1
|
Mosavie M, Rynne J, Fish M, Smith P, Jennings A, Singh S, Millar J, Harvala H, Mora A, Kaloyirou F, Griffiths A, Hopkins V, Washington C, Estcourt LJ, Roberts D, Shankar-Hari M. Changes in Phenotypic and Molecular Features of Naïve and Central Memory T Helper Cell Subsets following SARS-CoV-2 Vaccination. Vaccines (Basel) 2024; 12:1040. [PMID: 39340069 PMCID: PMC11435719 DOI: 10.3390/vaccines12091040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/02/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024] Open
Abstract
Molecular changes in lymphocytes following SARS-CoV-2 vaccination are incompletely understood. We hypothesized that studying the molecular (transcriptomic, epigenetic, and T cell receptor (TCR) repertoire) changes in CD4+ T cells following SARS-CoV-2 vaccination could inform protective mechanisms and refinement of future vaccines. We tested this hypothesis by reporting alterations in CD4+ T cell subsets and molecular features of CD4+ naïve and CD4+ central memory (CM) subsets between the unvaccinated and vaccinated groups. Compared with the unvaccinated, the vaccinated had higher HLA-DR expression in CD4+ T subsets, a greater number of differentially expressed genes (DEGs) that overlapped with key differentially accessible regions (DARs) along the chromatin linked to inflammasome activation, translation, regulation (of apoptosis, inflammation), and significant changes in clonal architecture beyond SARS-CoV-2 specificity. Several of these differences were more pronounced in the CD4+CM subset. Taken together, our observations imply that the COVID-19 vaccine exerts its protective effects via modulation of acute inflammation to SARS-CoV-2 challenge.
Collapse
Affiliation(s)
- Mia Mosavie
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, 4-5 Little France Drive, Edinburgh EH16 4UU, UK
| | - Jennifer Rynne
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, 4-5 Little France Drive, Edinburgh EH16 4UU, UK
| | - Matthew Fish
- Center for Bacterial Pathogenesis, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Peter Smith
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, 4-5 Little France Drive, Edinburgh EH16 4UU, UK
| | - Aislinn Jennings
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, 4-5 Little France Drive, Edinburgh EH16 4UU, UK
| | - Shivani Singh
- Department of Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Jonathan Millar
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, 4-5 Little France Drive, Edinburgh EH16 4UU, UK
| | - Heli Harvala
- Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
- Microbiology Services, Colindale, NHS Blood and Transplant, Colindale NW9 5BG, UK
| | - Ana Mora
- Heart Lung Research Institute Clinical Research Facility, Cambridge CB2 0BB, UK
| | - Fotini Kaloyirou
- Statistics and Clinical Research, NHS Blood and Transplant, Cambridge CB2 0PT, UK
| | - Alexandra Griffiths
- Statistics and Clinical Research, NHS Blood and Transplant, Bristol BS34 7QH, UK
| | - Valerie Hopkins
- Statistics and Clinical Research, NHS Blood and Transplant, Cambridge CB2 0PT, UK
| | | | - Lise J Estcourt
- Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - David Roberts
- Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Manu Shankar-Hari
- Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, 4-5 Little France Drive, Edinburgh EH16 4UU, UK
- Department of Critical Care Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| |
Collapse
|
2
|
Danesh V, Tellson A, Boehm LM, Stevens AB, Ogola GO, Shrestha A, Cho J, Jimenez EJ, Arroliga AC. Exploring the Association of Metabolic Syndrome with In-Hospital Survival of Older Patients Hospitalized with COVID-19: Beyond Chronological Age. J Gen Intern Med 2024; 39:1811-1819. [PMID: 38587729 PMCID: PMC11282001 DOI: 10.1007/s11606-024-08744-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Despite the variability and complexity of geriatric conditions, few COVID-19 reports of clinical characteristic prognostication provide data specific to oldest-old adults (over age 85), and instead generally report broadly as 65 and older. OBJECTIVE To examine metabolic syndrome criteria in adults across 25 hospitals with variation in chronological age. DESIGN AND PARTICIPANTS This cohort study examined 39,564 hospitalizations of patients aged 18 or older with COVID-19 who received inpatient care between March 13, 2020, and February 28, 2022. EXPOSURE ICU admission and/or in-hospital mortality. MAIN MEASURES Metabolic syndrome criteria and patient demographics were examined as risk factors. The main outcomes were admission to ICU and hospital mortality. KEY RESULTS Oldest old patients (≥ 85 years) hospitalized with COVID-19 accounted for 7.0% (2758/39,564) of all adult hospitalizations. They had shorter ICU length of stay, similar overall hospitalization duration, and higher rates of discharge destinations providing healthcare services (i.e., home health, skilled nursing facility) compared to independent care. Chronic conditions varied by age group, with lower proportions of diabetes and uncontrolled diabetes in the oldest-old cohort compared with young-old (65-74 years) and middle-old (75-84 years) groups. Evaluations of the effect of metabolic syndrome and patient demographics (i.e., age, sex, race) on ICU admission demonstrate minimal change in the magnitude of effect for metabolic syndrome on ICU admission across the different models. CONCLUSIONS Metabolic syndrome measures are important individual predictors of COVID-19 outcomes. Building on prior examinations that metabolic syndrome is associated with death and ARDS across all ages, this analysis supports that metabolic syndrome criteria may be more relevant than chronological age as risk factors for poor outcomes attributed to COVID-19.
Collapse
Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA.
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Alaina Tellson
- Nursing Research, Baylor Scott & White Health, Dallas, TX, USA
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alan B Stevens
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Gerald O Ogola
- Biostatistics, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Anisha Shrestha
- Data Core, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Jinmyoung Cho
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA
| | | | - Alejandro C Arroliga
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Baylor Scott & White Health, Dallas, TX, USA
| |
Collapse
|
3
|
Gáspár Z, Szabó BG, Andrikovics H, Ceglédi A, Rajmon M, Ábrahám A, Várnai Z, Kiss-Dala N, Szlávik J, Sinkó J, Vályi-Nagy I, Lakatos B. Secondary infections and long-term outcomes among hospitalized elderly and non-elderly patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and treated with baricitinib: a comparative study from the national centre of Hungary. GeroScience 2024; 46:2863-2877. [PMID: 38367195 PMCID: PMC11009165 DOI: 10.1007/s11357-024-01099-y] [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: 09/10/2023] [Accepted: 02/03/2024] [Indexed: 02/19/2024] Open
Abstract
Baricitinib is considered a first-line treatment for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected adult patients with an associated cytokine storm syndrome (CSS). Our objective was to compare rates of secondary infections and long-term outcomes of elderly and non-elderly patients who received baricitinib for COVID-19. We conducted a single-centre observational study between November 2020 and September 2023, focusing on hospitalized adult SARS-CoV-2 patients with CSS, categorized as elderly (≥ 65 years) and non-elderly (< 65 years). Enrolment, severity stratification, and diagnosis of infectious complications followed predefined criteria. Outcomes of all-cause mortality and rates of non-severe and severe secondary infections were assessed at 1-year post-treatment initiation. Kaplan-Meier analysis was performed for survival analysis. In total, 490 patients were enrolled (median age 65 ± 23 (21-100) years (years, median ± IQR, min-max); 49.18% elderly; 59.59% male). Elderly patients were admitted to the hospital significantly earlier (7 ± 5 days vs. 8 ± 4 days; p = 0.02), experienced a higher occurrence of severe COVID-19 (121/241, 50.21% vs. 98/249, 39.36%; p = 0.02), and required the use of non-invasive ventilation at baseline (167/225, 74.22% vs. 153/236, 64.83%; p = 0.03). At 1 year, all-cause mortality was significantly higher in the elderly subgroup (111/241, 46.06% vs. 29/249, 11.65%; p < 0.01). At 90 days and 1 year, rates of any severe secondary infection were also more prevalent among the elderly (56/241, 23.24% vs. 37/249 14.86%; p = 0.02 and 58/241, 24.07% vs. 39/249, 15.66%; p = 0.02). In conclusion, elderly SARS-CoV-2-infected patients experience a more severe clinical course, higher secondary infection rates, and increased risk for long-term mortality, regardless of immunomodulatory therapy.
Collapse
Affiliation(s)
- Zsófia Gáspár
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
| | - Bálint Gergely Szabó
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary.
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary.
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary.
| | - Hajnalka Andrikovics
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
- Laboratory of Molecular Genetics, National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- Department of Transfusion Medicine, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
| | - Andrea Ceglédi
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Martin Rajmon
- Faculty of Medicine, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
| | - Anita Ábrahám
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Zsuzsanna Várnai
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Noémi Kiss-Dala
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
| | - János Szlávik
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - János Sinkó
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
| | - István Vályi-Nagy
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
| | - Botond Lakatos
- National Institute of Haematology and Infectious Diseases, Central Hospital of Southern Pest, Albert Flórián Street 5-7., 1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Üllői Street 26., 1085, Budapest, Hungary
| |
Collapse
|