Quartuccio Luca, De Marchi Ginevra, Domenis Rossana, Cabas Nicola, Guella Silvia, Paradiso Antonella, Fabro Cinzia, Beltrami Antonio Paolo, De Vita Salvatore, Curcio Francesco
Division of Rheumatology, Academic Hospital "Santa Maria della Misericordia", ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy.
Institute of Clinical Pathology, Academic Hospital "Santa Maria della Misericordia", ASUFC, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy.
J Clin Med. 2023 Jan 30;12(3):1083. doi: 10.3390/jcm12031083.
To evaluate humoral and T-cell cellular-mediated immune response after three doses of SARS-CoV-2 mRNA vaccines in patients with systemic lupus erythematosus (SLE) under Belimumab.
12 patients on Belimumab and 13 age-matched healthy volunteers were recruited. Patients were in remission or in low disease activity, and they were taking no corticosteroids or only low doses. None of the patients and controls had detectable anti-SARS-CoV-2 antibodies due to previous exposure to the virus. All the patients received three doses of mRNA anti-SARS-CoV-2 vaccines and the humoral and cellular-mediated response were tested 4 weeks after the second dose (T0), 6 months after the second dose (T1) and 4 weeks after the third dose (T2). Comparison with the control group was performed at time T0 (i.e., 4 weeks after the second dose). Total anti-SARS-CoV-2 RBD antibodies were analyzed using a diagnostic assay, while cellular-mediated response was evaluated using the interferon-gamma release assay (IGRA).
A humoral response was documented in all the patients at T0 (median 459; IQR 225.25-758.5), but the antibody titer significantly declined from T0 to T1 (median 44.7; IQR: 30.3-202; = 0.0066). At T2, the antibody titer significantly increased from T1 (median 2500; IQR: 2500-2500), and it was not different from T0 (respectively < 0.0001, = 0.66). Cellular-mediated response significantly declined from T0 to T1 ( = 0.003) but not from T0 to T2 ( = 0.3). No differences were found between patients and controls at T0 as regards both humoral and cellular responses ( = 1.0 and = 0.09 for humoral and cellular responses, respectively).
The third dose of mRNA COVID-19 vaccine can restore both humoral and cellular immune response in SLE patients on Belimumab.
评估贝利尤单抗治疗下的系统性红斑狼疮（SLE）患者接种三剂严重急性呼吸综合征冠状病毒2（SARS-CoV-2）mRNA疫苗后的体液免疫和T细胞介导的细胞免疫反应。
招募了12例接受贝利尤单抗治疗的患者和13例年龄匹配的健康志愿者。患者病情处于缓解期或低疾病活动度，未服用皮质类固醇或仅服用低剂量皮质类固醇。由于既往未接触过该病毒，所有患者和对照均未检测到抗SARS-CoV-2抗体。所有患者均接种三剂mRNA抗SARS-CoV-2疫苗，并在第二剂接种后4周（T0）、第二剂接种后6个月（T1）和第三剂接种后4周（T2）检测体液免疫和细胞介导免疫反应。在T0时间点（即第二剂接种后4周）与对照组进行比较。使用诊断检测法分析总抗SARS-CoV-2受体结合域（RBD）抗体，同时使用干扰素-γ释放检测法（IGRA）评估细胞介导免疫反应。
所有患者在T0时均出现体液免疫反应（中位数459；四分位间距225.25 - 758.5），但抗体滴度从T0到T1显著下降（中位数44.7；四分位间距：30.3 - 202；P = 0.0066）。在T2时，抗体滴度从T1显著升高（中位数2500；四分位间距：2500 - 2500），且与T0时无差异（分别为P < 0.0001，P = 0.66）。细胞介导免疫反应从T0到T1显著下降（P = 0.003），但从T0到T2无下降（P = 0.3）。在T0时，患者和对照组在体液免疫和细胞免疫反应方面均未发现差异（体液免疫反应P = 1.0，细胞免疫反应P = 0.09）。
第三剂mRNA新型冠状病毒肺炎（COVID-19）疫苗可恢复接受贝利尤单抗治疗的SLE患者的体液免疫和细胞免疫反应。
