COVID Breakfast “Under starters Orders” and “we’re Off”

C

If you have every listened to Horse Race Commentary you will get this

A couple of weeks ago when I looked at the COVID stuff there were 500 papers, a week later and we have 1400. Where are the MS papers?

There are loads of scientists with time on their hands and so why not write a covid19 paper, reviewed in a week, online in less than two, and if you hit it big and get their first a few thousand citations….Instant success for REF21 I am surprised we haven’t been ordered to write one or ten:-).

I have spent my time reading and Blogging rather than writing papers. I guess people on the front line are not having a lot of time to read and with the Hail Storm of COVID papers we are going to make that harder. So sorting the “Wheat from the Chaff” is important. So we have been feeding forward info that looks interesting to our team. Many of these papers discuss clinical findings and are essential for understanding this disease, then there are raft of papers discussing the world wide response and now we will see a number of papers relating to specific diseases.

As for the MS, where is the insight from the Great and the Good?…Waiting for the pharma paper writers to do them:-). Dream on they are all isolating:-)

Search for “covid and multiple sclerosis” and you get nothing.

However that has now changed. Not only has ProfG set up a micro-site to answer your questions he has got possibly the first MS paper out.

The paper can be downloaded (Click here) Copyright allows the authors to put copy on their blogs

https://www.dropbox.com/s/rm3tmoy60d6z0i7/MSARDS%20COVID.pdf?dl=0

The COVID-19 pandemic and the use of MS Disease-Modifying Therapies. Gavin Giovannoni, Chris Hawkes, Jeannette Lechner-Scott, Michael Levy, Emmanuelle Waubant, Julian Gold Multiple sclerosis and related disorders. Published:March 27, 2020DOI:https://doi.org/10.1016/j.msard.2020.102073

Adam Hills and Kylie from Down Under

The ProfGs….ProfG and ProfG Down Under don’t have the same views…This is good because it makes you think! Just like the Association of British Neurologists and the Antipodean Neurologists have different views.

I have been roped into a debate on this very aspect, so I have been learning to say “Gudday Ray” in my Best Australian Accent…and afterwards I will be after a “Becks” (Ask an Antipodean to say the word “Becks” (A German Beer) and this is how you can distinguish a New Zealander from an Australian…I’m sure if you are from the US..they both sound Irish anyway…Only joking.

We will start to see Case reports.

I was excited by a tweet as we have the anecdote of an MS COVID19 survivor who was 2 weeks post alemtuzumab on second cycle. You can’t get much more immunosuppressed than this! They developed mild signs 6 days after their partner, who was tested SAR-CoV-2 positive. So classic onset (I could be now day 4…Yieks….So If I go Offline you can guess. Hopefully a false alarm..P.S. I promise I will not do an Aprils Fools on my Demise).

Anyway, the person with MS recovered a week later….If only we know they actually had COVID-19 as opposed some COVID-mimic signs, a psychosomatic thing, after all we are still in Cold and flu season and now we have Hay Fever too….unrelated to COVID. This could have been a Nature-type Paper. Why? Because it informs on the nature of the immune protection. If you understand that it aids in your choices of how to deal with the virus and MS.

To me this effect would suggest that the Innate Immune System is critical for protection against the virus and most MS treatments, do not put a big dint in these populations of cells. A chance study where they removed the lung of someone with cancer, who turned out to have COVID19 also, suggests that the innate response is key

Ablative HSCT is going to be worst here and certainly in the first few weeks after treatment.

I will hedge my bets, although this may change as I read and learn more, that the monocyte, rather than the natural killer cell are the important elements. NK cells are good at targeting things via antibodies and in this case good antibody responses are not made until a few weeks after infection. Also if you look in the lungs of people who died with SARS caused by coronavirus 1, their lungs had neutrophils,macrophages and CD8 T cells present and no natural killer cells or B cells. Is this what causes the death? In part I think proably yes, because you have to kill the virally-infected cell to get rid of the virus, if this is in your lungs then you are destroying the lining of your lungs and so I guess a massive infection will be associated with substanial damage. Again all Immunology 101.

So your MS drugs may help rather than hinder…but it won’t always be good news as it is a matter of timing and have heard of a death of someone with MS, maybe relating to lack of availble treatment, hopefully not Immunology 101. There are some autopsy reports from China online but they are writing in Chinese…time for Google translate.

Remember 60-66% of people taking alemtuzumab can make an anti-drug response to alemtuzumab within 1 month of the onset of infusion when they have few peripheral T or B cells

. So suggests that people with alemtuzumab could make an anti-body response to a new infection. That people are recovering within a week of symptom onset when it is taking 14-21 days to see an IgG anti-viral response, suggests that IgG is not the major protector in getting rid of the virus in the first place. Immunology 101 however would say that the anti-COVID anti-body response will then be important in making sure you do not get re-infected.

These types of human experiments provide massive insight into the biology of COVID-19 . So make sure your stories are captured at the MS Register in the UK and tweet #MSCOVID19, if you get infected, document you or your partners symptoms and hopefully recovery. We are all Guinea pigs in this experiment.

TP of the week

For all of you without loo roll during COVID19. This week’s “toilet paper of the week” is below. Feel free to print out and wipe :-)… Not worth an altmetric. Search Rituximab and EAE if interested. I believe does not cross-react with mouse CD20. The authors can send the data showing that rituximab depleting mouse CD20 B cells to bartsmsblog@gmail.com

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