Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain.
Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain.
J Clin Immunol. 2022 Feb;42(2):240-252. doi: 10.1007/s10875-021-01174-5. Epub 2021 Nov 17.
Common variable immunodeficiency (CVID) is characterized by hypogammaglobulinemia and/or a defective antibody response to T-dependent and T-independent antigens. CVID response to immunization depends on the antigen type, the vaccine mechanism, and the specific patient immune defect. In CVID patients, humoral and cellular responses to the currently used COVID-19 vaccines remain unexplored. Eighteen CVID subjects receiving 2-dose anti-SARS-CoV-2 vaccines were prospectively studied. S1-antibodies and S1-specific IFN-γ T cell response were determined by ELISA and FluoroSpot, respectively. The immune response was measured before the administration and after each dose of the vaccine, and it was compared to the response of 50 healthy controls (HC). The development of humoral and cellular responses was slower in CVID patients compared with HC. After completing vaccination, 83% of CVID patients had S1-specific antibodies and 83% had S1-specific T cells compared with 100% and 98% of HC (p = 0.014 and p = 0.062, respectively), but neutralizing antibodies were detected only in 50% of the patients. The strength of both humoral and cellular responses was significantly lower in CVID compared with HC, after the first and second doses of the vaccine. Absent or discordant humoral and cellular responses were associated with previous history of autoimmunity and/or lymphoproliferation. Among the three patients lacking humoral response, two had received recent therapy with anti-B cell antibodies. Further studies are needed to understand if the response to COVID-19 vaccination in CVID patients is protective enough. The 2-dose vaccine schedule and possibly a third dose might be especially necessary to achieve full immune response in these patients.
普通变异性免疫缺陷(CVID)的特征是低丙种球蛋白血症和/或对 T 依赖性和 T 非依赖性抗原的抗体反应缺陷。CVID 对免疫接种的反应取决于抗原类型、疫苗机制和特定患者的免疫缺陷。在 CVID 患者中,对目前使用的 COVID-19 疫苗的体液和细胞反应仍未得到探索。18 名接受 2 剂抗 SARS-CoV-2 疫苗的 CVID 患者进行了前瞻性研究。通过 ELISA 和 FluoroSpot 分别测定 S1 抗体和 S1 特异性 IFN-γ T 细胞反应。在疫苗接种前和每次接种后测量免疫反应,并与 50 名健康对照(HC)的反应进行比较。与 HC 相比,CVID 患者的体液和细胞反应发展较慢。完成疫苗接种后,83%的 CVID 患者有 S1 特异性抗体,83%的患者有 S1 特异性 T 细胞,而 HC 中这两个比例分别为 100%和 98%(p=0.014 和 p=0.062),但仅在 50%的患者中检测到中和抗体。与 HC 相比,在接种第一剂和第二剂疫苗后,CVID 患者的体液和细胞反应强度均显著降低。体液和细胞反应缺失或不一致与自身免疫和/或淋巴增生的既往病史有关。在 3 名缺乏体液反应的患者中,有 2 名最近接受了抗 B 细胞抗体治疗。需要进一步研究以了解 CVID 患者对 COVID-19 疫苗接种的反应是否足够保护。在这些患者中,可能需要 2 剂疫苗接种方案和可能的第 3 剂疫苗来实现完全免疫反应。
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