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2020 ; 43
(ä): 102174
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The underpinning biology relating to multiple sclerosis disease modifying
treatments during the COVID-19 pandemic
#MMPMID32464584
Baker D
; Amor S
; Kang AS
; Schmierer K
; Giovannoni G
Mult Scler Relat Disord
2020[Aug]; 43
(ä): 102174
PMID32464584
show ga
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.
|Alemtuzumab/therapeutic use
[MESH]
|Antibodies, Monoclonal, Humanized/therapeutic use
[MESH]