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Noonan E, Straesser MD, Makin T, Williams A, Al-Hazaymeh A, Routes JM, Verbsky J, Borish L, Lawrence MG. Impaired Response to Polysaccharide Vaccine in Selective IgE Deficiency. J Clin Immunol 2023; 43:1448-1454. [PMID: 37169968 DOI: 10.1007/s10875-023-01501-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Immunoglobulin E deficiency (IgED) (defined as IgE < 2 IU/mL) is enriched in patients with primary antibody deficiency (PAD). We hypothesized that selective IgED (sIgED) is a more sensitive predictor of the development of PAD than declining IgG, as IgE production typically requires two class switch recombination (CSR) events in contrast to IgG. Thus, the inability of patients with sIgED to mount an appropriate antibody response to a T-cell independent antigen or evidence of aberrant induction of ɛ germ line (ɛGL) or IgE heavy chain (IgEHC) transcripts in vitro would support the concept that sIgED is a biomarker for emerging PAD. METHODS We compared pre- and post-polysaccharide vaccination titers in healthy patients with sIgED without a history of recurrent infections or autoimmunity (n = 20) and in healthy controls (HCs) (n = 17). Subsequently, we assessed in vitro induction of εGL and IgEHC transcripts in patients with sIgED and HC (n = 6) in response to IL-4 + CD40L stimulation. RESULTS Thirty percent of patients with sIgED did not have a robust vaccine response compared to 0% of HCs (p = 0.017). Individuals with sIgED with an abnormal vaccine response demonstrated persistent germline mRNA expression in their B-cells at day 5, with lower levels of IgEHC, compared to both HCs and sIgED participants with a normal vaccine response. CONCLUSION Patients with sIgED are more likely to have abnormal antibody responses to a T cell-independent antigen and may have dysregulated CSR machinery. Following individuals with sIgED longitudinally may be beneficial in the early identification of PAD.
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Affiliation(s)
- Emily Noonan
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Matthew D Straesser
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Central Pennsylvania Asthma and Allergy Care, Holliday, PA, USA
| | - Thomas Makin
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Abigail Williams
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Amani Al-Hazaymeh
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - John M Routes
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James Verbsky
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Larry Borish
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Department of Microbiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Monica G Lawrence
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
- School of Medicine, University of Virginia, Box 801355, Charlottesville, VA, 22903, USA.
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Keshavarz B, Wiencek JR, Workman LJ, Straesser MD, Muehling LM, Canderan G, Drago F, Bonham CA, Sturek JM, Ramani C, McNamara CA, Woodfolk JA, Kadl A, Platts-Mills TA, Wilson JM. Quantitative Measurement of IgG to Severe Acute Respiratory Syndrome Coronavirus-2 Proteins Using ImmunoCAP. Int Arch Allergy Immunol 2021; 182:417-424. [PMID: 33621972 PMCID: PMC8018212 DOI: 10.1159/000514203] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Detailed understanding of the immune response to severe acute respiratory syndrome coronavirus (SARS-CoV)-2, the cause of coronavirus disease 2019 (CO-VID-19) has been hampered by a lack of quantitative antibody assays. OBJECTIVE The objective was to develop a quantitative assay for IgG to SARS-CoV-2 proteins that could be implemented in clinical and research laboratories. METHODS The biotin-streptavidin technique was used to conjugate SARS-CoV-2 spike receptor-binding domain (RBD) or nucleocapsid protein to the solid phase of the ImmunoCAP. Plasma and serum samples from patients hospitalized with COVID-19 (n = 60) and samples from donors banked before the emergence of COVID-19 (n = 109) were used in the assay. SARS-CoV-2 IgG levels were followed longitudinally in a subset of samples and were related to total IgG and IgG to reference antigens using an ImmunoCAP 250 platform. RESULTS At a cutoff of 2.5 μg/mL, the assay demonstrated sensitivity and specificity exceeding 95% for IgG to both SARS-CoV-2 proteins. Among 36 patients evaluated in a post-hospital follow-up clinic, median levels of IgG to spike-RBD and nucleocapsid were 34.7 μg/mL (IQR 18-52) and 24.5 μg/mL (IQR 9-59), respectively. Among 17 patients with longitudinal samples, there was a wide variation in the magnitude of IgG responses, but generally the response to spike-RBD and to nucleocapsid occurred in parallel, with peak levels approaching 100 μg/mL, or 1% of total IgG. CONCLUSIONS We have described a quantitative assay to measure IgG to SARS-CoV-2 that could be used in clinical and research laboratories and implemented at scale. The assay can easily be adapted to measure IgG to mutated COVID-19 proteins, has good performance characteristics, and has a readout in standardized units.
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Affiliation(s)
- Behnam Keshavarz
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Joesph R. Wiencek
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - Lisa J. Workman
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew D. Straesser
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Lyndsey M. Muehling
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Glenda Canderan
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Fabrizio Drago
- Division of Cardiovascular Medicine and the Robert M. Berne Cardiovascular Center, University of Virginia, Charlottesville, Virginia, USA
| | - Catherine A. Bonham
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jeffrey M. Sturek
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Chintan Ramani
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Coleen A. McNamara
- Division of Cardiovascular Medicine and the Robert M. Berne Cardiovascular Center, University of Virginia, Charlottesville, Virginia, USA
| | - Judith A. Woodfolk
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Alexandra Kadl
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Department of Pharmacology, University of Virginia, Charlottesville, Virginia, USA
| | - Thomas A.E. Platts-Mills
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jeffrey M. Wilson
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Keshavarz B, Wiencek JR, Workman LJ, Straesser MD, Muehling LM, Canderan G, Drago F, Bonham CA, Sturek JM, Ramani C, McNamara CA, Woodfolk JA, Kadl A, Platts-Mills TAE, Wilson JM. Quantitative measurement of IgG to SARS-CoV-2 proteins using ImmunoCAP. medRxiv 2020. [PMID: 33200147 DOI: 10.1101/2020.11.09.20228411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Detailed understanding of the immune response to SARS-CoV-2, the cause of coronavirus disease 2019 (COVID-19), has been hampered by a lack of quantitative antibody assays. Objective To develop a quantitative assay for IgG to SARS-CoV-2 proteins that could readily be implemented in clinical and research laboratories. Methods The biotin-streptavidin technique was used to conjugate SARS-CoV-2 spike receptor-binding-domain (RBD) or nucleocapsid protein to the solid-phase of the ImmunoCAP resin. Plasma and serum samples from patients with COVID-19 (n=51) and samples from donors banked prior to the emergence of COVID-19 (n=109) were used in the assay. SARS-CoV-2 IgG levels were followed longitudinally in a subset of samples and were related to total IgG and IgG to reference antigens using an ImmunoCAP 250 platform. Results Performance characteristics demonstrated 100% sensitivity and 99% specificity at a cut-off level of 2.5 µg/mL for both SARS-CoV-2 proteins. Among 36 patients evaluated in a post-hospital follow-up clinic, median levels of IgG to spike-RBD and nucleocapsid were 34.7 µg/mL (IQR 18-52) and 24.5 µg/mL (IQR 9-59), respectively. Among 17 patients with longitudinal samples there was a wide variation in the magnitude of IgG responses, but generally the response to spike-RBD and to nucleocapsid occurred in parallel, with peak levels approaching 100 µg/mL, or 1% of total IgG. Conclusions We have described a quantitative assay to measure IgG to SARS-CoV-2 that could be used in clinical and research laboratories and implemented at scale. The assay can easily be adapted to measure IgG to novel antigens, has good performance characteristics and a read-out in standardized units.
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Straesser MD, Oliver E, Palacios T, Kyin T, Patrie J, Borish L, Saini SS, Lawrence MG. Serum IgE as an immunological marker to predict response to omalizumab treatment in symptomatic chronic urticaria. J Allergy Clin Immunol Pract 2017; 6:1386-1388.e1. [PMID: 29175369 DOI: 10.1016/j.jaip.2017.10.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/20/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Matthew D Straesser
- Division of Allergy and Clinical Immunology, University of Virginia Health System, Charlottesville, Va
| | - Eric Oliver
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Thamiris Palacios
- Division of Allergy and Clinical Immunology, University of Virginia Health System, Charlottesville, Va
| | - Timothy Kyin
- Division of Allergy and Clinical Immunology, University of Virginia Health System, Charlottesville, Va
| | - James Patrie
- Division of Public Health Sciences, University of Virginia, Charlottesville, Va
| | - Larry Borish
- Division of Allergy and Clinical Immunology, University of Virginia Health System, Charlottesville, Va; Division of Microbiology, University of Virginia Health System, Charlottesville, Va
| | - Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Monica G Lawrence
- Division of Allergy and Clinical Immunology, University of Virginia Health System, Charlottesville, Va.
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