Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.
Front Immunol. 2022 Jul 28;13:934476. doi: 10.3389/fimmu.2022.934476. eCollection 2022.
The antibody response after vaccination is impaired in common variable immunodeficiency (CVID).
We aimed to study the spike receptor-binding domain IgG antibody (anti-S-RBD) levels during a four-dose SARS-CoV-2 vaccination strategy and after monoclonal antibody (mAB) treatment in CVID. Moreover, we assessed the anti-S-RBD levels in immunoglobulin replacement therapy (IgRT) products.
In an observational study, we examined anti-S-RBD levels after the second, third, and fourth dose of mRNA SARS-CoV-2 vaccines. Moreover, we measured anti-S-RBD after treatment with mAB. Finally, anti-S-RBD was assessed in common IgRT products. Antibody non-responders (anti-S-RBD < 7.1) were compared by McNemar's test and anti-S-RBD levels were compared with paired and non-paired Wilcoxon signed rank tests as well as Kruskal-Wallis tests.
Among 33 individuals with CVID, anti-S-RBD levels increased after the third vaccine dose (165 BAU/ml [95% confidence interval: 85; 2280 BAU/ml], = 0.006) and tended to increase after the fourth dose (193 BAU/ml, [-22; 569 BAU/ml], = 0.080) compared to the previous dose. With increasing number of vaccinations, the proportion of patients who seroconverted (anti-S-RBD ≥ 7.1) increased non-significantly. mAB treatment resulted in a large increase in anti-S-RBD and a higher median level than gained after the fourth dose of vaccine ( = 0.009). IgRT products had varying concentrations of anti-S-RBD ( < 0.001), but none of the products seemed to affect the overall antibody levels ( = 0.460).
Multiple SARS-CoV-2 vaccine doses in CVID seem to provide additional protection, as antibody levels increased after the third and fourth vaccine dose. However, anti-S-RBD levels from mAB outperform the levels mounted after vaccination.
Boosting with SARS-CoV-2 vaccines seems to improve the antibody response in CVID patients.
The third and possibly also the fourth dose of mRNA SARS-CoV-2 vaccine in CVID improve the antibody response as well as stimulate seroconversion in most non-responders.
在常见变异性免疫缺陷（CVID）中，疫苗接种后的抗体反应受损。
我们旨在研究四剂 SARS-CoV-2 疫苗接种策略和 CVID 中单克隆抗体（mAB）治疗后刺突受体结合域 IgG 抗体（抗-S-RBD）水平。此外，我们评估了免疫球蛋白替代疗法（IgRT）产品中的抗-S-RBD 水平。
在一项观察性研究中，我们检查了 mRNA SARS-CoV-2 疫苗第二、第三和第四剂后的抗-S-RBD 水平。此外，我们还测量了 mAB 治疗后的抗-S-RBD。最后，评估了常见 IgRT 产品中的抗-S-RBD。通过 McNemar 检验比较抗体无应答者（抗-S-RBD < 7.1），并通过配对和非配对 Wilcoxon 符号秩检验以及 Kruskal-Wallis 检验比较抗-S-RBD 水平。
在 33 名 CVID 患者中，第三剂疫苗后抗-S-RBD 水平升高（165 BAU/ml [95%置信区间：85；2280 BAU/ml]， = 0.006），第四剂疫苗后抗-S-RBD 水平有升高趋势（193 BAU/ml，[-22；569 BAU/ml]， = 0.080）。随着接种次数的增加，血清转换患者（抗-S-RBD≥7.1）的比例无显著增加。mAB 治疗导致抗-S-RBD 大幅增加，且高于第四剂疫苗后的中位数水平（ = 0.009）。IgRT 产品具有不同浓度的抗-S-RBD（ < 0.001），但没有一种产品似乎影响总体抗体水平（ = 0.460）。
CVID 中多次 SARS-CoV-2 疫苗接种似乎提供了额外的保护，因为第三和第四剂疫苗后抗体水平增加。然而，mAB 后的抗-S-RBD 水平优于接种疫苗后的水平。
在 CVID 患者中，SARS-CoV-2 疫苗加强似乎可改善抗体反应。
CVID 患者中，第三剂和可能第四剂 mRNA SARS-CoV-2 疫苗可改善抗体反应，并刺激大多数无应答者的血清转化。
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