Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Front Immunol. 2023 Mar 22;14:1106664. doi: 10.3389/fimmu.2023.1106664. eCollection 2023.
Little is known about the immune determinants for severe coronavirus disease 2019 (COVID-19) in individuals vaccinated against severe acute respiratory syndrome coronavirus 2. We therefore attempted to identify differences in humoral and cellular immune responses between patients with non-severe and severe breakthrough COVID-19.
We prospectively enrolled hospitalized patients with breakthrough COVID-19 (severe and non-severe groups) and uninfected individuals who were vaccinated at a similar time (control group). Severe cases were defined as those who required oxygen therapy while hospitalized. Enzyme-linked immunosorbent assays and flow cytometry were used to evaluate humoral and cellular immune responses, respectively.
Anti-S1 IgG titers were significantly lower in the severe group than in the non-severe group within 1 week of symptom onset and higher in the non-severe group than in the control group. Compared with the control group, the cellular immune response tended to be diminished in breakthrough cases, particularly in the severe group. In multivariate analysis, advanced age and low anti-S1 IgG titer were associated with severe breakthrough COVID-19.
Severe breakthrough COVID-19 might be attributed by low humoral and cellular immune responses early after infection. In the vaccinated population, delayed humoral and cellular immune responses may contribute to severe breakthrough COVID-19.
对于接种了严重急性呼吸综合征冠状病毒 2 疫苗的个体中，导致 2019 年冠状病毒病（COVID-19）重症的免疫决定因素知之甚少。因此，我们试图确定突破性 COVID-19（轻症和重症组）患者之间体液和细胞免疫反应的差异。
我们前瞻性地招募了突破性 COVID-19（重症和轻症组）住院患者和在相似时间接种疫苗的未感染个体（对照组）。重症病例定义为住院期间需要吸氧治疗的病例。酶联免疫吸附试验和流式细胞术分别用于评估体液和细胞免疫反应。
在症状出现后 1 周内，重症组的抗 S1 IgG 滴度明显低于轻症组，而非重症组的滴度高于对照组。与对照组相比，突破病例的细胞免疫反应趋于减弱，尤其是重症组。多变量分析显示，高龄和低抗 S1 IgG 滴度与重症突破性 COVID-19 相关。
重症突破性 COVID-19 可能归因于感染后早期的低体液和细胞免疫反应。在接种疫苗的人群中，延迟的体液和细胞免疫反应可能导致重症突破性 COVID-19。
