Immunologic characterization of a immunosuppressed multiple sclerosis patient that recovered from SARS-CoV-2 infection

Abstract

A multiple sclerosis patient infected by SARS-CoV-2 during fingolimod therapy was hospitalized with moderate clinical features, and recovered in 15 days. High levels of CCL5 and CCL10 chemokines and of antibody-secreting B cells were detected, while the levels other B- and T-cell subsets were comparable to that of appropriate controls. However, CD4+ and CD8+ cells were oligoclonally expanded and prone to apoptosis when stimulated in vitro. This study suggests that fingolimod-immunosuppressed patients, despite the low circulating lymphocytes, may rapidly expand antibody-secreting cells and mount an effective immune response that favors COVID-19 recovery after drug discontinuation.

Keywords: COVID-19; Fingolimod; Multiple sclerosis.

Graphical abstract

Fig. 1

T- and B-cell immunophenotyping and TR repertoire analysis. (A) Analysis of lymphocyte subsets in the COVID-19 patient after 5 and 15 days from hospitalization, compared with a representative MS patient on fingolimod (green) and a representative MS patient who discontinued fingolimod (14 days of washout; blue). CD4+ T cells and B cells are presented in the upper and lower row, respectively. (B) TRBV chain usage. (C) Average percentages of TRBV perturbations in CD4- and CD4+ populations. Dots represent the global average perturbation of the TRBV repertoire. (D) Map representing the CDR3 distribution perturbation at the single-TRBV. Black and white dots represent the TRBV families whose perturbations are respectively higher than the mean + 3SD and mean + 2SD of the value seen in the corresponding TRBV family calculated in 12 healthy controls. The number of these over-perturbed TRBV elements is indicated in the right column. TRBV: T-cell receptor variable beta chain. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)