SEARCHNARRATIVE_REVIEWneurology, immunology

narrative_review·neurology, immunology, infectious disease, vitamins, nutrition·PMC10000583

COVID-19 and Multiple Sclerosis: A Complex Relationship Possibly Aggravated by Low Vitamin D Levels

Cells · 3 authors, 2 centres

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TL;DR

This narrative review explores the complex interplay between COVID-19 and multiple sclerosis (MS), detailing shared immunopathogenic mechanisms like cytokine storms, inflammasome activation, and gut-brain axis dysfunction, and the potential for SARS-CoV-2 to trigger or worsen MS. It highlights that low vitamin D levels are a risk factor for both diseases and may be a relevant adjunctive therapy, though evidence is inconclusive, and underscores the need for further research using animal models.

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This narrative review synthesizes evidence on the complex relationship between COVID-19 and multiple sclerosis (MS), focusing on shared immunopathogenesis and the modulatory role of vitamin D. The authors describe how SARS-CoV-2, by causing systemic inflammation, cytokine storms, microbiota dysbiosis, and potential CNS invasion, could theoretically trigger or exacerbate MS in susceptible individuals. Shared pathological pathways include dysregulated type I interferon responses, Th1/Th17 axis hyperactivation, and NLRP3 inflammasome overactivity. The review emphasizes that vitamin D deficiency is prevalent in both conditions and is associated with disease severity. While vitamin D supplementation shows immunomodulatory potential in preclinical MS models and some clinical data, robust evidence for its efficacy as therapy in either disease remains inconclusive. The authors conclude that the interplay warrants further investigation and propose utilizing available animal models, such as Syrian hamsters and transgenic mice, to study the simultaneous effects of both diseases and explore vitamin D's therapeutic potential.

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narrative_review

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neurology

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ORIGINAL PAPER

PMC10000583

COVID-19 and Multiple Sclerosis: A Complex Relationship Possibly Aggravated by Low Vitamin D Levels

Cells

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ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an exceptionally transmissible and pathogenic coronavirus that appeared at the end of 2019 and triggered a pandemic of acute respiratory disease, known as coronavirus disease 2019 (COVID-19). COVID-19 can evolve into a severe disease associated with immediate and delayed sequelae in different organs, including the central nervous system (CNS). A topic that deserves attention in this context is the complex relationship between SARS-CoV-2 infection and multiple sclerosis (MS). Here, we initially described the clinical and immunopathogenic characteristics of these two illnesses, accentuating the fact that COVID-19 can, in defined patients, reach the CNS, the target tissue of the MS autoimmune process. The well-known contribution of viral agents such as the Epstein-Barr virus and the postulated participation of SARS-CoV-2 as a risk factor for the triggering or worsening of MS are then described. We emphasize the contribution of vitamin D in this scenario, considering its relevance in the susceptibility, severity and control of both pathologies. Finally, we discuss the experimental animal models that could be explored to better understand the complex interplay of these two diseases, including the possible use of vitamin D as an adjunct immunomodulator to treat them.

CITATION EXPORT

William Danilo Fernandes de Souza, Denise Morais da Fonseca, Alexandrina Sartori. COVID-19 and Multiple Sclerosis: A Complex Relationship Possibly Aggravated by Low Vitamin D Levels. Cells. (2023). https://doi.org/10.3390/cells12050684

AUTHORS

3 · 2 CENTRES

William Danilo Fernandes de Souza, Denise Morais da Fonseca, Alexandrina Sartori

1Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-689, Brazil
2Laboratory of Mucosal Immunology, Department of Immunology, Institute of Biomedical Sciences, University of Sao Paulo, São Paulo 05508-000, Brazil

EDITOR / REVIEWER

Lars Ove Brandenburg