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Eerike M, Parimi VP, D.M., Pyati A, Sundaramurthy R, Sakthivadivel V, Pidugu AB, Pharm.D., Surapareddy B, Ramineni NT, Priyadarshini R, Patil PP. Clinical and immunological responses to COVID-19 vaccination in rheumatoid arthritis patients on disease modifying antirheumatic drugs: a cross-sectional study. J Rheum Dis 2024; 31:15-24. [PMID: 38130958 PMCID: PMC10730806 DOI: 10.4078/jrd.2023.0054] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 12/23/2023]
Abstract
Objective This study was conducted to investigate the immunological and clinical response to COVID-19 vaccination in rheumatoid arthritis (RA) patients receiving disease modifying antirheumatic drugs (DMARDs). Methods A cross-sectional study was conducted among RA patients who received two doses of COVID-19 vaccine within 6 months to one year. Demographic information, comorbidities, vaccination details, and past COVID-19 infection details were collected. Hemoglobin (Hb), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) levels were estimated. Disease Activity Score-28 (DAS-28) was calculated for RA patients. Anti-spike antibody (ASA) concentrations were measured, and compared with a healthy control population. Correlations of ASA with age, sex, disease parameters, medication use, and comorbidities were assessed. Results A total of 103 RA patients and 185 controls were included in the study. RA patients had higher mean age, lower mean Hb, higher ESR, and elevated IL-6 levels. Both groups showed positive results for anti-spike antibodies, with a higher percentage in controls. Among RA patients majority had low DAS-28 score. The number of DMARDs used showed a negative correlation with antibody levels. There was a slight positive correlation between ASA concentration and DAS-28 score. Comorbidities did not significantly influence antibody concentration. No significant differences were found in antibody levels based on the type of COVID-19 vaccine or previous COVID-19 infection or booster dose vaccination among RA patients. Conclusion The study revealed that RA patients showed a reduced antibody response following COVID-19 vaccination compared to the control group and potentially influenced by immunosuppressive treatments and disease-related factors.
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Affiliation(s)
- Madhavi Eerike
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Vijaya Prasanna Parimi
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - D.M.
- Department of Rheumatology, ESIC Medical College, Sanathnagar, Hyderabad, India
| | - Anand Pyati
- Departments of Biochemistry, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Raja Sundaramurthy
- Departments of Microbiology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | | | | | - Pharm.D.
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Bhavana Surapareddy
- Department of Rheumatology, ESIC Medical College, Sanathnagar, Hyderabad, India
| | | | - Rekha Priyadarshini
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Parag Parshuram Patil
- Departments of Pathology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
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Goto T, Chong Y, Tani N, Susai N, Yoshinaga T, Sasaki T, Taniguchi M, Kusakabe T, Shimono N, Akashi K, Ikematsu H. Distinct features of SARS-CoV-2 humoral immunity against Omicron breakthrough infection. Vaccine 2023; 41:7019-7025. [PMID: 37858449 DOI: 10.1016/j.vaccine.2023.10.035] [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: 08/04/2023] [Revised: 09/27/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND SARS-CoV-2 Omicron breakthrough infection (Omicron-BTI) after vaccination has been frequently observed. A more detailed understanding of the humoral immunity against Omicron-BTI is required. METHODS We measured strain-specific live-virus based neutralizing activity, anti-spike IgG, and anti-receptor-binding domain (RBD) IgG titers in individuals with Omicron/BA.1-BTI and directly compared them with controls with diverse combinations of wild-type (WT) mRNA vaccination and infection history. RESULTS Omicron-BTI individuals showed markedly higher neutralizing titers against all the WT, Delta, and Omicron strains in convalescent sera, compared with unvaccinated Omicron-infection individuals with only Omicron neutralizing activity. Similar tendencies were found in strain-specific anti-spike and anti-RBD IgG titers. The Omicron-specificity (BA.1/WT neutralizing ratio), Omicron-neutralizing efficiency per antibody unit, and anti-Omicron RBD-directivity of anti-spike antibodies in Omicron-BTI individuals were all significantly lower than those in unvaccinated Omicron-infection individuals, but they were equivalent to or higher than those in uninfected vaccinees. The induction of Omicron-specific neutralizing activity after Omicron-BTI was not weakened for eight months from the last vaccination. CONCLUSIONS These findings suggest that cross-reactive vaccine-induced immunity was intensively stimulated following Omicron breakthrough infection, which contributed to Omicron neutralization. Measuring SARS-CoV-2 variant-specific antibody levels as well as neutralizing activity is useful for evaluating humoral immunity after breakthrough infection in the current situation of antigenic gaps between vaccinated and epidemic (Omicron sub-lineages) strains.
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Affiliation(s)
- Takeyuki Goto
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences (The First Department of Internal Medicine), Fukuoka, Japan
| | - Yong Chong
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences (The First Department of Internal Medicine), Fukuoka, Japan.
| | - Naoki Tani
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences (The First Department of Internal Medicine), Fukuoka, Japan
| | - Natsumi Susai
- Laboratory for Bio-Drug Discovery, Shionogi & Co., Ltd., Osaka, Japan
| | - Tomoyo Yoshinaga
- Laboratory for Bio-Drug Discovery, Shionogi & Co., Ltd., Osaka, Japan
| | - Tomoki Sasaki
- R&D Department, KAICO Ltd., Fukuoka, Japan; Laboratory of Insect Genome Science, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, Fukuoka, Japan
| | | | - Takahiro Kusakabe
- Laboratory of Insect Genome Science, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuyuki Shimono
- Center for the Study of Global Infection, Kyushu University Hospital, Fukuoka, Japan
| | - Koichi Akashi
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences (The First Department of Internal Medicine), Fukuoka, Japan
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Wang R, Wang S, Guo W, Zhang T, Kang Q, Wang P, Zhou F, Yang L. Flow injection analysis coupled with photoelectrochemical immunoassay for simultaneous detection of anti-SARS-CoV-2-spike and anti-SARS-CoV-2-nucleocapsid antibodies in serum samples. Anal Chim Acta 2023; 1280:341857. [PMID: 37858551 DOI: 10.1016/j.aca.2023.341857] [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: 05/19/2023] [Revised: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
A thin-layer flow cell of low internal volume (12 μL) is incorporated in a flow injection analysis (FIA) system for simultaneous and real-time photoelectrochemical (PEC) immunoassay of anti-SARS-CoV-2 spike 1 (S1) and anti-SARS-CoV-2 nucleocapsid (N) antibodies. Covalent linkage of S1 and N proteins to two separate polyethylene glycol (PEG)-covered gold nanoparticles (AuNPs)/TiO2 nanotube array (NTA) electrodes affords 10 consecutive analyses with surface regenerations in between. An indium tin oxide (ITO) allows visible light to impinge onto the two electrodes. The detection limits for anti-S1 and anti-N antibodies were estimated to be 177 and 97 ng mL-1, respectively. Such values compare well with those achieved with other reported methods and satisfy the requirement for screening convalescent patients with low antibody levels. Additionally, our method exhibits excellent intra-batch (RSD = 1.3%), inter-batch (RSD = 3.4%), intra-day (RSD = 1.0%), and inter-day (RSD = 1.6%) reproducibility. The obviation of an enzyme label and continuous analysis markedly decreased the assay cost and duration, rendering this method cost-effective. The excellent anti-fouling property of PEG enables accuracy validation by comparing our PEC immunoassays of patient sera to those of ELISA. In addition, the simultaneous detection of two antibodies holds great potential in disease diagnosis and immunity studies.
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Affiliation(s)
- Ruimin Wang
- Institute of Surface Analysis and Chemical Biology, University of Jinan, Jinan, Shandong, 250022, PR China
| | - Shuai Wang
- Institute of Surface Analysis and Chemical Biology, University of Jinan, Jinan, Shandong, 250022, PR China
| | - Wanze Guo
- Institute of Surface Analysis and Chemical Biology, University of Jinan, Jinan, Shandong, 250022, PR China
| | - Tiantian Zhang
- University Hospital, University of Jinan, Jinan, Shandong, 250022, PR China
| | - Qing Kang
- Institute of Surface Analysis and Chemical Biology, University of Jinan, Jinan, Shandong, 250022, PR China.
| | - Pengcheng Wang
- Institute of Surface Analysis and Chemical Biology, University of Jinan, Jinan, Shandong, 250022, PR China.
| | - Feimeng Zhou
- School of Life Sciences, Tiangong University, Tianjin, 300387, PR China
| | - Lixia Yang
- Key Laboratory of Jiangxi Province for Persistent Pollutants Control and Resources Recycle, Nanchang Hangkong University, Nanchang, 330063, PR China
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4
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Joung S, Weber B, Wu M, Liu Y, Tang AB, Driver M, Sternbach S, Wynter T, Hoang A, Barajas D, Kao YH, Khuu B, Bravo M, Masoom H, Tran T, Sun N, Botting PG, Claggett BL, Prostko JC, Frias EC, Stewart JL, Robertson J, Kwan AC, Torossian M, Pedraza I, Sterling C, Goldzweig C, Oft J, Zabner R, Fert-Bober J, Ebinger JE, Sobhani K, Cheng S, Le CN. Serological response to vaccination in post-acute sequelae of COVID. BMC Infect Dis 2023; 23:97. [PMID: 36797666 PMCID: PMC9933819 DOI: 10.1186/s12879-023-08060-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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Individuals with post-acute sequelae of COVID (PASC) may have a persistence in immune activation that differentiates them from individuals who have recovered from COVID without clinical sequelae. To investigate how humoral immune activation may vary in this regard, we compared patterns of vaccine-provoked serological response in patients with PASC compared to individuals recovered from prior COVID without PASC. METHODS We prospectively studied 245 adults clinically diagnosed with PASC and 86 adults successfully recovered from prior COVID. All participants had measures of humoral immunity to SARS-CoV-2 assayed before or after receiving their first-ever administration of COVID vaccination (either single-dose or two-dose regimen), including anti-spike (IgG-S and IgM-S) and anti-nucleocapsid (IgG-N) antibodies as well as IgG-S angiotensin-converting enzyme 2 (ACE2) binding levels. We used unadjusted and multivariable-adjusted regression analyses to examine the association of PASC compared to COVID-recovered status with post-vaccination measures of humoral immunity. RESULTS Individuals with PASC mounted consistently higher post-vaccination IgG-S antibody levels when compared to COVID-recovered (median log IgG-S 3.98 versus 3.74, P < 0.001), with similar results seen for ACE2 binding levels (median 99.1 versus 98.2, P = 0.044). The post-vaccination IgM-S response in PASC was attenuated but persistently unchanged over time (P = 0.33), compared to in COVID recovery wherein the IgM-S response expectedly decreased over time (P = 0.002). Findings remained consistent when accounting for demographic and clinical variables including indices of index infection severity and comorbidity burden. CONCLUSION We found evidence of aberrant immune response distinguishing PASC from recovered COVID. This aberrancy is marked by excess IgG-S activation and ACE2 binding along with findings consistent with a delayed or dysfunctional immunoglobulin class switching, all of which is unmasked by vaccine provocation. These results suggest that measures of aberrant immune response may offer promise as tools for diagnosing and distinguishing PASC from non-PASC phenotypes, in addition to serving as potential targets for intervention.
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Affiliation(s)
- Sandy Joung
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Brittany Weber
- grid.62560.370000 0004 0378 8294Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA USA
| | - Min Wu
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Yunxian Liu
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Amber B. Tang
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Matthew Driver
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Sarah Sternbach
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Timothy Wynter
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Amy Hoang
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Denisse Barajas
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Yu Hung Kao
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Briana Khuu
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Michelle Bravo
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Hibah Masoom
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Teresa Tran
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Nancy Sun
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Patrick G. Botting
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Brian L. Claggett
- grid.62560.370000 0004 0378 8294Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA USA
| | - John C. Prostko
- grid.417574.40000 0004 0366 7505Abbott Diagnostics, Abbott Park, IL USA
| | - Edwin C. Frias
- grid.417574.40000 0004 0366 7505Abbott Diagnostics, Abbott Park, IL USA
| | - James L. Stewart
- grid.417574.40000 0004 0366 7505Abbott Diagnostics, Abbott Park, IL USA
| | - Jackie Robertson
- grid.50956.3f0000 0001 2152 9905Division of Infectious Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Alan C. Kwan
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Mariam Torossian
- grid.50956.3f0000 0001 2152 9905Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Isabel Pedraza
- grid.50956.3f0000 0001 2152 9905Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Carina Sterling
- grid.50956.3f0000 0001 2152 9905Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Caroline Goldzweig
- grid.50956.3f0000 0001 2152 9905Cedars-Sinai Medical Care Foundation, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Jillian Oft
- grid.50956.3f0000 0001 2152 9905Division of Infectious Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Rachel Zabner
- grid.50956.3f0000 0001 2152 9905Division of Infectious Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Justyna Fert-Bober
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Joseph E. Ebinger
- grid.50956.3f0000 0001 2152 9905Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Kimia Sobhani
- grid.50956.3f0000 0001 2152 9905Department of Pathology and Laboratory Medicine, Cedars- Sinai Medical Center, Los Angeles, CA USA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Catherine N. Le
- grid.50956.3f0000 0001 2152 9905Division of Infectious Diseases, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA USA
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Brunner WM, Freilich D, Victory J, Krupa N, Scribani MB, Jenkins P, Lasher EG, Fink A, Shah A, Cross P, Bush V, Peek LJ, Pestano GA, Gadomski AM. Comparison of antibody response durability of mRNA-1273, BNT162b2, and Ad26.COV2.S SARS-CoV-2 vaccines in healthcare workers. Int J Infect Dis 2022; 123:183-191. [PMID: 36044963 PMCID: PMC9420538 DOI: 10.1016/j.ijid.2022.08.022] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES There are limited comparative immunologic durability data post COVID-19 vaccinations. METHODS Approximately 8.4 months after primary COVID-19 vaccination, 647 healthcare workers completed surveys about COVID-19 vaccinations/infections and blood draws. The groups included participants vaccinated with mRNA-1273 (n = 387), BNT162b2 (n = 212), or Ad26.COV2.S (n = 10) vaccines; unvaccinated participants (n = 10); and participants who received a booster dose (n = 28). The primary outcome was immunoglobin anti-spike titer. Secondary/tertiary outcomes included neutralizing antibodies (enzyme-linked immunosorbent assay-based pseudoneutralization) and vaccine effectiveness (VE). Antibody levels were compared using analysis of variance and linear regression. RESULTS Mean age was 49.7 and 75.3% of the participants were female. Baseline variables were balanced except for immunosuppression, previous COVID-19 infection, and post-primary vaccination time. Unadjusted median (interquartile range [IQR]) anti-spike titers (AU/ml) were 1539.5 (876.7-2626.7) for mRNA-1273, 751.2 (422.0-1381.5) for BNT162b2, 451.6 (103.0-2396.7) for Ad26.COV2.S, 113.4 (3.7-194.0) for unvaccinated participants, and 31898.8 (21347.1-45820.1) for participants administered with booster dose (mRNA-1273 vs BNT162b2, P <.001; mRNA-1273, BNT162b2, or boosted vs unvaccinated, P <.006; mRNA-1273, BNT162b2, Ad26.COV2.S, or unvaccinated vs boosted, P <.001). Unadjusted median (IQR) pseudoneutralization was as follows: 90.9% (80.1-95.0) for mRNA-1273, 77.2% (59.1-89.9) for BNT162b2, 57.9% (36.6-95.8) for Ad26.COV2.S, 40.1% (21.7-60.6) for unvaccinated, and 96.4% (96.1-96.6) for participants administered with booster dose (mRNA-1273 vs BNT162b2, P <.001; mRNA-1273, BNT162b2, or boosted vs unvaccinated, P <.028; mRNA-1273, BNT162b2, Ad26.COV2.S, or unvaccinated vs boosted, P <.001). VE was 87-89% for participants administered mRNA-1273 vaccine, BNT162b2 vaccine, and booster dose, and 33% for Ad26.COV2.S (none significantly different). CONCLUSION Antibody responses 8.4 months after primary vaccination were significantly higher with mRNA-1273 than those observed with BNT162b2.
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Affiliation(s)
- Wendy M. Brunner
- Bassett Research Institute, Bassett Medical Center, Cooperstown, 13326, USA,Corresponding author: Wendy M. Brunner, 1 Atwell Road, Cooperstown, New York, 13326, New York, USA. Tel: 607-547-6559
| | - Daniel Freilich
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, 13326, USA
| | - Jennifer Victory
- Bassett Research Institute, Bassett Medical Center, Cooperstown, 13326, USA
| | - Nicole Krupa
- Bassett Research Institute, Bassett Medical Center, Cooperstown, 13326, USA
| | | | - Paul Jenkins
- Bassett Research Institute, Bassett Medical Center, Cooperstown, 13326, USA
| | - Emily G. Lasher
- Bassett Research Institute, Bassett Medical Center, Cooperstown, 13326, USA
| | - Amanda Fink
- Bassett Research Institute, Bassett Medical Center, Cooperstown, 13326, USA
| | - Anshini Shah
- Medical Education, Bassett Medical Center, Cooperstown, 13326, USA
| | - Peggy Cross
- Bassett Research Institute, Bassett Medical Center, Cooperstown, 13326, USA
| | - Valerie Bush
- Bassett Healthcare Network Clinical Laboratory, Cooperstown, 13326, USA
| | | | | | - Anne M. Gadomski
- Bassett Research Institute, Bassett Medical Center, Cooperstown, 13326, USA
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Igari H, Asano H, Murata S, Yoshida T, Kawasaki K, Kageyama T, Ikeda K, Koshikawa H, Okuda Y, Urushihara M, Chiba H, Yahaba M, Taniguchi T, Matsushita K, Yoshino I, Yokote K, Nakajima H. Antibody responses and SARS-CoV-2 infection after BNT162b2 mRNA booster vaccination among healthcare workers in Japan. J Infect Chemother 2022; 28:1483-1488. [PMID: 35870791 PMCID: PMC9296373 DOI: 10.1016/j.jiac.2022.07.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Abstract
Introduction Vaccine effectiveness against SARS-CoV-2 infections decreases due to waning immunity, and booster vaccination was therefore introduced. We estimated the anti-spike antibody (AS-ab) recovery by booster vaccination and analyzed the risk factors for SARS-CoV-2 infections. Methods The subjects were health care workers (HCWs) in a Chiba University Hospital vaccination cohort. They had received two doses of vaccine (BNT162b2) and a booster vaccine (BNT162b2). We retrospectively analyzed AS-ab titers and watched out for SARS-CoV-2 infection for 90 days following booster vaccination. Results AS-ab titer eight months after two-dose vaccinations had decreased to as low as 587 U/mL (median, IQR (interquartile range) 360–896). AS-ab titer had then increased to 22471 U/mL (15761–32622) three weeks after booster vaccination. There were no significant differences among age groups. A total of 1708 HCWs were analyzed for SARS-CoV-2 infection, and 48 of them proved positive. SARS-CoV-2 infections in the booster-vaccinated and non-booster groups were 1.8% and 4.0%, respectively, and were not significant. However, when restricted to those 20–29 years old, SARS-CoV-2 infections in the booster-vaccinated and non-booster groups were 2.9% and 13.6%, respectively (p = 0.04). After multivariate logistic regression, COVID-19 wards (adjusted odds ratio (aOR):2.9, 95% confidence interval (CI) 1.5–5.6) and those aged 20–49 years (aOR:9.7, 95%CI 1.3–71.2) were risk factors for SARS-CoV-2 infection. Conclusions Booster vaccination induced the recovery of AS-ab titers. Risk factors for SARS-CoV-2 infection were HCWs of COVID-19 wards and those aged 20–49 years. Increased vaccination coverage, together with implementing infection control, remains the primary means of preventing HCWs from SARS-CoV-2 infection.
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Affiliation(s)
- Hidetoshi Igari
- Department of Infection Control, Chiba University Hospital, Japan; COVID-19 Vaccine Center, Chiba University Hospital, Japan.
| | - Haruna Asano
- Division of Laboratory Medicine, Chiba University Hospital, Japan.
| | - Shota Murata
- Division of Laboratory Medicine, Chiba University Hospital, Japan.
| | | | - Kenji Kawasaki
- Division of Laboratory Medicine, Chiba University Hospital, Japan.
| | - Takahiro Kageyama
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Key Ikeda
- Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Hiromi Koshikawa
- Department of Infection Control, Chiba University Hospital, Japan.
| | - Yoshio Okuda
- Department of Infection Control, Chiba University Hospital, Japan.
| | - Misao Urushihara
- Department of Infection Control, Chiba University Hospital, Japan
| | - Hitoshi Chiba
- Department of Infection Control, Chiba University Hospital, Japan.
| | - Misuzu Yahaba
- Department of Infection Control, Chiba University Hospital, Japan.
| | | | | | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Hiroshi Nakajima
- COVID-19 Vaccine Center, Chiba University Hospital, Japan; Department of Allergy and Clinical Immunology, Graduate School of Medicine, Chiba University, Chiba, Japan.
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7
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Barmettler S, DiGiacomo DV, Yang NJ, Lam T, Naranbhai V, Dighe AS, Burke KE, Blumenthal KG, Ling M, Hesterberg PE, Saff RR, MacLean J, Ofoman O, Berrios C, St Denis KJ, Lam EC, Gregory D, Iafrate AJ, Poznansky M, Lee H, Balazs A, Pillai S, Farmer JR. Response to Severe Acute Respiratory Syndrome Coronavirus 2 Initial Series and Additional Dose Vaccine in Patients With Predominant Antibody Deficiency. J Allergy Clin Immunol Pract 2022; 10:1622-1634.e4. [PMID: 35381395 PMCID: PMC8976568 DOI: 10.1016/j.jaip.2022.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/09/2022] [Accepted: 03/06/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with predominant antibody deficiency (PAD) is associated with high morbidity, yet data regarding the response to SARS-CoV-2 immunization in PAD patients, including additional dose vaccine, are limited. OBJECTIVE To characterize antibody response to SARS-CoV-2 vaccine in PAD patients and define correlates of vaccine response. METHODS We assessed the levels and function of anti-SARS-CoV-2 antibodies in 62 PAD patients compared with matched healthy controls at baseline, at 4 to 6 weeks after the initial series of immunization (a single dose of Ad26.COV2.S [Janssen] or two doses of BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]), and at 4 to 6 weeks after an additional dose immunization, if received. RESULTS After the initial series of SARS-CoV-2 vaccination, PAD patients had lower mean anti-spike antibody levels compared with matched healthy controls (140.1 vs 547.3 U/mL; P = .02). Patients with secondary PAD (eg, B-cell depletion therapy was used) and those with severe primary PAD (eg, common variable immunodeficiency with autoinflammatory complications) had the lowest mean anti-spike antibody levels. Immune correlates of a low anti-spike antibody response included low CD4+ T helper cells, low CD19+ total B cells, and low class-switched memory (CD27+IgD/M-) B cells. In addition, a low (<100 U/mL) anti-spike antibody response was associated with prior exposure to B-cell depletion therapy, both at any time in the past (odds ratio = 5.5; confidence interval, 1.5-20.4; P = .01) and proximal to vaccination (odds ratio = 36.4; confidence interval, 1.7-791.9; P = .02). Additional dose immunization with an mRNA vaccine in a subset of 31 PAD patients increased mean anti-spike antibody levels (76.3 U/mL before to 1065 U/mL after the additional dose; P < .0001). CONCLUSIONS Patients with secondary and severe primary PAD, characterized by low T helper cells, low B cells, and/or low class-switched memory B cells, were at risk for low antibody response to SARS-CoV-2 immunization, which improved after an additional dose vaccination in most patients.
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Affiliation(s)
- Sara Barmettler
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Daniel V DiGiacomo
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Nancy J Yang
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Tiffany Lam
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Vivek Naranbhai
- Harvard Medical School, Boston, Mass; Dana-Farber Cancer Institute, Boston, Mass
| | - Anand S Dighe
- Harvard Medical School, Boston, Mass; Department of Pathology, Massachusetts General Hospital, Boston, Mass
| | - Kristin E Burke
- Gastroenterology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Mass
| | - Kimberly G Blumenthal
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Morris Ling
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass
| | - Paul E Hesterberg
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Rebecca R Saff
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | | | - Onosereme Ofoman
- Department of Pathology, Massachusetts General Hospital, Boston, Mass
| | - Cristhian Berrios
- Department of Pathology, Massachusetts General Hospital, Boston, Mass
| | - Kerri J St Denis
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Department of Medicine, Harvard University, Cambridge, Mass
| | - Evan C Lam
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Department of Medicine, Harvard University, Cambridge, Mass
| | - David Gregory
- Division of Infectious Diseases Medicine, Department of Medicine, Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, Mass; Pediatric Infectious Disease Unit, Department of Pediatrics, Massachusetts General Hospital, Boston, Mass
| | | | - Mark Poznansky
- Division of Infectious Diseases Medicine, Department of Medicine, Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, Mass
| | - Hang Lee
- Harvard Medical School, Boston, Mass
| | - Alejandro Balazs
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Department of Medicine, Harvard University, Cambridge, Mass
| | - Shiv Pillai
- Harvard Medical School, Boston, Mass; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Department of Medicine, Harvard University, Cambridge, Mass
| | - Jocelyn R Farmer
- Division of Rheumatology, Department of Medicine, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Department of Medicine, Harvard University, Cambridge, Mass
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Bilgin H, Marku M, Yilmaz SS, Karahasan Yagci A, Sili U, Can B, Can Sarinoglu R, Mulazimoglu Durmusoglu L, Haklar G, Sirikci O, Eksioglu Demiralp E. The effect of immunization with inactivated SARS-CoV-2 vaccine (CoronaVac) and/or SARS-CoV-2 infection on antibody levels, plasmablasts, long-lived-plasma-cells, and IFN-γ release by natural killer cells. Vaccine 2022; 40:2619-2625. [PMID: 35339303 PMCID: PMC8930391 DOI: 10.1016/j.vaccine.2022.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/20/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We evaluated the antibody response, natural killer cell response and B cell phenotypes in healthcare workers (HCW) who are vaccinated with two doses of CoronaVac with or without documented SARS-CoV-2 infection and unvaccinated HCWs with SARS-CoV-2 infection. METHODS HCWs were divided into four groups: vaccine only (VO), vaccine after SARS-CoV-2 infection (VAI), SARS-CoV-2 infection only (IO), and SARS-CoV-2 infection after vaccine (IAV). Anti-SARS-CoV-2 spike protein (Anti-S) antibodies were measured by Elecsys Anti-SARS-CoV-2 S ELISA kit. Memory B cells (CD19+CD27+), plasmablast B cells (CD19+CD138+) and long-lived plasma cells (LLPC; CD138+CD19-) were measured by flow cytometry in 74 patients. Interferon gamma (IFN-γ) release by natural killer (NK) cells were measured by NKVue Test (NKMAX, Republic of Korea) in 76 patients. RT-PCR was performed with Bio-speedy® COVID-19 qPCR detection kit, Version 2 (Bioexen LTD, Istanbul, Turkey). RESULTS The Anti-S antibodies were detectable in all HCWs (n: 224). The median Anti-S titers (BAU/mL) was significantly higher in VAI (620 25-75% 373-1341) compared to VO (136, 25-75% 85-283) and IO (111, 25-75% 54-413, p < 0.01). VAI group had significantly lower percentage of plasmablasts (2.9; 0-8.7) compared to VO (6.8; 3.5-12.0) and IO (9.9; 4.7-47.5, p < 0.01) (n:74). Percentage of LLPCs in groups VO, VAI and IO was similar. There was no difference of IFN-γ levels between the study groups (n: 76). CONCLUSION The antibody response was similar between uninfected vaccinated HCWs and unvaccinated HCWs who had natural infection. HCWs who had two doses of CoronaVac either before or after the natural SARS-CoV-2 infection elicited significantly higher antibody responses compared to uninfected vaccinated HCWs. The lower percentages of plasmablasts in the VAI group may indicate their migration to lymph nodes and initiation of the germinal center reaction phase. IFN-γ response did not differ among the groups.
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Affiliation(s)
- Huseyin Bilgin
- Marmara University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Marisa Marku
- Marmara University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Sultan Seval Yilmaz
- Marmara University, School of Medicine, Department of Biochemistry, Istanbul, Turkey
| | | | - Uluhan Sili
- Marmara University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Baris Can
- Marmara University, School of Medicine, Department of Microbiology, Istanbul, Turkey
| | - Rabia Can Sarinoglu
- Marmara University, School of Medicine, Department of Microbiology, Istanbul, Turkey
| | | | - Goncagul Haklar
- Marmara University, School of Medicine, Department of Biochemistry, Istanbul, Turkey
| | - Onder Sirikci
- Marmara University, School of Medicine, Department of Biochemistry, Istanbul, Turkey,Corresponding author at: Fevzi Cakmak Mah Muhsinyazicioglu Cad No: 10 Marmara University Pendik Hospital, 34899 Istanbul, Turkey
| | - Emel Eksioglu Demiralp
- Istanbul Memorial Şişli Hospital, Tissue Typing and Immunology Laboratory, Istanbul, Turkey
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Singh AK, Phatak SR, Singh R, Bhattacharjee K, Singh NK, Gupta A, Sharma A. Humoral antibody kinetics with ChAdOx1-nCOV (Covishield™) and BBV-152 (Covaxin™) vaccine among Indian Healthcare workers: A 6-month longitudinal cross-sectional Coronavirus Vaccine-induced antibody titre (COVAT) study. Diabetes Metab Syndr 2022; 16:102424. [PMID: 35150961 PMCID: PMC8816907 DOI: 10.1016/j.dsx.2022.102424] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS There is limited data available on longitudinal humoral antibody dynamics following two doses of ChAdOx1-nCOV (Covishield™) and BBV-152 (Covaxin™) vaccine against SARS-CoV-2 among Indians. METHODS We conducted a 6-month longitudinal study in vaccinated healthcare workers by serially measuring quantitative anti-spike antibody at 3-weeks, 3-months and 6-months after the completion of second dose. Geometric mean titer (GMT) and linear mixed models were used to assess the dynamics of antibody levels at 6 months. RESULTS Of the 481 participants, GMT of anti-spike antibody decreased by 56% at 6-months regardless of age, gender, blood group, body-mass index and comorbidities in 360 SARS-CoV-2 naive individuals but significantly more in hypertensives. Participants with past infection had significantly higher GMT at all time points compared to the naive individuals. Among SARS-CoV-2 naive cohorts, a significantly higher GMT was noted amongst the Covishield recipients at all time points, but there was a 44% decline in GMT at 6-month compared to the peak titer period. Decline in GMT was insignificant (8%) in Covaxin recipients at 6-month despite a lower GMT at all time points vs. Covishield. There was 5.6-fold decrease in seropositivity rate at 6-month with both vaccines. Participants with type 2 diabetes mellitus have a lower seropositivity rate at all the time points. Seropositivity rate was significantly higher with Covishield vs. Covaxin at all time points except at 6-month where Covaxin recipients had a higher seropositivity rate but no difference noted in propensity-matched analysis. CONCLUSIONS There is waning humoral antibody response following two doses of either vaccine at six months. Covishield recipients had a higher anti-spike antibody GMT compared with Covaxin at all-time points, however a significant decline in antibody titers was seen with Covishield but not with Covaxin at 6-months.
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Affiliation(s)
- Awadhesh Kumar Singh
- Consultant Endocrinologist, G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India.
| | | | - Ritu Singh
- Consultant Gynecologist, G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India
| | | | | | - Arvind Gupta
- Department of Diabetes, Obesity and Metabolic Disorders, Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Arvind Sharma
- Associate Professor, Dept. of Community Medicine, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India
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Singh AK, Phatak SR, Singh R, Bhattacharjee K, Singh NK, Gupta A, Sharma A. Antibody response after first and second-dose of ChAdOx1-nCOV (Covishield TM®) and BBV-152 (Covaxin TM®) among health care workers in India: The final results of cross-sectional coronavirus vaccine-induced antibody titre (COVAT) study. Vaccine 2021; 39:6492-509. [PMID: 34600747 DOI: 10.1016/j.vaccine.2021.09.055] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 02/08/2023]
Abstract
Background We assessed the humoral immune response of both ChAdOx1-nCOV (CovishieldTM) and BBV-152 (CovaxinTM) vaccines in Indian health care workers (HCW). Methods A Pan-India, Cross-sectional, Coronavirus Vaccine-induced Antibody Titre (COVAT) study was conducted that measured SARS-CoV-2 anti-spike binding antibody quantitatively, 21 days or more after the first and second dose of two vaccines in both severe acute respiratory syndrome (SARS-CoV-2) naïve and recovered HCW. Primary aim was to analyze antibody response (seropositivity rate, Geometric Mean Titre [GMT] and 95% Confidence Interval [CI]) following each dose of both vaccines and its correlation to age, sex, blood group, body mass index (BMI) and comorbidities. Here we report the results of anti-spike antibody response after first and two completed doses. Results Among the 515 HCW (305 Male, 210 Female) who took two doses of both vaccines, 95.0% showed seropositivity to anti-spike antibody. However, both seropositivity rate and GMT (95% CI) of anti-spike antibody was significantly higher in Covishield vs. Covaxin recipients (98.1 vs. 80.0%; 129.3 vs. 48.3 AU/mL; both p < 0.001). This difference persisted in 457 SARS-CoV-2 naïve and propensity-matched (age, sex and BMI) analysis of 116 participants. Age > 60-years, males, people with any comorbidities, and history of hypertension (HTN) had a significantly less anti-spike antibody GMT compared to age ≤ 60 years, females, no comorbidities and no HTN respectively, after the completion of two doses of either vaccine. Gender, presence of comorbidities, and vaccine type were independent predictors of antibody seropositivity rate and anti-spike antibody titre levels in multiple logistic and log transformed linear regression analysis. Both vaccine recipients had similar solicited mild to moderate adverse events and none had severe or unsolicited side effects. Conclusions Both vaccines elicited good immune response after two doses, although seropositivity rates and GMT of anti-spike antibody titre was significantly higher in Covishield compared to Covaxin recipients.
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Wang SF, Tseng SP, Yen CH, Yang JY, Tsao CH, Shen CW, Chen KH, Liu FT, Liu WT, Chen YMA, Huang JC. Antibody-dependent SARS coronavirus infection is mediated by antibodies against spike proteins. Biochem Biophys Res Commun 2014; 451:208-14. [PMID: 25073113 PMCID: PMC7092860 DOI: 10.1016/j.bbrc.2014.07.090] [Citation(s) in RCA: 305] [Impact Index Per Article: 30.5] [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: 07/05/2014] [Accepted: 07/21/2014] [Indexed: 12/11/2022]
Abstract
The SARS coronavirus exhibits antibody-dependent enhancement (ADE). SARS-CoV ADE is strongly mediated by anti-spike but not anti-nucleocapsid Abs. Formerly untested HL-CZ cells are susceptible to SARS-CoV infection. Highly diluted anti-sera against SARS-CoV enhances SARS-CoV infectivity.
The severe acute respiratory syndrome coronavirus (SARS-CoV) still carries the potential for reemergence, therefore efforts are being made to create a vaccine as a prophylactic strategy for control and prevention. Antibody-dependent enhancement (ADE) is a mechanism through which dengue viruses, feline coronaviruses, and HIV viruses take advantage of anti-viral humoral immune responses to infect host target cells. Here we describe our observations of SARS-CoV using ADE to enhance the infectivity of a HL-CZ human promonocyte cell line. Quantitative-PCR and immunofluorescence staining results indicate that SARS-CoV is capable of replication in HL-CZ cells, and of displaying virus-induced cytopathic effects and increased levels of TNF-α, IL-4 and IL-6 two days post-infection. According to flow cytometry data, the HL-CZ cells also expressed angiotensin converting enzyme 2 (ACE2, a SARS-CoV receptor) and higher levels of the FcγRII receptor. We found that higher concentrations of anti-sera against SARS-CoV neutralized SARS-CoV infection, while highly diluted anti-sera significantly increased SARS-CoV infection and induced higher levels of apoptosis. Results from infectivity assays indicate that SARS-CoV ADE is primarily mediated by diluted antibodies against envelope spike proteins rather than nucleocapsid proteins. We also generated monoclonal antibodies against SARS-CoV spike proteins and observed that most of them promoted SARS-CoV infection. Combined, our results suggest that antibodies against SARS-CoV spike proteins may trigger ADE effects. The data raise new questions regarding a potential SARS-CoV vaccine, while shedding light on mechanisms involved in SARS pathogenesis.
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Affiliation(s)
- Sheng-Fan Wang
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sung-Pin Tseng
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Hung Yen
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jyh-Yuan Yang
- Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Taipei, Taiwan
| | - Ching-Han Tsao
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chun-Wei Shen
- Office of Occupational Safety and Health, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Kuan-Hsuan Chen
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fu-Tong Liu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Wu-Tse Liu
- Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ming Arthur Chen
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Microbiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Jason C Huang
- Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan; AIDS Prevention and Research Center, National Yang-Ming University, Taipei, Taiwan.
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