Zhang Siliang, He Jiaoxia, Tang Bin, Zhou Qin, Hu Yudong, Yu Yuan, Chen Jianwei, Liu Yi, Li Chunmeng, Ren Hong, Liao Xiaohui
Department of Nephrology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China.
Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China.
J Clin Med. 2023 Feb 3;12(3):1225. doi: 10.3390/jcm12031225.
It remains unclear what B cell and humoral responses are mounted by chronic kidney disease (CKD) patients in response to recombinant and inactivated SARS-CoV-2 vaccines. In this study, we aimed to explore the cellular and humoral responses, and the safety of recombinant and inactivated SARS-CoV-2 vaccines in CKD patients.
79 CKD and 420 non-CKD individuals, who completed a full course of vaccination, were enrolled in the study. Adverse events (AEs) were collected via a questionnaire. Cellular and humoral responses were detected at 1, 3, and 6 months, including IgG antibody against the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein (anti-RBD-IgG), neutralizing antibodies (NAbs), the positive rate of NAbs and anti-RBD-IgG, RBD-atypical memory B cells (MBCs) (CD3 - CD19 + RBD + CD21 - CD27-), RBD-activated MBCs (CD3 - CD19 + RBD + CD21 - CD27+), RBD-resting MBCs (CD3 - CD19 + RBD + CD21 + CD27+), and RBD-intermediate MBCs (CD3 - CD19 + RBD + CD21 + CD27-).
We found no differences in the positivity rates of NAbs (70.89% vs. 79.49%, = 0.212) and anti-RBD IgG (72.15% vs. 83.33%, = 0.092) between the CKD and control groups. A total of 22 CKD individuals completed the full follow-up (1, 3, and 6 months). Significant and sustained declines were found at 3 months in anti-RBD IgG (26.64 BAU/mL vs. 9.08 BAU/mL, < 0.001) and NAbs (161.60 IU/mL vs. 68.45 IU/mL < 0.001), and at 6 months in anti-RBD IgG (9.08 BAU/mL vs. 5.40 BAU/mL, = 0.064) and NAbs (68.45 IU/mL vs. 51.03 IU/mL, = 0.001). Significant differences were identified in MBC subgroups between CKD patients and healthy controls, including RBD-specific atypical MBCs (60.5% vs. 17.9%, < 0.001), RBD-specific activated MBCs (36.3% vs. 14.8%, < 0.001), RBD-specific intermediate MBCs (1.24% vs. 42.6%, < 0.001), and resting MBCs (1.34% vs. 22.4%, < 0.001). Most AEs in CKD patients were mild (grade 1 and 2) and self-limiting. One patient with CKD presented with a recurrence of nephrotic syndrome after vaccination.
The recombinant and inactivated SARS-CoV-2 vaccine was well-tolerated and showed a good response in the CKD cohort. Our study also revealed differences in MBC subtypes after SARS-CoV-2 vaccination between CKD patients and healthy controls.
慢性肾脏病（CKD）患者对重组和灭活严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗产生的B细胞和体液反应仍不清楚。在本研究中，我们旨在探讨CKD患者对重组和灭活SARS-CoV-2疫苗的细胞和体液反应以及安全性。
本研究纳入了79例完成全程疫苗接种的CKD患者和420例非CKD个体。通过问卷调查收集不良事件（AE）。在第1、3和6个月检测细胞和体液反应，包括针对SARS-CoV-2刺突蛋白受体结合域（RBD）的IgG抗体（抗RBD-IgG）、中和抗体（NAbs）、NAbs和抗RBD-IgG的阳性率、RBD非典型记忆B细胞（MBCs）（CD3 - CD19 + RBD + CD21 - CD27-）、RBD活化MBCs（CD3 - CD19 + RBD + CD21 - CD27+）、RBD静息MBCs（CD3 - CD19 + RBD + CD21 + CD27+）和RBD中间型MBCs（CD3 - CD19 + RBD + CD21 + CD27-）。
我们发现CKD组和对照组之间NAbs阳性率（70.89%对79.49%，P = 0.212）和抗RBD IgG阳性率（72.15%对83.33%，P = 0.092）没有差异。共有22例CKD个体完成了完整的随访（1、3和6个月）。在第3个月时，抗RBD IgG（26.64 BAU/mL对9.08 BAU/mL，P < 0.001）和NAbs（161.60 IU/mL对68.45 IU/mL，P < 0.001）显著且持续下降，在第6个月时，抗RBD IgG（9.08 BAU/mL对5.40 BAU/mL，P = 0.064）和NAbs（68.45 IU/mL对51.03 IU/mL，P = 0.001）也显著下降。CKD患者和健康对照之间的MBC亚组存在显著差异，包括RBD特异性非典型MBCs（60.5%对17.9%，P < 0.001）、RBD特异性活化MBCs（36.3%对14.8%，P < 0.001）、RBD特异性中间型MBCs（1.24%对42.6%，P < 0.001）和静息MBCs（1.34%对22.4%，P < 0.001）。CKD患者的大多数AE为轻度（1级和2级）且具有自限性。1例CKD患者在接种疫苗后出现肾病综合征复发。
重组和灭活SARS-CoV-2疫苗在CKD队列中耐受性良好且反应良好。我们的研究还揭示了CKD患者和健康对照在接种SARS-CoV-2疫苗后MBC亚型的差异。
