Vaccination and Immunotherapies in Neuroimmunological Diseases

Overview

Journal Nat Rev Neurol

Specialty Neurology

Date 2022 Apr 7

PMID 35388213

Authors

Alexander Winkelmann

Micha Loebermann

Michael Barnett

Hans-Peter Hartung

Uwe K Zettl

Affiliations

Soon will be listed here.

Abstract

Neuroimmunological diseases and their treatment compromise the immune system, thereby increasing the risk of infections and serious illness. Consequently, vaccinations to protect against infections are an important part of the clinical management of these diseases. However, the wide variety of immunotherapies that are currently used to treat neuroimmunological disease - particularly multiple sclerosis and neuromyelitis optica spectrum disorders - can also impair immunological responses to vaccinations. In this Review, we discuss what is known about the effects of various immunotherapies on immunological responses to vaccines and what these effects mean for the safe and effective use of vaccines in patients with a neuroimmunological disease. The success of vaccination in patients receiving immunotherapy largely depends on the specific mode of action of the immunotherapy. To minimize the risk of infection when using immunotherapy, assessment of immune status and exclusion of underlying chronic infections before initiation of therapy are essential. Selection of the required vaccinations and leaving appropriate time intervals between vaccination and administration of immunotherapy can help to safeguard patients. We also discuss the rapidly evolving knowledge of how immunotherapies affect responses to SARS-CoV-2 vaccines and how these effects should influence the management of patients on these therapies during the COVID-19 pandemic.

Citing Articles

Engineered immunological niche directs therapeutic development in models of progressive multiple sclerosis.

Rad L, Hughes K, Wheeler S, Decker J, Orbach S, Galvan A Proc Natl Acad Sci U S A. 2025; 122(7):e2409852122.

PMID: 39937858 PMC: 11848328. DOI: 10.1073/pnas.2409852122.

Optimizing Drug Selection in Children with Multiple Sclerosis: What Do We Know and What Remains Unanswered?.

Suntornlohanakul R, Yeh E Paediatr Drugs. 2024; 27(2):161-179.

PMID: 39724509 DOI: 10.1007/s40272-024-00675-1.

Identifying and reducing risks of neurological complications associated with vaccination.

Handunnetthi L, Ramasamy M, Turtle L, Hunt D Nat Rev Neurol. 2024; 20(9):541-554.

PMID: 39112653 DOI: 10.1038/s41582-024-01000-7.

Monoclonal antibody therapies for aquaporin-4-immunoglobulin G-positive neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease.

Tisavipat N, Juan H, Chen J Saudi J Ophthalmol. 2024; 38(1):2-12.

PMID: 38628414 PMC: 11017007. DOI: 10.4103/sjopt.sjopt_102_23.

Vaccine Safety and Immunogenicity in Patients With Multiple Sclerosis Treated With Natalizumab.

Carvajal R, Zabalza A, Carbonell-Mirabent P, Martinez-Gomez X, Esperalba J, Pappolla A JAMA Netw Open. 2024; 7(4):e246345.

PMID: 38607624 PMC: 11015356. DOI: 10.1001/jamanetworkopen.2024.6345.

References

Reich D, Lucchinetti C, Calabresi P . Multiple Sclerosis. N Engl J Med. 2018; 378(2):169-180. PMC: 6942519. DOI: 10.1056/NEJMra1401483. View

Lassmann H . Pathogenic Mechanisms Associated With Different Clinical Courses of Multiple Sclerosis. Front Immunol. 2019; 9:3116. PMC: 6335289. DOI: 10.3389/fimmu.2018.03116. View

Baecher-Allan C, Kaskow B, Weiner H . Multiple Sclerosis: Mechanisms and Immunotherapy. Neuron. 2018; 97(4):742-768. DOI: 10.1016/j.neuron.2018.01.021. View

Loebermann M, Winkelmann A, Hartung H, Hengel H, Reisinger E, Zettl U . Vaccination against infection in patients with multiple sclerosis. Nat Rev Neurol. 2012; 8(3):143-51. DOI: 10.1038/nrneurol.2012.8. View

Moiola L, Rommer P, Zettl U . Prevention and management of adverse effects of disease modifying treatments in multiple sclerosis. Curr Opin Neurol. 2020; 33(3):286-294. DOI: 10.1097/WCO.0000000000000824. View

Zrzavy T, Kollaritsch H, Rommer P, Boxberger N, Loebermann M, Wimmer I . Vaccination in Multiple Sclerosis: Friend or Foe?. Front Immunol. 2019; 10:1883. PMC: 6693409. DOI: 10.3389/fimmu.2019.01883. View

Pardi N, Hogan M, Porter F, Weissman D . mRNA vaccines - a new era in vaccinology. Nat Rev Drug Discov. 2018; 17(4):261-279. PMC: 5906799. DOI: 10.1038/nrd.2017.243. View

Pardi N, Hogan M, Weissman D . Recent advances in mRNA vaccine technology. Curr Opin Immunol. 2020; 65:14-20. DOI: 10.1016/j.coi.2020.01.008. View

Gary E, Weiner D . DNA vaccines: prime time is now. Curr Opin Immunol. 2020; 65:21-27. PMC: 7195337. DOI: 10.1016/j.coi.2020.01.006. View

10.

Rawat K, Kumari P, Saha L . COVID-19 vaccine: A recent update in pipeline vaccines, their design and development strategies. Eur J Pharmacol. 2020; 892:173751. PMC: 7685956. DOI: 10.1016/j.ejphar.2020.173751. View

11.

Poland G, Ovsyannikova I, Kennedy R . SARS-CoV-2 immunity: review and applications to phase 3 vaccine candidates. Lancet. 2020; 396(10262):1595-1606. PMC: 7553736. DOI: 10.1016/S0140-6736(20)32137-1. View

12.

Krammer F . SARS-CoV-2 vaccines in development. Nature. 2020; 586(7830):516-527. DOI: 10.1038/s41586-020-2798-3. View

13.

Beutler B . Innate immunity: an overview. Mol Immunol. 2003; 40(12):845-59. DOI: 10.1016/j.molimm.2003.10.005. View

14.

Kar U, Joosten L . Training the trainable cells of the immune system and beyond. Nat Immunol. 2020; 21(2):115-119. DOI: 10.1038/s41590-019-0583-y. View

15.

Higgins J, Soares-Weiser K, Lopez-Lopez J, Kakourou A, Chaplin K, Christensen H . Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review. BMJ. 2016; 355:i5170. PMC: 5063034. DOI: 10.1136/bmj.i5170. View

16.

Netea M, Joosten L, Latz E, Mills K, Natoli G, Stunnenberg H . Trained immunity: A program of innate immune memory in health and disease. Science. 2016; 352(6284):aaf1098. PMC: 5087274. DOI: 10.1126/science.aaf1098. View

17.

Dominguez-Andres J, Netea M . Long-term reprogramming of the innate immune system. J Leukoc Biol. 2018; 105(2):329-338. DOI: 10.1002/JLB.MR0318-104R. View

18.

Del Giudice G, Rappuoli R, Didierlaurent A . Correlates of adjuvanticity: A review on adjuvants in licensed vaccines. Semin Immunol. 2018; 39:14-21. DOI: 10.1016/j.smim.2018.05.001. View

19.

Villarreal R, Casale T . Commonly Used Adjuvant Human Vaccines: Advantages and Side Effects. J Allergy Clin Immunol Pract. 2020; 8(9):2953-2957. DOI: 10.1016/j.jaip.2020.04.045. View

20.

Pellegrino P, Clementi E, Radice S . On vaccine's adjuvants and autoimmunity: Current evidence and future perspectives. Autoimmun Rev. 2015; 14(10):880-8. DOI: 10.1016/j.autrev.2015.05.014. View