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Roubidoux EK, Brigleb PH, Vegesana K, Souquette A, Whitt K, Freiden P, Green A, Thomas PG, McGargill MA, Wolf J, Schultz-Cherry S. Utility of nasal swabs for assessing mucosal immune responses towards SARS-CoV-2. Sci Rep 2023; 13:17820. [PMID: 37857783 PMCID: PMC10587113 DOI: 10.1038/s41598-023-44989-5] [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: 07/25/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023] Open
Abstract
SARS-CoV-2 has caused millions of infections worldwide since its emergence in 2019. Understanding how infection and vaccination induce mucosal immune responses and how they fluctuate over time is important, especially since they are key in preventing infection and reducing disease severity. We established a novel methodology for assessing SARS-CoV-2 cytokine and antibody responses at the nasal epithelium by using nasopharyngeal swabs collected longitudinally before and after either SARS-CoV-2 infection or vaccination. We then compared responses between mucosal and systemic compartments. We demonstrate that cytokine and antibody profiles differ between compartments. Nasal cytokines show a wound healing phenotype while plasma cytokines are consistent with pro-inflammatory pathways. We found that nasal IgA and IgG have different kinetics after infection, with IgA peaking first. Although vaccination results in low nasal IgA, IgG induction persists for up to 180 days post-vaccination. This research highlights the importance of studying mucosal responses in addition to systemic responses to respiratory infections. The methods described herein can be used to further mucosal vaccine development by giving us a better understanding of immunity at the nasal epithelium providing a simpler, alternative clinical practice to studying mucosal responses to infection.
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Affiliation(s)
| | - Pamela H Brigleb
- Department of Host-Microbe Interactions, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kasi Vegesana
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Aisha Souquette
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kendall Whitt
- Department of Host-Microbe Interactions, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pamela Freiden
- Department of Host-Microbe Interactions, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Amanda Green
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Paul G Thomas
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Maureen A McGargill
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Joshua Wolf
- Department of Host-Microbe Interactions, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Stacey Schultz-Cherry
- Department of Host-Microbe Interactions, St. Jude Children's Research Hospital, Memphis, TN, USA.
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2
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Roubidoux EK, Brigleb PH, Vegesana K, Souquette A, Whitt K, Freiden P, Green A, Thomas PG, McGargill MA, Wolf J, Schultz-Cherry S. Utility of nasal swabs for assessing mucosal immune responses towards SARS-CoV-2. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.12.548630. [PMID: 37503213 PMCID: PMC10370023 DOI: 10.1101/2023.07.12.548630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
SARS-CoV-2 has caused millions of infections worldwide since its emergence in 2019. Understanding how infection and vaccination induce mucosal immune responses and how they fluctuate over time is important, especially since they are key in preventing infection and reducing disease severity. We established a novel methodology for assessing SARS-CoV-2 cytokine and antibody responses at the nasal epithelium by using nasopharyngeal swabs collected longitudinally before and after either SARS-CoV-2 infection or vaccination. We then compared responses between mucosal and systemic compartments. We demonstrate that cytokine and antibody profiles differ markedly between compartments. Nasal cytokines show a wound healing phenotype while plasma cytokines are consistent with pro-inflammatory pathways. We found that nasal IgA and IgG have different kinetics after infection, with IgA peaking first. Although vaccination results in low nasal IgA, IgG induction persists for up to 180 days post-vaccination. This research highlights the importance of studying mucosal responses in addition to systemic responses to respiratory infections to understand the correlates of disease severity and immune memory. The methods described herein can be used to further mucosal vaccine development by giving us a better understanding of immunity at the nasal epithelium providing a simpler, alternative clinical practice to studying mucosal responses to infection. Teaser A nasopharyngeal swab can be used to study the intranasal immune response and yields much more information than a simple viral diagnosis.
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3
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Kryukova N, Baranova I, Abramova N, Khromova E, Pachomov D, Svitich O, Chuchalin A, Kostinov M. Mucosal immunity in health care workers' respiratory tracts in the post-COVID-19 period. Sci Rep 2023; 13:7162. [PMID: 37138005 PMCID: PMC10154756 DOI: 10.1038/s41598-023-32670-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Coronavirus disease (COVID-19) has generated interest in the assessment of systemic immune status, but existing knowledge about mucosal immunity is clearly insufficient to understand the full pathogenetic mechanisms of the disease. The aim of this study was to evaluate the long-term effects of novel coronavirus infection on mucosal immunity in the postinfection period among health care workers (HCWs). A total of 180 health care workers with and without a history of COVID-19 who ranged in age from 18 to 65 years were enrolled in this one-stage, cross-sectional study. The study subjects completed the 36-Item Short Form (36) Health Survey (SF-36) and the Fatigue Assessment Scale. Secretory immunoglobulin A (sIgA) and total immunoglobulin G (IgG) levels were quantified in saliva samples, induced sputum samples, and nasopharyngeal and oropharyngeal scrapings by an enzyme-linked immunosorbent assay. Specific anti-SARS-CoV-2 IgG antibodies were quantified in serum samples by chemiluminescence immunoassay. Analysis of the questionnaire data showed that all HCWs with a history of COVID-19 reported health problems that limited their daily activities and negative changes in their emotional health three months after the disease, regardless of its severity. The following shifts were detected in the adaptive arm of the immune response in different mucosal compartments. Among subjects who had severe or moderate-to-severe COVID-19, salivary sIgA levels were significantly higher than those in the control group (p < 0.05 and p < 0.005, respectively). Compared to the subjects in the control group, all subjects with prior COVID-19 had significantly higher levels of total IgG in induced sputum. In the group of patients who had had severe infection, total IgG in saliva was also higher (p < 0.05). A direct statistically significant correlation was also detected between the levels of total IgG in all studied samples and the levels of specific IgG antibodies against SARS-CoV-2 in the serum. A significant correlation was observed between total IgG levels and the parameters of physical and social activities, mental health, and fatigue levels. Our study demonstrated long-term changes in the humoral mucosal immune response, which were most pronounced in health care workers with a history of severe or moderate-to-severe COVID-19, and an association of these changes with certain clinical signs of post-COVID-19 syndrome.
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Affiliation(s)
- Nadezhda Kryukova
- Pirogov Russian National Research Medical University, Moscow, Russian Federation.
| | - Irina Baranova
- Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Natalia Abramova
- I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russian Federation
| | - Ekaterina Khromova
- I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russian Federation
| | - Dmitry Pachomov
- I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russian Federation
| | - Oksana Svitich
- I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russian Federation
| | - Alexander Chuchalin
- Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Mikhail Kostinov
- I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russian Federation
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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4
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Fiorelli D, Francavilla B, Magrini A, Di Girolamo S, Bernardini S, Nuccetelli M. Evaluation of the accuracy in the mucosal detection of anti-SARS-CoV-2 antibodies in nasal secretions and saliva. Int Immunopharmacol 2023; 115:109615. [PMID: 36563531 PMCID: PMC9763213 DOI: 10.1016/j.intimp.2022.109615] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
COVID-19 vaccination with mRNA vaccines induces immune responses capable of neutralizing SARS-CoV-2. Commercially available serological anti-SARS-CoV-2 quantitative and neutralizing assays are essential for the determination of immune responses to vaccines. Nevertheless, at present there is a lack of validated tests to assess the mucosal response to COVID-19 vaccination and standardized analytic and pre-analytic methods have not yet been defined. The aim of our study was to evaluate the accuracy of two diagnostic immunoassays for COVID-19 (ELISA for IgA-S1 and chemiluminescent assay for IgG-RBD) on serum, saliva, and nasal secretions, by the enrollment of three study populations (healthy controls, vaccinated subjects, and subjects recovered from COVID-19 infection). In order to obtain an appropriate cut-off value for the biological matrices studied, ROC curve analyses were performed. Data demonstrate that the analytical and pre-analytical method we have developed can provide accurate and reliable results for the detection of anti-SARS-CoV-2 mucosal specific antibodies (IgA-S1 and IgG-RBD) on saliva and, as a novelty, on nasal secretions, either after COVID-19 infection or in vaccinated subjects.
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Affiliation(s)
- Denise Fiorelli
- Department of Experimental Medicine, University of Tor Vergata, Rome, Italy
| | - Beatrice Francavilla
- Department of Otorhinolaryngology, University of Rome "Tor Vergata", Rome, Italy.
| | - Andrea Magrini
- Department of Occupational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Stefano Di Girolamo
- Department of Otorhinolaryngology, University of Rome "Tor Vergata", Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine, University of Tor Vergata, Rome, Italy
| | - Marzia Nuccetelli
- Department of Experimental Medicine, University of Tor Vergata, Rome, Italy
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5
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Ganesan S, Acosta H, Brigolin C, Orange K, Trabbic K, Chen C, Lien CE, Lin YJ, Lin MY, Chuang YS, Fattom A, Bitko V. Intranasal nanoemulsion adjuvanted S-2P vaccine demonstrates protection in hamsters and induces systemic, cell-mediated and mucosal immunity in mice. PLoS One 2022; 17:e0272594. [PMID: 36322572 PMCID: PMC9629544 DOI: 10.1371/journal.pone.0272594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/21/2022] [Indexed: 12/01/2022] Open
Abstract
With the rapid progress made in the development of vaccines to fight the SARS-CoV-2 pandemic, almost >90% of vaccine candidates under development and a 100% of the licensed vaccines are delivered intramuscularly (IM). While these vaccines are highly efficacious against COVID-19 disease, their efficacy against SARS-CoV-2 infection of upper respiratory tract and transmission is at best temporary. Development of safe and efficacious vaccines that are able to induce robust mucosal and systemic immune responses are needed to control new variants. In this study, we have used our nanoemulsion adjuvant (NE01) to intranasally (IN) deliver stabilized spike protein (S-2P) to induce immunogenicity in mouse and hamster models. Data presented demonstrate the induction of robust immunity in mice resulting in 100% seroconversion and protection against SARS-CoV-2 in a hamster challenge model. There was a significant induction of mucosal immune responses as demonstrated by IgA- and IgG-producing memory B cells in the lungs of animals that received intranasal immunizations compared to an alum adjuvanted intramuscular vaccine. The efficacy of the S-2P/NE01 vaccine was also demonstrated in an intranasal hamster challenge model with SARS-CoV-2 and conferred significant protection against weight loss, lung pathology, and viral clearance from both upper and lower respiratory tract. Our findings demonstrate that intranasal NE01-adjuvanted vaccine promotes protective immunity against SARS-CoV-2 infection and disease through activation of three arms of immune system: humoral, cellular, and mucosal, suggesting that an intranasal SARS-CoV-2 vaccine may play a role in addressing a unique public health problem and unmet medical need.
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Affiliation(s)
- Shyamala Ganesan
- BlueWillow Biologics, Ann Arbor, Michigan, United States of America
| | - Hugo Acosta
- BlueWillow Biologics, Ann Arbor, Michigan, United States of America
| | - Chris Brigolin
- BlueWillow Biologics, Ann Arbor, Michigan, United States of America
| | - Kallista Orange
- BlueWillow Biologics, Ann Arbor, Michigan, United States of America
| | - Kevin Trabbic
- BlueWillow Biologics, Ann Arbor, Michigan, United States of America
| | - Charles Chen
- Medigen Vaccine Biologics Corporation, Taipei, Taiwan
- Temple University, Philadelphia, Pennsylvania, United States of America
| | - Chia-En Lien
- Medigen Vaccine Biologics Corporation, Taipei, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- * E-mail: (C-EL); (VB)
| | - Yi-Jiun Lin
- Medigen Vaccine Biologics Corporation, Taipei, Taiwan
| | - Meei-Yun Lin
- Medigen Vaccine Biologics Corporation, Taipei, Taiwan
| | | | - Ali Fattom
- BlueWillow Biologics, Ann Arbor, Michigan, United States of America
| | - Vira Bitko
- BlueWillow Biologics, Ann Arbor, Michigan, United States of America
- * E-mail: (C-EL); (VB)
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Yegorov S, Kadyrova I, Negmetzhanov B, Kolesnikova Y, Kolesnichenko S, Korshukov I, Baiken Y, Matkarimov B, Miller MS, Hortelano GH, Babenko D. Sputnik-V reactogenicity and immunogenicity in the blood and mucosa: a prospective cohort study. Sci Rep 2022; 12:13207. [PMID: 35915123 PMCID: PMC9342835 DOI: 10.1038/s41598-022-17514-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/26/2022] [Indexed: 12/30/2022] Open
Abstract
Sputnik-V (Gam-COVID-Vac) is a heterologous, recombinant adenoviral (rAdv) vector-based, COVID-19 vaccine now used in > 70 countries. Yet there is a shortage of data on this vaccine's performance in diverse populations. Here, we performed a prospective cohort study to assess the reactogenicity and immunologic outcomes of Sputnik-V vaccination in Kazakhstan. COVID-19-free participants (n = 82 at baseline) were followed at day 21 after Sputnik-V dose 1 (rAd5) and dose 2 (rAd26). Self-reported local and systemic adverse events were captured using questionnaires. Blood and nasopharyngeal swabs were collected to perform SARS-CoV-2 diagnostic and immunologic assays. We observed that most of the reported adverse events were mild-to-moderate injection site or systemic reactions, no severe or potentially life-threatening conditions were reported, and dose 1 appeared to be more reactogenic than dose 2. The seroconversion rate was 97% post-dose 1, remaining the same post-dose 2. The proportion of participants with detectable virus neutralization was 83% post-dose 1, increasing to 98% post-dose 2, with the largest relative increase observed in participants without prior COVID-19 exposure. Dose 1 boosted nasal S-IgG and S-IgA, while the boosting effect of dose 2 on mucosal S-IgG, but not S-IgA, was only observed in subjects without prior COVID-19. Systemically, vaccination reduced serum levels of growth regulated oncogene (GRO), which correlated with an elevation in blood platelet count. Overall, Sputnik-V dose 1 elicited both blood and mucosal SARS-CoV-2 immunity, while the immune boosting effect of dose 2 was minimal. Thus, adjustments to the current vaccine dosing regimen are necessary to optimize immunization efficacy and cost-effectiveness. While Sputnik-V reactogenicity is similar to that of other COVID-19 vaccines, the induced alterations to the GRO/platelet axis warrant investigation of the vaccine's effects on systemic immunology.
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Affiliation(s)
- Sergey Yegorov
- Department of Biochemistry and Biomedical Sciences, Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada.
- School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan.
| | - Irina Kadyrova
- Research Centre, Karaganda Medical University, Karaganda, Kazakhstan.
| | - Baurzhan Negmetzhanov
- School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
- National Laboratory Astana, Centre for Life Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan
| | | | | | - Ilya Korshukov
- Research Centre, Karaganda Medical University, Karaganda, Kazakhstan
| | - Yeldar Baiken
- School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
- National Laboratory Astana, Centre for Life Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan
- School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Bakhyt Matkarimov
- National Laboratory Astana, Centre for Life Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Matthew S Miller
- Department of Biochemistry and Biomedical Sciences, Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | - Gonzalo H Hortelano
- School of Sciences and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Dmitriy Babenko
- Research Centre, Karaganda Medical University, Karaganda, Kazakhstan
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7
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Lin YJ, Lin MY, Chuang YS, Liu LTC, Kuo TY, Chen C, Ganesan S, Fattom A, Bitko V, Lien CE. Protection of hamsters challenged with SARS-CoV-2 after two doses of MVC-COV1901 vaccine followed by a single intranasal booster with nanoemulsion adjuvanted S-2P vaccine. Sci Rep 2022; 12:11369. [PMID: 35790783 PMCID: PMC9255510 DOI: 10.1038/s41598-022-15238-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/21/2022] [Indexed: 11/09/2022] Open
Abstract
Intramuscular vaccines have greatly reduced hospitalization and death due to severe COVID-19. However, most countries are experiencing a resurgence of infection driven predominantly by the Delta and Omicron variants of SARS-CoV-2. In response, booster dosing of COVID-19 vaccines has been implemented in many countries to address waning immunity and reduced protection against the variants. However, intramuscular boosting fails to elicit mucosal immunity and therefore does not solve the problem of persistent viral carriage and transmission, even in patients protected from severe disease. In this study, two doses of stabilized prefusion SARS-CoV-2 spike (S-2P)-based intramuscular vaccine adjuvanted with Alum/CpG1018, MVC-COV1901, were used as a primary vaccination series, followed by an intranasal booster vaccination with nanoemulsion (NE01)-adjuvanted S-2P vaccine in a hamster model to demonstrate immunogenicity and protection from viral challenge. Here we report that this vaccination regimen resulted not only in the induction of robust immunity and protection against weight loss and lung pathology following challenge with SARS-CoV-2, but also led to increased viral clearance from both upper and lower respiratory tracts. Our findings showed that intramuscular MVC-COV1901 vaccine followed by a booster with intranasal NE01-adjuvanted vaccine promotes protective immunity against both viral infection and disease, suggesting that this immunization protocol may offer a solution in addressing a significant, unmet medical need for both the COVID-19 and future pandemics.
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Affiliation(s)
- Yi-Jiun Lin
- Medigen Vaccine Biologics Corporation, Taipei City, Taiwan
| | - Meei-Yun Lin
- Medigen Vaccine Biologics Corporation, Taipei City, Taiwan
| | - Ya-Shan Chuang
- Medigen Vaccine Biologics Corporation, Taipei City, Taiwan
| | | | - Tsun-Yung Kuo
- Department of Biotechnology and Animal Science, National Ilan University, Yilan County, Taiwan
| | - Charles Chen
- Medigen Vaccine Biologics Corporation, Taipei City, Taiwan
- Temple University, Philadelphia, PA, 19122, USA
| | | | - Ali Fattom
- BlueWillow Biologics, Ann Arbor, MI, 48105, USA
- LLC, Ann Arbor, MI, 48105, USA
| | - Vira Bitko
- BlueWillow Biologics, Ann Arbor, MI, 48105, USA.
| | - Chia-En Lien
- Medigen Vaccine Biologics Corporation, Taipei City, Taiwan.
- Institute of Public Health, National Yang-Ming Chiao Tung University, Taipei City, Taiwan.
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8
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Guerrieri M, Francavilla B, Fiorelli D, Nuccetelli M, Passali FM, Coppeta L, Somma G, Bernardini S, Magrini A, Di Girolamo S. Nasal and Salivary Mucosal Humoral Immune Response Elicited by mRNA BNT162b2 COVID-19 Vaccine Compared to SARS-CoV-2 Natural Infection. Vaccines (Basel) 2021; 9:vaccines9121499. [PMID: 34960244 PMCID: PMC8708818 DOI: 10.3390/vaccines9121499] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 01/22/2023] Open
Abstract
SARS-CoV-2 antibody assays are crucial in managing the COVID-19 pandemic. Approved mRNA COVID-19 vaccines are well known to induce a serum antibody responses against the spike protein and its RBD. Mucosal immunity plays a major role in the fight against COVID-19 directly at the site of virus entry; however, vaccine abilities to elicit mucosal immune responses have not been reported. We detected anti-SARS-CoV-2 IgA-S1 and IgG-RBD in three study populations (healthy controls, vaccinated subjects, and subjects recovered from COVID-19 infection) on serum, saliva, and nasal secretions using two commercial immunoassays (ELISA for IgA-S1 and chemiluminescent assay for IgG-RBD). Our results show that the mRNA BNT162b2 vaccine Comirnaty (Pfizer/BioNTech, New York, NY, USA) determines the production of nasal and salivary IgA-S1 and IgG-RBD against SARS-CoV-2. This mucosal humoral immune response is stronger after the injection of the second vaccine dose compared to subjects recovered from COVID-19. Since there is a lack of validated assays on saliva and nasal secretions, this study shows that our pre-analytical and analytical procedures are consistent with the data. Our findings indicate that the mRNA COVID-19 vaccine elicits antigen-specific nasal and salivary immune responses, and that mucosal antibody assays could be used as candidates for non-invasive monitoring of vaccine-induced protection against viral infection.
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Affiliation(s)
- Mariapia Guerrieri
- Department of Otorhinolaryngology, University of Rome “Tor Vergata”, 00100 Rome, Italy; (M.G.); (F.M.P.); (S.D.G.)
| | - Beatrice Francavilla
- Department of Otorhinolaryngology, University of Rome “Tor Vergata”, 00100 Rome, Italy; (M.G.); (F.M.P.); (S.D.G.)
- Correspondence:
| | - Denise Fiorelli
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00100 Rome, Italy; (D.F.); (M.N.); (S.B.)
| | - Marzia Nuccetelli
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00100 Rome, Italy; (D.F.); (M.N.); (S.B.)
| | - Francesco Maria Passali
- Department of Otorhinolaryngology, University of Rome “Tor Vergata”, 00100 Rome, Italy; (M.G.); (F.M.P.); (S.D.G.)
| | - Luca Coppeta
- Department of Occupational Medicine, University of Rome “Tor Vergata”, 00100 Rome, Italy; (L.C.); (G.S.); (A.M.)
| | - Giuseppina Somma
- Department of Occupational Medicine, University of Rome “Tor Vergata”, 00100 Rome, Italy; (L.C.); (G.S.); (A.M.)
| | - Sergio Bernardini
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00100 Rome, Italy; (D.F.); (M.N.); (S.B.)
- Department of Laboratory Medicine, Tor Vergata University Hospital, 00100 Rome, Italy
| | - Andrea Magrini
- Department of Occupational Medicine, University of Rome “Tor Vergata”, 00100 Rome, Italy; (L.C.); (G.S.); (A.M.)
| | - Stefano Di Girolamo
- Department of Otorhinolaryngology, University of Rome “Tor Vergata”, 00100 Rome, Italy; (M.G.); (F.M.P.); (S.D.G.)
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9
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Rothschild N. Does Fecal-Oral Transmission of SARS-CoV-2 Due to Low Sanitation Conditions Contribute to Low Mortality Rates From COVID-19. Cureus 2021; 13:e18557. [PMID: 34754698 PMCID: PMC8571565 DOI: 10.7759/cureus.18557] [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] [Accepted: 10/04/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The novel coronavirus disease 2019 (COVID-19) is a global pandemic generated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The primary infection site is mucosal surfaces, mainly the lungs and the intestine, where epithelial cells can be infected. COVID-19 has spread throughout the world, causing millions of deaths and hundreds of millions of confirmed infections. Despite the global spread of SARS-CoV-2, there are extreme differences between countries in mortality rates and confirmed infections. METHODS Pearson correlations and a t-test were performed on data from 137 countries in order to test the correlation between number of deaths from diarrheal diseases (pre-COVID-19 pandemic data) as a marker for countries' sanitation level, and the number of confirmed COVID-19 cases and deaths per million. RESULTS It was found that countries' prevalence of confirmed COVID-19 cases and deaths per million are statistically correlated with their sanitation level. CONCLUSIONS The hypothesis proposed in this article is that the low mortality rates from COVID-19 in countries where the level of sanitation is low are due to fecal-oral infection of the population by SARS-CoV-2, rather than infection of the respiratory system. This hypothesis is supported by the protective effect of the low sanitation level presented in this work and the fact that lung infection by SARS-CoV-2 can cause severe pathology, while infection in the intestine generally causes minor or no symptoms.
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10
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Velikova T, Snegarova V, Kukov A, Batselova H, Mihova A, Nakov R. Gastrointestinal mucosal immunity and COVID-19. World J Gastroenterol 2021; 27:5047-5059. [PMID: 34497434 PMCID: PMC8384742 DOI: 10.3748/wjg.v27.i30.5047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/01/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
As the gastrointestinal tract may also be a crucial entry or interaction site of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the role of the gut mucosal immune system as a first-line physical and immunological defense is critical. Furthermore, gastrointestinal involvement and symptoms in coronavirus disease 2019 (COVID-19) patients have been linked to worse clinical outcomes. This review discusses recent data on the interactions between the virus and the immune cells and molecules in the mucosa during the infection. By carrying out appropriate investigations, the mucosal immune system role in SARS-CoV-2 infection in therapy and prevention can be established. In line with this, COVID-19 vaccines that stimulate mucosal immunity against the virus may have more advantages than the others.
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Affiliation(s)
- Tsvetelina Velikova
- Department of Clinical Immunology, University Hospital Lozenetz, Medical Faculty, Sofia University, St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Violeta Snegarova
- Clinic of Internal Diseases, Naval Hospital – Varna, Military Medical Academy, Medical Faculty, Medical University, Varna 9000, Bulgaria
| | - Alexander Kukov
- Department of Clinical Immunology, University Hospital Lozenetz, Medical Faculty, Sofia University, St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Hristiana Batselova
- Department of Epidemiology and Disaster Medicine, Medical University, Plovdiv, University Hospital "St George", Plovdiv 6000, Bulgaria
| | - Antoaneta Mihova
- Department of Clinical Immunology, University Hospital Lozenetz, Medical Faculty, Sofia University, St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Radislav Nakov
- Clinic of Gastroenterology, Tsaritsa Joanna University Hospital, Medical University of Sofia, Sofia 1527, Bulgaria
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