Wall Nadezhda, Lamerton Rachel, Ashford Fiona, Perez-Toledo Marisol, Jasiulewicz Aleksandra, Banham Gemma D, Newby Maddy L, Faustini Sian E, Richter Alex G, Selvaskandan Haresh, Billany Roseanne E, Adenwalla Sherna F, Henderson Ian R, Crispin Max, Graham-Brown Matthew, Harper Lorraine, Cunningham Adam F
Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK.
Vaccines (Basel). 2024 Dec 25;13(1):7. doi: 10.3390/vaccines13010007.
: Generalised immune dysfunction in chronic kidney disease, especially in patients requiring haemodialysis (HD), significantly enhances the risk of severe infections. Vaccine-induced immunity is typically reduced in HD populations. The SARS-CoV-2 pandemic provided an opportunity to examine the magnitude and functionality of antibody responses in HD patients to a previously unencountered antigen-Spike (S)-glycoprotein-after vaccination with different vaccine platforms (viral vector (VV); mRNA (mRV)). We compared the total and functional anti-S antibody responses (cross-variant neutralisation and complement binding) in 187 HD patients and 43 healthy controls 21-28 days after serial immunisation. : After 2 doses of the same vaccine, HD patients had anti-S antibody levels and a complement binding capacity comparable to controls. However, 2 doses of mRV induced greater polyfunctional antibody responses than VV (defined by the presence of both complement binding and cross-variant neutralisation activity). Interestingly, an mRV boost after 2 doses of VV significantly enhanced antibody functionality in HD patients without a prior history of SARS-CoV-2 infection. : HD patients can generate near-normal, functional antigen-specific antibody responses following serial vaccination to a novel antigen. Encouragingly, exploiting immunological memory by using mRNA vaccines and boosting may improve the success of vaccination strategies in this vulnerable patient population.
慢性肾脏病患者，尤其是需要进行血液透析（HD）的患者，普遍存在免疫功能障碍，这显著增加了严重感染的风险。在HD人群中，疫苗诱导的免疫力通常会降低。新冠疫情提供了一个机会，来研究HD患者在接种不同疫苗平台（病毒载体（VV）；信使核糖核酸（mRV））后，针对一种此前未接触过的抗原——刺突（S）糖蛋白——的抗体反应的强度和功能。我们比较了187例HD患者和43例健康对照在进行系列免疫接种21至28天后的总抗S抗体反应和功能性抗S抗体反应（交叉变异中和及补体结合）。在接种2剂相同疫苗后，HD患者的抗S抗体水平和补体结合能力与对照组相当。然而，2剂mRV诱导的多功能抗体反应比VV更强（由补体结合和交叉变异中和活性两者的存在来定义）。有趣的是，在接种2剂VV后再接种一剂mRV，可显著增强无新冠病毒感染既往史的HD患者的抗体功能。HD患者在针对一种新抗原进行系列接种后，能够产生接近正常的、具有功能的抗原特异性抗体反应。令人鼓舞的是，通过使用信使核糖核酸疫苗和加强免疫来利用免疫记忆，可能会提高针对这一脆弱患者群体的疫苗接种策略的成功率。
