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Roozen GVT, Prins MLM, Prins C, Janse JJ, de Gruyter HLM, Pothast CR, Huisman W, Koopman JPR, Lamers OAC, Kuijer M, Myeni SK, van Binnendijk RS, Hartog GD, Heemskerk MHM, Jochems SP, Feltkamp MCW, Kikkert M, Rosendaal FR, Roestenberg M, Visser LG, Roukens AHE. Intradermal delivery of the third dose of the mRNA-1273 SARS-CoV-2 vaccine: safety and immunogenicity of a fractional booster dose. Clin Microbiol Infect 2024:S1198-743X(24)00159-9. [PMID: 38552793 DOI: 10.1016/j.cmi.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES The aim of this study was to assess the safety and immunogenicity of a dose-sparing fractional intradermal (ID) booster strategy with the mRNA-1273 COVID-19 vaccine. METHODS COVID-19 naive adults aged 18-30 years were recruited from a previous study on primary vaccination regimens that compared 20 μg ID vaccinations with 100 μg intramuscular (IM) vaccinations with mRNA-1273 as the primary vaccination series. Participants previously immunized with ID regimens were randomly assigned (1:1) to receive a fractional ID booster dose (20 μg) or the standard-of-care intramuscular (IM) booster dose (50 μg) of the mRNA-1273 vaccine, 6 months after completing their primary series (ID-ID and ID-IM group, respectively). Participants that had received a full dose IM regimen as the primary series, received the IM standard-of-care booster dose (IM-IM group). In addition, COVID-19 naive individuals aged 18-40 years who had received an IM mRNA vaccine as the primary series were recruited from the general population to receive a fractional ID booster dose (IM-ID group). Immunogenicity was assessed using IgG anti-spike antibody responses and neutralizing capacity against SARS-CoV-2. Cellular immune responses were measured in a sub-group. Safety and tolerability were monitored. RESULTS In January 2022, 129 participants were included in the study. Fractional ID boosting was safe and well tolerated, with fewer systemic adverse events compared with IM boosting. At day 28 post-booster, anti-spike S1 IgG geometric mean concentrations were 9106 (95% CI, 7150-11 597) binding antibody units (BAU)/mL in the IM-IM group and 4357 (3003-6322) BAU/mL; 6629 (4913-8946) BAU/mL; and 5264 (4032-6873) BAU/mL in the ID-IM, ID-ID, and IM-ID groups, respectively. DISCUSSION Intradermal boosting provides robust immune responses and is a viable dose-sparing strategy for mRNA COVID-19 vaccines. The favourable side-effect profile supports its potential to reduce vaccine hesitancy. Fractional dosing strategies should be considered early in the clinical development of future mRNA vaccines to enhance vaccine availability and pandemic preparedness.
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Affiliation(s)
- Geert V T Roozen
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands; Department of Parasitology, LUCID, LUMC, Leiden, The Netherlands.
| | - Manon L M Prins
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Corine Prins
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | | | | | | | - Wesley Huisman
- Department of Parasitology, LUCID, LUMC, Leiden, The Netherlands
| | | | | | - Marjan Kuijer
- Department of Immune Surveillance, National Institute for Public Health and the Environment (RIVM), Utrecht, The Netherlands
| | - Sebenzile K Myeni
- Department of Medical Microbiology, LUCID, LUMC, Leiden, The Netherlands
| | - Rob S van Binnendijk
- Department of Immune Surveillance, National Institute for Public Health and the Environment (RIVM), Utrecht, The Netherlands
| | - Gerco den Hartog
- Department of Immune Surveillance, National Institute for Public Health and the Environment (RIVM), Utrecht, The Netherlands; Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | | | - Simon P Jochems
- Department of Parasitology, LUCID, LUMC, Leiden, The Netherlands
| | | | - Marjolein Kikkert
- Department of Medical Microbiology, LUCID, LUMC, Leiden, The Netherlands
| | | | - Meta Roestenberg
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands; Department of Parasitology, LUCID, LUMC, Leiden, The Netherlands
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Anna H E Roukens
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands
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Prins MLM, Roozen GVT, Pothast CR, Huisman W, van Binnendijk R, den Hartog G, Kuiper VP, Prins C, Janse JJ, Lamers OAC, Koopman JPR, Kruithof AC, Kamerling IMC, Dijkland RC, de Kroon AC, Azimi S, Feltkamp MCW, Kuijer M, Jochems SP, Heemskerk MHM, Rosendaal FR, Roestenberg M, Visser LG, Roukens AHE. Immunogenicity and reactogenicity of intradermal mRNA-1273 SARS-CoV-2 vaccination: a non-inferiority, randomized-controlled trial. NPJ Vaccines 2024; 9:1. [PMID: 38167735 PMCID: PMC10761693 DOI: 10.1038/s41541-023-00785-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
Fractional dosing can be a cost-effective vaccination strategy to accelerate individual and herd immunity in a pandemic. We assessed the immunogenicity and safety of primary intradermal (ID) vaccination, with a 1/5th dose compared with the standard intramuscular (IM) dose of mRNA-1273 in SARS-CoV-2 naïve persons. We conducted an open-label, non-inferiority, randomized controlled trial in the Netherlands between June and December 2021. One hundred and fifty healthy and SARS-CoV-2 naïve participants, aged 18-30 years, were randomized (1:1:1) to receive either two doses of 20 µg mRNA-1273 ID with a standard needle (SN) or the Bella-mu® needle (BM), or two doses of 100 µg IM, 28 days apart. The primary outcome was non-inferiority in seroconversion rates at day 43 (D43), defined as a neutralizing antibody concentration threshold of 465 IU/mL, the lowest response in the IM group. The non-inferiority margin was set at -15%. Neutralizing antibody concentrations at D43 were 1789 (95% CI: 1488-2150) in the IM and 1263 (951-1676) and 1295 (1020-1645) in the ID-SN and ID-BM groups, respectively. The absolute difference in seroconversion proportion between fractional and standard-dose groups was -13.95% (-24.31 to -3.60) for the ID-SN and -13.04% (-22.78 to -3.31) for the ID-BM group and exceeded the predefined non-inferiority margin. Although ID vaccination with 1/5th dose of mRNA-1273 did not meet the predefined non-inferior criteria, the neutralizing antibody concentrations in these groups are far above the proposed proxy for protection against severe disease (100 IU/mL), justifying this strategy in times of vaccine scarcity to accelerate mass protection against severe disease.
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Affiliation(s)
- Manon L M Prins
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Geert V T Roozen
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cilia R Pothast
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wesley Huisman
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob van Binnendijk
- Department of Immune Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Gerco den Hartog
- Department of Immune Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Laboratory of Medical Immunology, RadboudUMC, Nijmegen, The Netherlands
| | - Vincent P Kuiper
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Corine Prins
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacqueline J Janse
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Olivia A C Lamers
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Pieter R Koopman
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annelieke C Kruithof
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- Center for Human Drug Research, Leiden, The Netherlands
| | - Ingrid M C Kamerling
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- Center for Human Drug Research, Leiden, The Netherlands
| | - Romy C Dijkland
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alicia C de Kroon
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Shohreh Azimi
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mariet C W Feltkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjan Kuijer
- Department of Immune Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Simon P Jochems
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mirjam H M Heemskerk
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Meta Roestenberg
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna H E Roukens
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.
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Pothast CR, van Dijk K, Pool ES, Halkes CJM, Heemskerk MHM, Tjon JM. SARS-CoV-2 mRNA vaccination of aplastic anemia patients is safe and effective. Am J Hematol 2023; 98:E20-E23. [PMID: 36371670 PMCID: PMC9877677 DOI: 10.1002/ajh.26780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Cilia R. Pothast
- Department of HematologyLeiden University Medical CenterLeidenThe Netherlands
| | - Kayleigh van Dijk
- Department of HematologyLeiden University Medical CenterLeidenThe Netherlands
| | - Emma S. Pool
- Department of HematologyLeiden University Medical CenterLeidenThe Netherlands
| | | | | | - Jennifer M.‐L. Tjon
- Department of HematologyLeiden University Medical CenterLeidenThe Netherlands
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Boerenkamp LS, Pothast CR, Dijkland RC, van Dijk K, van Gorkom GNY, van Loo IHM, Wieten L, Halkes CJM, Heemskerk MHM, Van Elssen CHMJ. Increased CD8 T-cell immunity after COVID-19 vaccination in lymphoid malignancy patients lacking adequate humoral response: An immune compensation mechanism? Am J Hematol 2022; 97:E457-E461. [PMID: 36106926 PMCID: PMC9537869 DOI: 10.1002/ajh.26729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Lara S. Boerenkamp
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Cilia R. Pothast
- Experimental HematologyLeiden University Medical CenterLeidenThe Netherlands
| | - Romy C. Dijkland
- Experimental HematologyLeiden University Medical CenterLeidenThe Netherlands
| | - Kayleigh van Dijk
- Experimental HematologyLeiden University Medical CenterLeidenThe Netherlands
| | - Gwendolyn N. Y. van Gorkom
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Inge H. M. van Loo
- Medical MicrobiologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Lotte Wieten
- Department of Transplantation ImmunologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | | | | | - Catharina H. M. J. Van Elssen
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtThe Netherlands
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5
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Zlei M, Sidorov IA, Joosten SA, Heemskerk MHM, Myeni SK, Pothast CR, de Brouwer CS, Boomaars-van der Zanden AL, van Meijgaarden KE, Morales ST, Wessels E, Janse JJ, Goeman JJ, Cobbaert CM, Kroes ACM, Cannegieter SC, Roestenberg M, Visser LG, Kikkert M, Feltkamp MCW, Arbous SM, Staal FJT, Ottenhoff THM, van Dongen JJM, Roukens AHE, de Vries JJC. Immune Determinants of Viral Clearance in Hospitalised COVID-19 Patients: Reduced Circulating Naïve CD4+ T Cell Counts Correspond with Delayed Viral Clearance. Cells 2022; 11:cells11172743. [PMID: 36078151 PMCID: PMC9455062 DOI: 10.3390/cells11172743] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Virus-specific cellular and humoral responses are major determinants for protection from critical illness after SARS-CoV-2 infection. However, the magnitude of the contribution of each of the components to viral clearance remains unclear. Here, we studied the timing of viral clearance in relation to 122 immune parameters in 102 hospitalised patients with moderate and severe COVID-19 in a longitudinal design. Delayed viral clearance was associated with more severe disease and was associated with higher levels of SARS-CoV-2-specific (neutralising) antibodies over time, increased numbers of neutrophils, monocytes, basophils, and a range of pro-inflammatory cyto-/chemokines illustrating ongoing, partially Th2 dominating, immune activation. In contrast, early viral clearance and less critical illness correlated with the peak of neutralising antibodies, higher levels of CD4 T cells, and in particular naïve CD4+ T cells, suggesting their role in early control of SARS-CoV-2 possibly by proving appropriate B cell help. Higher counts of naïve CD4+ T cells also correlated with lower levels of MIF, IL-9, and TNF-beta, suggesting an indirect role in averting prolonged virus-induced tissue damage. Collectively, our data show that naïve CD4+ T cell play a critical role in rapid viral T cell control, obviating aberrant antibody and cytokine profiles and disease deterioration. These data may help in guiding risk stratification for severe COVID-19.
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Affiliation(s)
- Mihaela Zlei
- Department of Immunology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Igor A. Sidorov
- Clinical Microbiological Laboratory, Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Simone A. Joosten
- Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Mirjam H. M. Heemskerk
- Department of Hematology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Sebenzile K. Myeni
- Molecular Virology Laboratory, Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Cilia R. Pothast
- Department of Hematology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Caroline S. de Brouwer
- Clinical Microbiological Laboratory, Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - A. Linda Boomaars-van der Zanden
- Molecular Virology Laboratory, Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Krista E. van Meijgaarden
- Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Shessy T. Morales
- Molecular Virology Laboratory, Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Els Wessels
- Clinical Microbiological Laboratory, Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jacqueline J. Janse
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jelle J. Goeman
- Medical Statistics Section, Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Christa M. Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Aloys C. M. Kroes
- Clinical Microbiological Laboratory, Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Suzanne C. Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Meta Roestenberg
- Department of Parasitology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Leonardus G. Visser
- Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marjolein Kikkert
- Molecular Virology Laboratory, Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Mariet C. W. Feltkamp
- Clinical Microbiological Laboratory, Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Sesmu M. Arbous
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Intensive Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Frank J. T. Staal
- Department of Immunology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Tom H. M. Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | | | - Anna H. E. Roukens
- Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jutte J. C. de Vries
- Clinical Microbiological Laboratory, Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence:
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Pothast CR, Dijkland RC, Thaler M, Hagedoorn RS, Kester MGD, Wouters AK, Hiemstra PS, van Hemert MJ, Gras S, Falkenburg JHF, Heemskerk MHM. SARS-CoV-2-specific CD4 + and CD8 + T cell responses can originate from cross-reactive CMV-specific T cells. eLife 2022; 11:82050. [PMID: 36408799 PMCID: PMC9822249 DOI: 10.7554/elife.82050] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022] Open
Abstract
Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specific CD4+ and CD8+ T cells in SARS-CoV-2-unexposed donors has been explained by the presence of T cells primed by other coronaviruses. However, based on the relatively high frequency and prevalence of cross-reactive T cells, we hypothesized cytomegalovirus (CMV) may induce these cross-reactive T cells. Stimulation of pre-pandemic cryo-preserved peripheral blood mononuclear cells (PBMCs) with SARS-CoV-2 peptides revealed that frequencies of SARS-CoV-2-specific T cells were higher in CMV-seropositive donors. Characterization of these T cells demonstrated that membrane-specific CD4+ and spike-specific CD8+ T cells originate from cross-reactive CMV-specific T cells. Spike-specific CD8+ T cells recognize SARS-CoV-2 spike peptide FVSNGTHWF (FVS) and dissimilar CMV pp65 peptide IPSINVHHY (IPS) presented by HLA-B*35:01. These dual IPS/FVS-reactive CD8+ T cells were found in multiple donors as well as severe COVID-19 patients and shared a common T cell receptor (TCR), illustrating that IPS/FVS-cross-reactivity is caused by a public TCR. In conclusion, CMV-specific T cells cross-react with SARS-CoV-2, despite low sequence homology between the two viruses, and may contribute to the pre-existing immunity against SARS-CoV-2.
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Affiliation(s)
- Cilia R Pothast
- Department of Hematology, Leiden University Medical CenterLeidenNetherlands
| | - Romy C Dijkland
- Department of Hematology, Leiden University Medical CenterLeidenNetherlands
| | - Melissa Thaler
- Department of Medical Microbiology, Leiden University Medical CenterLeidenNetherlands
| | - Renate S Hagedoorn
- Department of Hematology, Leiden University Medical CenterLeidenNetherlands
| | - Michel GD Kester
- Department of Hematology, Leiden University Medical CenterLeidenNetherlands
| | - Anne K Wouters
- Department of Hematology, Leiden University Medical CenterLeidenNetherlands
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical CenterLeidenNetherlands
| | - Martijn J van Hemert
- Department of Medical Microbiology, Leiden University Medical CenterLeidenNetherlands
| | - Stephanie Gras
- Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe UniversityVictoriaAustralia,Department of Biochemistry and Molecular Biology, Monash UniversityClaytonAustralia
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Hanssen JLJ, Stienstra J, Boers SA, Pothast CR, Zaaijer HL, Tjon JM, Heemskerk MHM, Feltkamp MCW, Arend SM. Convalescent Plasma in a Patient with Protracted COVID-19 and Secondary Hypogammaglobulinemia Due to Chronic Lymphocytic Leukemia: Buying Time to Develop Immunity? Infect Dis Rep 2021; 13:855-864. [PMID: 34698153 PMCID: PMC8544405 DOI: 10.3390/idr13040077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022] Open
Abstract
It is not exactly clear yet which type of immune response prevails to accomplish viral clearance in coronavirus disease 2019 (COVID-19). Studying a patient with chronic lymphocytic leukemia and hypogammaglobulinemia who suffered from COVID-19 provided insight in the immunological responses after treatment with COVID-19 convalescent plasma (CCP). Treatment consisted of oxygen, repeated glucocorticosteroids and multiple dosages of CCP guided by antibody levels. Retrospectively performed humoral and cellular immunity analysis made clear that not every serological test for COVID-19 is appropriate for follow-up of sufficient neutralizing antibodies after CCP. In retrospect, we think that CCP merely bought time for this patient to develop an adequate cellular immune response which led to viral clearance and ultimately clinical recovery.
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Affiliation(s)
- Jaap L. J. Hanssen
- Department of Infectious Diseases, Leiden University Medical Center, C5-P, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
- Correspondence: ; Tel.: +31-71-5262620
| | - Johan Stienstra
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Stefan A. Boers
- Department of Medical Microbiology, Leiden University Medical Center, E4-P, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (S.A.B.); (M.C.W.F.)
| | - Cilia R. Pothast
- Department of Hematology, Leiden University Medical Center, C2-R, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (C.R.P.); (J.M.T.); (M.H.M.H.)
| | - Hans L. Zaaijer
- Sanquin Blood Supply Foundation, Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands;
| | - Jennifer M. Tjon
- Department of Hematology, Leiden University Medical Center, C2-R, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (C.R.P.); (J.M.T.); (M.H.M.H.)
| | - Mirjam H. M. Heemskerk
- Department of Hematology, Leiden University Medical Center, C2-R, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (C.R.P.); (J.M.T.); (M.H.M.H.)
| | - Mariet C. W. Feltkamp
- Department of Medical Microbiology, Leiden University Medical Center, E4-P, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (S.A.B.); (M.C.W.F.)
| | - Sandra M. Arend
- Department of Infectious Diseases, Leiden University Medical Center, C5-P, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
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