Thermal dysregulation in patients with multiple sclerosis during SARS-CoV-2 infection. The potential therapeutic role of exercise

Abstract

Thermoregulation is a homeostatic mechanism that is disrupted in some neurological diseases. Patients with multiple sclerosis (MS) are susceptible to increases in body temperature, especially with more severe neurological signs. This condition can become intolerable when these patients suffer febrile infections such as coronavirus disease-2019 (COVID-19). We review the mechanisms of hyperthermia in patients with MS, and they may encounter when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Finally, the thermoregulatory role and relevant adaptation to regular physical exercise are summarized.

Keywords:

Multiple sclerosis, exercise, thermoregulation, sweat gland, SARS-CoV-2, ANS Autonomic nervous system, APN, Adiponectin, CNS, Central nervous system, COVID-19, Coronavirus disease-2019, EDHF, Endothelial-derived hyperpolarizing factor, eNOS, Endothelial nitric oxide synthase, MS, Multiple sclerosis, NLRP3, NLR family pyrin domain containing 3, NO, Nitric oxide, PACAP, Pituitary adenylate cyclase-activating polypeptide, PAMPs, Pathogen-associated molecular patterns, PGs, Prostaglandins, PGE2, Prostaglandin E2, ROS, Reactive oxygen species, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, SNS, Sympathetic nervous system, TRPV-1, Transient receptor potential vanilloid type 1, VDP, Vascular-dilating prostanoids, VEGF, Vascular endothelial growth factor, VIP, Vasoactive intestinal peptide

4. Conclusions

We reviewed thermoregulation management following exercise training in MS patients infected with COVID-19. The mechanisms of exercise-induced vascular benefits involve increased eNOS bioavailability and the anti-inflammatory effects of NO. Regular physical exercise increases vasodilation sensitivity to maintain core body temperature by reducing the sweat threshold and increasing responses of cutaneous vessels. Exercise-induced adaptations in the cardiovascular system mitigates perceived exertion and fatigue during physical exercise through improved thermoregulation, allowing MS patients to better manage neurological signs during and after infection with SARS-CoV-2.

Author contributions

OR, BT, NZ and HZ conceptualized and wrote the first draft. AMT, IL, HZ, and OR developed the study concept. KG, KS, and HZ reviewed and edited the final version of manuscript. All authors contributed to the article and approved the submitted version.

Declaration of Competing Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.