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SeyedAlinaghi S, Dashti M, Afzalian A, Siami H, Ghasemzadeh A, Varshochi S, Parikhani SN, Amrollah MF, Nourian A, Mehraeen E, Dadras O. The immunologic outcomes and adverse events of COVID-19 vaccine booster dose in immunosuppressed people: A systematic review. Prev Med Rep 2024; 44:102778. [PMID: 38979481 PMCID: PMC11228787 DOI: 10.1016/j.pmedr.2024.102778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction This study examines the efficacy and safety of three COVID-19 booster vaccines including mRNA-based vaccines (BNT162b2 (BioNTech/Pfizer) and/or mRNA-1273 (Moderna)), Non-Replicating Viral-Vector vaccines (ChAdOx1 nCoV-19 vaccine (AstraZeneca) and/or Ad26. COV2.S (Johnson & Johnson)), and Protein Subunit vaccine (SpikoGen) in immunosuppressed patients. Methods Relevant articles were systematically searched using medical subject heading (MeSH) and keywords "COVID-19" and "booster dose" or "booster vaccine" or ''fourth dose" in the online databases of PubMed, Embase, Scopus, and Web of Science. To identify eligible studies, a two-phase screening process was implemented. Initially, three researchers evaluated the studies based on the relevancy of the title and abstract. Results A total of 58 studies met the inclusion criteria and were included in this review. The findings suggest that booster doses offer greater protection against the disease than the primary dose. The study also compared various vaccine types, revealing that viral vector and nucleic acid vaccines outperformed inactivated vaccines. Results indicated that individuals receiving booster doses experienced superior outcomes compared to those without boosters. Vaccination against COVID-19 emerged as the most effective preventive measure against infection and symptom severity. Elevated antibody levels post-booster dose vaccination in the population signaled robust immune responses, underscoring the benefits of supplementary vaccine doses. Conclusion This systematic review highlights preliminary evidence supporting the immunologic outcomes and safety of COVID-19 vaccine boosters in enhancing immune responses against SARS-CoV-2. However, further research is needed to determine optimal timing intervals between primary vaccination series and boosters while considering global equity issues and variant-specific considerations.
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Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Dashti
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arian Afzalian
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Siami
- School of Medicine, Islamic Azad University, Tehran, Iran
| | - Afsaneh Ghasemzadeh
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanaz Varshochi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Masoomeh Fathi Amrollah
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahid Nourian
- Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Omid Dadras
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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Groß-Albenhausen E, Weier A, Velten M, Heider T, Chunder R, Kuerten S. Immune monitoring of SARS-CoV-2-specific T cell and B cell responses in patients with multiple sclerosis treated with ocrelizumab. Front Immunol 2023; 14:1254128. [PMID: 37841269 PMCID: PMC10569464 DOI: 10.3389/fimmu.2023.1254128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Since the development of the coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), there has been significant interest in determining the effectiveness of SARS-CoV-2 vaccines in patients under immunomodulatory or immunosuppressive therapies. The aim of this study was to evaluate the impact of ocrelizumab, a monoclonal anti-CD20 antibody, on SARS-CoV-2-specific T cell and B cell responses in patients with relapsing-remitting multiple sclerosis (RRMS). Methods To this end, peripheral blood mononuclear cells (PBMCs) were isolated from n = 23 patients with RRMS. Of these patients, n = 17 were tested before (time point t0) and one month after (time point t1) their first dose of ocrelizumab. In addition, we studied n = 9 RRMS patients that got infected with SARS-CoV-2 over the course of ocrelizumab therapy (time point t2). PBMCs were also isolated from n = 19 age- and gender-matched healthy controls (HCs) after vaccination or infection with SARS-CoV-2, respectively. Interferon-γ (IFN-γ)/interleukin-2 (IL-2) and granzyme B (GzB)/perforin (PFN) double-color enzyme-linked immunospot (ELISPOT) assays or single-color ELISPOT assays were performed to measure SARS-CoV-2 antigen-specific T cell and B cell responses. Anti-viral antibody titers were quantified in the serum by chemiluminescence immunoassay. Results Our data indicate a significant difference in the SARS-CoV-2 specific IFN-γ (P = 0.0119) and PFN (P = 0.0005) secreting T cell compartment in the MS cohort at t0 compared to HCs. Following the first dose of ocrelizumab treatment, a significant decrease in the number of SARS-CoV-2 spike protein-specific B cells was observed (P = 0.0012). Infection with SARS-CoV-2 in MS patients under ocrelizumab therapy did not significantly alter their existing immune response against the virus. Kaplan-Meier survival analysis suggested that the spike S1 protein-specific immunoglobulin (Ig)G response might be a key parameter for predicting the probability of (re)infection with SARS-CoV-2. Discussion Our results call for a critical discussion regarding appropriate vaccination intervals and potential biomarkers for the prediction of (re)infection with SARS-CoV-2 in patients with MS receiving ocrelizumab. Unique identifier DRKS00029110; URL: http://apps.who.int/trialsearch/.
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Affiliation(s)
- Elina Groß-Albenhausen
- Institute of Neuroanatomy, Faculty of Medicine, University of Bonn and University Hospital Bonn, Bonn, Germany
| | - Alicia Weier
- Institute of Neuroanatomy, Faculty of Medicine, University of Bonn and University Hospital Bonn, Bonn, Germany
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Bonn, Bonn, Germany
| | - Thorsten Heider
- Clinic for Neurology, Klinikum St. Marien Amberg, Amberg, Germany
| | - Rittika Chunder
- Institute of Neuroanatomy, Faculty of Medicine, University of Bonn and University Hospital Bonn, Bonn, Germany
| | - Stefanie Kuerten
- Institute of Neuroanatomy, Faculty of Medicine, University of Bonn and University Hospital Bonn, Bonn, Germany
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Labani A, Chou S, Kaviani K, Ropero B, Russman K, Becker D. Incidence of multiple sclerosis relapses and pseudo-relapses following COVID-19 vaccination. Mult Scler Relat Disord 2023; 77:104865. [PMID: 37418929 DOI: 10.1016/j.msard.2023.104865] [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: 01/10/2023] [Revised: 06/13/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic created an urgency for an effective vaccine. The FDA approved vaccines offered by Pfizer-BioNTech (BNT162b2), ModernaTX (mRNA-1273) and Janssen/Johnson & Johnson (Ad26.COV2.S) have shown minimal side effects (SE) in general population studies. Multiple sclerosis (MS) patients were not specifically represented in the above studies. The MS community is interested in how these vaccines behave in people with MS. In this study, we compare the SE experienced by MS to that of the general population after SARS-CoV-2 vaccination and evaluate their risk of relapses or pseudo-relapses. METHODS A retrospective, single-site, cohort study of 250 MS patients who received the initial cycle of FDA approved SARS-CoV-2 vaccines with 151 of whom also received an additional booster dose. SE resulting immediately after COVID-19 vaccination were collected as part of the standard clinical care during patient visits. RESULTS Out of the studied 250 MS patients, 135 received the first and second doses of BNT162b2 with less than 1% and 4% pseudo-relapses respectively and 79 received the third BNT162b2 dose with a pseudo-relapse rate of 3%. 88 received the mRNA-1273 vaccine with a pseudo-relapse frequency of 2% and 5% after the first and second doses respectively. 70 patients had the mRNA-1273 vaccine booster with a 3% pseudo-relapse rate. 27 received the Ad26.COV2.S first dose, 2 of whom received a second Ad26.COV2.S booster dose, with no reports of MS worsening. No acute relapses were reported in our patient population. All patients experiencing pseudo-relapse symptoms returned to baseline within 96 h. CONCLUSION COVID-19 vaccine is safe in patients with MS. Cases of temporary worsening of MS symptoms following SARS-CoV-2 are rare. Our findings support those reported by other recent studies and the CDC recommendation for MS patients to receive the FDA-approved COVID-19 vaccines, including the boosters.
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Affiliation(s)
- Amir Labani
- International Neurorehabilitation Institute, Lutherville, MD, United States
| | - Scott Chou
- International Neurorehabilitation Institute, Lutherville, MD, United States
| | - Kasra Kaviani
- International Neurorehabilitation Institute, Lutherville, MD, United States
| | - Brenda Ropero
- International Neurorehabilitation Institute, Lutherville, MD, United States
| | - Katharine Russman
- International Neurorehabilitation Institute, Lutherville, MD, United States
| | - Daniel Becker
- International Neurorehabilitation Institute, Lutherville, MD, United States; John Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, United States.
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Foettinger F, Pilz G, Wipfler P, Harrer A, Kern JM, Trinka E, Moser T. Immunomodulatory Aspects of Therapeutic Plasma Exchange in Neurological Disorders—A Pilot Study. Int J Mol Sci 2023; 24:ijms24076552. [PMID: 37047524 PMCID: PMC10095570 DOI: 10.3390/ijms24076552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Therapeutic plasma exchange (TPE) is used for drug-resistant neuroimmunological disorders, but its mechanism of action remains poorly understood. We therefore prospectively explored changes in soluble, humoral, and cellular immune components associated with TPE. We included ten patients with neurological autoimmune disorders that underwent TPE and assessed a panel of clinically relevant pathogen-specific antibodies, total serum immunoglobulin (Ig) levels, interleukin-6 (IL-6, pg/mL), C-reactive protein (CRP, mg/dL), procalcitonin (PCT, µg/L) and major lymphocyte subpopulations (cells/µL). Blood was collected prior to TPE (pre-TPE, baseline), immediately after TPE (post-TPE), as well as five weeks (follow-up1) and 130 days (follow-up2) following TPE. Pathogen-specific antibody levels were reduced by −86% (p < 0.05) post-TPE and recovered to 55% (follow-up1) and 101% (follow-up2). Ig subclasses were reduced by −70–89% (p < 0.0001) post-TPE with subsequent complete (IgM/IgA) and incomplete (IgG) recovery throughout the follow-ups. Mean IL-6 and CRP concentrations increased by a factor of 3–4 at post-TPE (p > 0.05) while PCT remained unaffected. We found no alterations in B- and T-cell populations. No adverse events related to TPE occurred. TPE induced a profound but transient reduction in circulating antibodies, while the investigated soluble immune components were not washed out. Future studies should explore the effects of TPE on particular cytokines and assess inflammatory lymphocyte lineages to illuminate the mode of action of TPE beyond autoantibody removal.
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Azar JH, Evans JP, Sikorski MH, Chakravarthy KB, McKenney S, Carmody I, Zeng C, Teodorescu R, Song NJ, Hamon JL, Bucci D, Velegraki M, Bolyard C, Weller KP, Reisinger SA, Bhat SA, Maddocks KJ, Denlinger N, Epperla N, Gumina RJ, Vlasova AN, Oltz EM, Saif LJ, Chung D, Woyach JA, Shields PG, Liu SL, Li Z, Rubinstein MP. Selective suppression of de novo SARS-CoV-2 vaccine antibody responses in patients with cancer on B cell-targeted therapy. JCI Insight 2023; 8:e163434. [PMID: 36749632 PMCID: PMC10070099 DOI: 10.1172/jci.insight.163434] [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: 07/08/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
We assessed vaccine-induced antibody responses to the SARS-CoV-2 ancestral virus and Omicron variant before and after booster immunization in 57 patients with B cell malignancies. Over one-third of vaccinated patients at the pre-booster time point were seronegative, and these patients were predominantly on active cancer therapies such as anti-CD20 monoclonal antibody. While booster immunization was able to induce detectable antibodies in a small fraction of seronegative patients, the overall booster benefit was disproportionately evident in patients already seropositive and not receiving active therapy. While ancestral virus- and Omicron variant-reactive antibody levels among individual patients were largely concordant, neutralizing antibodies against Omicron tended to be reduced. Interestingly, in all patients, including those unable to generate detectable antibodies against SARS-CoV-2 spike, we observed comparable levels of EBV- and influenza-reactive antibodies, demonstrating that B cell-targeting therapies primarily impair de novo but not preexisting antibody levels. These findings support rationale for vaccination before cancer treatment.
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Affiliation(s)
- Joseph H. Azar
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - John P. Evans
- Center for Retrovirus Research
- Department of Veterinary Biosciences
- Molecular, Cellular and Developmental Biology Program
| | - Madison H. Sikorski
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Karthik B. Chakravarthy
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Selah McKenney
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Ian Carmody
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Cong Zeng
- Center for Retrovirus Research
- Department of Veterinary Biosciences
| | - Rachael Teodorescu
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - No-Joon Song
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Jamie L. Hamon
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Donna Bucci
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Maria Velegraki
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Chelsea Bolyard
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Kevin P. Weller
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Sarah A. Reisinger
- The Ohio State University Comprehensive Cancer Center – James, The James Cancer Hospital
| | - Seema A. Bhat
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center – James
| | - Kami J. Maddocks
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center – James
| | - Nathan Denlinger
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center – James
| | - Narendranath Epperla
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center – James
| | - Richard J. Gumina
- Department of Internal Medicine, Division of Cardiovascular Medicine; and
| | - Anastasia N. Vlasova
- Center for Food Animal Health, Animal Sciences Department, Ohio Agricultural Research and Development Center, College of Food, Agricultural and Environmental Sciences, The Ohio State University, Columbus, Ohio, USA
- Veterinary Preventive Medicine Department, College of Veterinary Medicine, The Ohio State University, Wooster, Ohio, USA
- Viruses and Emerging Pathogens Program, Infectious Diseases Institute
| | - Eugene M. Oltz
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
- Department of Microbial Infection and Immunity; and
| | - Linda J. Saif
- Center for Food Animal Health, Animal Sciences Department, Ohio Agricultural Research and Development Center, College of Food, Agricultural and Environmental Sciences, The Ohio State University, Columbus, Ohio, USA
- Veterinary Preventive Medicine Department, College of Veterinary Medicine, The Ohio State University, Wooster, Ohio, USA
- Viruses and Emerging Pathogens Program, Infectious Diseases Institute
| | - Dongjun Chung
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer A. Woyach
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center – James
| | - Peter G. Shields
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Shan-Lu Liu
- Center for Retrovirus Research
- Department of Veterinary Biosciences
- Viruses and Emerging Pathogens Program, Infectious Diseases Institute
- Department of Microbial Infection and Immunity; and
| | - Zihai Li
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
| | - Mark P. Rubinstein
- Division of Medical Oncology, Department of Internal Medicine
- The Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center – James
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Bazzi SA, Maguire C, Holay N, Geltman J, Hurley K, DiPasquale C, Abigania M, Olson E, Ehrlich LIR, Triplett TA, Melamed E. Longitudinal COVID-19 immune trajectories in patients with neurological autoimmunity on anti-CD20 therapy. Mult Scler Relat Disord 2022; 68:104195. [PMID: 36223705 PMCID: PMC9511881 DOI: 10.1016/j.msard.2022.104195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES During the COVID-19 pandemic, B cell depleting therapies pose a clinical concern for patients with neuroimmune conditions, as patients may not mount a sufficient immune response to SARS-CoV-2 infection and vaccinations. Studies to-date have reported conflicting results on the degree of antibody production post-SARS-CoV-2 infection and vaccinations in B cell depleted patients, focusing primarily on short-term immune profiling. Our objective was to follow longitudinal immune responses in COVID-19 B cell depleted patients with neuroimmune disorders post-COVID-19 and SARS-CoV-2-vaccination. METHODS CD20 B cell depleted autoimmune patients and age/sex-matched controls positive for SARS-CoV-2 were recruited at Dell Medical School, UT Austin between 2020 and 2021, followed prospectively for 12 months and evaluated at multiple time points for spike S1 receptor binding domain (RBD) antibody titers, B and T cell composition, and frequency of T cells specific for SARS-CoV-2 antigens. RESULTS Immune responses post-SARS-CoV-2 infection and vaccination were evaluated in a cohort of COVID-19 B cell depleted neuroimmune patients (n = 5), COVID-19 non-B cell depleted autoimmune patients (n = 15), COVID-19 immunocompetent patients (n = 117), and healthy controls (n = 6) for a total of 259 samples in 137 participants. 4/5 B cell-depleted patients developed detectable anti-spike RBD antibodies, which were boosted by vaccination in 2 patients. While spike RBD antibodies were associated with presence of CD20+ B cells, very few B cells were required. In contrast, patients whose B cell compartment primarily consisted of CD19+CD20- Bcells during acute COVID-19 disease or vaccination did not seroconvert. Interestingly, circulating Bcells in B cell depleted patients were significantly CD38high with co-expression of CD24 and CD27, indicating that B cell depletion may impact B cell activation patterns. Additionally, all B cell depleted patients mounted a sustained T cell response to SARS-CoV-2 antigens, regardless of seroconversion. Specifically, all patients developed naïve, central memory, effector memory, and effector memory RA+ T cells, suggesting intact T cell memory conversion in B cell depleted patients compared to controls. DISCUSSION We present the longest COVID-19 immune profiling analysis to date in B cell depleted patients, demonstrating that both humoral and cellular immune responses can be generated and sustained up to 12 months post SARS-CoV-2 infection and vaccination. Notably, failure to establish humoral immunity did not result in severe disease. We also highlight specific T and B cell signatures that could be used as clinical biomarkers to advise patients on timing of SARS-CoV-2 vaccinations.
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Affiliation(s)
- Sam A Bazzi
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Cole Maguire
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Nisha Holay
- Department of Oncology Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Janelle Geltman
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Kerin Hurley
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | | | | | - Eric Olson
- Babson Diagnostics, Austin, TX, United States
| | - Lauren I R Ehrlich
- Department of Oncology Dell Medical School, University of Texas at Austin, Austin, TX, United States; Department of Molecular Biosciences, University of Texas at Austin, Austin, TX, United States
| | - Todd A Triplett
- Department of Oncology Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Esther Melamed
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, United States.
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Feige J, Berek K, Seiberl M, Hilpold P, Hitzl W, Di Pauli F, Hegen H, Deisenhammer F, Trinka E, Harrer A, Wipfler P, Moser T. Humoral Response to SARS-CoV-2 Antigen in Patients Treated with Monoclonal Anti-CD20 Antibodies: It Is Not All about B Cell Recovery. Neurol Int 2022; 14:943-951. [PMID: 36412697 PMCID: PMC9680461 DOI: 10.3390/neurolint14040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Anti-CD20 therapies decrease the humoral response to SARS-CoV-2 immunization. We aimed to determine the extent of the humoral response to SARS-CoV-2 antigens in correlation with peripheral B-cell dynamics among patients with central nervous system inflammatory disorders treated with anti-CD20 medications. We retrospectively included patients receiving anti-CD20 therapy after antigen contact who were divided into responders (>7 binding antibody units (BAU)/mL) and non-responders (<7 BAU/mL). In participants with first antigen contact prior to therapy, we investigated the recall response elicited once under treatment. We included 80 patients (responders n = 34, non-responders n = 37, recall cohort n = 9). The B-cell counts among responders were significantly higher compared to non-responders (mean 1012 cells/µL ± SD 105 vs. mean 17 cells/µL ± SD 47; p < 0.001). Despite very low B-cell counts (mean 9 cells/µL ± SD 20), humoral response was preserved among the recall cohort (mean 1653 BAU/mL ± SD 2250.1) and did not differ significantly from responders (mean 735 BAU/mL ± SD 1529.9; p = 0.14). Our data suggest that peripheral B cells are required to generate antibodies to neo-antigens but not for a recall response during anti-CD20 therapy. Evaluation of B-cell counts and pre-existing SARS-CoV-2 antibodies might serve as biomarkers for estimating the immune competence to mount a humoral response to SARS-CoV-2 antigens.
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Affiliation(s)
- Julia Feige
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Michael Seiberl
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
| | - Patrick Hilpold
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
| | - Wolfgang Hitzl
- Research Management (RM): Biostatistics and Publication of Clinical Studies Team, Paracelsus Medical University, 5020 Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University, 5020 Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Florian Deisenhammer
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, 5020 Salzburg, Austria
| | - Andrea Harrer
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
- Department of Dermatology and Allergology, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Peter Wipfler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
| | - Tobias Moser
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +0043-57255-30300
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8
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Verstegen NJM, Hagen RR, van den Dijssel J, Kuijper LH, Kreher C, Ashhurst T, Kummer LYL, Steenhuis M, Duurland M, de Jongh R, de Jong N, van der Schoot CE, Bos AV, Mul E, Kedzierska K, van Dam KPJ, Stalman EW, Boekel L, Wolbink G, Tas SW, Killestein J, van Kempen ZLE, Wieske L, Kuijpers TW, Eftimov F, Rispens T, van Ham SM, ten Brinke A, van de Sandt CE. Immune dynamics in SARS-CoV-2 experienced immunosuppressed rheumatoid arthritis or multiple sclerosis patients vaccinated with mRNA-1273. eLife 2022; 11:e77969. [PMID: 35838348 PMCID: PMC9337853 DOI: 10.7554/elife.77969] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patients affected by different types of autoimmune diseases, including common conditions such as multiple sclerosis (MS) and rheumatoid arthritis (RA), are often treated with immunosuppressants to suppress disease activity. It is not fully understood how the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific humoral and cellular immunity induced by infection and/or upon vaccination is affected by immunosuppressants. Methods The dynamics of cellular immune reactivation upon vaccination of SARS-CoV-2 experienced MS patients treated with the humanized anti-CD20 monoclonal antibody ocrelizumab (OCR) and RA patients treated with methotrexate (MTX) monotherapy were analyzed at great depth via high-dimensional flow cytometry of whole blood samples upon vaccination with the SARS-CoV-2 mRNA-1273 (Moderna) vaccine. Longitudinal B and T cell immune responses were compared to SARS-CoV-2 experienced healthy controls (HCs) before and 7 days after the first and second vaccination. Results OCR-treated MS patients exhibit a preserved recall response of CD8+ T central memory cells following first vaccination compared to HCs and a similar CD4+ circulating T follicular helper 1 and T helper 1 dynamics, whereas humoral and B cell responses were strongly impaired resulting in absence of SARS-CoV-2-specific humoral immunity. MTX treatment significantly delayed antibody levels and B reactivation following the first vaccination, including sustained inhibition of overall reactivation marker dynamics of the responding CD4+ and CD8+ T cells. Conclusions Together, these findings indicate that SARS-CoV-2 experienced MS-OCR patients may still benefit from vaccination by inducing a broad CD8+ T cell response which has been associated with milder disease outcome. The delayed vaccine-induced IgG kinetics in RA-MTX patients indicate an increased risk after the first vaccination, which might require additional shielding or alternative strategies such as treatment interruptions in vulnerable patients. Funding This research project was supported by ZonMw (The Netherlands Organization for Health Research and Development, #10430072010007), the European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement (#792532 and #860003), the European Commission (SUPPORT-E, #101015756) and by PPOC (#20_21 L2506), the NHMRC Leadership Investigator Grant (#1173871).
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Affiliation(s)
- Niels JM Verstegen
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Ruth R Hagen
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner LaboratoryAmsterdamNetherlands
| | - Jet van den Dijssel
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner LaboratoryAmsterdamNetherlands
| | - Lisan H Kuijper
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Christine Kreher
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Thomas Ashhurst
- Sydney Cytometry Core Research Facility, Charles Perkins Centre, Centenary Institute, and The University of SydneySydneyAustralia
- School of Medical Sciences, Faculty of Medicine and Health, The University of SydneySydneyAustralia
| | - Laura YL Kummer
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Maurice Steenhuis
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Mariel Duurland
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Rivka de Jongh
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Nina de Jong
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner LaboratoryAmsterdamNetherlands
| | - Amélie V Bos
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Erik Mul
- Department of Research Facilities, Sanquin ResearchAmsterdamNetherlands
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido UniversitySapporoJapan
| | - Koos PJ van Dam
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Eileen W Stalman
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Laura Boekel
- Department of Rheumatology, Amsterdam Rheumatology and immunology CenterAmsterdamNetherlands
| | - Gertjan Wolbink
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Rheumatology, Amsterdam Rheumatology and immunology CenterAmsterdamNetherlands
| | - Sander W Tas
- Amsterdam Rheumatology and immunology Center, Department of Rheumatology and Clinical Immunology, University of AmsterdamAmsterdamNetherlands
| | - Joep Killestein
- Amsterdam UMC, Vrije Universiteit, Department of NeurologyAmsterdamNetherlands
| | - Zoé LE van Kempen
- Amsterdam UMC, Vrije Universiteit, Department of NeurologyAmsterdamNetherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
- Department of Clinical Neurophysiology, St Antonius HospitalNieuwegeinNetherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Disease, University of AmsterdamAmsterdamNetherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, University of AmsterdamAmsterdamNetherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Swammerdam Institute for Life Sciences, University of AmsterdamAmsterdamNetherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
| | - Carolien E van de Sandt
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, University of AmsterdamAmsterdamNetherlands
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
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9
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Moser T, O'Sullivan C, Otto F, Hitzl W, Pilz G, Schwenker K, Mrazek C, Haschke-Becher E, Trinka E, Wipfler P, Harrer A. Long-term immunological consequences of anti-CD20 therapies on humoral responses to COVID-19 vaccines in multiple sclerosis: an observational study. Ther Adv Neurol Disord 2022; 15:17562864221092092. [PMID: 35479655 PMCID: PMC9036387 DOI: 10.1177/17562864221092092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Anti-CD20 therapies induce pronounced B-cell depletion and blunt humoral responses to vaccines. Recovery kinetics of anti-CD20 therapy-mediated cellular and humoral effects in people with multiple sclerosis (pwMS) are poorly defined. Objective: To investigate the duration of the anti-CD20 treatment-induced effects on humoral responses to COVID-19 vaccines. Methods: This retrospective observational study included pwMS who had discontinued anti-CD20 therapy for ⩾12 months and remained without immunomodulation. We retrieved demographics and laboratory parameters including B-cell counts and immunoglobulin (IgG, IgM, IgA) levels prior to anti-CD20 commencement (baseline) and longitudinally after anti-CD20 treatment discontinuation from electronic medical records. Humoral responses to SARS-CoV-2 vaccines were compared with a population of 11 pwMS with ongoing anti-CD20 medication (control cohort). Results: A total of 24 pwMS had discontinued anti-CD20 therapy for a median of 34 months (range: 16–38 months). Antibody responses to COVID-19 vaccines were available in 17 (71%). Most individuals (n = 15, 88%) elicited a measurable antibody response [mean: 774 BAU/ml (±SD 1283 BAU/ml)] to SARS-CoV-2 immunization on average 22 months (range: 10–30 months) from the last anti-CD20 infusion, which was higher compared with the population with ongoing anti-CD20 therapy (n = 11, mean: 12.36 ± SD 11.94 BAU/ml; p < 0.00001). Significantly increased antibody levels compared with the control cohort were found among pwMS who were vaccinated >18 months after treatment discontinuation (19–24 months: n = 2, p = 0.013; 25–36 months: n = 9; p < 0.001). The interindividual kinetics for B-cell reconstitution were heterogeneous and mean B-cell counts approached normal ranges 18 months after treatment discontinuation. There was no correlation of B-cell repopulation and vaccine responses. Mean total IgG, IgM, and IgA levels remained within the reference range. Conclusion: Anti-CD20-induced inhibition of humoral responses to COVID-19 vaccines is transient and antibody production was more pronounced >18 months after anti-CD20 treatment discontinuation. The immunological effect on B-cell counts appears to wane by the same time.
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Affiliation(s)
- Tobias Moser
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Ciara O'Sullivan
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, Salzburg, Austria
| | - Ferdinand Otto
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, Salzburg, Austria
| | - Wolfgang Hitzl
- Research Management (RM): Biostatistics and Publication of Clinical Studies Team, Paracelsus Medical University, Salzburg, Austria
| | - Georg Pilz
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, Salzburg, Austria
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, Salzburg, Austria
| | - Cornelia Mrazek
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, Salzburg, Austria
| | - Peter Wipfler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, Salzburg, Austria
| | - Andrea Harrer
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Center for Cognitive Neuroscience, European Reference Network EpiCARE, Salzburg, Austria
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10
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Shree T. Can B cell-deficient patients rely on COVID-19 vaccine-induced T cell immunity? Br J Haematol 2022; 197:659-661. [PMID: 35412649 PMCID: PMC9111762 DOI: 10.1111/bjh.18210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
Abstract
Anti‐CD20 antibody treatments prevent humoral responses to vaccines against severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) vaccines, but the nature of T‐cell responses in this setting is less well understood. Riise et al. assess vaccine‐induced epitope‐specific CD8 T cell responses in patients with lymphoma recently treated with rituximab and find a wide range of responses, with the most recently treated patients frequently failing to respond, while others exhibit responses stronger than healthy controls. They suggest these epitopes among others could be used in a T cell‐targeted vaccine, and such strategies are indeed in clinical trials now. Commentary on: Riise J, et al. Rituximab‐treated patients with lymphoma develop strong CD8 T‐cell responses following COVID‐19 vaccination. Br J Haematol. 2022;197:697‐708
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Affiliation(s)
- Tanaya Shree
- Stanford University School of Medicine, Stanford, CA, USA
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11
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Zanetta C, Rocca MA, Filippi M. Impact of immunotherapies on COVID-19 outcomes in multiple sclerosis patients. Expert Rev Clin Immunol 2022; 18:495-512. [PMID: 35395927 DOI: 10.1080/1744666x.2022.2064845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION SARS-CoV-2 pandemic has led the scientific community to maximize efforts to prevent infections and disease severity in patients with multiple sclerosis (pwMS). We analyze the impact of immunotherapies on COVID-19 outcomes in pwMS, providing our interpretation of data. AREAS COVERED Infections, hospitalizations, intensive care unit admissions and death rates in COVID-19 pwMS are comparable to general population. Severity of disability, MS clinical phenotype, age and comorbidities, along with the use of intravenous methylprednisolone and anti-CD20 treatments, are risk factors for COVID-19 severity. Disease modifying treatments (DMTs) can be safely started and continued during the pandemic. Benefit-risk evaluation is mandatory when managing second-line therapies, to balance risk of worse COVID-19 outcomes and MS reactivation. COVID-19 vaccination is safe in MS and its efficacy could be reduced in fingolimod and ocrelizumab-treated patients. EXPERT OPINION Rate of (re)-infection and outcomes with SARS-CoV-2 variants in pwMS and antiviral properties of DMTs need to be further explored. Data on COVID-19 in pregnant MS women, children and elderly pwMS are limited. Evidence on long-term effects of infection is needed. Impact of emerging DMTs on COVID-19 should be investigated. More data and longer follow-up are needed to characterize long-term efficacy and safety profile of vaccinations in pwMS.
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Affiliation(s)
| | - Maria A Rocca
- Neurology Unit.,Neuroimaging Research Unit, Division of Neuroscience.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neurology Unit.,Neurorehabilitation Unit.,Neuroimaging Research Unit, Division of Neuroscience.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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