Covid, mRNA vaccines effective in those being treated for multiple sclerosis
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If multiple sclerosis drugs work by blocking the immune system, what happens when the patient receives the Covid-19 vaccine? Researchers from the University of Modena and Reggio Emilia answered this question in an article just published on Nature Communication. “The study – he explains Sara De Biasi from the University of Modena and Reggio Emilia, first author of the work – demonstrates that, despite the use of immunomodulatory therapy, patients with multiple sclerosis develop a specific and long-lasting immune response following vaccination against SARS-CoV-2″ .
The problem of immunomodulatory drugs
Immunosuppressive and immunomodulatory therapies used to treat multiple sclerosis act at different levels on the mechanisms of inflammation: they can inhibit the expansion of activated lymphocytes, direct pathological immune cells away from the central nervous system or decrease the number of B and T lymphocytes. However, this immunomodulation may increase the risk of infections in patients, reduce the effectiveness of vaccines or the duration of specific immunity. In short, therapy for multiple sclerosis could compromise the full response capacity of the immune system, with consequences that could pose a problem with infections, such as that of SARS-CoV-2.
Vaccines for Covid-19 are also effective in those with MS
To evaluate the effectiveness of mRNA vaccines for Covid-19 in people with multiple sclerosis, researchers involved 94 patients treated with different drugs (cladribine, dimethyl fumarate, fingolimod, interferon, natalizumab, teriflunomide, rituximab or ocrelizumab) and vaccinated with three doses. The scientists took samples of SARS-CoV-2-specific T and B cells up to 8 months after vaccination, and, using advanced tools, analyzed their composition and metabolic profile. It emerged that, approximately 6 months after the third dose of the vaccine, in people with relapsing-remitting multiple sclerosis treated, the overall response of T and B cells specific to the virus was similar to that of people without MS: effective and long-lasting in time. The analysis, however, revealed some differences: those who were treated with fingolimod or natalizumab developed an immune profile different from that of all the other patients: their cells, while remaining functional and able to respond to vaccination, seem respond like those of an aged immune system.
Towards the personalization of vaccination therapies
“This study – he comments Andrea Cossarizza, professor at the University of Modena and Reggio Emilia and coordinator of the study – demonstrates for the first time that the cells that are produced and activated following vaccination for SARS-CoV-2 have a metabolism that depends, at least in part, on therapy that is used to treat multiple sclerosis”. Fingolimod, for example, modulates lymphocyte trafficking and, like natalizumab, modifies the composition of B and T cells. Furthermore, in the case of natalizumab it is noted that B cells are metabolically dormant and it is likely that the drug affects their ability to differentiate and produce antibodies. Those who develop lymphocytes that are metabolically active on multiple fronts, however, are more protected from Covid-19 than those with senescent cells. “Knowing the metabolic pathways used by the cells activated by a vaccine in a patient who receives one therapy rather than another – concludes Cossarizza – could allow us to improve the personalization of vaccination prophylaxis in people with multiple sclerosis, using, for example, drugs that intervene precisely on these pathways”. Thanks to the use of in silico predictive models, it will be possible to evaluate the molecular and cellular state of the patients’ immune system before vaccination, therefore predicting the desired immune response, paving the way for future studies to increase effectiveness.
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