PDF(Pubmed)
Abstract：
Patients with inborn errors of immunity (IEI) are at increased risk of severe coronavirus disease-2019 (COVID-19). Effective vaccination against COVID-19 is therefore of great importance in this group, but little is known about the immunogenicity of COVID-19 vaccines in these patients.
We sought to study humoral and cellular immune responses after mRNA-1273 COVID-19 vaccination in adult patients with IEI.
In a prospective, controlled, multicenter study, 505 patients with IEI (common variable immunodeficiency [CVID], isolated or undefined antibody deficiencies, X-linked agammaglobulinemia, combined B- and T-cell immunodeficiency, phagocyte defects) and 192 controls were included. All participants received 2 doses of the mRNA-1273 COVID-19 vaccine. Levels of severe acute respiratory syndrome coronavirus-2-specific binding antibodies, neutralizing antibodies, and T-cell responses were assessed at baseline, 28 days after first vaccination, and 28 days after second vaccination.
Seroconversion rates in patients with clinically mild antibody deficiencies and phagocyte defects were similar to those in healthy controls, but seroconversion rates in patients with more severe IEI, such as CVID and combined B- and T-cell immunodeficiency, were lower. Binding antibody titers correlated well to the presence of neutralizing antibodies. T-cell responses were comparable to those in controls in all IEI cohorts, with the exception of patients with CVID. The presence of noninfectious complications and the use of immunosuppressive drugs in patients with CVID were negatively correlated with the antibody response.
COVID-19 vaccination with mRNA-1273 was immunogenic in mild antibody deficiencies and phagocyte defects and in most patients with combined B- and T-cell immunodeficiency and CVID. Lowest response was detected in patients with X-linked agammaglobulinemia and in patients with CVID with noninfectious complications. The assessment of longevity of immune responses in these vulnerable patient groups will guide decision making for additional vaccinations.
We sought to study humoral and cellular immune responses after mRNA-1273 COVID-19 vaccination in adult patients with IEI.
In a prospective, controlled, multicenter study, 505 patients with IEI (common variable immunodeficiency [CVID], isolated or undefined antibody deficiencies, X-linked agammaglobulinemia, combined B- and T-cell immunodeficiency, phagocyte defects) and 192 controls were included. All participants received 2 doses of the mRNA-1273 COVID-19 vaccine. Levels of severe acute respiratory syndrome coronavirus-2-specific binding antibodies, neutralizing antibodies, and T-cell responses were assessed at baseline, 28 days after first vaccination, and 28 days after second vaccination.
Seroconversion rates in patients with clinically mild antibody deficiencies and phagocyte defects were similar to those in healthy controls, but seroconversion rates in patients with more severe IEI, such as CVID and combined B- and T-cell immunodeficiency, were lower. Binding antibody titers correlated well to the presence of neutralizing antibodies. T-cell responses were comparable to those in controls in all IEI cohorts, with the exception of patients with CVID. The presence of noninfectious complications and the use of immunosuppressive drugs in patients with CVID were negatively correlated with the antibody response.
COVID-19 vaccination with mRNA-1273 was immunogenic in mild antibody deficiencies and phagocyte defects and in most patients with combined B- and T-cell immunodeficiency and CVID. Lowest response was detected in patients with X-linked agammaglobulinemia and in patients with CVID with noninfectious complications. The assessment of longevity of immune responses in these vulnerable patient groups will guide decision making for additional vaccinations.
摘要：
先天性免疫错误（IEI）患者患严重冠状病毒病-2019（COVID-19）的风险增加。因此，针对COVID-19的有效疫苗接种在这一群体中非常重要，但对COVID-19疫苗在这些患者中的免疫原性知之甚少。
我们试图研究成年IEI患者在mRNA-1273COVID-19疫苗接种后的体液和细胞免疫反应。
在未来，控制,多中心研究，505例IEI患者（常见可变免疫缺陷[CVID]，孤立或未定义的抗体缺乏，X-连锁丙种球蛋白血症,联合B细胞和T细胞免疫缺陷，吞噬细胞缺陷）和192个对照被包括在内。所有参与者都接受了2剂mRNA-1273COVID-19疫苗。严重急性呼吸综合征冠状病毒-2特异性结合抗体的水平，中和抗体，在基线时评估T细胞反应，第一次接种疫苗后28天，第二次接种疫苗后28天。
临床轻度抗体缺乏和吞噬细胞缺陷患者的血清转换率与健康对照组相似，但是IEI更严重的患者的血清转换率，如CVID和B细胞和T细胞联合免疫缺陷，较低。结合抗体滴度与中和抗体的存在密切相关。T细胞反应与所有IEI队列中的对照组相当，除CVID患者外。CVID患者的非感染性并发症的存在和免疫抑制药物的使用与抗体反应呈负相关。
用mRNA-1273接种COVID-19在轻度抗体缺乏和吞噬细胞缺陷以及大多数患有B细胞和T细胞免疫缺陷和CVID的患者中具有免疫原性。在X连锁无丙种球蛋白血症患者和具有非感染性并发症的CVID患者中检测到最低反应。评估这些脆弱患者群体中免疫反应的寿命将指导进一步接种疫苗的决策。
我们试图研究成年IEI患者在mRNA-1273COVID-19疫苗接种后的体液和细胞免疫反应。
在未来，控制,多中心研究，505例IEI患者（常见可变免疫缺陷[CVID]，孤立或未定义的抗体缺乏，X-连锁丙种球蛋白血症,联合B细胞和T细胞免疫缺陷，吞噬细胞缺陷）和192个对照被包括在内。所有参与者都接受了2剂mRNA-1273COVID-19疫苗。严重急性呼吸综合征冠状病毒-2特异性结合抗体的水平，中和抗体，在基线时评估T细胞反应，第一次接种疫苗后28天，第二次接种疫苗后28天。
临床轻度抗体缺乏和吞噬细胞缺陷患者的血清转换率与健康对照组相似，但是IEI更严重的患者的血清转换率，如CVID和B细胞和T细胞联合免疫缺陷，较低。结合抗体滴度与中和抗体的存在密切相关。T细胞反应与所有IEI队列中的对照组相当，除CVID患者外。CVID患者的非感染性并发症的存在和免疫抑制药物的使用与抗体反应呈负相关。
用mRNA-1273接种COVID-19在轻度抗体缺乏和吞噬细胞缺陷以及大多数患有B细胞和T细胞免疫缺陷和CVID的患者中具有免疫原性。在X连锁无丙种球蛋白血症患者和具有非感染性并发症的CVID患者中检测到最低反应。评估这些脆弱患者群体中免疫反应的寿命将指导进一步接种疫苗的决策。
