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Tortorella C, Aiello A, Gasperini C, Agrati C, Castilletti C, Ruggieri S, Meschi S, Matusali G, Colavita F, Farroni C, Cuzzi G, Cimini E, Tartaglia E, Vanini V, Prosperini L, Haggiag S, Galgani S, Quartuccio ME, Salmi A, Repele F, Altera AMG, Cristofanelli F, D'Abramo A, Bevilacqua N, Corpolongo A, Puro V, Vaia F, Capobianchi MR, Ippolito G, Nicastri E, Goletti D. Humoral- and T-Cell-Specific Immune Responses to SARS-CoV-2 mRNA Vaccination in Patients With MS Using Different Disease-Modifying Therapies. Neurology 2022; 98:e541-e554. [PMID: 34810244 PMCID: PMC8826460 DOI: 10.1212/wnl.0000000000013108] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/04/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To evaluate the immune-specific response after full severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination of patients with multiple sclerosis (MS) treated with different disease-modifying drugs by the detection of both serologic and T-cell responses. METHODS Healthcare workers (HCWs) and patients with MS, having completed the 2-dose schedule of an mRNA-based vaccine against SARS-CoV-2 in the past 2-4 weeks, were enrolled from 2 parallel prospective studies conducted in Rome, Italy, at the National Institute for Infectious diseases Spallanzani-IRCSS and San Camillo Forlanini Hospital. Serologic response was evaluated by quantifying the region-binding domain (RBD) and neutralizing antibodies. Cell-mediated response was analyzed by a whole-blood test quantifying interferon (IFN)-γ response to spike peptides. Cells responding to spike stimulation were identified by fluorescence-activated cell sorting analysis. RESULTS We prospectively enrolled 186 vaccinated individuals: 78 HCWs and 108 patients with MS. Twenty-eight patients with MS were treated with IFN-β, 35 with fingolimod, 20 with cladribine, and 25 with ocrelizumab. A lower anti-RBD antibody response rate was found in patients treated with ocrelizumab (40%, p < 0.0001) and fingolimod (85.7%, p = 0.0023) compared to HCWs and patients treated with cladribine or IFN-β. Anti-RBD antibody median titer was lower in patients treated with ocrelizumab (p < 0.0001), fingolimod (p < 0.0001), and cladribine (p = 0.010) compared to HCWs and IFN-β-treated patients. Serum neutralizing activity was present in all the HCWs tested and in only a minority of the fingolimod-treated patients (16.6%). T-cell-specific response was detected in the majority of patients with MS (62%), albeit with significantly lower IFN-γ levels compared to HCWs. The lowest frequency of T-cell response was found in fingolimod-treated patients (14.3%). T-cell-specific response correlated with lymphocyte count and anti-RBD antibody titer (ρ = 0.554, p < 0.0001 and ρ = 0.255, p = 0.0078 respectively). IFN-γ T-cell response was mediated by both CD4+ and CD8+ T cells. DISCUSSION mRNA vaccines induce both humoral and cell-mediated specific immune responses against spike peptides in all HCWs and in the majority of patients with MS. These results carry relevant implications for managing vaccinations, suggesting promoting vaccination in all treated patients with MS. CLASSIFICATION OF EVIDENCE This study provides Class III data that SARS-CoV-2 mRNA vaccination induces both humoral and cell-mediated specific immune responses against viral spike proteins in a majority of patients with MS.
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Affiliation(s)
- Carla Tortorella
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Alessandra Aiello
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Claudio Gasperini
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Chiara Agrati
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Concetta Castilletti
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Serena Ruggieri
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Silvia Meschi
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Giulia Matusali
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Francesca Colavita
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Chiara Farroni
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Gilda Cuzzi
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Eleonora Cimini
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Eleonora Tartaglia
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Valentina Vanini
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Luca Prosperini
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Shalom Haggiag
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Simona Galgani
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Maria Esmeralda Quartuccio
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Andrea Salmi
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Federica Repele
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Anna Maria Gerarda Altera
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Flavia Cristofanelli
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Alessandra D'Abramo
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Nazario Bevilacqua
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Angela Corpolongo
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Vincenzo Puro
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Francesco Vaia
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Maria Rosaria Capobianchi
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Giuseppe Ippolito
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Emanuele Nicastri
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Delia Goletti
- From the Department of Neurosciences (C.T., C.G., L.P., S.H., S.G., M.E.Q.), San Camillo-Forlanini Hospital; Translational Research Unit (A.A., C.F., G.C., V.V., A.S., F.R., A.M.G.A., D.G.), Laboratory of Cellular Immunology (C.A., E.C., E.T., Flavia Cristofanelli), Laboratory of Virology (C.C., S.M., G.M., Francesca Colavita, M.R.C.), UOS Professioni Sanitarie Tecniche (V.V.), Clinical Division of Infectious Diseases (A.D.A., N.B., A.C., E.N.), UOC Emerging Infections and CRAIDS (V.P.), Health Direction (F.V.), and Scientific Direction (G.I.), National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS; Department of Human Neurosciences (S.R.), Sapienza University of Rome; and Neuroimmunology Unit (S.R.), IRCSS Fondazione Santa Lucia, Rome, Italy.
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