Antibody responses to the SARS-CoV-2 vaccine in individuals with various inborn errors of immunity - 04/11/21

Doi : 10.1016/j.jaci.2021.08.016

Ottavia M. Delmonte, MD, PhD ^a,^{∗
These authors are co-first authors and contributed equally to this work.}, Jenna R.E. Bergerson, MD ^a,^{∗
These authors are co-first authors and contributed equally to this work.}, Peter D. Burbelo, PhD ^b,^{∗
These authors are co-first authors and contributed equally to this work.}, Jessica R. Durkee-Shock, MD ^c, Kerry Dobbs, BS ^a, Marita Bosticardo, PhD ^a, Michael D. Keller, MD ^c, David H. McDermott, MD ^d, V. Koneti Rao, MD ^a, Dimana Dimitrova, MD ^e, Eugenia Quiros-Roldan, MD ^f,^g, Luisa Imberti, MD ^g, Elise M.N. Ferrè, PA-C ^a, Monica Schmitt, CRNP ^a, Christine Lafeer, RN ^a, Justina Pfister, RN ^a, Dawn Shaw, RN ^a, Deborah Draper, RN ^a, Meng Truong, RN ^a, Jean Ulrick, RN ^a, Tom DiMaggio, RN ^a, Amanda Urban, DNP ^a, Steven M. Holland, MD ^a, Michail S. Lionakis, MD, ScD ^a, Jeffrey I. Cohen, MD ^h, Emily E. Ricotta, PhD ^a,^{^{‡
These authors are co-last authors and contributed equally to this work.}}, Luigi D. Notarangelo, MD ^a,^⁎,^{^{‡
These authors are co-last authors and contributed equally to this work.}} , Alexandra F. Freeman, MD ^a,^⁎,^{^{‡
These authors are co-last authors and contributed equally to this work.}}
^a Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
^b National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Md
^c Center for Cancer and Immunology Research and Division of Allergy and Immunology, Children’s National Hospital, Washington, DC
^d Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
^e Experimental Transplantation and Immunotherapy Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md
^f Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
^g CREA Laboratory, Diagnostic Laboratory, ASST Spedali Civili di Brescia, Brescia, Italy
^h Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md

^∗Corresponding author: Alexandra Freeman, MD, Building 10, Room 12C103, National Institutes of Health, 10 Center Dr, Bethesda, MD 20892.Building 10, Room 12C103, National Institutes of Health10 Center DrBethesdaMD20892^∗∗Luigi D. Notarangelo, MD, Building 10, Room 5-3950, National Institutes of Health, 10 Center Dr, Bethesda, MD 20892.Building 10, Room 5-3950, National Institutes of Health10 Center DrBethesdaMD20892

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Abstract

Background

SARS-CoV-2 vaccination is recommended in patients with inborn errors of immunity (IEIs); however, little is known about immunogenicity and safety in these patients.

Objective

We sought to evaluate the impact of genetic diagnosis, age, and treatment on antibody response to COVID-19 vaccine and related adverse events in a cohort of patients with IEIs.

Methods

Plasma was collected from 22 health care worker controls, 81 patients with IEIs, and 2 patients with thymoma; the plasma was collected before immunization, 1 to 6 days before the second dose of mRNA vaccine, and at a median of 30 days after completion of the immunization schedule with either mRNA vaccine or a single dose of Johnson & Johnson’s Janssen vaccine. Anti-spike (anti-S) and anti-nucleocapsid antibody titers were measured by using a luciferase immunoprecipitation systems method. Information on T- and B-cell counts and use of immunosuppressive drugs was extracted from medical records, and information on vaccine-associated adverse events was collected after each dose.

Results

Anti-S antibodies were detected in 27 of 46 patients (58.7%) after 1 dose of mRNA vaccine and in 63 of 74 fully immunized patients (85.1%). A lower rate of seroconversion (7 of 11 [63.6%]) was observed in patients with autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy. Previous use of rituximab and baseline counts of less than 1000 CD3⁺ T cells/mL and less than 100 CD19⁺ B cells/mL were associated with lower anti-S IgG levels. No significant adverse events were reported.

Conclusion

Vaccinating patients with IEIs is safe, but immunogenicity is affected by certain therapies and gene defects. These data may guide the counseling of patients with IEIs regarding prevention of SARS-CoV-2 infection and the need for subsequent boosts.

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Key words : SARS-CoV-2, antibody response, COVID-19, inborn errors of immunity, immunomodulators, immune suppressants, JAK inhibitors, adverse events

Abbreviations used : anti-N, Anti-S, APECED, GM, HCW, IEI, LU

Mappa

Introduction

Results and discussion

	Supported by the Intramural Research programs of the National Institute of Dental and Craniofacial Research and the National Institute of Allergy and Infectious Diseases, National Institutes of Health (grant 1 ZIA AI001270-01[to L.D.N.]) and Regione Lombardia (the project Risposta immune in pazienti con COVID-19 e co-morbidità).
	Disclosure of potential conflict of interest: L. D. Notarangelo declares receipt of royalty payments from UpToDate. The rest of the authors declare that they have no relevant conflicts of interest.

Esportazione

Vol 148 - N° 5

P. 1192-1197 - Novembre 2021 Ritorno al numero

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Antibody responses to the SARS-CoV-2 vaccine in individuals with various inborn errors of immunity - 04/11/21

Abstract

Background

Objective

Methods

Results

Conclusion

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