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Patnaik S, Mruthyunjaya P, Murmu KC, Mahapatra S, Patro ARK, Misra R, Pati S, Prasad P, Ahmed S. RNAseq-based transcriptomics of treatment-naïve multi-inflammatory syndrome in children (MIS-C) demonstrates predominant activation of matrisome, innate and humoral immune pathways. Rheumatol Int 2024; 44:1445-1454. [PMID: 37823896 DOI: 10.1007/s00296-023-05478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023]
Abstract
MIS-C is a rare, highly inflammatory state resembling incomplete Kawasaki disease, temporarily associated with COVID-19. The pathogenesis is not completely known. RNAseq was carried out on whole blood of six treatment-naïve MIS-C patients. This was compared against RNAseq transcriptomics data of five healthy controls (HC), four Kawasaki Disease (KD) and seven systemic Juvenile Idiopathic Arthritis (sJIA). Using PCA, MIS-C clustered separately from HC, KD and sJIA. Amongst the top 50 significant genes in the three comparisons with HC, KD, and sJIA, common genes were: TMCC2, ITGA2B, DMTN, GFI1B, PF4, QSER1, GRAP2, TUBB1. DSEA revealed that maximum number of hits for overexpressed pathways was for NABA matrisome activation when MIS-C was compared against HC. Cytokine stimulated cellular activation pathways, specifically IL-10 were downregulated. MIS-C had more activated pathways of neutrophil degranulation and acquired immune activation but less of coagulation system or heat-shock system involvement as compared to KD. As compared to sJIA, humoral immune response and complements were activated. Matrisome activation was higher, with increased cell-cell interaction and ECM signalling. This analysis revealed novel insights into the pathogenesis of MIS-C, including the potential role of matrisomes, humoral immune system and down-regulated interleukin-10 pathways.
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Affiliation(s)
- Sibabratta Patnaik
- Department of Paediatrics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Prakashini Mruthyunjaya
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, India
| | | | - Soumendu Mahapatra
- Chromatin and Epigenetics Unit, Institute of Life Sciences, Bhubaneswar, India
| | - A Raj Kumar Patro
- Department of Biochemistry and Molecular Diagnostics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Ramnath Misra
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, India
| | | | - Punit Prasad
- Chromatin and Epigenetics Unit, Institute of Life Sciences, Bhubaneswar, India.
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, India.
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Kawano Y, Wang X, Patel NJ, Qian G, Kowalski E, Bade KJ, Vanni KMM, Jonsson AH, Williams ZK, Cook CE, Srivatsan S, Wallace ZS, Sparks JA. Breakthrough COVID-19 After Tixagevimab/Cilgavimab Among Patients With Systemic Autoimmune Rheumatic Diseases. J Rheumatol 2024; 51:305-312. [PMID: 37839812 PMCID: PMC10925916 DOI: 10.3899/jrheum.2023-0742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To determine the incidence and baseline factors associated with breakthrough coronavirus disease 2019 (COVID-19) after preexposure prophylaxis (PrEP) with tixagevimab/cilgavimab among patients with systemic autoimmune rheumatic diseases (SARDs). METHODS We performed a retrospective cohort study among patients with SARDs who received tixagevimab/cilgavimab between January 2, 2022, and November 16, 2022. The primary outcome was breakthrough COVID-19 after tixagevimab/cilgavimab. We performed multivariable Cox regression models adjusted for baseline factors to identify risk factors for breakthrough COVID-19. RESULTS We identified 444 patients with SARDs who received tixagevimab/cilgavimab (mean age 62.0 years, 78.2% female). There were 83 (18.7%) breakthrough COVID-19 cases (incidence rate 31.5/1000 person-months, 95% CI 24.70-38.24), 7 (1.6%) hospitalizations, and 1 (0.2%) death. Older age was inversely associated with breakthrough COVID-19 (adjusted hazard ratio [aHR] 0.86/10 years, 95% CI 0.75-0.99). Higher baseline spike antibody levels were associated with lower risk of breakthrough COVID-19 (aHR 0.42, 95% CI 0.18-0.99 for spike antibody levels > 200 vs < 0.4 units). CD20 inhibitor users had a similar risk of breakthrough COVID-19 (aHR 1.05, 95% CI 0.44-2.49) compared to conventional synthetic disease-modifying antirheumatic drug (DMARD) users. CONCLUSION We found that patients with SARDs had frequent breakthrough COVID-19, but the proportion experiencing severe COVID-19 was low. DMARD type, including CD20 inhibitors, did not significantly affect risk of breakthrough COVID-19. Evidence of prior humoral immunity was protective against breakthrough infection, highlighting the continued need for a multimodal approach to prevent severe COVID-19 as novel PrEP therapies are being developed.
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Affiliation(s)
- Yumeko Kawano
- Y. Kawano, MD, A.H. Jonsson, MD, PhD, J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical School
| | - Xiaosong Wang
- X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Naomi J Patel
- N.J. Patel, MD, Z.S. Wallace, MD, MSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School
| | - Grace Qian
- X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Emily Kowalski
- X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Katarina J Bade
- X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - Kathleen M M Vanni
- X. Wang, MS, G. Qian, BA&Sc, E. Kowalski, BS, K.J. Bade, BS, K.M.M. Vanni, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital
| | - A Helena Jonsson
- Y. Kawano, MD, A.H. Jonsson, MD, PhD, J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical School
| | - Zachary K Williams
- Z.K. Williams, BA, C.E. Cook, MPH, S. Srivatsan, BA, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire E Cook
- Z.K. Williams, BA, C.E. Cook, MPH, S. Srivatsan, BA, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shruthi Srivatsan
- Z.K. Williams, BA, C.E. Cook, MPH, S. Srivatsan, BA, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zachary S Wallace
- N.J. Patel, MD, Z.S. Wallace, MD, MSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School
| | - Jeffrey A Sparks
- Y. Kawano, MD, A.H. Jonsson, MD, PhD, J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, and Harvard Medical School;
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Garcia-Cirera S, Calvet J, Delgado de la Poza JF, Berenguer-Llergo A, Orellana C, Rusiñol M, Llop M, Arévalo M, Garcia-Pinilla A, Costa E, Aymerich C, Gómez R, Carreras A, Gratacós J. Biological and glucocorticoids treatment impair the medium-term immunogenicity to SARS-CoV-2 mRNA vaccines in autoimmune inflammatory rheumatic diseases. Eur J Med Res 2024; 29:28. [PMID: 38183092 PMCID: PMC10768211 DOI: 10.1186/s40001-023-01620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/24/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND This study aims to assess the sustained immunological response to the SARS-CoV-2 vaccine in patients with autoimmune inflammatory rheumatic diseases (AIRD) undergoing different treatment regimens. METHODS We conducted a prospective observational study involving 157 AIRD patients without prior COVID-19 infection. Treatment regimens included non-treatment or glucocorticoid-only (not-treated/GCs), non-biological drugs, biological therapy, and JAK inhibitors. All participants completed the two-dose vaccine schedule, and 110 of them received an additional booster dose. Serum samples were collected approximately 3-6 months after the second and third vaccine doses to measure antibodies against the Spike protein (antiS-AB) and neutralizing antibodies (nAB) targeting six SARS-CoV-2 variants. RESULTS Following the third dose, all patients exhibited a significant increase in antiS-AB (FC = 15, p < 0.0001). Patients under biological therapy had lower titres compared to the non-biological (66% decrease, p = 0.038) and the not-treated/GCs group (62% decrease, p = 0.0132), with the latter persisting after the booster dose (86% decrease, p = 0.0027). GC use was associated with lower antiS-AB levels in the biological group (87% decrease, p = 0.0124), although not statistically significant after confounders adjustment. nABs showed the highest positivity rates for the wild-type strain before (50%) and after the booster dose (93%), while the Omicron variant exhibited the lowest rates (11% and 55%, respectively). All variants demonstrated similar positivity patterns and good concordance with antiS-AB (AUCs from 0.896 to 0.997). CONCLUSIONS The SARS-CoV-2 vaccine booster strategy effectively elicited a sustained antibody immune response in AIRD patients. However, patients under biological therapies exhibited a reduced response to the booster dose, particularly when combined with GCs.
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Affiliation(s)
- Silvia Garcia-Cirera
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), 08003, Barcelona, Spain
| | - Joan Calvet
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain.
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), 08003, Barcelona, Spain.
| | - Juan Francisco Delgado de la Poza
- Immunology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), 08208, Sabadell, Spain
| | - Antoni Berenguer-Llergo
- Rheumatology Department, Biostatistics and Bioinformatics at Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), 08028, Sabadell, Spain
| | - Cristóbal Orellana
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Menna Rusiñol
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Maria Llop
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Marta Arévalo
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Alba Garcia-Pinilla
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Ester Costa
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Cristina Aymerich
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Rafael Gómez
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Anna Carreras
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), 08003, Barcelona, Spain
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