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Wiedemann A, Pellaton C, Dekeyser M, Guillaumat L, Déchenaud M, Krief C, Lacabaratz C, Grimbert P, Pantaleo G, Lévy Y, Durrbach A. Longitudinal evaluation of the impact of immunosuppressive regimen on immune responses to COVID-19 vaccination in kidney transplant recipients. Front Med (Lausanne) 2022; 9:978764. [PMID: 36072955 PMCID: PMC9441691 DOI: 10.3389/fmed.2022.978764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/03/2022] [Indexed: 12/01/2022] Open
Abstract
Immunocompromised patients have a high risk of death from SARS-CoV-2 infection. Vaccination with an mRNA vaccine may protect these patients against severe COVID-19. Several studies have evaluated the impact of immune-suppressive drug regimens on cellular and humoral responses to SARS-CoV-2 variants of concern in this context. We performed a prospective longitudinal study assessing specific humoral (binding and neutralizing antibodies against spike (S) and T-lymphocyte (cytokine secretion and polyfunctionality) immune responses to anti-COVID-19 vaccination with at least two doses of BNT162b2 mRNA vaccine in stable kidney transplant recipients (KTR) on calcineurin inhibitor (CNI)- or belatacept-based treatment regimens. Fifty-two KTR−31 receiving CNI and 21 receiving belatacept—were enrolled in this study. After two doses of vaccine, 46.9% of patients developed anti-S IgG. Anti-spike IgG antibodies were produced in only 21.4% of the patients in the belatacept group, vs. 83.3% of those in the CNI group. The Beta and Delta variants and, more importantly, the Omicron variant, were less well neutralized than the Wuhan strain. T-cell functions were also much weaker in the belatacept group than in the CNI group. Renal transplant patients have an impaired humoral response to BNT162b2 vaccination. Belatacept-based regimens severely weaken both humoral and cellular vaccine responses. Clinically, careful evaluations of at least binding IgG responses, and prophylactic or post-exposure strategies are strongly recommended for transplant recipients on belatacept-based regimens.
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Affiliation(s)
- Aurélie Wiedemann
- Vaccine Research Institute, Université Paris-Est Créteil, Faculté de Médecine, INSERM U955, Créteil, France
| | - Céline Pellaton
- Service of Immunology and Allergy, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Manon Dekeyser
- Department of Nephrology, Assistance Publique Hopitaux de Paris (APHP), Creteil, France
- Paris-Saclay University, Gustave Roussy Institut, Institut National de la Santé et de la Recherche Médicale (INSERM) - Unité Mixte de Recherche (UMR) 1186, Integrative Tumor Immunology and Immunotherapy, Villejuif, France
| | - Lydia Guillaumat
- Vaccine Research Institute, Université Paris-Est Créteil, Faculté de Médecine, INSERM U955, Créteil, France
| | - Marie Déchenaud
- Vaccine Research Institute, Université Paris-Est Créteil, Faculté de Médecine, INSERM U955, Créteil, France
| | - Corinne Krief
- Vaccine Research Institute, Université Paris-Est Créteil, Faculté de Médecine, INSERM U955, Créteil, France
| | - Christine Lacabaratz
- Vaccine Research Institute, Université Paris-Est Créteil, Faculté de Médecine, INSERM U955, Créteil, France
| | - Philippe Grimbert
- Department of Nephrology, Assistance Publique Hopitaux de Paris (APHP), Creteil, France
- Paris-Saclay University, Gustave Roussy Institut, Institut National de la Santé et de la Recherche Médicale (INSERM) - Unité Mixte de Recherche (UMR) 1186, Integrative Tumor Immunology and Immunotherapy, Villejuif, France
- Université Paris-Est Créteil, Faculté de Médecine, INSERM U955, Créteil, France
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Swiss Vaccine Research Institute, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Yves Lévy
- Vaccine Research Institute, Université Paris-Est Créteil, Faculté de Médecine, INSERM U955, Créteil, France
- Groupe Henri-Mondor Albert-Chenevier, Service Immunologie Clinique, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Antoine Durrbach
- Department of Nephrology, Assistance Publique Hopitaux de Paris (APHP), Creteil, France
- Paris-Saclay University, Gustave Roussy Institut, Institut National de la Santé et de la Recherche Médicale (INSERM) - Unité Mixte de Recherche (UMR) 1186, Integrative Tumor Immunology and Immunotherapy, Villejuif, France
- *Correspondence: Antoine Durrbach
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Time-Limited Therapy with Belatacept in Kidney Transplant Recipients. J Clin Med 2022; 11:jcm11113229. [PMID: 35683619 PMCID: PMC9181670 DOI: 10.3390/jcm11113229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/28/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit–risk ratio, we established a strategy consisting of time-limited belatacept therapy/transient calcineurin inhibitor withdrawal, whose results are analyzed in that study. Methods: We considered all the kidney transplant recipients that had been switched from conventional immunosuppressive therapy to belatacept and then for whom belatacept has been withdrawn intentionally. Furthermore, in the first 8 patients, we assessed changes in peripheral blood mononuclear cells (PBMC) transcriptome using RNAseq before and 3 months after belatacept withdrawal. Results: Over the study period, 28 out of 94 patients had belatacept intentionally withdrawn including 25 (89%) switched to low-dose CNI. One rejection due to poor compliance occurred. The eGFR after 12 months remained stable from 48 ± 19 mL.1.73 m−2 to 46 ± 17 mL.1.73 m−2 (p = 0.68). However, patients that resumed belatacept/withdrew CNIs (n = 10) had a trend towards a better eGFR comparing with the others (n = 15): 54 ± 20 mL.1.73 m−2 vs. eGFR 43 ± 16 mL.1.73 m−2, respectively (p = 0.15). The only factor associated with belatacept resumption was when the withdrawal took place during the COVID-19 outbreak. Transcriptome analysis of PBMCs, did not support rebound in alloimmune response. Conclusions: These findings underpin the use of belatacept as part of a time-limited therapy, in selected kidney transplant recipients, possibly as an approach to allow efficient vaccination against SARS-CoV-2.
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Lindemann M, Baumann C, Wilde B, Gäckler A, Meller L, Horn PA, Krawczyk A, Witzke O. Prospective, Longitudinal Study on Specific Cellular Immune Responses after Vaccination with an Adjuvanted, Recombinant Zoster Vaccine in Kidney Transplant Recipients. Vaccines (Basel) 2022; 10:vaccines10060844. [PMID: 35746452 PMCID: PMC9227383 DOI: 10.3390/vaccines10060844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
Solid organ transplant recipients have an up to ninefold higher risk of varicella-zoster virus (VZV) reactivation than the general population. Due to lifelong immunosuppressive therapy, vaccination against VZV may be less effective in kidney transplant (KTX) recipients. In the current study, twelve female and 17 male KTX recipients were vaccinated twice with the adjuvanted, recombinant zoster vaccine Shingrix™, which contains the VZV glycoprotein E (gE). Cellular immunity against various VZV antigens was analyzed with interferon-gamma ELISpot. We observed the strongest vaccination-induced changes after stimulation with a gE peptide pool. One month after the second vaccination, median responses were 8.0-fold higher than the responses prior to vaccination (p = 0.0006) and 4.8-fold higher than responses after the first vaccination (p = 0.0007). After the second vaccination, we observed an at least twofold increase in ELISpot responses towards gE peptides in 22 out of 29 patients (76%). Male sex, good kidney function, early time point after transplantation, and treatment with tacrolimus or mycophenolate were correlated significantly with higher VZV-specific cellular immunity, whereas diabetes mellitus was correlated with impaired responses. Thus, our data indicate that vaccination with Shingrix™ significantly augmented cellular, VZV gE-specific immunity in KTX recipients, which was dependent on several covariates.
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Affiliation(s)
- Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (C.B.); (P.A.H.)
- Correspondence: ; Tel.: +49-201-723-4217
| | - Charleen Baumann
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (C.B.); (P.A.H.)
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Essen-Duisburg, 45147 Essen, Germany; (L.M.); (A.K.); (O.W.)
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.W.); (A.G.)
| | - Anja Gäckler
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.W.); (A.G.)
| | - Lara Meller
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Essen-Duisburg, 45147 Essen, Germany; (L.M.); (A.K.); (O.W.)
| | - Peter A. Horn
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (C.B.); (P.A.H.)
| | - Adalbert Krawczyk
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Essen-Duisburg, 45147 Essen, Germany; (L.M.); (A.K.); (O.W.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Essen-Duisburg, 45147 Essen, Germany; (L.M.); (A.K.); (O.W.)
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Wünsch K, Anastasiou OE, Alt M, Brochhagen L, Cherneha M, Thümmler L, van Baal L, Madel RJ, Lindemann M, Taube C, Witzke O, Rohn H, Krawczyk A, Jansen S. COVID-19 in Elderly, Immunocompromised or Diabetic Patients—From Immune Monitoring to Clinical Management in the Hospital. Viruses 2022; 14:v14040746. [PMID: 35458476 PMCID: PMC9024512 DOI: 10.3390/v14040746] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 01/01/2023] Open
Abstract
The novel, highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a pandemic of acute respiratory illness worldwide and remains a huge threat to the healthcare system’s capacity to respond to COVID-19. Elderly and immunocompromised patients are at increased risk for a severe course of COVID-19. These high-risk groups have been identified as developing diminished humoral and cellular immune responses. Notably, SARS-CoV-2 RNA remains detectable in nasopharyngeal swabs of these patients for a prolonged period of time. These factors complicate the clinical management of these vulnerable patient groups. To date, there are no well-defined guidelines for an appropriate duration of isolation for elderly and immunocompromised patients, especially in hospitals or nursing homes. The aim of the present study was to characterize at-risk patient cohorts capable of producing a replication-competent virus over an extended period after symptomatic COVID-19, and to investigate the humoral and cellular immune responses and infectivity to provide a better basis for future clinical management. In our cohort, the rate of positive viral cultures and the sensitivity of SARS-CoV-2 antigen tests correlated with higher viral loads. Elderly patients and patients with diabetes mellitus had adequate cellular and humoral immune responses to SARS-CoV-2 infection, while immunocompromised patients had reduced humoral and cellular immune responses. Our patient cohort was hospitalized for longer compared with previously published cohorts. Longer hospitalization was associated with a high number of nosocomial infections, representing a potential hazard for additional complications to patients. Most importantly, regardless of positive SARS-CoV-2 RNA detection, no virus was culturable beyond a cycle threshold (ct) value of 33 in the majority of samples. Our data clearly indicate that elderly and diabetic patients develop a robust immune response to SARS-CoV-2 and may be safely de-isolated at a ct value of more than 35.
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Affiliation(s)
- Korbinian Wünsch
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Olympia E. Anastasiou
- Institute for Virology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Mira Alt
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Leonie Brochhagen
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Maxim Cherneha
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Laura Thümmler
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Lukas van Baal
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Rabea J. Madel
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Christian Taube
- Department of Pneumology, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, 45147 Essen, Germany;
| | - Oliver Witzke
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Hana Rohn
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
- Correspondence: (H.R.); (S.J.)
| | - Adalbert Krawczyk
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
| | - Sarah Jansen
- West German Centre of Infectious Diseases, Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (K.W.); (M.A.); (L.B.); (M.C.); (L.T.); (R.J.M.); (O.W.); (A.K.)
- Correspondence: (H.R.); (S.J.)
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Malipiero G, Moratto A, Infantino M, D'Agaro P, Piscianz E, Manfredi M, Grossi V, Benvenuti E, Bulgaresi M, Benucci M, Villalta D. Assessment of humoral and cellular immunity induced by the BNT162b2 SARS-CoV-2 vaccine in healthcare workers, elderly people, and immunosuppressed patients with autoimmune disease. Immunol Res 2021; 69:576-583. [PMID: 34417958 PMCID: PMC8379062 DOI: 10.1007/s12026-021-09226-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/11/2021] [Indexed: 01/01/2023]
Abstract
The development of vaccines to prevent SARS-CoV-2 infection has mainly relied on the induction of neutralizing antibodies (nAbs) to the Spike protein of SARS-CoV-2, but there is growing evidence that T cell immune response can contribute to protection as well. In this study, an anti-receptor binding domain (RBD) antibody assay and an INFγ-release assay (IGRA) were used to detect humoral and cellular responses to the Pfizer-BioNTech BNT162b2 vaccine in three separate cohorts of COVID-19-naïve patients: 108 healthcare workers (HCWs), 15 elderly people, and 5 autoimmune patients treated with immunosuppressive agents. After the second dose of vaccine, the mean values of anti-RBD antibodies (Abs) and INFγ were 123.33 U/mL (range 27.55-464) and 1513 mIU/mL (range 145-2500) in HCWs and 210.7 U/mL (range 3-500) and 1167 mIU/mL (range 83-2500) in elderly people. No correlations between age and immune status were observed. On the contrary, a weak but significant positive correlation was found between INFγ and anti-RBD Abs values (rho = 0.354, p = 0.003). As to the autoimmune cohort, anti-RBD Abs were not detected in the two patients with absent peripheral CD19+B cells, despite high INFγ levels being observed in all 5 patients after vaccination. Even though the clinical relevance of T cell response has not yet been established as a correlate of vaccine-induced protection, IGRA testing has showed optimal sensitivity and specificity to define vaccine responders, even in patients lacking a cognate antibody response to the vaccine.
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Affiliation(s)
- Giacomo Malipiero
- Immunology and Allergy Unit, Ospedale S-Maria degli Angeli, Pordenone, Italy
| | - Anna Moratto
- Immunology and Allergy Unit, Ospedale S-Maria degli Angeli, Pordenone, Italy
| | - Maria Infantino
- Immunology and Allergy Laboratory Unit, San Giovanni Di Dio Hospital, Florence, Italy
| | - Pierlanfranco D'Agaro
- Laboratory for Hygiene and Public Health, University Hospital of Trieste, Trieste, Italy
| | - Elisa Piscianz
- Laboratory for Hygiene and Public Health, University Hospital of Trieste, Trieste, Italy
| | - Mariangela Manfredi
- Immunology and Allergy Laboratory Unit, San Giovanni Di Dio Hospital, Florence, Italy
| | - Valentina Grossi
- Immunology and Allergy Laboratory Unit, San Giovanni Di Dio Hospital, Florence, Italy
| | - Enrico Benvenuti
- Geriatric Unit Firenze-Empoli, Santa Maria Annunziata Hospital, Florence, Italy
| | - Matteo Bulgaresi
- Geriatric Unit Firenze-Empoli, Santa Maria Annunziata Hospital, Florence, Italy
| | - Maurizio Benucci
- Rheumatology Unit, San Giovanni Di Dio Hospital, Florence, Italy
| | - Danilo Villalta
- Immunology and Allergy Unit, Ospedale S-Maria degli Angeli, Pordenone, Italy.
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Long-Term SARS-CoV-2 Specific Immunity Is Affected by the Severity of Initial COVID-19 and Patient Age. J Clin Med 2021; 10:jcm10194606. [PMID: 34640623 PMCID: PMC8509457 DOI: 10.3390/jcm10194606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/25/2021] [Accepted: 10/02/2021] [Indexed: 11/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently the greatest medical challenge. Although crucial to the future management of the pandemic, the factors affecting the persistence of long-term SARS-CoV-2 immunity are not well understood. Therefore, we determined the extent of important correlates of SARS-CoV-2 specific protection in 200 unvaccinated convalescents after COVID-19. To investigate the effective memory response against the virus, SARS-CoV-2 specific T cell and humoral immunity (including virus-neutralizing antibodies) was determined over a period of one to eleven months. SARS-CoV-2 specific immune responses were present in 90% of individual patients. Notably, immunosuppressed patients did not have long-term SARS-CoV-2 specific T cell immunity. In our cohort, the severity of the initial illness influenced SARS-CoV-2 specific T cell immune responses and patients’ humoral immune responses to Spike (S) protein over the long-term, whereas the patients’ age influenced Membrane (M) protein-specific T cell responses. Thus, our study not only demonstrated the long-term persistence of SARS-CoV-2 specific immunity, it also determined COVID-19 severity and patient age as significant factors affecting long-term immunity.
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