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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: 0] [Impact Index Per Article: 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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Torres P, Sancho-Saldaña A, Gil Sánchez A, Peralta S, Solana MJ, Bakkioui S, González-Mingot C, Quibus L, Ruiz-Fernández E, San Pedro-Murillo E, Brieva L. A prospective study of cellular immune response to booster COVID-19 vaccination in multiple sclerosis patients treated with a broad spectrum of disease-modifying therapies. J Neurol 2023; 270:2380-2391. [PMID: 36933032 PMCID: PMC10024306 DOI: 10.1007/s00415-023-11575-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Most people with Multiple Sclerosis (pwMS) are subjected to immunomodulatory disease-modifying treatments (DMTs). As a result, immune responses to COVID-19 vaccinations could be compromised. There are few data on cellular immune responses to the use of COVID-19 vaccine boosters in pwMS under a broad spectrum of DMTs. METHODS In this prospective study, we analysed cellular immune responses to SARS-CoV-2 mRNA booster vaccinations in 159 pwMS with DMT, including: ocrelizumab, rituximab, fingolimod, alemtuzumab, dimethyl fumarate, glatiramer acetate, teriflunomide, natalizumab and cladribine. RESULTS DMTs, and particularly fingolimod, interact with cellular responses to COVID-19 vaccination. One booster dose does not increase cellular immunity any more than two doses, except in the cases of natalizumab and cladribine. SARS-CoV-2 infection combined with two doses of vaccine resulted in a greater cellular immune response, but this was not observed after supplementary booster jabs. Ocrelizumab-treated pwMS who had previously received fingolimod did not develop cellular immunity, even after receiving a booster. The time after MS diagnosis and disability status negatively correlated with cellular immunity in ocrelizumab-treated pwMS in a booster dose cohort. CONCLUSIONS After two doses of SARS-CoV-2 vaccination, a high response yield was achieved, except in patients who had received fingolimod. The effects of fingolimod on cellular immunity persisted for more than 2 years after a change to ocrelizumab (which, in contrast, conserved cellular immunity). Our results confirmed the need to find alternative protective measures for fingolimod-treated people and to consider the possible failure to provide protection against SARS-CoV-2 when switching from fingolimod to ocrelizumab.
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Affiliation(s)
- Pascual Torres
- Metabolic Pathophysiology Research Group, Department of Experimental Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
| | - Agustín Sancho-Saldaña
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | - Anna Gil Sánchez
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
| | - Silvia Peralta
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | - Maria José Solana
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | - Sofian Bakkioui
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
| | - Cristina González-Mingot
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | - Laura Quibus
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | - Emilio Ruiz-Fernández
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | | | - Luis Brieva
- Neuroimmunology Group, Department of Medicine, University of Lleida (UdL)-IRBLleida, 25198, Lleida, Spain.
- Department of Neurology, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain.
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Pernicová E, Macounová P, Krsek M, Maďar R. Summary of Safety and Efficacy of COVID Vaccination in Patients with Multiple Sclerosis. Eur Neurol 2023; 86:263-276. [PMID: 36871554 PMCID: PMC10614228 DOI: 10.1159/000529982] [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: 07/26/2022] [Accepted: 02/08/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND The SARS-CoV-2 pandemic represents one of the most challenging issues that have recently influenced everyday life in countries all over the world. Understanding the risk of this disease is of high importance in patients with multiple sclerosis (MS) as they represent a vulnerable population through their treatment with disease-modifying therapies (DMTs). Infective episodes may trigger relapses and lead to deterioration of the health condition. SUMMARY Vaccination is an important preventive measure against infectious diseases. In MS patients, concerns have been raised about the effectiveness of vaccines in patients on various immunomodulatory drugs and about their possible adverse effects including impairment of neurological functions. The objectives of this article were to summarize the current knowledge on immune responses to the COVID-19 vaccines and their safety in MS patients and to provide practical guidance based on the data available to date. KEY MESSAGES Although MS is not associated with a higher risk of COVID-19, this infection can trigger relapses or pseudo-relapses. Vaccines against SARS-CoV-2 are recommended for all MS patients who are not in the active phase of the disease, despite the fact that there is still a lack of long-term reliable data on the effectiveness and safety of vaccines against COVID-19. Some DMTs can reduce vaccine humoral responses, but might still provide some protection and adequate T-cell response. To optimize the effectiveness of vaccination, the ideal timing of vaccine application and DMTs dosing regimen is crucial.
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Affiliation(s)
- Eva Pernicová
- Avenier, Centres of Vaccination and Travel Medicine, Brno and Ostrava, Czechia
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petra Macounová
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czechia,
| | - Martin Krsek
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Rastislav Maďar
- Avenier, Centres of Vaccination and Travel Medicine, Brno and Ostrava, Czechia
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
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Czarnowska A, Kapica-Topczewska K, Tarasów E, Tarasiuk J, Chorąży M, Kochanowicz J, Kułakowska A. Case report: First manifestation of multiple sclerosis temporally correlated with COVID-19 vaccination. Front Neurol 2023; 14:1097799. [PMID: 36873437 PMCID: PMC9975751 DOI: 10.3389/fneur.2023.1097799] [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: 11/14/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023] Open
Abstract
There are several case reports describing a temporal correlation between the first clinical manifestation of multiple sclerosis (MS) and the occurrence of relapses with vaccination against SARS-CoV-2. Here we report a case of a 33-year-old male who developed partial right upper and lower extremities numbness 2 weeks after receiving Johnson & Johnson's Janssen COVID-19 vaccine. The brain MRI performed during diagnostics in the Department of Neurology detected several demyelinating lesions, one with enhancement. Oligoclonal bands were present in the cerebrospinal fluid. The patient was treated with high-dose glucocorticoid therapy with improvement and the diagnosis of MS was made. It seems plausible that the vaccination revealed the underlying autoimmune condition. Cases like the one we reported here are rare, and-based on current knowledge-the benefits of vaccination against SARS-CoV-2 far outweigh the potential risks.
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Affiliation(s)
- Agata Czarnowska
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | | | - Eugeniusz Tarasów
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Joanna Tarasiuk
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Monika Chorąży
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Alina Kułakowska
- Department of Neurology, Medical University of Białystok, Białystok, Poland
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Tavazzi E, Della Porta G, Robustelli Della Cuna FS, Gervasio L, Guerra E, Tejada Condemayta MA, Filosa A, Montomoli C, Bergamaschi R. Quantitative and qualitative features of acute phase-adverse events following SARS-CoV-2 vaccination in a large sample of people with multiple sclerosis. Mult Scler Relat Disord 2022; 68:104120. [PMID: 35988330 PMCID: PMC9376979 DOI: 10.1016/j.msard.2022.104120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Few data are available on adverse events (AE) associated to vaccines in persons with multiple sclerosis (pwMS). AIMS to study the incidence of acute phase AE (AP-AE) related to SARS-CoV-2 mRNA vaccines in pwMS compared to a control group, and to analyze the association between AP-AE and disease modifying treatments (DMT). METHODS This was a cross-sectional study on 438 PwMS and 481 age- and sex-matched subjects not affected by dysimmune diseases that underwent two doses of SARS-CoV-2 mRNA BNT162b2 vaccine (Pfizer/BioNtech). RESULTS Two hundred and twenty five (51.4%) pwMS complained of ≥1 AP-AE after the first dose, 269 (61.4%) after the second dose. A logistic regression analysis revealed that only pwMS on Fingolimod and Ocrelizumab did not show a higher risk of developing AP-AE. The likelihood to present with ≥1 AP-AE, after correcting for age and sex, was significantly higher in pwMS than controls. CONCLUSIONS This study reports qualitative and quantitative features of AP-AE associated with the first and second doses of SARS-CoV-2 vaccine in a large sample of pwMS. The only risk factor identified for developing AP-AE is female gender. AntiCD-20 monoclonal antibodies and S1P inhibitors are associated with a lower risk of AP-AE occurrence.
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Affiliation(s)
- E Tavazzi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Via Mondino 2, Pavia 27100, Italy.
| | - G Della Porta
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Via Mondino 2, Pavia 27100, Italy
| | - F S Robustelli Della Cuna
- Department of Drug Sciences, University of Pavia, Pavia, Italy; Pharmacy Service, IRCCS Mondino Foundation, Pavia, Italy
| | - L Gervasio
- Pharmacy Service, IRCCS Mondino Foundation, Pavia, Italy
| | - E Guerra
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - M A Tejada Condemayta
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Via Mondino 2, Pavia 27100, Italy
| | - A Filosa
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - C Montomoli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - R Bergamaschi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Via Mondino 2, Pavia 27100, Italy
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Khan MZI, Nazli A, Al-furas H, Asad MI, Ajmal I, Khan D, Shah J, Farooq MA, Jiang W. An overview of viral mutagenesis and the impact on pathogenesis of SARS-CoV-2 variants. Front Immunol 2022; 13:1034444. [PMID: 36518757 PMCID: PMC9742215 DOI: 10.3389/fimmu.2022.1034444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
Viruses are submicroscopic, obligate intracellular parasites that carry either DNA or RNA as their genome, protected by a capsid. Viruses are genetic entities that propagate by using the metabolic and biosynthetic machinery of their hosts and many of them cause sickness in the host. The ability of viruses to adapt to different hosts and settings mainly relies on their ability to create de novo variety in a short interval of time. The size and chemical composition of the viral genome have been recognized as important factors affecting the rate of mutations. Coronavirus disease 2019 (Covid-19) is a novel viral disease that has quickly become one of the world's leading causes of mortality, making it one of the most serious public health problems in recent decades. The discovery of new medications to cope with Covid-19 is a difficult and time-consuming procedure, as new mutations represent a serious threat to the efficacy of recently developed vaccines. The current article discusses viral mutations and their impact on the pathogenicity of newly developed variants with a special emphasis on Covid-19. The biology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), its mutations, pathogenesis, and treatment strategies are discussed in detail along with the statistical data.
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Affiliation(s)
| | - Adila Nazli
- Faculty of Biological Sciences, Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Hawaa Al-furas
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development, Ministry of Education (MOE) of China, Guangzhou City Key Laboratory of Precision Chemical Drug Development, School of Pharmacy, Jinan University, Guangzhou, China
| | - Muhammad Imran Asad
- Faculty of Biological Sciences, Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Iqra Ajmal
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences, East China Normal University, Shanghai, China
| | - Dildar Khan
- Faculty of Biological Sciences, Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Jaffer Shah
- Department of Health, New York, NY, United States,*Correspondence: Jaffer Shah, ; Muhammad Asad Farooq, ; Wenzheng Jiang,
| | - Muhammad Asad Farooq
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences, East China Normal University, Shanghai, China,*Correspondence: Jaffer Shah, ; Muhammad Asad Farooq, ; Wenzheng Jiang,
| | - Wenzheng Jiang
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences, East China Normal University, Shanghai, China,*Correspondence: Jaffer Shah, ; Muhammad Asad Farooq, ; Wenzheng Jiang,
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