Impaired neutralizing antibodies and preserved cellular immunogenicity against SARS-CoV-2 in systemic autoimmune rheumatic diseases

Intapiboon, Porntip; Uae-areewongsa, Parichat; Ongarj, Jomkwan; Sophonmanee, Ratchanon; Seepathomnarong, Purilap; Seeyankem, Bunya; Surasombatpattana, Smonrapat; Pinpathomrat, Nawamin

doi:10.1038/s41541-022-00568-9

Cited by 3 publications

(3 citation statements)

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“…A decline in vaccine immunogenicity has been observed in patients with ARDs receiving immunosuppressive drugs [ 5 , 6 , 7 , 8 ]. However, some studies have reported a preserved cellular response after homologous ChAdOx1/ChAdOx1 or heterologous CoronaVac/ChAdOx1 vaccines, suggesting the beneficial effect of the vaccine [ 6 , 16 ]. Moreover, because of the waning of immunogenicity over time and the emergence of the SARS-CoV-2 variants of concern (VOCs), third and fourth vaccinations with mRNA vaccines are now recommended in both healthy and vulnerable populations.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, a proof-of-concept heterologous vaccine study demonstrated superior anti-RBD IgG, Nab, and T-cell reactivity after ChAdOx1-nCoV-19 vaccination boosted by the BNT162b2 vaccine, compared to homologous regimens in both healthy populations and patients with ARDs [ 29 ]. In addition, we previously reported that T-cell function was preserved, including IFN-γ + CD4 + T cells, IFN-γ + CD8 + T cells, and TNFα + CD4 + T cells, in patients with ARDs who received heterologous CoronaVac/ChAdOx1 as a primary series vaccine [ 16 ]. Mahasirimongkol et al also demonstrated the benefit of using an inactivated vaccine, followed by the ChAdOx1-nCoV-19 vaccine, compared to homologous regimens with an inactivated vaccine or to an adenoviral vector vaccine in a healthy population [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Humoral Immunogenicity of mRNA Booster Vaccination after Heterologous CoronaVac-ChAdOx1 nCoV-19 or Homologous ChAdOx1 nCoV-19 Vaccination in Patients with Autoimmune Rheumatic Diseases: A Preliminary Report

et al. 2023

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Immunogenicity data on the mRNA SARS-CoV-2 vaccine booster after completing a primary series vaccination, other than the mRNA vaccine, in patients with autoimmune rheumatic diseases (ARDs) is scarce. In this study, we reported the humoral immunogenicity of an mRNA booster 90–180 days after completing heterologous CoronaVac/ChAdOx1 nCoV-19 (n = 19) or homologous ChAdOx1 nCoV-19 (n = 14) vaccination by measuring the anti-SARS-CoV-2 receptor binding domain (RBD) IgG levels at one and three months after mRNA booster vaccination. This study included 33 patients with ARDs [78.8% women; mean (SD) age: 42.9 (10.6) years]. Most patients received prednisolone (75.8%, mean [IQR] daily dose: 7.5 [5, 7.5] mg) and azathioprine (45.5%). The seropositivity rates were 100% and 92.9% in CoronaVac/ChAdOx1 and ChAdOx1/ChAdOx1, respectively. The median (IQR) anti-RBD IgG level was lower in the ChAdOx1/ChAdOx1 group than in the CoronaVac/ChAdOx1 group (1867.8 [591.6, 2548.6] vs. 3735.8 [2347.9, 5014.0] BAU/mL, p = 0.061). A similar trend was significant in the third month [597.8 (735.5) vs. 1609.9 (828.4) BAU/mL, p = 0.003]. Minor disease flare-ups occurred in 18.2% of the patients. Our findings demonstrated satisfactory humoral immunogenicity of mRNA vaccine boosters after a primary series, with vaccine strategies other than the mRNA platform. Notably, the vaccine-induced immunity was lower in the ChAdOx1/ChAdOx1 primary series.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Humoral Immunogenicity of mRNA Booster Vaccination after Heterologous CoronaVac-ChAdOx1 nCoV-19 or Homologous ChAdOx1 nCoV-19 Vaccination in Patients with Autoimmune Rheumatic Diseases: A Preliminary Report

et al. 2023

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“…The PRNT was carried out at the Institute of Biological Products at the Department of Medical Sciences. The experiment was performed as described previously [ 13 ]. In short, Vero cells were seeded and incubated at 37 °C for 1 day.…”

Section: Methodsmentioning

confidence: 99%

Heterologous COVID-19 Vaccination and Booster with mRNA Vaccine Provide Enhanced Immune Response in Patients with Cirrhosis: A Prospective Observational Study

Sripongpun,

Pinpathomrat,

Sophonmanee

et al. 2023

Vaccines

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This study aimed to evaluate the antibody and cellular responses to different coronavirus 2019 (COVID-19) vaccination regimens in patients with cirrhosis and to assess the antibody response after a vaccine booster. We conducted a prospective observational study of 89 patients with cirrhosis and 41 healthy volunteers who received two COVID-19 vaccine doses. Next, we prospectively evaluated 24 patients with cirrhosis who received a booster COVID-19 vaccine dose. In both studies, blood samples were collected before and 4 weeks after vaccination, and anti-spike receptor-binding domain protein IgG levels, T-cell phenotypes, and effector functions were assessed. The heterologous vaccine regimen (CoronaVac [SV]/AstraZeneca [AZ]) produced a better antibody response and CD4+IFNg+ T cell response compared to homogeneous vaccine regimens. The antibody response after the second dose of the vaccine was similar in patients with cirrhosis and healthy volunteers. Patients who received a booster dose of the mRNA vaccine had significantly increased antibody titers compared to those who received the AZ vaccine. In patients with cirrhosis, heterologous vaccination with SV/AZ resulted in a better immune response than the AZ/AZ and SV/SV regimens. Moreover, a booster dose of the mRNA vaccine led to a greater increase in antibody titers compared to the AZ vaccine.

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Antibody responses following the surge of SARS-CoV-2 Omicron infection among patients with systemic autoimmune rheumatic diseases

Xiang

Liu

et al. 2023

Rheumatology Advances in Practice

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Objectives The surge of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant Omicron infections has affected most Chinese residents at the end of 2022, including a number of patients with systemic autoimmune rheumatic diseases (SARDs). Methods To investigate the antibody level of the Omicron variant in SARDs patients after SARS-CoV-2 Omicron infection, we tested BA.5.2 and BF.7 Omicron variant IgG antibody level using enzyme-linked immunosorbent assay (ELISA) from the collected blood samples from 102 SARDs patients and 19 healthy controls (HCs). The type of SARDs, demographics, concurrent treatment, doses of SARS-CoV-2 vaccines, and outcomes were also recorded. Results A total of 102 SARDs patients (mean age, 40.3 years, 89.2% female), including 60 systemic lupus erythematosus (SLE), 32 rheumatoid arthritis (RA) and 10 other SARDs, were identified. Of these, 87 (85.3%) were infected with SARS-CoV-2. We found that the BA.5.2 and BF.7 antibody levels of infected SARDs patients were lower than those of HCs (p < 0.05). 65(63.7%) patients had at least one dose of a SARS-CoV-2 vaccine. SARDs patients with at least two doses SARS-CoV-2 vaccine had a higher level of BA.5.2 and BF.7 antibody than unvaccinated group (p < 0.05). There was no evidence for significant inhibition effect of glucocorticoids (GCs) on the BA.5.2 and BF.7 Omicron variant antibody level in SARDs patients. SLE patients with bDMARDs use had a lower BA.5.2 Omicron variant antibody level than patients with GCs and/or hydroxychloroquine use. Conclusion These data suggest that patients with SARDs had a lower antibody response than healthy controls after Omicron infection. Lay summary What does this mean for patients ? SARS-CoV-2 is a type of coronavirus that causes COVID-19. Spread of SARS-CoV-2 lead to the COVID-19 pandemic and a global threat to public health. Different variants of SARS-CoV-2 have developed as the virus changes over time. Omicron is one such variant. Patients with systemic autoimmune rheumatic diseases (SARDs), such as rheumatoid arthritis, systemic lupus erythematosus and Sjögren’s syndrome, are often treated with drugs called immunosuppressants. Immunosuppressants make your immune system less active, meaning that it is harder to defend against diseases like COVID-19. As a result, SARD patients are at higher risk of developing severe COVID-19. We performed a study to describe the characteristics and immune responses of SARD patients with COVID-19 Omicron infection in China. We found that SARD patients had fewer antibodies against Omicron than healthy people. We also found that lupus patients who used biologic drugs had a lower antibody level than those using glucocorticoids (steroids) and/or hydroxychloroquine. Importantly, SARD patients who had at least two doses of SARS-CoV-2 vaccine had higher levels of antibodies than unvaccinated patients. These findings suggest that patients with SARDs have a lower antibody response after Omicron infection than healthy people, meaning that their immune systems are less able to defend against future re-infection. Our data therefore support the importance of COVID-19 booster vaccination among patients with SARDs.

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Impaired neutralizing antibodies and preserved cellular immunogenicity against SARS-CoV-2 in systemic autoimmune rheumatic diseases

Cited by 3 publications

References 38 publications

Humoral Immunogenicity of mRNA Booster Vaccination after Heterologous CoronaVac-ChAdOx1 nCoV-19 or Homologous ChAdOx1 nCoV-19 Vaccination in Patients with Autoimmune Rheumatic Diseases: A Preliminary Report

Humoral Immunogenicity of mRNA Booster Vaccination after Heterologous CoronaVac-ChAdOx1 nCoV-19 or Homologous ChAdOx1 nCoV-19 Vaccination in Patients with Autoimmune Rheumatic Diseases: A Preliminary Report

Heterologous COVID-19 Vaccination and Booster with mRNA Vaccine Provide Enhanced Immune Response in Patients with Cirrhosis: A Prospective Observational Study

Antibody responses following the surge of SARS-CoV-2 Omicron infection among patients with systemic autoimmune rheumatic diseases

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