Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Research Article Volume 4 Issue 8

Coronavirus and Multiple Sclerosis, Autopsy and Biopsy and Choice of Therapy

Homayoun Roshanisefat1,2*

1Department of Neurology, Slagelse Hospital, 4200 Slagelse-DK, Sweden
2Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88 Stockholm-SE, Sweden

*Corresponding Author: Homayoun Roshanisefat, Department of Neurology, Slagelse Hospital, 4200 Slagelse-DK, Sweden and Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, 182 88 Stockholm-SE, Sweden. E-mail:

Received: May 05, 2020; Published: July 28, 2020



Background: Coronavirus in trigeminal nerve (TGN) has for decades been studied as a candidate neurotropic virus associated with multiple sclerosis (MS). The novel coronavirus 2019 (COVID-19) outbreak in infected cases is challenging the whole immune system. The lesson from MS treatment and a new era of COVID-19 therapies are of value to review.

Method: Searched databases to identify the strongest evidence of biopsy, autopsy, and cerebrospinal fluid (CSF), when using keywords MS and coronavirus, from January 1940 to April 2020. The result presents a solid knowledge of biopsy and autopsy for the association of COVID-19 and MS, then COVID-19 single and combination therapies being evaluated as presented in clinical use or clinical trials and compare common sites with MS.

Results: All therapies with proven clinical efficacy against COVID-19 and its current deployment in COVID-19 and their common aspect with MS therapies (MSTR) and immunology are screened. Some MSTR despite some different side-effect e.g. risk for infection or cardiac arrest are candidates of being used as COVID-19 life-saving therapy.

Conclusion: This global health disaster caused by airborne virus COVID-19, has created a new break to learn more about MS etiology and this airborne agent and future drug choices when reviewing the five months COVID-19 data through significant medical reports on World Wide Web.

Keywords: Multiple Sclerosis; Coronavirus; Trigeminal Nerve; Biopsy; Autopsy; Immunology



  1. Burks JS., et al. “Two coronaviruses isolated from central nervous system tissue of two multiple sclerosis patients”. Science4459 (1980): 933-934.
  2. Perlman S., et al. “Spread of a neurotropic murine coronavirus into the CNS via the trigeminal and olfactory nerves”. Virology2 (1989): 556-560.
  3. Nagashima K., et al. “Demyelinating encephalomyelitis induced by a long-term corona virus infection in rats”. Acta Neuropathologica3 (1979): 205-213.
  4. Murray RS., et al. “Detection of coronavirus RNA and antigen in multiple sclerosis brain”. Annals of Neurology 5 (1992): 525-533.
  5. Arbour N., et al. “Neuroinvasion by Human Respiratory Coronaviruses”. Journal of Virology 19 (2000): 8913-8921.
  6. Dessau RB., et al. “Coronaviruses in brain tissue from patients with multiple sclerosis”. Acta Neuropathologica6 (2001): 601-604.
  7. Bourouiba L. “Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19”. JAMA (2020).
  8. Dessau R., et al. “Coronaviruses in spinal fluid of patients with acute monosymptomatic optic neuritis”. Acta Neurologica Scandinavica2 (1999): 88-91.
  9. Zheng C., et al. “Risk-adapted Treatment Strategy For COVID-19 Patients”. International Journal of Infectious Diseases (2020).
  10. Huang C., et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. The Lancet10223 (2020): 497-506.
  11. Mao L., et al. “Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China”. JAMA Neurology (2020).
  12. East E., et al. “Chronic relapsing experimental allergic encephalomyelitis (CREAE) in plasminogen activator inhibitor‐1 knockout mice: the effect of fibrinolysis during neuroinflammation”. Neuropathology and Applied Neurobiology2 (2008): 216-230.
  13. Xu Z., et al. “Pathological findings of COVID-19 associated with acute respiratory distress syndrome”. The Lancet Respiratory Medicine (2020).
  14. Menge T., et al. “Disease-Modifying Agents for Multiple Sclerosis”. Drugs17 (2008): 2445-2468.
  15. Yan S., et al. “An Evolutionary RGD Motif in the Spike Protein of SARS-CoV-2 may Serve as a Potential High Risk Factor for Virus Infection?” (2020).
  16. Sigrist C., et al. “A potential role for integrins in host cell entry by SARS-CoV-2”. Antiviral Research 177 (2020): 104759.
  17. Langer-Gould A and L Steinman. “Progressive multifocal leukoencephalopathy and multiple sclerosis: lessons from natalizumab”. Current Neurology and Neuroscience Reports3 (2006): 253-258.
  18. Novi G., et al. “COVID-19 in a MS patient treated with ocrelizumab: does immunosuppression have a protective role?” Multiple Sclerosis and Related Disorders (2020): 102120.
  19. Wu D and XO Yang. “TH17 responses in cytokine storm of COVID-19: An emerging target of JAK2 inhibitor Fedratinib”. Journal of Microbiology, Immunology and Infection (2020).
  20. Pardanani A., et al. “Safety and efficacy of fedratinib in patients with primary or secondary myelofibrosis: a randomized clinical trial”. JAMA Oncology5 (2015): 643-651.
  21. Bright JJ., et al. “Tyrphostin B42 inhibits IL-12-induced tyrosine phosphorylation and activation of Janus kinase-2 and prevents experimental allergic encephalomyelitis”. Journal of Immunology10 (1999): 6255-6262.
  22. Xu X., et al. “Effective treatment of severe COVID-19 patients with Tocilizumab”. ChinaXiv preprint (2020).
  23. Ringelstein M., et al. “Long-term therapy with interleukin 6 receptor blockade in highly active neuromyelitis optica spectrum disorder”. JAMA neurology7 (2010): 756-763.
  24. Tsurukawa S., et al. “Herpes Zoster Meningitis Complicating Combined Tocilizumab and Cyclosporine Therapy for Adult-Onset Still’s Disease”. Case Reports in Rheumatology (2016).
  25. Santos-Faria D., et al. “Tocilizumab and rituximab have similar effectiveness and are both superior to a second tumour necrosis factor inhibitor in rheumatoid arthritis patients who discontinued a first TNF inhibitor”. Acta Reumatólogica Portuguesa 2 (2019): 103-113.
  26. Mahase E. “Covid-19: what treatments are being investigated?”. British Medical Journal Publishing Group (2020).
  27. Roshanisefat H., et al. “Neurological side-effects of Tnf-α blocking agents. A report of 39 cases: Sc118”. European Journal of Neurology 19 (2020): 30.
  28. Yao A., et al. “Bilateral facial nerve palsies secondary to chronic inflammatory demyelinating polyneuropathy following adalimumab treatment”. Clinical Neurology And Neurosurgery 164 (2018): 64-66.
  29. Thomas TC., et al. “Inhibition of complement activity by humanized anti-C5 antibody and single-chain Fv”. Molecular Immunology 33 (1996): 1389-1401.
  30. Lythgoe M and P Middleton. “Ongoing Clinical Trials for the Management of the COVID-19 Pandemic”. (2020).
  31. Pittock SJ., et al. “Eculizumab in aquaporin-4–positive neuromyelitis optica spectrum disorder”. New England Journal of Medicine7 (2019): 614-625.
  32. Goncalves MVM., et al. “Eculizumab, Neuromyelitis Optica, and Tuberculosis: We Live An Era of Challenging Combinations”. CNS Neuroscience and Therapeutics11 (2015): 914-915.
  33. Royer DJ., et al. “Complement and CD4+ T cells drive context-specific corneal sensory neuropathy”. eLife 8 (2019).
  34. Wiwanitkit V. “COVID-19 can present with a rash and be mistaken for Dengue”. Journal of the American Academy of Dermatology (2020).
  35. Chiricozzi A., et al. “Ixekizumab Effectiveness and Safety in the Treatment of Moderate-to-Severe Plaque Psoriasis: A Multicenter, Retrospective Observational Study”. American Journal of Clinical Dermatology (2019): 1-7.
  36. Schofield C., et al. “Characterization of IL-17AA and IL-17FF in rheumatoid arthritis and multiple sclerosis”. Bioanalysis22 (2016): 2317-2327.
  37. Bian H., et al. “Meplazumab treats COVID-19 pneumonia: an open-labelled, concurrent controlled add-on clinical trial”. medRxiv (2020): 2020.03.21.20040691.
  38. Liu S., et al. “MiR-155 modulates the progression of neuropathic pain through targeting SGK3”. International Journal of Clinical and Experimental Pathology11 (2015): 14374-14382.
  39. Junker A., et al. “MicroRNA profiling of multiple sclerosis lesions identifies modulators of the regulatory protein CD47”. Brain 12 (2009): 3342-3352.
  40. Krumbholz, M and E Meinl. “B cells in MS and NMO: pathogenesis and therapy”. Seminars in Immunopathology 3 (2014): 339-350.
  41. Lythgoe M and P Middleton. “Ongoing Clinical Trials for the Management of the COVID-19 Pandemic”. 41.6 (2020): 363-382.
  42. Compston A. “Methylprednisolone and multiple sclerosis”. Archives of neurology6 (1988): 669-670.
  43. Martínez‐Cáceres E., et al. “Treatment with methylprednisolone in relapses of multiple sclerosis patients: immunological evidence of immediate and short‐term but not long‐lasting effects”. Clinical and Experimental Immunology 1 (2002): 165-171.
  44. Zhang Jj., et al. “Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China”. Allergy (2020).
  45. Ayers MC and DS Conway. “A case of presumed herpes keratouveitis in a patient treated with fingolimod”. Multiple Sclerosis Journal - Experimental, Translational and Clinical (2016).
  46. Koscielny V. “Phase III SUNBEAM and RADIANCE PART B trials for Ozanimod in relapsing multiple sclerosis demonstrate superiority versus interferon-β-1a (Avonex®) in reducing annualized relapse rates and MRI brain lesions”. Neurodegenerative Disease Management3 (2018): 141-142.
  47. Han W., et al. “The course of clinical diagnosis and treatment of a case infected with coronavirus disease 2019”. Journal of Medical Virology (2020).
  48. Brownlee W., et al. “Treating multiple sclerosis and neuromyelitis optica spectrum disorder during the COVID-19 pandemic”. Neurology (2020).
  49. Matsuo T and R Takabatake. “Multiple sclerosis-like disease secondary to alpha interferon”. Ocular Immunology and Inflammation4 (2002): 299-304.
  50. Leng Z., et al. “Transplantation of ACE2-mesenchymal stem cells improves the outcome of patients with COVID-19 pneumonia”. Aging and Disease2 (2020): 216-228.
  51. Metcalfe SM., et al. “Multiple sclerosis and the LIF/IL-6 axis: use of nanotechnology to harness the tolerogenic and reparative properties of LIF”. Nanobiomedicine 2 (2015): 2-5.
  52. Metcalfe SM. “Mesenchymal stem cells and management of COVID-19 pneumonia”. Medicine in Drug Discovery (2020): 100019.
  53. Maja Živković., et al. “The Role of TPA I/D and PAI-1 4G/5G Polymorphisms in Multiple Sclerosis”. Disease Markers (2014): 8.
  54. Bayry J., et al. “Intravenous immunoglobulin for infectious diseases: back to the pre-antibiotic and passive prophylaxis era?” Trends in Pharmacological Sciences6 (2004): 306-310.
  55. Jawhara S. “Could Intravenous Immunoglobulin Collected from Recovered Coronavirus Patients Protect against COVID-19 and Strengthen the Immune System of New Patients?” International Journal of Molecular Sciences 7 (2020): 2272.
  56. Kühtreiber WM., et al. “Long-term reduction in hyperglycemia in advanced type 1 diabetes: the value of induced aerobic glycolysis with BCG vaccinations”. NPJ Vaccines1 (2018): 1-14.
  57. Mailand MT and JL Frederiksen. “Vaccines and multiple sclerosis: a systematic review”. Journal of neurology6 (2017): 1035-1050.
  58. Sewell DL., et al. “Infection with <em>Mycobacterium bovis</em> BCG Diverts Traffic of Myelin Oligodendroglial Glycoprotein Autoantigen-Specific T Cells Away from the Central Nervous System and Ameliorates Experimental Autoimmune Encephalomyelitis”. Clinical and Diagnostic Laboratory Immunology4 (2003): 564-572.
  59. Al-Bari MA. “Chloroquine analogues in drug discovery: new directions of uses, mechanisms of actions and toxic manifestations from malaria to multifarious diseases”. Journal of Antimicrobe Chemotherapy6 (2015): 1608-1621.
  60. Manic G., et al. “Chloroquine and hydroxychloroquine for cancer therapy”. Molecular Cell Oncology1 (2014): e29911.
  61. Chang R and WZ Sun. “Repositioning Chloroquine as Ideal Antiviral Prophylactic against COVID-19-Time is Now”. (2020).
  62. Soilu-Hanninen M., et al. “High sensitivity measurement of CRP and disease progression in multiple sclerosis”. Neurology 1 (2005): 153-155.
  63. Nonnecke B., et al. “Acute phase response elicited by experimental bovine diarrhea virus (BVDV) infection is associated with decreased vitamin D and E status of vitamin-replete preruminant calves”. Journal of Dairy Science9 (2014): 5566-5579.
  64. Smolders J., et al. “High dose cholecalciferol (vitamin D3) oil as add-on therapy in subjects with relapsing-remitting multiple sclerosis receiving subcutaneous interferon b-1a. in European Committee for Treatment and Research in Multiple Sclerosis conference”. London, England. (2016).
  65. Haeusler D., et al. “High dose vitamin D worsens experimental CNS autoimmune disease by raising T cell-excitatory calcium”. in Multiple Sclerosis Journal (2019).
  66. Häusler D and MS Weber. “Vitamin D Supplementation in Central Nervous System Demyelinating Disease—Enough Is Enough”. International Journal of Molecular Sciences1 (2019): 218.
  67. Li W., et al. “Receptor and viral determinants of SARS-coronavirus adaptation to human ACE2”. The EMBO Journal 8 (2005): 1634-1643.
  68. Monteil V., et al. “Inhibition of SARS-CoV-2 infections in engineered human tissues using clinical-grade soluble human ACE2”. Cell (2020).
  69. Stegbauer J., et al. “Role of the renin-angiotensin system in autoimmune inflammation of the central nervous system”. Proceedings of the National Academy of Sciences35 (2009): 14942-14947.
  70. Lycke J. “Trials of antivirals in the treatment of multiple sclerosis”. Acta Neurologica Scandinavica 136 (2017): 45-48.
  71. Drosu NC., et al. “Could antiretrovirals be treating EBV in MS? A case report”. Multiple Sclerosis and Related Disorders 22 (2018): 19-21.
  72. Hartung H., et al. “Neuroprotective effects of temelimab in relapsing-remitting MS patients extend to 96 weeks”. in Multiple Sclerosis Journal (2019).
  73. Boucher A., et al. “Long-term human coronavirus-myelin cross-reactive T-cell clones derived from multiple sclerosis patients”. Clinical Immunology 3 (2007): 258-267.
  74. Giovannoni G., et al. “The COVID-19 pandemic and the use of MS Disease-Modifying Therapies”. Multiple Sclerosis and Related Disorders (2020).


Citation: Homayoun Roshanisefat. “Coronavirus and Multiple Sclerosis, Autopsy and Biopsy and Choice of Therapy". Acta Scientific Medical Sciences 4.8 (2020): 124-135.


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