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Lavell AHA, Schramade AE, Sikkens JJ, van der Straten K, van Dort KA, Slim MA, Appelman B, van Vught LA, Vlaar APJ, Kootstra NA, van Gils MJ, Smulders YM, de Jongh RT, Bomers MK. 25-Hydroxyvitamin D concentrations do not affect the humoral or cellular immune response following SARS-CoV-2 mRNA vaccinations. Vaccine 2024; 42:1478-1486. [PMID: 37775466 DOI: 10.1016/j.vaccine.2023.08.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND To improve effectiveness of vaccination against SARS-CoV-2, it is important to identify factors that influence the immune response induced by vaccination. Evidence for the role of vitamin D in immune response against SARS-CoV-2 is contradictory. It is therefore of interest whether 25-hydroxyvitamin D (25[OH]D) concentrations affect the humoral and/or cellular response following SARS-CoV-2 vaccination. METHODS In this prospective cohort study, blood samples were collected from 98 SARS-CoV-2 naive health care workers (HCW) receiving the first two doses of either BNT162b2 or mRNA-1273 in 2021. Wild-type spike (S) protein binding and neutralizing antibodies were determined approximately three weeks after the first dose and four to five weeks after the second dose. Antigen specific T-cells and functionality (proliferative response and interferon gamma [IFN-γ] release) were determined in 18 participants four weeks after the second dose of BNT162b2. We studied the association between 25(OH)D concentrations, which were determined prior to vaccination, and humoral and cellular immune responses following vaccination. RESULTS We found no association between 25(OH)D concentrations (median 55.9 nmol/L [IQR 40.5-69.8]) and binding or neutralizing antibody titers after complete vaccination (fold change of antibody titers per 10 nmol/L 25(OH)D increase: 0.98 [95% CI 0.93-1.04] and 1.03 [95% CI: 0.96-1.11], respectively), adjusted for age, sex and type of mRNA vaccine. Subsequently, continuous 25(OH)D concentrations were divided into commonly used clinical categories (<25 nmol/L [n = 6, 6%], 25-49 nmol/L [n = 33, 34%], 50-75 nmol/L [n = 37, 38%] and ≥75 nmol/L [n = 22, 22%]), but no association with the humoral immune response following vaccination was found. Also, 25(OH)D concentrations were not associated with the SARS-CoV-2 specific T cell response. CONCLUSION No association was found between 25(OH)D concentrations and the humoral or cellular immune response following mRNA vaccination against SARS-CoV-2. Based on our findings there is no rationale to advise vitamin D optimization preceding SARS-CoV-2 vaccination in HCW with moderate vitamin D status.
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Affiliation(s)
- A H A Lavell
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - A E Schramade
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - J J Sikkens
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - K van der Straten
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Internal Medicine, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - K A van Dort
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Experimental Immunology, 1105 AZ, the Netherlands
| | - M A Slim
- Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - B Appelman
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - L A van Vught
- Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - A P J Vlaar
- Amsterdam UMC Location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - N A Kootstra
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Experimental Immunology, 1105 AZ, the Netherlands
| | - M J van Gils
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Y M Smulders
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - R T de Jongh
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, the Netherlands
| | - M K Bomers
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands.
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Zilver SJM, de Groot CJM, Grobben M, Remmelzwaal S, Burgers E, Nunez Velasco D, Juncker HG, van Keulen BJ, van Goudoever JB, de Leeuw RA, van Gils MJ, Ris-Stalpers C, van Leeuwen E. Vaccination from the early second trimester onwards gives a robust SARS-CoV-2 antibody response throughout pregnancy and provides antibodies for the neonate. Int J Infect Dis 2023; 130:126-135. [PMID: 36868302 PMCID: PMC9977072 DOI: 10.1016/j.ijid.2023.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 10/01/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES Preventative measures against Coronavirus Disease 2019 (COVID-19) are essential for pregnant women; they are particularly vulnerable to emerging infectious pathogens due to alterations in their physiology. We aimed to determine the optimum timing of vaccination to protect pregnant women and their neonates from COVID-19. METHODS A prospective observational longitudinal cohort study in pregnant women who received COVID-19 vaccination. We collected blood samples to evaluate levels of anti-spike, receptor binding domain (RBD) and nucleocapsid antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before vaccination, and 15 days after first and second vaccination. We determined neutralizing antibodies from mother-infant dyads in maternal and umbilical cord blood at birth. If available, IgA was measured in human milk. RESULTS We included 178 pregnant women. Median anti-spike IgG levels increased significantly from 1.8 to 5431 binding antibody units/milliliter (BAU/mL) and RBD from 6 to 4466 BAU/mL. Virus neutralization showed similar results between different weeks' gestations at vaccination (p > 0.3). CONCLUSIONS We advise vaccination in the early second trimester of pregnancy for the optimum balance between maternal antibody response and placental antibody transfer to the neonate.
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Affiliation(s)
- S J M Zilver
- Amsterdam UMC location Vrije Universiteit Amsterdam, department of obstetrics and gynecology, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands.
| | - C J M de Groot
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, department of obstetrics and gynecology, Meibergdreef 9, Amsterdam, the Netherlands
| | - M Grobben
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; Amsterdam Institute for Infection and Immunity, Infectious diseases, Amsterdam, The Netherlands
| | - S Remmelzwaal
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, Netherlands
| | - E Burgers
- Amsterdam UMC location Vrije Universiteit Amsterdam, department of obstetrics and gynecology, Boelelaan 1117, Amsterdam, the Netherlands
| | - D Nunez Velasco
- Amsterdam UMC location University of Amsterdam, department of obstetrics and gynecology, Meibergdreef 9, Amsterdam, the Netherlands
| | - H G Juncker
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit, University of Amsterdam, department of pediatrics, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - B J van Keulen
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit, University of Amsterdam, department of pediatrics, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - J B van Goudoever
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit, University of Amsterdam, department of pediatrics, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - R A de Leeuw
- Amsterdam UMC location University of Amsterdam, department of obstetrics and gynecology, Meibergdreef 9, Amsterdam, the Netherlands
| | - M J van Gils
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; Amsterdam Institute for Infection and Immunity, Infectious diseases, Amsterdam, The Netherlands
| | - C Ris-Stalpers
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, department of obstetrics and gynecology, Meibergdreef 9, Amsterdam, the Netherlands
| | - E van Leeuwen
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, department of obstetrics and gynecology, Meibergdreef 9, Amsterdam, the Netherlands
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Maisonnasse P, Aldon Y, Marc A, Marlin R, Dereuddre-Bosquet N, Kuzmina NA, Freyn AW, Snitselaar JL, Gonçalves A, Caniels TG, Burger JA, Poniman M, Chesnais V, Diry S, Iershov A, Ronk AJ, Jangra S, Rathnasinghe R, Brouwer P, Bijl T, van Schooten J, Brinkkemper M, Liu H, Yuan M, Mire CE, van Breemen MJ, Contreras V, Naninck T, Lemaître J, Kahlaoui N, Relouzat F, Chapon C, Ho Tsong Fang R, McDanal C, Osei-Twum M, St-Amant N, Gagnon L, Montefiori DC, Wilson IA, Ginoux E, de Bree GJ, García-Sastre A, Schotsaert M, Coughlan L, Bukreyev A, van der Werf S, Guedj J, Sanders RW, van Gils MJ, Le Grand R. COVA1-18 neutralizing antibody protects against SARS-CoV-2 in three preclinical models. Res Sq 2021:rs.3.rs-235272. [PMID: 33619476 PMCID: PMC7899470 DOI: 10.21203/rs.3.rs-235272/v1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
One year into the Coronavirus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), effective treatments are still needed 1-3 . Monoclonal antibodies, given alone or as part of a therapeutic cocktail, have shown promising results in patients, raising the hope that they could play an important role in preventing clinical deterioration in severely ill or in exposed, high risk individuals 4-6 . Here, we evaluated the prophylactic and therapeutic effect of COVA1-18 in vivo , a neutralizing antibody isolated from a convalescent patient 7 and highly potent against the B.1.1.7. isolate 8,9 . In both prophylactic and therapeutic settings, SARS-CoV-2 remained undetectable in the lungs of COVA1-18 treated hACE2 mice. Therapeutic treatment also caused a dramatic reduction in viral loads in the lungs of Syrian hamsters. When administered at 10 mg kg - 1 one day prior to a high dose SARS-CoV-2 challenge in cynomolgus macaques, COVA1-18 had a very strong antiviral activity in the upper respiratory compartments with an estimated reduction in viral infectivity of more than 95%, and prevented lymphopenia and extensive lung lesions. Modelling and experimental findings demonstrate that COVA1-18 has a strong antiviral activity in three different preclinical models and could be a valuable candidate for further clinical evaluation.
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Affiliation(s)
- P Maisonnasse
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, Paris, France
| | - Y Aldon
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - A Marc
- Université de Paris, INSERM, IAME, F-75018 Paris, France
| | - R Marlin
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, Paris, France
| | - N Dereuddre-Bosquet
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, Paris, France
| | - N A Kuzmina
- Department of Pathology, University of Texas Medical Branch at Galveston, Texas, USA
- Galveston National Laboratory, Texas, USA
| | - A W Freyn
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York (NY), USA
| | - J L Snitselaar
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - A Gonçalves
- Université de Paris, INSERM, IAME, F-75018 Paris, France
| | - T G Caniels
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - J A Burger
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - M Poniman
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - V Chesnais
- Life and Soft, 92350 Le Plessis-Robinson, France
| | - S Diry
- Life and Soft, 92350 Le Plessis-Robinson, France
| | - A Iershov
- Life and Soft, 92350 Le Plessis-Robinson, France
| | - A J Ronk
- Department of Pathology, University of Texas Medical Branch at Galveston, Texas, USA
- Galveston National Laboratory, Texas, USA
| | - S Jangra
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York (NY), USA
| | - R Rathnasinghe
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York (NY), USA
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York (NY), USA
| | - Pjm Brouwer
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - Tpl Bijl
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - J van Schooten
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - M Brinkkemper
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - H Liu
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - M Yuan
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - C E Mire
- Galveston National Laboratory, Texas, USA
- Department of Microbiology, University of Texas Medical Branch at Galveston, Texas, USA
| | - M J van Breemen
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - V Contreras
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, Paris, France
| | - T Naninck
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, Paris, France
| | - J Lemaître
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, Paris, France
| | - N Kahlaoui
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, Paris, France
| | - F Relouzat
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, Paris, France
| | - C Chapon
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, Paris, France
| | - R Ho Tsong Fang
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, Paris, France
| | - C McDanal
- Duke Human Vaccine Institute & Department of Surgery, Durham, NC 27710, USA
| | | | | | | | - D C Montefiori
- Duke Human Vaccine Institute & Department of Surgery, Durham, NC 27710, USA
| | - I A Wilson
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - E Ginoux
- Life and Soft, 92350 Le Plessis-Robinson, France
| | - G J de Bree
- Internal Medicine of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - A García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York (NY), USA
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York (NY), USA
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York (NY), USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York (NY), USA
| | - M Schotsaert
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York (NY), USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York (NY), USA
| | - L Coughlan
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York (NY), USA
- University of Maryland School of Medicine, Department of Microbiology and Immunology and Center for Vaccine Development and Global Health (CVD), 685 W. Baltimore Street, HSF1, Office #380E, Baltimore, MD 21201
| | - A Bukreyev
- Department of Pathology, University of Texas Medical Branch at Galveston, Texas, USA
- Galveston National Laboratory, Texas, USA
- Department of Microbiology, University of Texas Medical Branch at Galveston, Texas, USA
| | - S van der Werf
- Molecular Genetics of RNA Viruses, Department of Virology, Institut Pasteur, CNRS UMR 3569, Université de Paris, Paris, France
- National Reference Center for Respiratory Viruses, Institut Pasteur, Paris, France
| | - J Guedj
- Université de Paris, INSERM, IAME, F-75018 Paris, France
| | - R W Sanders
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
- Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10021, USA
| | - M J van Gils
- Departments of Medical Microbiology of the Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, 1105 AZ, Amsterdam, The Netherlands
| | - R Le Grand
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, Paris, France
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