1
|
Liew MY, Mathews JI, Li A, Singh R, Jaramillo SA, Weiss ZF, Bowman K, Ankomah PO, Ghantous F, Lewis GD, Neuringer I, Bitar N, Lipiner T, Dighe AS, Kotton CN, Seaman MS, Lemieux JE, Goldberg MB. Delayed and Attenuated Antibody Responses to Coronavirus Disease 2019 Vaccination With Poor Cross-Variant Neutralization in Solid-Organ Transplant Recipients-A Prospective Longitudinal Study. Open Forum Infect Dis 2023; 10:ofad369. [PMID: 37577118 PMCID: PMC10414143 DOI: 10.1093/ofid/ofad369] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background Therapeutically immunosuppressed transplant recipients exhibit attenuated responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. To elucidate the kinetics and variant cross-protection of vaccine-induced antibodies in this population, we conducted a prospective longitudinal study in heart and lung transplant recipients receiving the SARS-CoV-2 messenger RNA (mRNA) 3-dose vaccination series. Methods We measured longitudinal serum antibody and neutralization responses against the ancestral and major variants of SARS-CoV-2 in SARS-CoV-2-uninfected lung (n = 18) and heart (n = 17) transplant recipients, non-lung-transplanted patients with cystic fibrosis (n = 7), and healthy controls (n = 12) before, during, and after the primary mRNA vaccination series. Results Among healthy controls, strong anti-spike responses arose immediately following vaccination and displayed cross-neutralization against all variants. In contrast, among transplant recipients, after the first 2 vaccine doses, increases in antibody concentrations occurred gradually, and cross-neutralization was completely absent against the Omicron B.1.1.529 variant. However, most (73%) of the transplant recipients had a significant response to the third vaccine dose, reaching levels comparable to those of healthy controls, with improved but attenuated neutralization of immune evasive variants, particularly Beta, Gamma, and Omicron. Responses in non-lung-transplanted patients with cystic fibrosis paralleled those in healthy controls. Conclusions In this prospective, longitudinal analysis of variant-specific antibody responses, lung and heart transplant recipients display delayed and defective responses to the first 2 SARS-CoV-2 vaccine doses but significantly augmented responses to a third dose. Gaps in antibody-mediated immunity among transplant recipients are compounded by decreased neutralization against Omicron variants, leaving many patients with substantially weakened immunity against currently circulating variants.
Collapse
Affiliation(s)
- May Y Liew
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Josh I Mathews
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Li
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rohan Singh
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Salvador A Jaramillo
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zoe F Weiss
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn Bowman
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pierre O Ankomah
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fadi Ghantous
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gregory D Lewis
- Heart Transplant Program, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Isabel Neuringer
- Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Natasha Bitar
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Taryn Lipiner
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anand S Dighe
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Camille N Kotton
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael S Seaman
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob E Lemieux
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Infectious Disease and Microbiome Program, The Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, Massachusetts, USA
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcia B Goldberg
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Infectious Disease and Microbiome Program, The Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, Massachusetts, USA
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Seaman MS, Siedner MJ, Boucau J, Lavine CL, Ghantous F, Liew MY, Mathews JI, Singh A, Marino C, Regan J, Uddin R, Choudhary MC, Flynn JP, Chen G, Stuckwisch AM, Lipiner T, Kittilson A, Melberg M, Gilbert RF, Reynolds Z, Iyer SL, Chamberlin GC, Vyas TD, Vyas JM, Goldberg MB, Luban J, Li JZ, Barczak AK, Lemieux JE. Vaccine breakthrough infection leads to distinct profiles of neutralizing antibody responses by SARS-CoV-2 variant. JCI Insight 2022; 7:e159944. [PMID: 36214224 PMCID: PMC9675445 DOI: 10.1172/jci.insight.159944] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 03/07/2022] [Accepted: 08/26/2022] [Indexed: 08/15/2023] Open
Abstract
Protective immunity against SARS-CoV-2 infection after COVID-19 vaccination may differ by variant. We enrolled vaccinated (n = 39) and unvaccinated (n = 11) individuals with acute, symptomatic SARS-CoV-2 Delta or Omicron infection and performed SARS-CoV-2 viral load quantification, whole-genome sequencing, and variant-specific antibody characterization at the time of acute illness and convalescence. Viral load at the time of infection was inversely correlated with antibody binding and neutralizing antibody responses. Across all variants tested, convalescent neutralization titers in unvaccinated individuals were markedly lower than in vaccinated individuals. Increases in antibody titers and neutralizing activity occurred at convalescence in a variant-specific manner. For example, among individuals infected with the Delta variant, neutralizing antibody responses were weakest against BA.2, whereas infection with Omicron BA.1 variant generated a broader response against all tested variants, including BA.2.
Collapse
Affiliation(s)
- Michael S. Seaman
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Mark J. Siedner
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julie Boucau
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | | | - Fadi Ghantous
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - May Y. Liew
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Arshdeep Singh
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Caitlin Marino
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | - James Regan
- Brigham and Women’s Hospital Boston, Massachusetts, USA
| | - Rockib Uddin
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Geoffrey Chen
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Taryn Lipiner
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | - Zahra Reynolds
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Tammy D. Vyas
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jatin M. Vyas
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Broad Institute, Cambridge, Massachusetts, USA
| | - Marcia B. Goldberg
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeremy Luban
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Broad Institute, Cambridge, Massachusetts, USA
- UMass Med School, Worcester, Massachusetts, USA
| | - Jonathan Z. Li
- Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital Boston, Massachusetts, USA
| | - Amy K. Barczak
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | - Jacob E. Lemieux
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Broad Institute, Cambridge, Massachusetts, USA
| |
Collapse
|
3
|
Boucau J, Marino C, Regan J, Uddin R, Choudhary MC, Flynn JP, Chen G, Stuckwisch AM, Mathews J, Liew MY, Singh A, Lipiner T, Kittilson A, Melberg M, Li Y, Gilbert RF, Reynolds Z, Iyer SL, Chamberlin GC, Vyas TD, Goldberg MB, Vyas JM, Li JZ, Lemieux JE, Siedner MJ, Barczak AK. Duration of Shedding of Culturable Virus in SARS-CoV-2 Omicron (BA.1) Infection. N Engl J Med 2022; 387:275-277. [PMID: 35767428 PMCID: PMC9258747 DOI: 10.1056/nejmc2202092] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - May Y Liew
- Massachusetts General Hospital, Boston, MA
| | | | | | | | | | - Yijia Li
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Seaman MS, Siedner MJ, Boucau J, Lavine CL, Ghantous F, Liew MY, Mathews J, Singh A, Marino C, Regan J, Uddin R, Choudhary MC, Flynn JP, Chen G, Stuckwisch AM, Lipiner T, Kittilson A, Melberg M, Gilbert RF, Reynolds Z, Iyer SL, Chamberlin GC, Vyas TD, Vyas JM, Goldberg MB, Luban J, Li JZ, Barczak AK, Lemieux JE. Vaccine Breakthrough Infection with the SARS-CoV-2 Delta or Omicron (BA.1) Variant Leads to Distinct Profiles of Neutralizing Antibody Responses. medRxiv 2022:2022.03.02.22271731. [PMID: 35262094 PMCID: PMC8902886 DOI: 10.1101/2022.03.02.22271731] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 12/23/2022]
Abstract
There is increasing evidence that the risk of SARS-CoV-2 infection among vaccinated individuals is variant-specific, suggesting that protective immunity against SARS-CoV-2 may differ by variant. We enrolled vaccinated (n = 39) and unvaccinated (n = 11) individuals with acute, symptomatic SARS-CoV-2 Delta or Omicron infection and performed SARS-CoV-2 viral load quantification, whole-genome sequencing, and variant-specific antibody characterization at the time of acute illness and convalescence. Viral load at the time of infection was inversely correlated with antibody binding and neutralizing antibody responses. Increases in antibody titers and neutralizing activity occurred at convalescence in a variant-specific manner. Across all variants tested, convalescent neutralization titers in unvaccinated individuals were markedly lower than in vaccinated individuals. For individuals infected with the Delta variant, neutralizing antibody responses were weakest against BA.2, whereas infection with Omicron BA.1 variant generated a broader response against all tested variants, including BA.2.
Collapse
Affiliation(s)
- Michael S Seaman
- Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Mark J Siedner
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA
| | - Julie Boucau
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA
| | | | | | - May Y Liew
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Caitlin Marino
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - James Regan
- Brigham and Women's Hospital Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jatin M Vyas
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA
| | - Marcia B Goldberg
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA
| | - Jeremy Luban
- UMass Med School, Worcester, MA, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
- Broad Institute, Cambridge, MA, USA
| | | | - Amy K Barczak
- Massachusetts General Hospital, Boston, MA, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Jacob E Lemieux
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
| |
Collapse
|
5
|
Boucau J, Marino C, Regan J, Uddin R, Choudhary MC, Flynn JP, Chen G, Stuckwisch AM, Mathews J, Liew MY, Singh A, Lipiner T, Kittilson A, Melberg M, Li Y, Gilbert RF, Reynolds Z, Iyer SL, Chamberlin GC, Vyas TD, Goldberg MB, Vyas JM, Li JZ, Lemieux JE, Siedner MJ, Barczak AK. Duration of viable virus shedding in SARS-CoV-2 omicron variant infection. medRxiv 2022:2022.03.01.22271582. [PMID: 35262089 PMCID: PMC8902872 DOI: 10.1101/2022.03.01.22271582] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Clinical features of SARS-CoV-2 Omicron variant infection, including incubation period and transmission rates, distinguish this variant from preceding variants. However, whether the duration of shedding of viable virus differs between omicron and previous variants is not well understood. To characterize how variant and vaccination status impact shedding of viable virus, we serially sampled symptomatic outpatients newly diagnosed with COVID-19. Anterior nasal swabs were tested for viral load, sequencing, and viral culture. Time to PCR conversion was similar between individuals infected with the Delta and the Omicron variant. Time to culture conversion was also similar, with a median time to culture conversion of 6 days (interquartile range 4-8 days) in both groups. There were also no differences in time to PCR or culture conversion by vaccination status.
Collapse
Affiliation(s)
- Julie Boucau
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Caitlin Marino
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - James Regan
- Brigham and Women’s Hospital Boston, MA, USA
| | | | - Manish C. Choudhary
- Brigham and Women’s Hospital Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - May Y. Liew
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | - Yijia Li
- Brigham and Women’s Hospital Boston, MA, USA
| | | | | | | | | | | | - Marcia B. Goldberg
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jatin M. Vyas
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jonathan Z. Li
- Brigham and Women’s Hospital Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jacob E. Lemieux
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
| | - Mark J. Siedner
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Amy K. Barczak
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Communicating author:
| |
Collapse
|
6
|
Lemieux JE, Li A, Gentili M, Perugino CA, Weiss ZF, Bowman K, Ankomah P, Liu H, Lewis GD, Bitar N, Lipiner T, Hacohen N, Pillai SS, Goldberg MB. Vaccine serologic responses among transplant patients associate with COVID-19 infection and T peripheral helper cells. medRxiv 2021. [PMID: 34282426 DOI: 10.1101/2021.07.11.21260338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Therapeutically immunosuppressed transplant recipients exhibit attenuated responses to COVID-19 vaccines. To better understand the immune alterations that determined poor vaccine response, we correlated quantities of circulating T and B cell subsets at baseline with longitudinal serologic responses to SARS-CoV-2 mRNA vaccination in heart and lung transplant recipients. Methods Samples at baseline and at approximately 8 and 30 days after each vaccine dose for 22 heart and lung transplant recipients with no history of COVID-19, four heart and lung transplant recipients with prior COVID-19 infection, and 12 healthy controls undergoing vaccination were analyzed. Anti-spike protein receptor binding domain (RBD) IgG and pseudovirus neutralization activity were measured. Proportions of B and T cell subsets at baseline were comprehensively quantitated. Results At 8-30 days post vaccination, healthy controls displayed robust anti-RBD IgG responses, whereas heart and lung transplant recipients showed minimally increased responses. A parallel absence of activity was observed in pseudovirus neutralization. In contrast, three of four (75%) transplant recipients with prior COVID-19 infection displayed robust responses at levels comparable to controls. Baseline levels of activated PD-1 + HLA-DR + CXCR5 - CD4 + T cells (also known as T peripheral helper [T PH ] cells) and CD4+ T cells strongly predicted the ability to mount a response. Conclusions Immunosuppressed patients have defective vaccine responses but can be induced to generate neutralizing antibodies after SARS-CoV-2 infection. Strong correlations of vaccine responsiveness with baseline T PH and CD4 + T cell numbers highlights a role for T helper activity in B cell differentiation into antibody secreting cells during vaccine response.
Collapse
|