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Aguinam ET, Nadesalingam A, Chan A, Smith P, Paloniemi M, Cantoni D, Gronlund J, Gronlund H, Carnell GW, Castillo-Olivares J, Temperton N, Blacklaws B, Heeney JL, Baxendale H. Differential T-cell and Antibody Responses induced by mRNA versus adenoviral vectored COVID-19 vaccines in Patients with Immunodeficiencies. J Allergy Clin Immunol Glob 2023; 2:100091. [PMID: 37038555 PMCID: PMC10015741 DOI: 10.1016/j.jacig.2023.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/18/2023] [Accepted: 02/02/2023] [Indexed: 03/17/2023]
Abstract
Background Immunodeficient patients (IDPs) are at higher risk of contracting severe COVID-19 disease. Targeted vaccination strategies have been implemented to enhance vaccine-induced protection. In this population however, clinical effectiveness is variable and duration of protection unknown. Objective To understand the cellular and humoral immune responses to mRNA and adenoviral vectored COVID-19 vaccines in patients with immunodeficiency. Methods Immune responses to SARS-COV-2 spike were assessed after two doses of homologous ChAdOx1-nCoV-19 or BNT162b2 vaccines in 112 infection-naïve IDPs and 131 healthy health care workers (HCWs) as controls. Predictors of vaccine responsiveness were investigated. Results Immune responses to vaccination were low, and viral neutralisation by antibody not detected despite high titre binding responses in many IDPs. In those responding, the frequency of specific T-cell responses in IDPs was similar to controls whilst antibody responses were lower. Sustained vaccine specific differences were identified: T-cell responses were greater in ChAdOx1-nCoV-19 compared with BNT162b2 immunised IDPs and antibody binding and neutralisation was greater in all cohorts immunised with BNT162b2. The positive correlation between T-cell and antibody responses was weak and increased with subsequent vaccination. Conclusion Immunodeficient patients have impaired immune responses to mRNA and viral vector COVID-19 vaccines that appear influenced by vaccine formulation. Understanding the relative roles of T-cell and antibody mediated protection and potential of heterologous prime and boost immunization protocols is needed to optimise the vaccination approach in these high-risk groups.
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Key Words
- covid-19
- sars-cov-2
- vaccine
- chadox1-ncov-19
- bnt162b2
- immunodeficiency
- antibodies
- t-cells
- immunoglobulins
- healthcare workers
- ceft, peptides pool from human cytomegalovirus, epstein barr virus, influenza a virus and clostridium tetani
- covid-19, coronavirus disease 2019
- hcws, health care workers
- hcws-npi, health care workers with no prior covid-19 infection
- hcws-pi, health care workers with prior covid-19 infection
- hicc, humoral immune correlates of covid-19
- idps, immunodeficient patients
- iga, immunoglobulin a
- igg, immunoglobulin g
- iggrx, immunoglobulin replacement therapy
- pbmc, peripheral blood mononuclear cells
- pmn, pseudovirus micro neutralisation
- pv1, post first vaccine dose
- pv2, post second vaccine dose
- rbd, receptor binding domain
- rph, royal papworth hospital
- rx, treatment
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- sid, secondary immunodeficiency
- vocs, variants of concern
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Affiliation(s)
- Ernest T Aguinam
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, UK
| | - Angalee Nadesalingam
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, UK
| | - Andrew Chan
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, UK
| | - Peter Smith
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, UK
| | - Minna Paloniemi
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, UK
| | - Diego Cantoni
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, UK
| | | | | | - George W Carnell
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, UK
| | | | - Nigel Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, UK
| | - Barbara Blacklaws
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, UK
| | - Jonathan L Heeney
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, UK
| | - Helen Baxendale
- Royal Papworth Hospital, Cambridgeshire, UK,Correspondence to: Helen Baxendale, Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Cambridge Biomedical Campus,CB2 0AY, +44 (0)1223 639508
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Affiliation(s)
- Martina Zappa
- Department of Medicine and Surgery, Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, University of Insubria, Via Crotto Roncaccio 16, Tradate, VA, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, University of Insubria, Via Crotto Roncaccio 16, Tradate, VA, Italy; Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Italy.
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Abstract
COVID-19, the disease caused by the SARS-CoV-2 betacoronavirus, was declared a pandemic by the World Health Organization on March 11, 2020. Since then, SARS-CoV-2 has triggered a devastating global health and economic emergency. In response, a broad range of preclinical animal models have been used to identify effective therapies and vaccines. Current animal models do not express the full spectrum of human COVID-19 disease and pathology, with most exhibiting mild to moderate disease without mortality. NHPs are physiologically, genetically, and immunologically more closely related to humans than other animal species; thus, they provide a relevant model for SARS-CoV-2 investigations. This overview summarizes NHP models of SARS-CoV-2 and their role in vaccine and therapeutic development.
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Key Words
- ace2, angiotensin l converting enzyme 2
- ade, antibody dependent enhancement
- agm, african green monkey
- ards, acute respiratory distress syndrome
- balf, bronchoalveolar lavage fluid
- cj, conjunctival
- cm, cynomolgus macaque
- covid-19, coronavirus disease 19
- cp, convalescent plasma
- dad, diffuse alveolar damage
- dpc, days post challenge
- dpi, days post infection
- ggos, ground glass opacities
- grna, genomic ribonucleic acid
- hcq, hydroxychloroquine
- it, intratracheal
- nab, neutralizing antibodies
- ptm, pigtail macaque
- rbd, receptor binding domain
- rm, rhesus macaque
- s, spike
- sgrna, subgenomic ribonucleic acid
- th1, type 1 t helper cell
- vrna, viral ribonucleic acid
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Affiliation(s)
- Anita M Trichel
- Division of Laboratory Animal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Watson ME, Inagaki K, Weinberg JB. Severe Acute Respiratory Syndrome Coronavirus 2: Manifestations of Disease and Approaches to Treatment and Prevention in Humans. Comp Med 2021; 71:342-358. [PMID: 34535198 PMCID: PMC8594263 DOI: 10.30802/aalas-cm-21-000011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/08/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic was caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This virus has challenged civilization and modern science in ways that few infectious diseases and natural disasters have previously, causing globally significant human morbidity and mortality and triggering economic downturns across financial markets that will be dealt with for generations. Despite this, the pandemic has also brought an opportunity for humanity to come together and participate in a shared scientific investigation. Clinically, SARS-CoV-2 is associated with lower mortality rates than other recently emerged coronaviruses, such as SARS-CoV and the Middle East respiratory syndrome coronavirus (MERS-CoV). However, SARS-CoV-2 exhibits efficient human-to-human spread, with transmission often occurring before symptom recognition; this feature averts containment strategies that had worked previ- ously for SARS-CoV and MERS-CoV. Severe COVID-19 disease is characterized by dysregulated inflammatory responses associated with pulmonary congestion and intravascular coagulopathy leading to pneumonia, vascular insults, and multiorgan disease. Approaches to treatment have combined supportive care with antivirals, such as remdesivir, with immunomodulatory medications, including corticosteroids and cytokine-blocking antibody therapies; these treatments have advanced rapidly through clinical trials. Innovative approaches to vaccine development have facilitated rapid advances in design, testing, and distribution. Much remains to be learned about SARS-CoV-2 and COVID-19, and further biomedical research is necessary, including comparative medicine studies in animal models. This overview of COVID-19 in humans will highlight important aspects of disease, relevant pathophysiology, underlying immunology, and therapeutics that have been developed to date.
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Key Words
- ards, acute respiratory distress syndrome
- ace2, angiotensin-converting enzyme 2
- covid-19, coronavirus disease 2019
- hcov, human coronavirus
- ifn, interferon
- mers, middle east respiratory syndrome
- mis-c, multisystem inflammatory syndrome in children
- rbd, receptor binding domain
- sars, severe acute respiratory syndrome
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- s, spike
- tmprss2, type 2 transmembrane serine protease
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Affiliation(s)
- Michael E Watson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Kengo Inagaki
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Jason B Weinberg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
- Department of Microbiology & Immunology, University of Michigan, Ann Arbor, Michigan
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Wong SY, Dixon R, Martinez Pazos V, Gnjatic S, Colombel JF, Cadwell K. Serologic Response to Messenger RNA Coronavirus Disease 2019 Vaccines in Inflammatory Bowel Disease Patients Receiving Biologic Therapies. Gastroenterology 2021; 161:715-718.e4. [PMID: 33887219 PMCID: PMC8055494 DOI: 10.1053/j.gastro.2021.04.025] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Serre-Yu Wong
- The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Rebekah Dixon
- The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vicky Martinez Pazos
- The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sacha Gnjatic
- The Precision Immunology Institute, Tisch Cancer Institute, Division of Hematology/Oncology, Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ken Cadwell
- Skirball Institute of Biomolecular Medicine, Department of Microbiology, Division of Gastroenterology and Hepatology, Department of Medicine, New York University School of Medicine, New York, New York
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Gioia M, Ciaccio C, Calligari P, De Simone G, Sbardella D, Tundo G, Fasciglione GF, Di Masi A, Di Pierro D, Bocedi A, Ascenzi P, Coletta M. Role of proteolytic enzymes in the COVID-19 infection and promising therapeutic approaches. Biochem Pharmacol 2020; 182:114225. [PMID: 32956643 PMCID: PMC7501082 DOI: 10.1016/j.bcp.2020.114225] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
In the Fall of 2019 a sudden and dramatic outbreak of a pulmonary disease (Coronavirus Disease COVID-19), due to a new Coronavirus strain (i.e., SARS-CoV-2), emerged in the continental Chinese area of Wuhan and quickly diffused throughout the world, causing up to now several hundreds of thousand deaths. As for common viral infections, the crucial event for the viral life cycle is the entry of genetic material inside the host cell, realized by the spike protein of the virus through its binding to host receptors and its activation by host proteases; this is followed by translation of the viral RNA into a polyprotein, exploiting the host cell machinery. The production of individual mature viral proteins is pivotal for replication and release of new virions. Several proteolytic enzymes either of the host and of the virus act in a concerted fashion to regulate and coordinate specific steps of the viral replication and assembly, such as (i) the entry of the virus, (ii) the maturation of the polyprotein and (iii) the assembly of the secreted virions for further diffusion. Therefore, proteases involved in these three steps are important targets, envisaging that molecules which interfere with their activity are promising therapeutic compounds. In this review, we will survey what is known up to now on the role of specific proteolytic enzymes in these three steps and of most promising compounds designed to impair this vicious cycle.
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Key Words
- covid-19, coronavirus disease – 19
- sars-cov, severe acute respiratory syndrome coronavirus
- sars-cov-2, severe acute respiratory syndrome – 2
- mers-cov, middle east respiratory syndrome coronavirus
- orf, open reading frame
- plpro, papain-like protease
- mpro, main protease
- pp, polyprotein
- nsp, non structural protein
- rdrp, rna dependent rna polymerase
- hel, helicase
- s protein, spike protein
- tmprss2, trans-membrane protease serine protease-2
- tmprss4, trans-membrane protease serine protease-4
- hat, human airway trypsin-like protease
- tgn, trans-golgi network
- ace2, angiotensin-converting enzyme receptor-2
- rbd, receptor binding domain
- pc, pro-protein convertase
- hcov-oc43, human coronavirus-oc43
- mhv-a59, murine hepatitis virus – a59
- hiv, human immunodeficiency virus
- cmk, chloro-methyl-ketone
- dec, decanoyl
- phac, phenyl-acetyl
- ttsp, type ii transmembrane serine proteases family
- hpv, human papillomavirus
- hbv, hepatitis b virus
- evd, ebola virus disease
- zikv, zika virus
- jev, japanese encephalitis virus
- fpv, feline panleukopenia virus
- hpaiv, highly pathogenic avian influenza virus
- cdv, canine distemper virus
- rsv, respiratory syncytial virus (rsv)
- a1at, alpha-1-anti trypsin
- aebsf, 4-(2-aminomethyl)-benzene sulphonyl fluoride
- bhh, bromhexine hydrochloride
- pcsk, pro-protein convertase subtilisin/kexin
- ampk, adenosine monophosphate-activated protein kinase
- hcov-nl63, human coronavirus – nl63
- hcov-229e, human coronavirus – 229e
- hcov-hku1, human coronavirus – hku1
- 3cpro, 3chymotrypsin protease of rhinoviruses
- 3d-qsar, three-dimensional quantitative structure-activity relationships
- fda, food and drug agency
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Affiliation(s)
- Magda Gioia
- Department of Clinical Sciences and Translational Medicine, University of Roma Tor Vergata, Roma, Italy.
| | - Chiara Ciaccio
- Department of Clinical Sciences and Translational Medicine, University of Roma Tor Vergata, Roma, Italy.
| | - Paolo Calligari
- Department of Chemical and Technological Sciences, University of Roma Tor Vergata, Roma, Italy
| | | | | | | | | | | | - Donato Di Pierro
- Department of Clinical Sciences and Translational Medicine, University of Roma Tor Vergata, Roma, Italy
| | - Alessio Bocedi
- Department of Chemical and Technological Sciences, University of Roma Tor Vergata, Roma, Italy
| | - Paolo Ascenzi
- Department of Sciences, Roma Tre University, Roma, Italy,Interdepartmental Laboratory for Electron Microscopy, Roma Tre University, Roma, Italy
| | - Massimo Coletta
- Department of Clinical Sciences and Translational Medicine, University of Roma Tor Vergata, Roma, Italy.
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7
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Yonker LM, Neilan AM, Bartsch Y, Patel AB, Regan J, Arya P, Gootkind E, Park G, Hardcastle M, St John A, Appleman L, Chiu ML, Fialkowski A, De la Flor D, Lima R, Bordt EA, Yockey LJ, D'Avino P, Fischinger S, Shui JE, Lerou PH, Bonventre JV, Yu XG, Ryan ET, Bassett IV, Irimia D, Edlow AG, Alter G, Li JZ, Fasano A. Pediatric Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Clinical Presentation, Infectivity, and Immune Responses. J Pediatr 2020; 227:45-52.e5. [PMID: 32827525 PMCID: PMC7438214 DOI: 10.1016/j.jpeds.2020.08.037] [Citation(s) in RCA: 224] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES As schools plan for re-opening, understanding the potential role children play in the coronavirus infectious disease 2019 (COVID-19) pandemic and the factors that drive severe illness in children is critical. STUDY DESIGN Children ages 0-22 years with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting to urgent care clinics or being hospitalized for confirmed/suspected SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) at Massachusetts General Hospital were offered enrollment in the Massachusetts General Hospital Pediatric COVID-19 Biorepository. Enrolled children provided nasopharyngeal, oropharyngeal, and/or blood specimens. SARS-CoV-2 viral load, ACE2 RNA levels, and serology for SARS-CoV-2 were quantified. RESULTS A total of 192 children (mean age, 10.2 ± 7.0 years) were enrolled. Forty-nine children (26%) were diagnosed with acute SARS-CoV-2 infection; an additional 18 children (9%) met the criteria for MIS-C. Only 25 children (51%) with acute SARS-CoV-2 infection presented with fever; symptoms of SARS-CoV-2 infection, if present, were nonspecific. Nasopharyngeal viral load was highest in children in the first 2 days of symptoms, significantly higher than hospitalized adults with severe disease (P = .002). Age did not impact viral load, but younger children had lower angiotensin-converting enzyme 2 expression (P = .004). Immunoglobulin M (IgM) and Immunoglobulin G (IgG) to the receptor binding domain of the SARS-CoV-2 spike protein were increased in severe MIS-C (P < .001), with dysregulated humoral responses observed. CONCLUSIONS This study reveals that children may be a potential source of contagion in the SARS-CoV-2 pandemic despite having milder disease or a lack of symptoms; immune dysregulation is implicated in severe postinfectious MIS-C.
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Key Words
- ace2, angiotensin-converting enzyme
- covid-19, coronavirus disease-19
- ipo8, importin-8
- irb, institutional review board
- mgh, massachusetts general hospital
- mis-c, multisystem inflammatory syndrome in children
- nt-probnb, n-terminal pro b-type natriuretic peptide
- rbd, receptor binding domain
- rsv, respiratory syncytial virus
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
- Lael M Yonker
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Anne M Neilan
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Yannic Bartsch
- Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA
| | - Ankit B Patel
- Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Department of Medicine, Renal Division, Boston, MA
| | - James Regan
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Puneeta Arya
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Grace Park
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Margot Hardcastle
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Anita St John
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Lori Appleman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Michelle L Chiu
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Denis De la Flor
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Rosiane Lima
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Evan A Bordt
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Laura J Yockey
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Paolo D'Avino
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - Stephanie Fischinger
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA
| | - Jessica E Shui
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Paul H Lerou
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Joseph V Bonventre
- Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Department of Medicine, Renal Division, Boston, MA
| | - Xu G Yu
- Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA; Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Edward T Ryan
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ingrid V Bassett
- Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Daniel Irimia
- Harvard Medical School, Boston, MA; Center for Engineering in Medicine, Department of Surgery, Boston, MA
| | - Andrea G Edlow
- Harvard Medical School, Boston, MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Massachusetts General Hospital Boston, Boston, MA
| | - Galit Alter
- Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA
| | - Jonathan Z Li
- Harvard Medical School, Boston, MA; Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Baker D, Amor S, Kang AS, Schmierer K, Giovannoni G. The underpinning biology relating to multiple sclerosis disease modifying treatments during the COVID-19 pandemic. Mult Scler Relat Disord 2020; 43:102174. [PMID: 32464584 PMCID: PMC7214323 DOI: 10.1016/j.msard.2020.102174] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND SARS-CoV-2 viral infection causes COVID-19 that can result in severe acute respiratory distress syndrome (ARDS), which can cause significant mortality, leading to concern that immunosuppressive treatments for multiple sclerosis and other disorders have significant risks for both infection and ARDS. OBJECTIVE To examine the biology that potentially underpins immunity to the SARS-Cov-2 virus and the immunity-induced pathology related to COVID-19 and determine how this impinges on the use of current disease modifying treatments in multiple sclerosis. OBSERVATIONS Although information about the mechanisms of immunity are scant, it appears that monocyte/macrophages and then CD8 T cells are important in eliminating the SARS-CoV-2 virus. This may be facilitated via anti-viral antibody responses that may prevent re-infection. However, viral escape and infection of leucocytes to promote lymphopenia, apparent CD8 T cell exhaustion coupled with a cytokine storm and vascular pathology appears to contribute to the damage in ARDS. IMPLICATIONS In contrast to ablative haematopoietic stem cell therapy, most multiple-sclerosis-related disease modifying therapies do not particularly target the innate immune system and few have any major long-term impact on CD8 T cells to limit protection against COVID-19. In addition, few block the formation of immature B cells within lymphoid tissue that will provide antibody-mediated protection from (re)infection. However, adjustments to dosing schedules may help de-risk the chance of infection further and reduce the concerns of people with MS being treated during the COVID-19 pandemic.
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Key Words
- ace2, angiotensin converting enzyme two
- ards, acute respiratory distress syndrome
- asc, antibody secreting cells
- cns, central nervous system
- dmt, disease modifying therapies
- (hsct), haematopoietic stem cell therapy
- irt, immune reconstitution therapies
- ms, multiple sclerosis
- rbd, receptor binding domain
- rna, ribonucleic acid
- sars, severe acute respiratory syndrome
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Affiliation(s)
- David Baker
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 2AT; United Kingdom.
| | - Sandra Amor
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 2AT; United Kingdom; Pathology Department, VUmc, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Angray S Kang
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 2AT; United Kingdom; Centre for Oral Immunobiology and Regenerative Medicine, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Klaus Schmierer
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 2AT; United Kingdom; Clinical Board:Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 2AT; United Kingdom; Clinical Board:Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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