CD19+ cells 1 year after switching (p < 0.05). Similarly, there were no significant changes in CAB, OCT, and PROs. CONCLUSION These preliminary findings suggest that transition to DRF from OCRE may be an effective treatment option for people with RRMS who are clinically stable but may need to switch for reasons unrelated to effectiveness. Longer follow-up times on larger samples are needed to confirm these observations.
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Affiliation(s)
- Mark Gudesblatt
- NYU Langone South Shore Neurologic Associates, PC, 77 Medford Ave, Patchogue, NY, 11772, USA.
| | - Barbara Bumstead
- NYU Langone South Shore Neurologic Associates, PC, 77 Medford Ave, Patchogue, NY, 11772, USA
| | - Marijean Buhse
- NYU Langone South Shore Neurologic Associates, PC, 77 Medford Ave, Patchogue, NY, 11772, USA
| | - Myassar Zarif
- NYU Langone South Shore Neurologic Associates, PC, 77 Medford Ave, Patchogue, NY, 11772, USA
| | - Sarah A Morrow
- Department of Clinical Neurosciences, University of Calgary, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Jacqueline A Nicholas
- OhioHealth Multiple Sclerosis Center, Riverside Methodist Hospital, Columbus, OH, USA
| | - Laura M Hancock
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffrey Wilken
- Washington Neuropsychology Research Group, Fairfax, VA, USA
- Department of Neurology, Georgetown University School of Medicine, Washington, DC, USA
| | - Joanna Weller
- NYU Langone South Shore Neurologic Associates, PC, 77 Medford Ave, Patchogue, NY, 11772, USA
| | | | | | | | - Olivia Kaczmarek
- NYU Langone South Shore Neurologic Associates, PC, 77 Medford Ave, Patchogue, NY, 11772, USA
| | | | - Daniel Golan
- Multiple Sclerosis and Neuroimmunology Center, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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10
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Zhao K, Xiang X, Zheng Z, Zhang Q, Gu B, Zhang Y, Tang Z, Wei Y, Yuan L, Yang S, Lang L. COVID-19 and retinal layer thickness: A bidirectional Mendelian randomization study. Mult Scler Relat Disord 2024; 88:105700. [PMID: 38880027 DOI: 10.1016/j.msard.2024.105700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/16/2024] [Accepted: 06/02/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Observational studies have reported that COVID-19 is associated with alterations in retinal layer thickness, including changes in the ganglion cell inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL). However, the causal relationships remain unknown. Therefore, we assessed the direction and strength of the causal relationship between COVID-19 and GCIPL and RNFL thicknesses using a bidirectional two-sample Mendelian randomization (MR) design. METHODS Data were obtained from a large-scale COVID-19 Host Genetics Initiative (Nsample = 6,512,887), GCIPL dataset (Ncase = 31,434), and RNFL dataset (Ncase = 31,434). The inverse-variance weighted (IVW) method is the primary approach used to estimate causal effects. MR Egger, weighted median, weighted mode, MR Egger (bootstrap), and penalized weighted median methods were applied. Sensitivity analyses were implemented with RadialMR, MRPRESSO, MR-Egger regression, Cochran's Q statistic, leave-one-out analysis, and the funnel plot. RESULTS Forward MR analysis revealed that genetically identified COVID-19 susceptibility significantly increased the risk of GCIPL thickness (OR = 2.428, 95 % confidence interval [CI]:1.493-3.947, PIVW = 3.579 × 10-4) and RNFL thickness (OR = 1.735, 95 % CI:1.198-2.513, PIVW = 3.580 × 10-3) after Bonferroni correction. Reverse MR analysis did not indicate a significant causal association between GCIPL and RNFL thicknesses and COVID-19 phenotypes. No significant horizontal pleiotropy was found in the sensitivity analysis. CONCLUSIONS The host genetic liability to COVID-19 susceptibility was causally associated with increased GCIPL and RNFL thicknesses. Documenting this association increases our understanding of the pathophysiological mechanisms underlying COVID -19 susceptibility in retinopathy.
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Affiliation(s)
- Kun Zhao
- Department of PET-CT Molecular Imaging Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, PR China
| | - Xiqiao Xiang
- Department of PET-CT Molecular Imaging Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, PR China
| | - Ziwei Zheng
- Department of Ultrasonography, Shanghai Eighth People's Hospital, Shanghai, PR China
| | - Qingwei Zhang
- Department of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Diseases (Renji Hospital, Shanghai Jiaotong University School of Medicine), Shanghai, PR China
| | - Bingxin Gu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | - Yanyan Zhang
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, PR China
| | - Zhen Tang
- Department of PET-CT Molecular Imaging Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, PR China
| | - Yuanhao Wei
- School of Public Health, Harbin Medical University, Harbin, PR China
| | - Lin Yuan
- Department of PET-CT Molecular Imaging Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, PR China
| | - Shaoling Yang
- Department of Ultrasonography, Shanghai Eighth People's Hospital, Shanghai, PR China.
| | - Lili Lang
- Department of Ophthalmology, Shanghai JiaoTong University Affiliated Sixth People's Hospital South Campus, Shanghai, PR China.
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11
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Song X, Song W, Cui L, Duong TQ, Pandy R, Liu H, Zhou Q, Sun J, Liu Y, Li T. A Comprehensive Review of the Global Epidemiology, Clinical Management, Socio-Economic Impacts, and National Responses to Long COVID with Future Research Directions. Diagnostics (Basel) 2024; 14:1168. [PMID: 38893693 PMCID: PMC11171614 DOI: 10.3390/diagnostics14111168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Long COVID, characterized by a persistent symptom spectrum following SARS-CoV-2 infection, poses significant health, social, and economic challenges. This review aims to consolidate knowledge on its epidemiology, clinical features, and underlying mechanisms to guide global responses; Methods: We conducted a literature review, analyzing peer-reviewed articles and reports to gather comprehensive data on long COVID's epidemiology, symptomatology, and management approaches; Results: Our analysis revealed a wide array of long COVID symptoms and risk factors, with notable demographic variability. The current understanding of its pathophysiology suggests a multifactorial origin yet remains partially understood. Emerging diagnostic criteria and potential therapeutic strategies were identified, highlighting advancements in long COVID management; Conclusions: This review highlights the multifaceted nature of long COVID, revealing a broad spectrum of symptoms, diverse risk factors, and the complex interplay of physiological mechanisms underpinning the condition. Long COVID symptoms and disorders will continue to weigh on healthcare systems in years to come. Addressing long COVID requires a holistic management strategy that integrates clinical care, social support, and policy initiatives. The findings underscore the need for increased international cooperation in research and health planning to address the complex challenges of long COVID. There is a call for continued refinement of diagnostic and treatment modalities, emphasizing a multidisciplinary approach to manage the ongoing and evolving impacts of the condition.
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Affiliation(s)
- Xiufang Song
- National Science Library, Chinese Academy of Sciences, Beijing 100190, China;
- Department of Information Resources Management, School of Economics and Management, University of Chinese Academy of Sciences, Beijing 100190, China
| | - Weiwei Song
- Jiangsu Taizhou People’s Hospital, Taizhou 225306, China;
- School of Integrative Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing 210023, China
| | - Lizhen Cui
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing 100049, China;
| | - Tim Q. Duong
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA;
| | - Rajiv Pandy
- Indian Council of Forestry Research & Education, Dehradun 248006, India;
| | - Hongdou Liu
- Centre for Planetary Health and Food Security, School of Environment and Science, Griffith University, Nathan, Brisbane, QLD 4111, Australia;
| | - Qun Zhou
- Department of Library, China Agricultural University (East Campus), 17 Qinghua East Road, Haidian District, Beijing 100193, China; (Q.Z.); (J.S.)
| | - Jiayao Sun
- Department of Library, China Agricultural University (East Campus), 17 Qinghua East Road, Haidian District, Beijing 100193, China; (Q.Z.); (J.S.)
| | - Yanli Liu
- National Science Library, Chinese Academy of Sciences, Beijing 100190, China;
- Department of Information Resources Management, School of Economics and Management, University of Chinese Academy of Sciences, Beijing 100190, China
| | - Tong Li
- School of Agriculture and Food Sustainability, The University of Queensland, St. Lucia, Brisbane, QLD 4072, Australia
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12
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Hadidchi R, Wang SH, Rezko D, Henry S, Coyle PK, Duong TQ. SARS-CoV-2 infection increases long-term multiple sclerosis disease activity and all-cause mortality in an underserved inner-city population. Mult Scler Relat Disord 2024; 86:105613. [PMID: 38608516 DOI: 10.1016/j.msard.2024.105613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Although certain subsets patients with multiple sclerosis (MS), an immune-mediated disorder, are at higher risk of worse acute COVID-19 outcomes compared to the general population, it is not clear whether SARS-CoV-2 infection impacts long-term outcomes compared with MS patients without COVID-19 infection. OBJECTIVES This study investigated MS disease activity and mortality 3.5 years post SARS-CoV-2 infection and compared with MS patients without COVID-19. METHODS This retrospective study evaluated 1,633 patients with MS in the Montefiore Health System in the Bronx from January 2016 to July 2023. This health system serves a large minority population and was an epicenter for the early pandemic and subsequent surges of infection. Positive SARS-CoV-2 infection was determined by a positive polymerase-chain-reaction test. Primary outcomes were all-cause mortality, and optic neuritis post SARS-CoV-2 infection. Secondary outcomes included change in disease-modifying therapy (DMT), treatment with high-dose methylprednisolone, cerebellar deficits, relapse, and all-cause hospitalization post-infection. RESULTS MS patients with COVID-19 had similar demographics but higher prevalence of pre-existing major comorbidities (hypertension, type-2 diabetes, chronic obstructive pulmonary disease, congestive heart failure, chronic kidney disease, and coronary artery disease), optic neuritis, and history of high dose steroid treatment for relapses compared to MS patients without COVID-19. MS patients with COVID-19 had greater risk of mortality (adjusted HR=4.34[1.67, 11.30], p < 0.005), greater risk of post infection optic neuritis (adjusted HR=2.97[1.58, 5.58], p < 0.005), higher incidence of methylprednisolone treatment for post infection acute relapse (12.65% vs. 2.54 %, p < 0.001), and more hospitalization (78.92% vs. 66.81 %, p < 0.01), compared to MS patients without COVID-19. CONCLUSIONS MS patients who survived COVID-19 infection experienced worse long-term outcomes, as measured by treatment for relapse, hospitalization and mortality. Identifying risk factors for worse long-term outcomes may draw clinical attention to the need for careful follow-up of at-risk individuals post-SARS-CoV-2 infection.
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Affiliation(s)
- Roham Hadidchi
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Center for Health & Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Stephen H Wang
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Center for Health & Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MC, USA
| | - David Rezko
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Center for Health & Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Sonya Henry
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Center for Health & Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Patricia K Coyle
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Tim Q Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Center for Health & Data Innovation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.
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13
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Aghajanian S, Shafiee A, Akhondi A, Abadi SRF, Mohammadi I, Ehsan M, Mohammadifard F. The effect of COVID-19 on Multiple Sclerosis relapse: A systematic review and meta-analysis. Mult Scler Relat Disord 2024; 81:105128. [PMID: 37979408 DOI: 10.1016/j.msard.2023.105128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/08/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic autoimmune disease, affecting over 2.5 million people worldwide. There has been growing concern about the impact of COVID-19 on the clinical course of MS. However, these findings remain controversial, and there is a lack of high-quality evidence to establish the relationship between COVID-19 and MS. METHODS A comprehensive search was done to identify relevant studies reporting relapse rate in patients with MS (pwMS), those comparing the relapse rate of COVID-19 pwMS and MS controls, and studies investigating the effect of COVID-19 on relapse rate of pwMS. The results were presented as proportion of COVID-19 pwMS experiencing relapse and odds ratio determining the impact of COVID-19 on relapse rate. RESULTS Fourteen studies were included in the analyses. The proportion of COVID-19 positive pwMS with relapse was 7.71 per 100 cases (95 % confidence interval, CI: 4.41-13.89, I2=96 %). Quantitative evaluation of studies with pwMS without COVID-19 did not demonstrate a statistically significant difference in relapse rate of patients with COVID-19 (OR: 0.75, 95 %CI: 0.44-1.29, I2= 54 %). Subgroup and sensitivity analyses did not alter the lack of significance of association between COVID-19 and MS relapse. Sensitivity analysis excluding the outlying study was largely in favor of no difference between the groups (OR:1.00, 95 %CI: 0.72-1.38, I2=34 %) CONCLUSION: The results of this review does not suggest that COVID-19 influences the relapse rate in pwMS. While the findings alleviate the concerns regarding the co-occurrence of the diseases, further studies are needed to investigate the effects of confounding factors.
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Affiliation(s)
- Sepehr Aghajanian
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Iran; Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Arman Shafiee
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Iran
| | - Amirhossein Akhondi
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Iran
| | | | - Ida Mohammadi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Iran
| | | | - Fateme Mohammadifard
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Iran
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14
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Ramasamy A, Wang C, Brode WM, Verduzco-Gutierrez M, Melamed E. Immunologic and Autoimmune-Related Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Clinical Symptoms and Mechanisms of Disease. Phys Med Rehabil Clin N Am 2023; 34:623-642. [PMID: 37419536 PMCID: PMC10086105 DOI: 10.1016/j.pmr.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
The COVID-19 pandemic has resulted in a significant number of people developing long-term health effects of postacute sequelae SARS-CoV-2 infection (PASC). Both acute COVID-19 and PASC are now recognized as multiorgan diseases with multiple symptoms and disease causes. The development of immune dysregulation during acute COVID-19 and PASC is of high epidemiologic concern. Both conditions may also be influenced by comorbid conditions such as pulmonary dysfunction, cardiovascular disease, neuropsychiatric conditions, prior autoimmune conditions and cancer. This review discusses the clinical symptoms, pathophysiology, and risk factors that affect both acute COVID-19 and PASC.
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Affiliation(s)
- Akshara Ramasamy
- Department of Neurology, Dell Medical School, University of Texas at Austin, Health Discovery Building, 1601 Trinity Street, Austin, TX 78712, USA
| | - Chumeng Wang
- Department of Neurology, Dell Medical School, University of Texas at Austin, Health Discovery Building, 1601 Trinity Street, Austin, TX 78712, USA
| | - W Michael Brode
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, 1601 Trinity Street, Austin, TX 78712, USA
| | - Monica Verduzco-Gutierrez
- Department of Physical Medicine and Rehabilitation, University of Texas at San Antonio, 7703 Floyd Curl Drive, Mail Code 7798, San Antonio, TX 78229, USA
| | - Esther Melamed
- Department of Neurology, Dell Medical School, University of Texas at Austin, Health Discovery Building, 1601 Trinity Street, Austin, TX 78712, USA.
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15
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Tavazzi E, Pichiecchio A, Colombo E, Rigoni E, Asteggiano C, Vegezzi E, Masi F, Greco G, Bastianello S, Bergamaschi R. The Potential Role of SARS-CoV-2 Infection and Vaccines in Multiple Sclerosis Onset and Reactivation: A Case Series and Literature Review. Viruses 2023; 15:1569. [PMID: 37515255 PMCID: PMC10385211 DOI: 10.3390/v15071569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
The recent SARS-CoV-2 pandemic and related vaccines have raised several issues. Among them, the potential role of the viral infection (COVID-19) or anti-SARS-CoV-2 vaccines as causal factors of dysimmune CNS disorders, as well as the safety and efficacy of vaccines in patients affected by such diseases and on immune-active treatments have been analyzed. The aim is to better understand the relationship between SARS-CoV-2 infection/vaccines with dysimmune CNS diseases by describing 12 cases of multiple sclerosis/myelitis onset or reactivation after exposure to SARS-CoV-2 infection/vaccines and reviewing all published case reports or case series in which MS onset or reactivation was temporally associated with either COVID-19 (8 case reports, 3 case series) or anti-SARS-CoV-2 vaccines (13 case reports, 6 case series). All the cases share a temporal association between viral/vaccine exposure and symptoms onset. This finding, together with direct or immune-based mechanisms described both during COVID-19 and MS, claims in favor of a role for SARS-CoV-2 infection/vaccines in unmasking dysimmune CNS disorders. The most common clinical presentations involve the optic nerve, brainstem and spinal cord. The preferential tropism of the virus together with the presence of some host-related genetic/immune factors might predispose to the involvement of specific CNS districts.
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Affiliation(s)
| | - Anna Pichiecchio
- IRCCS Mondino Foundation, 27100 Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | | | | | - Carlo Asteggiano
- IRCCS Mondino Foundation, 27100 Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | | | - Francesco Masi
- IRCCS Mondino Foundation, 27100 Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | - Giacomo Greco
- IRCCS Mondino Foundation, 27100 Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | - Stefano Bastianello
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
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16
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Gombolay G, Hallman-Cooper J. COVID-19 and the Pandemic-Related Aspects in Pediatric Demyelinating Disorders. Semin Pediatr Neurol 2023; 46:101055. [PMID: 37451752 PMCID: PMC10169322 DOI: 10.1016/j.spen.2023.101055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 07/05/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as Coronavirus-19 (COVID-19) infection, has been associated with several neurological symptoms, including acute demyelinating syndromes (ADS). There is a growing body of literature discussing COVID-19 and demyelinating conditions in adults; however, there is less published about COVID-19 demyelinating conditions in the pediatric population. This review aims to discuss the impact of COVID-19 in pediatric patients with central nervous system ADS (cADS) and chronic demyelinating conditions. We reviewed PubMed, Google Scholar, and Medline for articles published between December 1, 2019 and October 25, 2022 related to COVID-19 and pediatric demyelinating conditions. Of 56 articles reviewed, 20 cases of initial presentation of ADS associated with COVID-19 were described. The most commonly described cADS associated with COVID-19 infection in children was Acute Disseminated Encephalomyelitis followed by Transverse Myelitis. Cases of Myelin Oligodendrocyte Glycoprotein Antibody Disease, Neuromyelitis Optica Spectrum Disorder, and Multiple Sclerosis are also described. The risk of severe COVID-19 in pediatric patients with demyelinating conditions appears low, including in patients on disease modifying therapies, but studies are limited. The pandemic did affect disease modifying therapies in ADS, whether related to changes in prescriber practice or access to medications. COVID-19 is associated with ADS in children and the COVID-19 pandemic has impacted pediatric patients with demyelinating conditions in various ways.
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Affiliation(s)
- Grace Gombolay
- Department of Pediatrics, Division of Pediatric Neurology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
| | - Jamika Hallman-Cooper
- Department of Pediatrics, Division of Pediatric Neurology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
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17
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López-Cortés VA, Torres-Romero SB, Ciendúa-Chaparro JA, Pelayo-González H, Méndez-Balbuena I. COGNITIVE, NEUROLOGICAL, NEUROPSYCHOLOGICAL AND NEUROPSYCHIATRIC ALTERATIONS IN POST-COVID-19 PATIENTS. ACTAS ESPANOLAS DE PSIQUIATRIA 2023; 51:88-97. [PMID: 37489554 PMCID: PMC10803853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 07/26/2023]
Abstract
The SARS-CoV-2 virus that causes the COVID-19 disease, reports hundreds of infections daily, the alterations and sequelae of this new pathogen have been reported globally, due to the seriousness of being an older adult and evolving seriously.
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18
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Vercellino M, Bosa C, Alteno A, Muccio F, Marasciulo S, Garelli P, Cavalla P. SARS-CoV-2 pandemic as a model to assess the relationship between intercurrent viral infections and disease activity in Multiple Sclerosis: A propensity score matched case-control study. Mult Scler Relat Disord 2023; 74:104715. [PMID: 37058763 PMCID: PMC10083140 DOI: 10.1016/j.msard.2023.104715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/05/2023] [Accepted: 04/08/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION An association between intercurrent viral respiratory infections and exacerbations of Multiple Sclerosis (MS) disease activity has been proposed by several studies. Considering the rapid spread of SARS-CoV2 worldwide and the systematic effort to immediately detect all incident cases with specific diagnostic tests, the pandemic can represent an interesting experimental model to assess the relationship between viral respiratory infections and MS disease activity. AIMS AND METHODS In this study, we have performed a propensity score matched case-control study with a prospective clinical/MRI follow-up, on a cohort of relapsing-remitting MS (RRMS) patients who tested positive for SARS-CoV2 in the period 2020-2022, with the aim to evaluate if the SARS-CoV2 infection influences the short-term risk of disease activity. Controls (RRMS patients not exposed to SARS-CoV-2, using 2019 as the reference period) were matched 1:1 with cases for age, EDSS, sex and disease-modifying treatment (DMT) (moderate efficacy vs high efficacy). Differences in relapses, MRI disease activity and confirmed disabilty worsening (CDW) between cases in the 6 months following the SARS-CoV-2 infection, and controls in a similar 6 months reference period in 2019 were compared. RESULTS We identified 150 cases of SARS-CoV2 infection in the period March 2020 - March 2022, out of a total population of approximately 1500 MS patients, matched with 150 MS patients not exposed to SARS-CoV2 (controls). Mean age was 40.9 ± 12.0 years in cases and 42.0 ± 10.9 years in controls, mean EDSS was 2.54±1.36 in cases and 2.60±1.32 in controls. All patients were treated with a DMT, and a considerable proportion with a high efficacy DMT (65.3% in cases and 66% in controls), reflecting a typical real world RRMS population. 52.8% of patients in this cohort had been vaccinated with a mRNA Covid-19 vaccine. We did not observe a significant difference in relapses (4.0% cases, 5.3% controls; p = 0.774), MRI disease activity (9.3% cases, 8.0% controls; p = 0.838), CDW (5.3% cases, 6.7% controls; p = 0.782) in the 6 months after SARS-CoV-2 infection between cases and controls. CONCLUSION Using a propensity score matching design and including both clinical and MRI data, this study does not suggest an increased risk of MS disease activity following SARS-CoV-2 infection. All MS patients in this cohort were treated with a DMT, and a considerable number with a high efficacy DMT. These results therefore may not be applicable to untreated patients, for which the risk of increased MS disease activity after SARS-CoV-2 infection may not be excluded. A possible hypothesis explaining these results could be that SARS-CoV2 is less prone, compared to other viruses, to induce exacerbations of MS disease activity; another possible interpretation of these data might be that DMT is able to effectively suppress the increase of disease activity triggered by SARS-CoV2 infection.
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Affiliation(s)
- Marco Vercellino
- Department of Neurosciences and Mental Health, AOU Città della Salute e della Scienza di Torino via Cherasco 15, 10126 Torino, Italy.
| | - Chiara Bosa
- Department of Neurosciences and Mental Health, AOU Città della Salute e della Scienza di Torino via Cherasco 15, 10126 Torino, Italy; Department of Neurosciences, University of Turin, via Cherasco 15, 10126 Torino, Italy
| | - Anastasia Alteno
- Department of Neurosciences and Mental Health, AOU Città della Salute e della Scienza di Torino via Cherasco 15, 10126 Torino, Italy
| | - Francesco Muccio
- Department of Neurosciences, University of Turin, via Cherasco 15, 10126 Torino, Italy
| | - Stella Marasciulo
- Department of Neurosciences, University of Turin, via Cherasco 15, 10126 Torino, Italy
| | - Paola Garelli
- Department of Neurosciences and Mental Health, AOU Città della Salute e della Scienza di Torino via Cherasco 15, 10126 Torino, Italy
| | - Paola Cavalla
- Department of Neurosciences and Mental Health, AOU Città della Salute e della Scienza di Torino via Cherasco 15, 10126 Torino, Italy
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Peeters G, Van Remoortel A, Nagels G, Van Schependom J, D'haeseleer M. Occurrence and Severity of Coronavirus Disease 2019 Are Associated With Clinical Disability Worsening in Patients With Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/3/e200089. [PMID: 36807080 PMCID: PMC9942531 DOI: 10.1212/nxi.0000000000200089] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/09/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Large-scale observational studies have shown that, in patients with multiple sclerosis (MS), the risk of becoming more severely ill from coronavirus disease 2019 (COVID-19) is determined by older age, male sex, cardiovascular comorbidities, African American ethnicity, progressive disease, recent use of corticosteroids, and B cell-depleting disease-modifying treatment. In contrast, the effect of COVID-19 on the disease course of MS has been studied much less extensively. Our main goal was to explore whether COVID-19 is associated with accelerated clinical disability worsening in patients with MS. METHODS Since March 2020, demographics and infectious outcome (categorized as ambulatory, hospitalized, and/or death) of patients with MS who developed COVID-19 have been collected at the Belgian National MS Center in Melsbroek. On February 28, 2022, this database was locked and complemented with clinical disability measures-Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk Test (T25FWT), 9-Hole Peg Test (9HPT), and Symbol Digit Modalities Test (SDMT)-that were available from a larger local database, obtained during routine medical follow-up. For each parameter, the first 2 assessments before COVID-19 diagnosis (T0 and T1; T1 is the closest to COVID-19 diagnosis), and the first thereafter (T2), were retrieved. RESULTS We identified 234 unique cases of COVID-19. Thirty-one patients were hospitalized (13.2%), and 5 died (2.1%) as a result of their infection. Among survivors with complete EDSS results (N = 138), mean annualized T1-to-T2 EDSS worsening was more pronounced, compared with the respective change between T0 and T1 (0.3 ± 0.9 vs 0.1 ± 0.9, p = 0.012). No such differences were found for the T25FWT, 9HPT, and SDMT scores. Severe COVID-19 (hospitalization) was associated with clinically relevant T1-to-T2 EDSS worsening (OR 2.65, p = 0.042). Vaccination coverage in the total cohort was 53.8%. Being unprotected by vaccination at the time of infection was associated with a worse COVID-19 outcome (hospitalization and/or death; OR 3.52, p = 0.002) but not with clinically relevant T1-to-T2 EDSS worsening. DISCUSSION The occurrence and severity of COVID-19 are both associated with clinical disability worsening in patients with MS. Vaccination protects against a more severe course of COVID-19 in this specific population. TRIAL REGISTRATION INFORMATION The study has been registered at ClinicalTrials.gov (study registration number: NCT05403463).
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Affiliation(s)
| | | | | | | | - Miguel D'haeseleer
- From the Universitair Ziekenhuis Brussel (UZ Brussel) (G.P., G.N., M.D.), Department of Neurology, Belgium; Nationaal Multiple Sclerose Centrum (NMSC) (G.P., A.V.R., M.D.), Melsbroek, Belgium; Vrije Universiteit Brussel (VUB) (G.N., J.V.S., M.D.), Center for Neurosciences (C4N), NEUR and AIMS, Brussels, Belgium; Icometrix (G.N.), Leuven, Belgium; and Vrije Universiteit Brussel (VUB) (J.V.S.), Department of Electronics and Informatics (ETRO), Belgium.
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Bu F, Guan R, Wang W, Liu Z, Yin S, Zhao Y, Chai J. Bioinformatics and systems biology approaches to identify the effects of COVID-19 on neurodegenerative diseases: A review. Medicine (Baltimore) 2022; 101:e32100. [PMID: 36626425 PMCID: PMC9750669 DOI: 10.1097/md.0000000000032100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease (COVID-19), has been devastated by COVID-19 in an increasing number of countries and health care systems around the world since its announcement of a global pandemic on 11 March 2020. During the pandemic, emerging novel viral mutant variants have caused multiple outbreaks of COVID-19 around the world and are prone to genetic evolution, causing serious damage to human health. As confirmed cases of COVID-19 spread rapidly, there is evidence that SARS-CoV-2 infection involves the central nervous system (CNS) and peripheral nervous system (PNS), directly or indirectly damaging neurons and further leading to neurodegenerative diseases (ND), but the molecular mechanisms of ND and CVOID-19 are unknown. We employed transcriptomic profiling to detect several major diseases of ND: Alzheimer 's disease (AD), Parkinson' s disease (PD), and multiple sclerosis (MS) common pathways and molecular biomarkers in association with COVID-19, helping to understand the link between ND and COVID-19. There were 14, 30 and 19 differentially expressed genes (DEGs) between COVID-19 and Alzheimer 's disease (AD), Parkinson' s disease (PD) and multiple sclerosis (MS), respectively; enrichment analysis showed that MAPK, IL-17, PI3K-Akt and other signaling pathways were significantly expressed; the hub genes (HGs) of DEGs between ND and COVID-19 were CRH, SST, TAC1, SLC32A1, GAD2, GAD1, VIP and SYP. Analysis of transcriptome data suggests multiple co-morbid mechanisms between COVID-19 and AD, PD, and MS, providing new ideas and therapeutic strategies for clinical prevention and treatment of COVID-19 and ND.
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Affiliation(s)
- Fan Bu
- Heilongjiang University of Chinese Medicine, Haerbin, Heilongjiang Province, China
- * Correspondence: Fan Bu, Heilongjiang University of Chinese Medicine, Haerbin 150040, Heilongjiang Province, China (e-mail: )
| | - Ruiqian Guan
- Heilongjiang University of Chinese Medicine, Haerbin, Heilongjiang Province, China
- Heilongjiang University of Chinese Medicine Affiliated Second Hospital, Haerbin, Heilongjiang Province, China
| | - Wanyu Wang
- Heilongjiang University of Chinese Medicine, Haerbin, Heilongjiang Province, China
| | - Zhao Liu
- Heilongjiang University of Chinese Medicine, Haerbin, Heilongjiang Province, China
| | - Shijie Yin
- Heilongjiang University of Chinese Medicine, Haerbin, Heilongjiang Province, China
| | - Yonghou Zhao
- Heilongjiang University of Chinese Medicine, Haerbin, Heilongjiang Province, China
- Heilongjiang University of Chinese Medicine Affiliated Second Hospital, Haerbin, Heilongjiang Province, China
| | - Jianbo Chai
- Heilongjiang University of Chinese Medicine, Haerbin, Heilongjiang Province, China
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Abstract
INTRODUCTION The pathogenesis of severe COVID-19 is due, in part, to dysregulation of the human immune system in response to SARS-CoV-2 infection. Immune cells infected with SARS-CoV-2 can trigger a hyperinflammatory response of both the adaptive and innate immune system that has been associated with severe disease, hospitalization, and death, and better treatment options are urgently needed. AREAS COVERED A mainstay of therapy for COVID-19 involves an antiviral agent, remdesivir, in combination with a systemic corticosteroid, dexamethasone. EXPERT OPINION The addition of a second immunomodulator, such as an interleukin-6 inhibitor or a Janus kinase inhibitor, has been associated with clinical benefit in a subset of patients with moderate-to-severe disease, but their use remains controversial. This manuscript reviews what is known about the approach to treatment of severe COVID-19 and examines how immunomodulators such as infliximab and abatacept may alter clinical management and COVID-19 research in the years ahead based on the results of randomized, controlled trials.
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