GiovanniRistori, researcher, Center for Experimental Neurological Therapies, S. Andrea Hospital-site, Neurosciences, Mental Healtgiovanni.ristori@uniroma1.it
Silvia Romano, Rome, Italy; Giulia Coarelli, Rome, Italy; Maria Chiara Buscarinu, Rome, Italy; Marco Salvetti, Rome, Italy
Submitted January 22, 2014
We thank Dr. Sethi for his comments on our article. [1] His hypothesis is plausible. Studies have been carried out regarding the association of early BCG vaccination and type 1 diabetes. Karaci and Aydin showed protective effects of repetitive vaccinations in Turkey, [2] while Sanjeevi et al. found an association between BCG vaccine and reduced production of GAD65 and IA-2 autoantibodies in Southern India. [3] It is still unclear how early administration of the BCG vaccine may work over time and how it may affect autoimmunity prevalence in children and young adults. It is possible that early priming with BCG sensitizes this population to environmental non-pathogenic mycobacteria that exert long-term immunomodulatory effects, especially in developing countries. This may represent a sort of 'benign' exposure to microbes that lacks or is deficient in the context of 'Westernization'. [4] Another possibility is that BCG vaccination could provide protection from mycobacterial triggers and disregulated immune response to mycobacterial antigens that have been associated with multiple sclerosis. [5,6]
1.Ristori G, Romano S, Cannoni S, et al. Effects of Bacille Calmette-Guerin after the first demyelinating event in the CNS. Neurology 2014; 82: 41-48.
2. Karaci M, Aydin M. The effect of BCG vaccine from
protection of type 1 diabetes mellitus. Journal of Contemporary Medicine
2012;2:1-8.
3. Sanjeevi CB, Ashok KD, Shtauvere-Brameus A. BCG vaccination and
GAD65 and IA-2 autoantibodies in autoimmune diabetes in Southern India.
Ann NY Acad Sci 2002;958:293-296.
4. Rook GA. Regulation of the immune system by biodiversity from the
natural environment: an ecosystem service essential to health. Proc Natl
Acad Sci U S A 2013;110:18360-18367.
5. Salvetti M, Ristori G, Buttinelli C, et al. The immune response to
mycobacterial 70-kDa heat shock proteins frequently involves autoreactive
T cells and is quantitatively disregulated in multiple sclerosis. J
Neuroimmunol 1996;65:143-153.
6. Cossu D, Masala S, Frau J, Cocco E, Marrosu MG, Sechi LA. Anti Mycobacterium avium subsp. paratuberculosis heat shock protein 70
antibodies in the sera of Sardinian patients with multiple sclerosis. J
Neurol Sci 2013;335:131-133.
For disclosures, please contact the editorial office at journal@neurology.org.
We thank Dr. Sethi for his comments on our article. [1] His hypothesis is plausible. Studies have been carried out regarding the association of early BCG vaccination and type 1 diabetes. Karaci and Aydin showed protective effects of repetitive vaccinations in Turkey, [2] while Sanjeevi et al. found an association between BCG vaccine and reduced production of GAD65 and IA-2 autoantibodies in Southern India. [3] It is still unclear how early administration of the BCG vaccine may work over time and how it may affect autoimmunity prevalence in children and young adults. It is possible that early priming with BCG sensitizes this population to environmental non-pathogenic mycobacteria that exert long-term immunomodulatory effects, especially in developing countries. This may represent a sort of 'benign' exposure to microbes that lacks or is deficient in the context of 'Westernization'. [4] Another possibility is that BCG vaccination could provide protection from mycobacterial triggers and disregulated immune response to mycobacterial antigens that have been associated with multiple sclerosis. [5,6]
1.Ristori G, Romano S, Cannoni S, et al. Effects of Bacille Calmette-Guerin after the first demyelinating event in the CNS. Neurology 2014; 82: 41-48.
2. Karaci M, Aydin M. The effect of BCG vaccine from protection of type 1 diabetes mellitus. Journal of Contemporary Medicine 2012;2:1-8.
3. Sanjeevi CB, Ashok KD, Shtauvere-Brameus A. BCG vaccination and GAD65 and IA-2 autoantibodies in autoimmune diabetes in Southern India. Ann NY Acad Sci 2002;958:293-296.
4. Rook GA. Regulation of the immune system by biodiversity from the natural environment: an ecosystem service essential to health. Proc Natl Acad Sci U S A 2013;110:18360-18367.
5. Salvetti M, Ristori G, Buttinelli C, et al. The immune response to mycobacterial 70-kDa heat shock proteins frequently involves autoreactive T cells and is quantitatively disregulated in multiple sclerosis. J Neuroimmunol 1996;65:143-153.
6. Cossu D, Masala S, Frau J, Cocco E, Marrosu MG, Sechi LA. Anti Mycobacterium avium subsp. paratuberculosis heat shock protein 70 antibodies in the sera of Sardinian patients with multiple sclerosis. J Neurol Sci 2013;335:131-133.
For disclosures, please contact the editorial office at journal@neurology.org.