Immunology Service, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital (HUVR)/CSIC/University of Seville, Seville, Spain.
Nephrology Service, University Hospital Virgen del Rocío, Seville, Spain.
Front Immunol. 2023 Feb 16;14:1099079. doi: 10.3389/fimmu.2023.1099079. eCollection 2023.
Kidney transplant recipients showed a weak humoral response to the mRNA COVID-19 vaccine despite receiving three cumulative doses of the vaccine. New approaches are still needed to raise protective immunity conferred by the vaccine administration within this group of high-risk patients.
To analyze the humoral response and identify any predictive factors within these patients, we designed a prospective monocentric longitudinal study of Kidney transplant recipients (KTR) who received three doses of mRNA-1273 COVID-19 vaccine. Specific antibody levels were measured by chemiluminescence. Parameters related to clinical status such as kidney function, immunosuppressive therapy, inflammatory status and thymic function were analyzed as potential predictors of the humoral response.
Seventy-four KTR and sixteen healthy controls were included. One month after the administration of the third dose of the COVID-19 vaccine, 64.8% of KTR showed a positive humoral response. As predictive factors of seroconversion and specific antibody titer, we found that immunosuppressive therapy, worse kidney function, higher inflammatory status and age were related to a lower response in KTR while immune cell counts, thymosin-a1 plasma concentration and thymic output were related to a higher humoral response. Furthermore, baseline thymosin-a1 concentration was independently associated with the seroconversion after three vaccine doses.
In addition to the immunosuppression therapy, condition of kidney function and age before vaccination, specific immune factors could also be relevant in light of optimization of the COVID-19 vaccination protocol in KTR. Therefore, thymosin-a1, an immunomodulatory hormone, deserves further research as a potential adjuvant for the next vaccine boosters.
尽管肾移植受者接受了三剂 mRNA COVID-19 疫苗，但他们对该疫苗的体液免疫反应较弱。对于这群高危患者，仍然需要新的方法来提高疫苗接种所赋予的保护性免疫。
为了分析这些患者的体液反应并确定任何预测因素，我们设计了一项前瞻性的单中心纵向研究，纳入了接受三剂 mRNA-1273 COVID-19 疫苗的肾移植受者（KTR）。通过化学发光法测量特定抗体水平。分析与临床状况相关的参数，如肾功能、免疫抑制治疗、炎症状态和胸腺功能，作为体液反应的潜在预测因素。
纳入了 74 名 KTR 和 16 名健康对照者。在接种第三剂 COVID-19 疫苗一个月后，64.8%的 KTR 出现了阳性体液反应。作为血清转化和特定抗体滴度的预测因素，我们发现免疫抑制治疗、肾功能更差、炎症状态更高和年龄与 KTR 的反应较低相关，而免疫细胞计数、胸腺素-α1 血浆浓度和胸腺输出与更高的体液反应相关。此外，基线时胸腺素-α1 浓度与三剂疫苗后的血清转化独立相关。
除了免疫抑制治疗、疫苗接种前的肾功能状况和年龄外，特定的免疫因素也可能与 KTR 的 COVID-19 疫苗接种方案优化相关。因此，免疫调节激素胸腺素-α1值得进一步研究，作为下一次疫苗加强剂的潜在佐剂。
