COVID-19 in patients with B cell immune deficiency

Vergidis, Paschalis; Levy, Emily R.; Ristagno, Elizabeth H.; Iyer, Vivek N.; O’Horo, John C.; Joshi, Avni Y.

doi:10.1016/j.jim.2022.113351

Cited by 2 publications

(1 citation statement)

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“…However, what this means for individuals with B cell deficiencies, who are unable to make antibodies, is not fully understood. In particular, it raises the question as to what type of immunity develops in the B cell-deficient population and whether there is a clinical benefit to vaccination given their increased risk of severe COVID-19 (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

T cell responses to SARS-CoV-2 infection and vaccination are elevated in B cell deficiency and reduce risk of severe COVID-19

Zonozi,

Walters,

Shulkin

et al. 2023

Sci. Transl. Med.

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Individuals with primary and pharmacologic B cell deficiencies have high rates of severe disease and mortality from coronavirus disease 2019 (COVID-19), but the immune responses and clinical outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination have yet to be fully defined. Here, we evaluate the cellular immune responses after both SARS-CoV-2 infection and vaccination in patients receiving the anti-CD20 therapy rituximab (RTX) and those with low B cell counts due to common variable immune deficiency (CVID) disease. Assessment of effector and memory CD4 + and CD8 + T cell responses to SARS-CoV-2 revealed elevated reactivity and proliferative capacity after both infection and vaccination in B cell–deficient individuals, particularly within the CD8 + T cell compartment, in comparison with healthy controls. Evaluation of clinical outcomes demonstrates that vaccination of RTX-treated individuals was associated with about 4.8-fold reduced odds of moderate or severe COVID-19 in the absence of vaccine-induced antibodies. Analysis of T cell differentiation demonstrates that RTX administration increases the relative frequency of naïve CD8 + T cells, potentially by depletion of CD8 + CD20 dim T cells, which are primarily of an effector memory or terminal effector memory (TEMRA) phenotype. However, this also leads to a reduction in preexisting antiviral T cell immunity. Collectively, these data indicate that individuals with B cell deficiencies have enhanced T cell immunity after both SARS-CoV-2 infection and vaccination that potentially accounts for reduced hospitalization and severe disease from subsequent SARS-CoV-2 infection.

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Section: Introductionmentioning

confidence: 99%