Airola Carlo, Andaloro Silvia, Gasbarrini Antonio, Ponziani Francesca Romana
Liver Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
Department of Translational Medicine and Surgery, Catholic University, 00168 Rome, Italy.
Vaccines (Basel). 2024 Mar 23;12(4):349. doi: 10.3390/vaccines12040349.
Vaccines prevent a significant number of deaths annually. However, certain populations do not respond adequately to vaccination due to impaired immune systems. Cirrhosis, a condition marked by a profound disruption of immunity, impairs the normal immunization process. Critical vaccines for cirrhotic patients, such as the hepatitis A virus (HAV), hepatitis B virus (HBV), influenza, pneumococcal, and coronavirus disease 19 (COVID-19), often elicit suboptimal responses in these individuals. The humoral response, essential for immunization, is less effective in cirrhosis due to a decline in B memory cells and an increase in plasma blasts, which interfere with the creation of a long-lasting response to antigen vaccination. Additionally, some T cell subtypes exhibit reduced activation in cirrhosis. Nonetheless, the persistence of memory T cell activity, while not preventing infections, may help to attenuate the severity of diseases in these patients. Alongside that, the impairment of innate immunity, particularly in dendritic cells (DCs), prevents the normal priming of adaptive immunity, interrupting the immunization process at its onset. Furthermore, cirrhosis disrupts the gut-liver axis balance, causing dysbiosis, reduced production of short-chain fatty acids (SCFAs), increased intestinal permeability, and bacterial translocation. Undermining the physiological activity of the immune system, these alterations could impact the vaccine response. Enhancing the understanding of the molecular and cellular factors contributing to impaired vaccination responses in cirrhotic patients is crucial for improving vaccine efficacy in this population and developing better prevention strategies.
疫苗每年可预防大量死亡。然而，某些人群由于免疫系统受损，对疫苗接种反应不佳。肝硬化是一种以免疫力严重紊乱为特征的疾病，会损害正常的免疫过程。对于肝硬化患者来说，关键疫苗，如甲型肝炎病毒（HAV）、乙型肝炎病毒（HBV）、流感、肺炎球菌和新型冠状病毒肺炎（COVID-19）疫苗，在这些个体中往往引发次优反应。体液反应对免疫至关重要，但在肝硬化患者中效果较差，这是因为B记忆细胞减少，浆母细胞增加，从而干扰了对抗原疫苗接种产生持久反应。此外，一些T细胞亚群在肝硬化患者中表现出激活减少。尽管如此，记忆T细胞活性的持续存在虽然不能预防感染，但可能有助于减轻这些患者疾病的严重程度。与此同时，先天免疫的损害，尤其是树突状细胞（DC）的损害，会阻止适应性免疫的正常启动，在免疫过程开始时就中断免疫。此外，肝硬化会破坏肠-肝轴平衡，导致生态失调、短链脂肪酸（SCFA）产生减少、肠道通透性增加和细菌易位。这些改变破坏了免疫系统的生理活性，可能会影响疫苗反应。加强对导致肝硬化患者疫苗接种反应受损的分子和细胞因素的理解，对于提高该人群的疫苗效力和制定更好的预防策略至关重要。
