An Investigation into COVID-19 Pandemic in India Cellular and humoral immunity to SARS-CoV-2 infection in multiple sclerosis patients on ocrelizumab and other disease-modifying therapies: a multi-ethnic observational study

ABSTRACT

Summary Pandemic of Coronavirus Disease (COVID-19) has put tremendous pressure on the people of different localities, states and countries. In a short span of time, it spread all over the world. This has affected the social life of people by enforcing them to stay at home and keep social distance. Many developed countries were also not able to handle the situation even though all resources were available with them. This chapter discussed about the symptoms of COVID-19, precautionary measures, ways of spreading the Coronavirus, and technologies used to fight COVID-19. This also discussed about the impact of COVID-19 on business, financial market, supply side, demand side and international trade on Indian economy. Objective To determine the impact of MS disease-modifying therapies (DMTs) on the development of cellular and humoral immunity to SARS-CoV-2 infection. Methods MS patients aged 18-60 were evaluated for anti-nucleocapsid and anti-Spike RBD antibody with electro-chemiluminescence immunoassay;antibody responses to Spike protein, RBD, N-terminal domain with multiepitope bead-based immunoassays (MBI);live virus immunofluorescence-based microneutralization assay;T-cell responses to SARS-CoV-2 Spike using TruCulture ELISA;and IL-2 and IFN? ELISpot assays. Assay results were compared by DMT class. Spearman correlation and multivariate analyses were performed to examine associations between immunologic responses and infection severity. Results Between 1/6/2021 and 7/21/2021, 389 MS patients were recruited (mean age 40.3?years;74% female;62% non-White). Most common DMTs were ocrelizumab (OCR) - 40%;natalizumab - 17%, Sphingosine 1-phosphate receptor (S1P) modulators -12%;and 15% untreated. 177 patients (46%) had laboratory evidence of SARS-CoV-2 infection;130 had symptomatic infection, 47 - asymptomatic. Antibody responses were markedly attenuated in OCR compared to other groups (p≤0.0001). T-cell responses (IFN?) were decreased in S1P (p=0.03), increased in natalizumab (p<0.001), and similar in other DMTs, including OCR. Cellular and humoral responses were moderately correlated in both OCR (r=0.45, p=0.0002) and non-OCR (r=0.64, p<0.0001). Immune responses did not differ by race/ethnicity. COVID-19 clinical course was mostly non-severe and similar across DMTs;7% (9/130) were hospitalized. Interpretation DMTs had differential effects on humoral and cellular immune responses to SARS-CoV-2 infection. Immune responses did not correlate with COVID-19 clinical severity in this relatively young and non-disabled group of MS patients. This article is protected by copyright. All rights reserved.