Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
Inflamm Bowel Dis. 2023 Aug 1;29(8):1202-1209. doi: 10.1093/ibd/izac193.
Some patients with inflammatory bowel disease (IBD) on immunosuppressive therapies may have a blunted response to certain vaccines, including the messenger RNA (mRNA) coronavirus disease 2019 (COVID-19) vaccines. However, few studies have evaluated the cell-mediated immune response (CMIR), which is critical to host defense after COVID-19 infection. The aim of this study was to evaluate the humoral immune response and CMIR after mRNA COVID-19 vaccination in patients with IBD.
This prospective study (HERCULES [HumoRal and CellULar initial and Sustained immunogenicity in patients with IBD] study) evaluated humoral immune response and CMIR after completion of 2 doses of mRNA COVID-19 vaccines in 158 IBD patients and 20 healthy control (HC) subjects. The primary outcome was the CMIR to mRNA COVID-19 vaccines in patients with IBD. The secondary outcomes were a comparison of (1) the CMIR in patients with IBD and HC subjects, (2) CMIR and humoral immune response in all participants, and (3) correlation between CMIR and humoral immune response.
The majority (89%) of patients with IBD developed a CMIR, which was not different vs HC subjects (94%) (P = .6667). There was no significant difference (P = .5488) in CMIR between immunocompetent (median 255 [interquartile range, 146-958] spike T cells per million peripheral blood mononuclear cells) and immunosuppressed patients (median 377 [interquartile range, 123-1440]). There was no correlation between humoral and cell-mediated immunity after vaccination (P = .5215). In univariable analysis, anti-tumor necrosis factor therapy was associated with a higher CMIRs (P = .02) and confirmed in a multivariable model (P = .02). No other variables were associated with CMIR.
Most patients with IBD achieved CMIR to a COVID-19 vaccine. Future studies are needed evaluating sustained CMIR and clinical outcomes.
一些接受免疫抑制治疗的炎症性肠病（IBD）患者对某些疫苗的反应可能减弱，包括信使 RNA（mRNA）冠状病毒病 2019（COVID-19）疫苗。然而，很少有研究评估细胞介导的免疫反应（CMIR），这对于 COVID-19 感染后宿主防御至关重要。本研究旨在评估 IBD 患者接受 mRNA COVID-19 疫苗接种后的体液免疫反应和 CMIR。
这项前瞻性研究（HERCULES [HumoRal 和 CellULar 初始和持续免疫原性在 IBD 患者中的研究]）评估了 158 例 IBD 患者和 20 名健康对照（HC）受试者完成 2 剂 mRNA COVID-19 疫苗接种后的体液免疫反应和 CMIR。主要结局是 IBD 患者的 CMIR。次要结局是：（1）IBD 患者与 HC 受试者的 CMIR 比较；（2）所有参与者的 CMIR 和体液免疫反应比较；（3）CMIR 与体液免疫反应的相关性。
大多数（89%）IBD 患者产生了 CMIR，与 HC 受试者（94%）无差异（P=0.6667）。免疫功能正常（中位数 255 [四分位距 146-958] 每百万外周血单核细胞中的刺突 T 细胞）和免疫抑制患者（中位数 377 [四分位距 123-1440]）之间的 CMIR 无显著差异（P=0.5488）。接种疫苗后体液免疫和细胞介导免疫之间无相关性（P=0.5215）。在单变量分析中，抗肿瘤坏死因子治疗与更高的 CMIR 相关（P=0.02），并在多变量模型中得到证实（P=0.02）。其他变量与 CMIR 无关。
大多数 IBD 患者对 COVID-19 疫苗产生 CMIR。需要进一步研究评估持续的 CMIR 和临床结局。
