The Impact of SARS-CoV-2 Infection on the Development of Neurodegeneration in Multiple Sclerosis

Abstract

The novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains a global challenge. Currently, there is some information on the consequences of COVID-19 infection in multiple sclerosis (MS) patients, as it is a newly discovered coronavirus, but its far-reaching effects on participation in neurodegenerative diseases seem to be significant. Recent cases reports showed that SARS-CoV-2 may be responsible for initiating the demyelination process in people who previously had no symptoms associated with any nervous system disorders. It is presently known that infection of SARS-CoV-2 evokes cytokine storm syndrome, which may be one of the factors leading to the acute cerebrovascular disease. One of the substantial problems is the coexistence of cerebrovascular disease and MS in an individual’s life span. Epidemiological studies showed an enhanced risk of death rate from vascular disabilities in MS patients of approximately 30%. It has been demonstrated that patients with severe SARS-CoV-2 infection usually show increased levels of D-dimer, fibrinogen, C-reactive protein (CRP), and overactivation of blood platelets, which are essential elements of prothrombotic events. In this review, the latest knowledge gathered during an ongoing pandemic of SARS-CoV-2 infection on the neurodegeneration processes in MS is discussed.

Humoral and cellular immune responses to SARS CoV-2 vaccination in People with Multiple Sclerosis and NMOSD patients receiving immunomodulatory treatments

“…( Chen, 2021 ; Polack et al, 2020 ) While there is no evidence to suggest that SARS CoV-2 vaccination exacerbates MS activity or accelerates disability progression ( Garg and Paliwal, 2021 ) it is known that respiratory infections are a risk factor for MS relapses. Emerging evidence indicates that COVID-19, too, has a detrimental effect on the clinical course of MS. ( Barzegar et al, 2021 ; Dziedzic et al, 2021 )…”

Elucidating the Neuropathologic Mechanisms of SARS-CoV-2 Infection

“…Viral induced demyelination could be a direct result of viral infection of oligodendrocytes, which leads to cell death and myelin degeneration, or to the exacerbated inflammatory response caused by virus replication (152,153). The cytokine storm caused by SARS-CoV-2 may cause the activation of glial cells and the start of the demyelination process (154). Conversely, other studies suggest that SARS-CoV-2 could act as an accelerating factor for MS but not the trigger for the disaese (155).…”

Humoral and cellular immune responses to SARS CoV-2 vaccination in Persons with Multiple Sclerosis and NMOSD patients receiving immunomodulatory treatments

“…(1, 2) While there is no evidence to suggest that SARS CoV-2 vaccination exacerbates MS activity or accelerates disability progression (3) it is known that respiratory infections are a risk factor for MS relapses. Emerging evidence indicates that COVID-19, too, has a detrimental effect on the clinical course of MS. (4,5) In Persons with Multiple Sclerosis (PwMS) Risk factors for severe COVID-19 have been shown to be the same as have been identified in the general population (6) Although the majority of disease modifying medications used to treat MS patients have no detrimental effect on the clinical course of COVID-19, (7)(8)(9) for B-cell depleting therapies conflicting evidence has been reported. (10,11) It remains unresolved whether PwMS treated with these medications are at a greater risk to acquire SARS CoV-2 infection and to develop a more severe disease course.…”

“…(1, 2) While there is no evidence to suggest that SARS CoV-2 vaccination exacerbates MS activity or accelerates disability progression (3) it is known that respiratory infections are a risk factor for MS relapses. Emerging evidence indicates that COVID-19, too, has a detrimental effect on the clinical course of MS. (4, 5)…”