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Thompson EA, Ngecu W, Stoddart L, Johnston TS, Chang A, Cascino K, Alejo JL, Abedon AT, Samaha H, Rouphael N, Tobian AA, Segev DL, Werbel WA, Karaba AH, Blankson JN, Cox AL. Heterologous versus homologous boosting regimens elicit qualitatively distinct, BA.5-cross reactive T cells in transplant recipients. JCI Insight 2023; 8:168470. [PMID: 37104041 DOI: 10.1172/jci.insight.168470] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND The Omicron BA.5 subvariant of SARS-CoV-2 markedly escapes neutralizing antibodies induced by vaccination due to mutations in the Spike (S) protein. Solid organ transplant recipients (SOTRs) suffer high COVID-19 morbidity and demonstrate poor Omicron strain recognition after COVID-19 vaccination. T cell responses may provide a crucial second line of defense. Therefore, it is critical to understand which vaccine regimens induce robust, conserved T cell responses. METHODS We evaluated anti-S IgG titers, subvariant pseudo-neutralization, and S-specific CD4+ and CD8+ T cell responses from SOTRs in a national, prospective observational trial (n=75). Participants were selected if they received 3 doses of mRNA (homologous boosting) or two doses of mRNA followed by Ad26.COV2.S (heterologous boosting). RESULTS Homologous boosting with three mRNA doses induced the highest anti-S IgG titers. However, antibodies induced by both vaccine regimens demonstrated significantly lower pseudo-neutralization against BA.5 compared to the ancestral strain. In contrast, vaccine-induced S-specific T cells maintained cross-reactivity against BA.5 compared to ancestral recognition. Homologous boosting induced higher frequencies of activated polyfunctional CD4+ T cell responses, with polyfunctional IL-21+ peripheral T follicular helper cells increased in mRNA-1273 compared to BNT¬¬162b2. IL-21+ cells robustly correlated with antibody titers. Heterologous boosting with Ad26.COV2.S did not increase CD8+ responses compared to homologous boosting. CONCLUSIONS These data demonstrate that boosting with the ancestral strain can induce cross-reactive T cell responses against emerging variants of concern in SOTRs, but alterative vaccine strategies are required to induce robust CD8+ T cell responses. TRIAL REGISTRATION IRB00248540FUNDING. U01AI138897, U54CA260492, Emory COVID-19 research repository.
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Affiliation(s)
- Elizabeth A Thompson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Wabathi Ngecu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Laila Stoddart
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - T Scott Johnston
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Amy Chang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Katherine Cascino
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Aura T Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Hady Samaha
- Hope Clinic, Infectious Diseases Division, Emory University, Decatur, United States of America
| | - Nadine Rouphael
- Hope Clinic, Infectious Diseases Division, Emory Unviversity, Decatur, United States of America
| | - Aaron Ar Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Dorry L Segev
- Department of Surgery, NYU Grossman School of Medicine, New York, United States of America
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Andrew H Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Joel N Blankson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
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