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Park HJ, Shin MS, Shin JJ, Kim H, Kang B, Par-Young J, Unlu S, Afinogenova Y, Catanzaro J, Young J, Kim M, Lee SJ, Jeon S, You S, Racke MK, Bucala R, Kang I. IL-1 receptor 1 signaling shapes the development of viral antigen-specific CD4 + T cell responses following COVID-19 mRNA vaccination. EBioMedicine 2024; 103:105114. [PMID: 38640835 PMCID: PMC11041015 DOI: 10.1016/j.ebiom.2024.105114] [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: 11/06/2023] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND The innate immune cytokine interleukin (IL)-1 can affect T cell immunity, a critical factor in host defense. In a previous study, we identified a subset of human CD4+ T cells which express IL-1 receptor 1 (IL-1R1). However, the expression of such receptor by viral antigen-specific CD4+ T cells and its biological implication remain largely unexplored. This led us to investigate the implication of IL-1R1 in the development of viral antigen-specific CD4+ T cell responses in humans, including healthy individuals and patients with primary antibody deficiency (PAD), and animals. METHODS We characterized CD4+ T cells specific for SARS-CoV-2 spike (S) protein, influenza virus, and cytomegalovirus utilizing multiplexed single cell RNA-seq, mass cytometry and flow cytometry followed by an animal study. FINDINGS In healthy individuals, CD4+ T cells specific for viral antigens, including S protein, highly expressed IL-1R1. IL-1β promoted interferon (IFN)-γ expression by S protein-stimulated CD4+ T cells, supporting the functional implication of IL-1R1. Following the 2nd dose of COVID-19 mRNA vaccines, S protein-specific CD4+ T cells with high levels of IL-1R1 increased, likely reflecting repetitive antigenic stimulation. The expression levels of IL-1R1 by such cells correlated with the development of serum anti-S protein IgG antibody. A similar finding of increased expression of IL-1R1 by S protein-specific CD4+ T cells was also observed in patients with PAD following COVID-19 mRNA vaccination although the expression levels of IL-1R1 by such cells did not correlate with the levels of serum anti-S protein IgG antibody. In mice immunized with COVID-19 mRNA vaccine, neutralizing IL-1R1 decreased IFN-γ expression by S protein-specific CD4+ T cells and the development of anti-S protein IgG antibody. INTERPRETATION Our results demonstrate the significance of IL-1R1 expression in CD4+ T cells for the development of viral antigen-specific CD4+ T cell responses, contributing to humoral immunity. This provides an insight into the regulation of adaptive immune responses to viruses via the IL-1 and IL-1R1 interface. FUNDING Moderna to HJP, National Institutes of Health (NIH) 1R01AG056728 and R01AG055362 to IK and KL2 TR001862 to JJS, Quest Diagnostics to IK and RB, and the Mathers Foundation to RB.
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Affiliation(s)
- Hong-Jai Park
- Department of Internal Medicine (Section of Rheumatology, Allergy & Immunology), Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Min Sun Shin
- Department of Internal Medicine (Section of Rheumatology, Allergy & Immunology), Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Junghee J Shin
- Department of Internal Medicine (Section of Rheumatology, Allergy & Immunology), Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Hyoungsu Kim
- Department of Internal Medicine (Section of Rheumatology, Allergy & Immunology), Yale University School of Medicine, New Haven, CT, 06520, USA; Department of Internal Medicine, Hallym University School of Medicine, Chuncheon, Gangwon-do, 24252, South Korea
| | - Byunghyun Kang
- Mucosal Immunology Section, Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, 20892, USA
| | - Jennefer Par-Young
- Department of Internal Medicine (Section of Rheumatology, Allergy & Immunology), Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Serhan Unlu
- Department of Internal Medicine (Section of Rheumatology, Allergy & Immunology), Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Yuliya Afinogenova
- Department of Internal Medicine (Section of Rheumatology, Allergy & Immunology), Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Jason Catanzaro
- Section of Pulmonary, Allergy, Immunology and Sleep Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Juan Young
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA
| | - Minhyung Kim
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Sang Jin Lee
- Department of Internal Medicine (Section of Rheumatology, Allergy & Immunology), Yale University School of Medicine, New Haven, CT, 06520, USA; Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, 41944, South Korea
| | - Sangchoon Jeon
- Yale University School of Nursing, West Haven, CT, 06516, USA
| | - Sungyong You
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | | | - Richard Bucala
- Department of Internal Medicine (Section of Rheumatology, Allergy & Immunology), Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Insoo Kang
- Department of Internal Medicine (Section of Rheumatology, Allergy & Immunology), Yale University School of Medicine, New Haven, CT, 06520, USA.
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Young JJ, Park HJ, Kim M, Par-Young J, Bartlett H, Kim HS, Unlu S, Osmani L, Shin MS, Bucala R, van Dyck CH, Allore H, Mecca AP, You S, Kang I. Aging gene signature of memory CD8 + T cells is associated with neurocognitive functioning in Alzheimer's disease. Immun Ageing 2023; 20:71. [PMID: 38042785 PMCID: PMC10693128 DOI: 10.1186/s12979-023-00396-y] [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: 09/27/2023] [Accepted: 11/20/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Memory CD8+ T cells expand with age. We previously demonstrated an age-associated expansion of effector memory (EM) CD8+ T cells expressing low levels of IL-7 receptor alpha (IL-7Rαlow) and the presence of its gene signature (i.e., IL-7Rαlow aging genes) in peripheral blood of older adults without Alzheimer's disease (AD). Considering age as the strongest risk factor for AD and the recent finding of EM CD8+ T cell expansion, mostly IL-7Rαlow cells, in AD, we investigated whether subjects with AD have alterations in IL-7Rαlow aging gene signature, especially in relation to genes possibly associated with AD and disease severity. RESULTS We identified a set of 29 candidate genes (i.e., putative AD genes) which could be differentially expressed in peripheral blood of patients with AD through the systematic search of publicly available datasets. Of the 29 putative AD genes, 9 genes (31%) were IL-7Rαlow aging genes (P < 0.001), suggesting the possible implication of IL-7Rαlow aging genes in AD. These findings were validated by RT-qPCR analysis of 40 genes, including 29 putative AD genes, additional 9 top IL-7R⍺low aging but not the putative AD genes, and 2 inflammatory control genes in peripheral blood of cognitively normal persons (CN, 38 subjects) and patients with AD (40 mild cognitive impairment and 43 dementia subjects). The RT-qPCR results showed 8 differentially expressed genes between AD and CN groups; five (62.5%) of which were top IL-7Rαlow aging genes (FGFBP2, GZMH, NUAK1, PRSS23, TGFBR3) not previously reported to be altered in AD. Unbiased clustering analysis revealed 3 clusters of dementia patients with distinct expression levels of the 40 analyzed genes, including IL-7Rαlow aging genes, which were associated with neurocognitive function as determined by MoCA, CDRsob and neuropsychological testing. CONCLUSIONS We report differential expression of "normal" aging genes associated with IL-7Rαlow EM CD8+ T cells in peripheral blood of patients with AD, and the significance of such gene expression in clustering subjects with dementia due to AD into groups with different levels of cognitive functioning. These results provide a platform for studies investigating the possible implications of age-related immune changes, including those associated with CD8+ T cells, in AD.
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Affiliation(s)
- Juan Joseph Young
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
| | - Hong-Jai Park
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
| | - Minhyung Kim
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennefer Par-Young
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
| | - Hugh Bartlett
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Hye Sun Kim
- Yale School of Public Health, New Haven, CT, USA
| | - Serhan Unlu
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
- Cleveland Clinic Fairview Hospital, Cleveland, OH, USA
| | - Lais Osmani
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
| | - Min Sun Shin
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
| | - Richard Bucala
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
| | - Christopher H van Dyck
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
| | - Heather Allore
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Adam P Mecca
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA
| | - Sungyong You
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Insoo Kang
- Department of Psychiatry, Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06520, USA.
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Young J, Park HJ, Kim M, Par-Young J, Bartlett H, Kim HS, Unlu S, Osmani L, Shin MS, Bucala R, van Dyck C, Allore H, Mecca A, You S, Kang I. Aging gene signature of IL-7 receptor alpha low effector memory CD8 + T cells is associated with neurocognitive functioning in Alzheimer's disease. Res Sq 2023:rs.3.rs-2736771. [PMID: 37066364 PMCID: PMC10104241 DOI: 10.21203/rs.3.rs-2736771/v1] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
CD45RA+ effector memory (EM) CD8+ T cell expansion was reported in Alzheimer's disease (AD). Such cells are IL-7 receptor alpha (IL-7Rα)low EM CD8+ T cells, which expand with age and have a unique aging gene signature (i.e., IL-7Rαlow aging genes). Here we investigated whether IL-7Rαlow aging genes and previously reported AD and memory (ADM) genes overlapped with clinical significance in AD patients. RT-qPCR analysis of 40 genes, including 29 ADM, 9 top IL-7Ralow aging and 2 control genes, showed 8 differentially expressed genes between AD and cognitively normal groups; five (62.5%) of which were top IL-7Rαlow aging genes. Over-representation analysis revealed that these genes were highly present in molecular and biological pathways associated with AD. Distinct expression levels of these genes were associated with neuropsychological testing performance in 3 subgroups of dementia participants. Our findings support the possible implication of the IL-7Rαlow aging gene signature with AD.
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Shin JJ, Fan W, Par-Young J, Piecychna M, Leng L, Israni-Winger K, Qing H, Gu J, Zhao H, Schulz WL, Unlu S, Kuster J, Young G, Liu J, Ko AI, Baeza Garcia A, Sauler M, Wisnewski AV, Young L, Orduña A, Wang A, Klementina O, Garcia AB, Hegyi P, Armstrong ME, Mitchell P, Ordiz DB, Garami A, Kang I, Bucala R. MIF is a common genetic determinant of COVID-19 symptomatic infection and severity. QJM 2023; 116:205-212. [PMID: 36222594 PMCID: PMC9620729 DOI: 10.1093/qjmed/hcac234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Genetic predisposition to coronavirus disease 2019 (COVID-19) may contribute to its morbidity and mortality. Because cytokines play an important role in multiple phases of infection, we examined whether commonly occurring, functional polymorphisms in macrophage migration inhibitory factor (MIF) are associated with COVID-19 infection or disease severity. AIM To determine associations of common functional polymorphisms in MIF with symptomatic COVID-19 or its severity. METHODS This retrospective case-control study utilized 1171 patients with COVID-19 from three tertiary medical centers in the USA, Hungary and Spain, together with a group of 637 pre-pandemic, healthy control subjects. Functional MIF promoter alleles (-794 CATT5-8,rs5844572), serum MIF and soluble MIF receptor levels, and available clinical characteristics were measured and correlated with COVID-19 diagnosis and hospitalization. Experimental mice genetically engineered to express human high- or low-expression MIF alleles were studied for response to coronavirus infection. RESULTS In patients with COVID-19, there was a lower frequency of the high-expression MIF CATT7 allele when compared to healthy controls [11% vs. 19%, odds ratio (OR) 0.54 [0.41-0.72], P < 0.0001]. Among inpatients with COVID-19 (n = 805), there was a higher frequency of the MIF CATT7 allele compared to outpatients (n = 187) (12% vs. 5%, OR 2.87 [1.42-5.78], P = 0.002). Inpatients presented with higher serum MIF levels when compared to outpatients or uninfected healthy controls (87 ng/ml vs. 35 ng/ml vs. 29 ng/ml, P < 0.001, respectively). Among inpatients, circulating MIF concentrations correlated with admission ferritin (r = 0.19, P = 0.01) and maximum CRP (r = 0.16, P = 0.03) levels. Mice with a human high-expression MIF allele showed more severe disease than those with a low-expression MIF allele. CONCLUSIONS In this multinational retrospective study of 1171 subjects with COVID-19, the commonly occurring -794 CATT7MIF allele is associated with reduced susceptibility to symptomatic SARS-CoV-2 infection but increased disease progression as assessed by hospitalization. These findings affirm the importance of the high-expression CATT7MIF allele, which occurs in 19% of the population, in different stages of COVID-19 infection.
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Affiliation(s)
- Junghee J Shin
- Sections of Rheumatology, Allergy and Immunology, New Haven, CT, USA
| | - Wei Fan
- Sections of Rheumatology, Allergy and Immunology, New Haven, CT, USA
| | | | - Marta Piecychna
- Sections of Rheumatology, Allergy and Immunology, New Haven, CT, USA
| | - Lin Leng
- Sections of Rheumatology, Allergy and Immunology, New Haven, CT, USA
| | | | - Hua Qing
- Department of Medicine, Department of Immunobiology, New Haven, CT, USA
| | - Jianlei Gu
- Department of Pathology, New Haven, CT, USA
| | | | - Wade L Schulz
- Department of Medicine, Department of Immunobiology, New Haven, CT, USA
| | - Serhan Unlu
- Sections of Rheumatology, Allergy and Immunology, New Haven, CT, USA
| | - John Kuster
- Sections of Rheumatology, Allergy and Immunology, New Haven, CT, USA
| | | | - Jian Liu
- Department of Pathology, New Haven, CT, USA
| | | | | | - Maor Sauler
- Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA
| | | | | | - Antonio Orduña
- Microbiology Service. Hospital Clínico Universtario. Valladolid. Spain
| | - Andrew Wang
- Sections of Rheumatology, Allergy and Immunology, New Haven, CT, USA
- Department of Medicine, Department of Immunobiology, New Haven, CT, USA
| | - Ocskay Klementina
- Universidad de Valladolid, Valladolid, Spain; University of Pécs, Pécs, Hungary. Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest Hungary
| | - Antonio Blesa Garcia
- Mucosal Immunology Lab. Unidad de Excelencia Instituto de Biología y Genética Molecular (IBGM), Universidad de Valladolid-CSIC. Valladolid. Spain
| | - Peter Hegyi
- Universidad de Valladolid, Valladolid, Spain; University of Pécs, Pécs, Hungary. Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | | | - David Bernardo Ordiz
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Centro de Investigaciones Biomédicas en Red de Enfermedades infecciosas (CIBERinfec). Madrid. Spain
| | - András Garami
- Universidad de Valladolid, Valladolid, Spain; University of Pécs, Pécs, Hungary. Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Insoo Kang
- Sections of Rheumatology, Allergy and Immunology, New Haven, CT, USA
| | - Richard Bucala
- Sections of Rheumatology, Allergy and Immunology, New Haven, CT, USA
- Department of Pathology, New Haven, CT, USA
- Yale Schools of Medicine and Public Health, New Haven, CT, USA
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Fan W, Par-Young J, Li K, Zhang Y, Xiao P, Hua L, Leng L, Chen X, Bucala R. Correction to: Clinical features and high-risk indicators of central nervous system involvement in primary Sjögren's syndrome. Clin Rheumatol 2023; 42:643. [PMID: 36565380 PMCID: PMC9873696 DOI: 10.1007/s10067-022-06488-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Wei Fan
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China.
| | - Jennefer Par-Young
- Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, Yale University School of Medicine, CT, 06520, New Haven, USA
| | - Kaiyan Li
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China
| | - Yi Zhang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China
| | - Pingping Xiao
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China
| | - Li Hua
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China
| | - Lin Leng
- Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, Yale University School of Medicine, CT, 06520, New Haven, USA
| | - Xuyan Chen
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China
| | - Richard Bucala
- Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, Yale University School of Medicine, CT, 06520, New Haven, USA.
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Fan W, Par-Young J, Li K, Zhang Y, Xiao P, Hua L, Leng L, Chen X, Bucala R. Clinical features and high-risk indicators of central nervous system involvement in primary Sjögren's syndrome. Clin Rheumatol 2023; 42:443-451. [PMID: 36401063 PMCID: PMC9873757 DOI: 10.1007/s10067-022-06448-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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Evidence for central nervous system involvement in primary Sjögren's syndrome (pSS) patients is controversial and extremely limited. We aimed to describe the clinical profiles and high-risk indicators of primary Sjögren's syndrome (pSS) patients with central nervous system (CNS) involvement (pSS-CNS). METHODS A total of 412 participants with pSS from a hospital in China from January 2012 to December 2019 were enrolled in the retrospective study. 42 pSS-CNS patients were compared with 370 pSS patients without CNS involvement. The clinical features, laboratory examinations, imaging characteristics, and treatment of the pSS-CNS cases were systematically analyzed. Potential risk factors related to pSS-CNS patients were identified by multivariate logistic regression analysis. RESULTS The prevalence of central nervous system involvement in the studied pSS patients was 10.2% (42/412), with 31.3% (14/42) of pSS patients having neurological manifestations as the initial symptom. The manifestations of hemiparesis (35.7%, 15/42), paraparesis (28.6%, 12/42), dysphonia (31.0%, 13/42), blurred vision (21.4%, 9/42), and dysfunctional proprioception (23.8%, 10/42) were more common in the pSS-CNS patients. Cerebral infarction (57.1%, 24/42), demyelination (31.0%, 13/42), myelitis (23.8%, 11/42), and angiostenosis (21.4%, 9/42) were most often found on MRI or CT scan imaging in the pSS-CNS patients. Intrathecal IgG level and total protein of cerebrospinal fluid were increased in 50% (8/16) of the pSS-CNS group. In comparison with patients without CNS involvement, the pSS-CNS patients were found to also have kidney and lung involvement, hematologic abnormalities, positive ANA and anti-SSA antibody tests, and reduced complement 3 (C3) and complement 4 (C4) levels (all p < 0.05). The prevalence of lung involvement, immune thrombocytopenia, and high-titer ANA (1:1000) were significantly higher in pSS-CNS disease activity compared to those in the moderately active group. Multivariate analysis identified lung involvement, anti-SSA positivity, and low C3 levels as prognostic factors for pSS-CNS. After high-dose glucocorticoids and immunosuppressive therapy, 60.5% (26/38) of pSS-CNS patients improved, 36.8% (14/38) were unresponsive to treatment, and 2.6% (1/38) died. CONCLUSION Clinical features are diverse in pSS-CNS patients, and the morbidity rate is low. CNS involvement was the initial presentation in state percentage here pSS patients. Pulmonary involvement, a positive anti-SSA antibody test, and reduced C3 levels are potential risk factors for CNS involvement in pSS. Treatment with high-dose glucocorticoids and immunosuppressive therapy appeared effective in 60% of pSS-CNS patients. Key Points • The CNS manifestations of pSS are diverse, and CNS imaging and CSF analysis are important for the diagnosis. • Pulmonary involvement, positive anti-SSA, and reduced C3 levels are potential risk factors of pSS-CNS. • About 60% of pSS-CNS patients were responsive to high-dose glucocorticoid administration and immunosuppressive therapy.
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Affiliation(s)
- Wei Fan
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China.
| | - Jennefer Par-Young
- Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Kaiyan Li
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China
| | - Yi Zhang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China
| | - Pingping Xiao
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China
| | - Li Hua
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China
| | - Lin Leng
- Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Xuyan Chen
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, 361021, China
| | - Richard Bucala
- Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, Yale University School of Medicine, New Haven, CT, 06520, USA.
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Ünlü S, Shin JJ, Par-Young J, Simonov M, Vinetz J, Petrylak DP, Kang I, Kim JW. Effect of Androgen-Androgen Receptor Directed Therapy on COVID-19 Outcome in Prostate Cancer Patients. Cancer Invest 2023; 41:77-83. [PMID: 36373994 DOI: 10.1080/07357907.2022.2139839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
TMPRSS2 is utilized by SARS-CoV-2 for cellular entry. Androgen-Androgen receptor directed therapy (A/ARDT) downregulates expression of TMPRSS2. We hypothesized A/ARDT might protect prostate cancer (PCa) patients from poor COVID-19 outcome. A retrospective analysis of PCa patients with COVID-19 infection was performed. 146 PCa cases were identified, 17% were on A/ARDT. Hospitalization rates were same 52% (OR = 0.99, 0.41-2.24). Mean hospitalization was 9.2 (Range: 1-25) and 14.9 (Range: 2-47) days in A/ARDT and non-A/ARDT groups, respectively. While definitive conclusions cannot be made regarding outcome differences between groups due to lack of statistical significance, these data generate hypothesis that A/ARDT might shorten hospitalization stay.
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Affiliation(s)
- Serhan Ünlü
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Junghee Jenny Shin
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jennefer Par-Young
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael Simonov
- Department of Internal Medicine, Clinical and Translational Research Accelerator, Yale University, New Haven, CT, USA
| | - Joseph Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Daniel P Petrylak
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Insoo Kang
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Joseph W Kim
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Shin JJ, Par-Young J, Unlu S, McNamara A, Park HJ, Shin MS, Gee RJ, Doyle H, Afinogenova Y, Zidan E, Kwah J, Russo A, Mamula M, Hsu FI, Catanzaro J, Racke M, Bucala R, Wilen C, Kang I. Defining Clinical and Immunological Predictors of Poor Immune Responses to COVID-19 mRNA Vaccines in Patients with Primary Antibody Deficiency. J Clin Immunol 2022; 42:1137-1150. [PMID: 35713752 PMCID: PMC9203263 DOI: 10.1007/s10875-022-01296-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
Immune responses to coronavirus disease 2019 (COVID-19) mRNA vaccines in primary antibody deficiencies (PADs) are largely unknown. We investigated antibody and CD4+ T-cell responses specific for SARS-CoV-2 spike protein (S) before and after vaccination and associations between vaccine response and patients' clinical and immunological characteristics in PADs. The PAD cohort consisted of common variable immune deficiency (CVID) and other PADs, not meeting the criteria for CVID diagnosis (oPADs). Anti-S IgG, IgA, and IgG subclasses 1 and 3 increased after vaccination and correlated with neutralization activity in HCs and patients with oPADs. However, 42% of CVID patients developed such responses after the 2nd dose. A similar pattern was also observed with S-specific CD4+ T-cells as determined by OX40 and 4-1BB expression. Patients with poor anti-S IgG response had significantly lower levels of baseline IgG, IgA, CD19+ B-cells, switched memory B-cells, naïve CD8+ T-cells, and a higher frequency of EM CD8+ T-cells and autoimmunity compared to patients with adequate anti-S IgG responses. Patients with oPADs can develop humoral and cellular immune responses to vaccines similar to HCs. However, a subset of CVID patients exhibit impairment in developing such responses, which can be predicted by the baseline immune profile and history of autoimmunity.
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Affiliation(s)
- Junghee Jenny Shin
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Jennefer Par-Young
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Serhan Unlu
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Andrew McNamara
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, 06516, USA
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, 06516, USA
| | - Hong-Jai Park
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Min Sun Shin
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Renelle J Gee
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Hester Doyle
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Yuliya Afinogenova
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Elena Zidan
- Department of Internal Medicine, Bridgeport Hospital - Yale New Haven Health, Bridgeport, CT, 06610, USA
| | - Jason Kwah
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Armand Russo
- Section of Hematology and Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, 06520, USA
| | - Mark Mamula
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Florence Ida Hsu
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Jason Catanzaro
- Section of Pulmonary, Allergy, Immunology and Sleep Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, 06520, USA
| | - Michael Racke
- Quest Diagnostics, 500 Plaza Dr, Secaucus, NJ, 07094, USA
| | - Richard Bucala
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA
| | - Craig Wilen
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, 06516, USA
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, 06516, USA
| | - Insoo Kang
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut, 06520, USA.
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Unlu S, Shin JJ, Par-Young J, Vinetz J, Petrylak DP, Kang I, Kim JW. Effect of androgen receptor directed therapy in prostate cancer patients with COVID-19. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
161 Background: TMPRSS2 is one of the two key enzymes that SARS-CoV-2 requires for its entry to the cell. TMPRSS2 is regulated by androgen receptor. It is well described Androgen Receptor Directed Therapy (ARDT) downregulates the expression of TMPRSS2. We hypothesized that the ARDT has a protective role in patients with prostate cancer (PCa) from poor outcome of COVID-19. Methods: A retrospective chart review of PCa patients with COVID-19 between March to October 2020 in the Yale-New Haven Health System was performed. Demographics, comorbidities, home medications, laboratory data, treatment, and clinical outcomes of COVID-19 were collected. ARDT was defined as the use of GnRH agonist, GnRH antagonist, or androgen receptor antagonist. This study was reviewed and approved by the Institutional Review Boards of Yale University. Results: A total of 146 (1.1%) prostate cancer cases were identified from the 13,642 cases of COVID-19. The clinical characteristics are summarized in the table. Twenty-five (17%) were on active ARDT and 121 (83%) not on ARDT (non-ARDT). The rates of hospitalization were the same: 52%, between the ARDT and non-ARDT group. Of those admitted, mean duration of hospitalization were 9.2 days (Range 1-25) and 14.9 days (Range: 2-47) in ARDT and non-ARDT groups, respectively (p=0.14). Rates of hospital stay >30 days were 0% versus 14.3% (9/63) in ARDT and non-ARDT groups, respectively (p=0.15). Intubation rates were 0% versus 11% (7/63) for ARDT and non-ARDT groups, respectively (p=0.21). Mortality rates were 8% and 13.2%, in ARDT and non-ARDT groups, respectively (p=0.47). Conclusions: The prevalence of PCa was infrequent. Despite advanced stage of the cancer in ARDT group, there was a trend toward decreased severity of COVID-19 and mortality rates compared to non-ARDT group. Our data support further investigation on a protective role of hormone therapy in PCa patients with COVID-19.[Table: see text]
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Affiliation(s)
| | | | | | | | | | - Insoo Kang
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Joseph W. Kim
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
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10
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Kuster JK, Unlu S, Makin TA, Par-Young J, Simonov M, Shafi S, Balanda M, Randolph C, Steele R, Hsu FI, Price C, Kohli-Pamnani A, Borish L, Lawrence MG, Kang I, Shin JJ. Low IgG trough and lymphocyte subset counts are associated with hospitalization for COVID-19 in patients with primary antibody deficiency. J Allergy Clin Immunol Pract 2022; 10:633-636.e3. [PMID: 34929372 PMCID: PMC8683251 DOI: 10.1016/j.jaip.2021.11.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 05/27/2023]
Affiliation(s)
- John K Kuster
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Serhan Unlu
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Thomas A Makin
- Division of Asthma, Allergy, & Immunology, Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Jennefer Par-Young
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Michael Simonov
- Clinical and Translational Research Accelerator (CTRA), Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Shamsa Shafi
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Matthew Balanda
- The Center for Allergy, Asthma, & Immunology, Waterbury, Conn
| | | | - Ryan Steele
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Florence Ida Hsu
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Christina Price
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | | | - Larry Borish
- Division of Asthma, Allergy, & Immunology, Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Monica G Lawrence
- Division of Asthma, Allergy, & Immunology, Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Insoo Kang
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Junghee J Shin
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.
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11
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Shin JJ, Jeon S, Unlu S, Par-Young J, Shin MS, Kuster JK, Afinogenova Y, Kang Y, Simonov M, Buller G, Bucala R, Kang I. A distinct association of inflammatory molecules with outcomes of COVID-19 in younger versus older adults. Clin Immunol 2021; 232:108857. [PMID: 34560283 PMCID: PMC8455237 DOI: 10.1016/j.clim.2021.108857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/16/2021] [Accepted: 09/15/2021] [Indexed: 12/19/2022]
Abstract
Aging can alter immunity affecting host defense. COVID-19 has the most devastating clinical outcomes in older adults, raising the implication of immune aging in determining its severity and mortality. We investigated biological predictors for clinical outcomes in a dataset of 13,642 ambulatory and hospitalized adult COVID-19 patients, including younger (age < 65, n = 566) and older (age ≥ 65, n = 717) subjects, with in-depth analyses of inflammatory molecules, cytokines and comorbidities. Disease severity and mortality in younger and older adults were associated with discrete immune mechanisms, including predominant T cell activation in younger adults, as measured by increased soluble IL-2 receptor alpha, and increased IL-10 in older adults although both groups also had shared inflammatory processes, including acute phase reactants, contributing to clinical outcomes. These observations suggest that progression to severe disease and death in COVID-19 may proceed by different immunologic mechanisms in younger versus older subjects and introduce the possibility of age-based immune directed therapies.
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Affiliation(s)
- Junghee J Shin
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Sangchoon Jeon
- Yale University School of Nursing, West Haven, CT 06516, USA
| | - Serhan Unlu
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Jennefer Par-Young
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Min Sun Shin
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - John K Kuster
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Yuliya Afinogenova
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Yumi Kang
- Department of Internal Medicine, Bridgeport Hospital - Yale New Haven Health, Bridgeport, CT 06610, United States of America
| | - Michael Simonov
- Clinical and Translational Research Accelerator (CTRA), Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Gregory Buller
- Department of Internal Medicine, Bridgeport Hospital - Yale New Haven Health, Bridgeport, CT 06610, United States of America
| | - Richard Bucala
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Insoo Kang
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
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