背景:对SARS-CoV-2病毒的免疫反应,COVID-19的病因很复杂。抗体介导的反应对于病毒清除很重要,但也可能导致严重COVID-19的过度炎症。我们介绍了一例遗传上无法产生抗体和严重COVID-19的个体,除了恢复期COVID-19血浆外,没有接受其他特异性抗病毒治疗,说明在没有体液抗病毒反应的情况下可以发生过度炎症。此外,该病例表明,对SARS-CoV-2T细胞反应的评估可以促进COVID-19患者体液免疫反应弱或缺失的临床决策.
方法:一名男性患有X连锁无丙种球蛋白血症,接受常规免疫球蛋白替代疗法,因严重COVID-19住院35天。全身炎症参数高度升高。在用恢复期COVID-19血浆治疗后,他变得发热,疲劳减轻。他在第42天出院,鼻咽SARS-CoV-2PCR最终在第49天呈阴性。在施用血浆疗法之前SARS-CoV-2特异性T细胞的证据表明抗体对于病毒清除至关重要。定期评估显示,康复后SARS-CoV-2特异性T细胞反应稳健且持续,这表明无需预防性施用恢复期COVID-19血浆。
结论:评估SARS-CoV-2T细胞反应有助于COVID-19体液免疫缺陷患者的临床治疗。
BACKGROUND: The immune response to SARS-CoV-2 virus, the cause of COVID-19, is complex. Antibody mediated responses are important for viral clearance but may also drive hyperinflammation in severe COVID-19. We present a
case of an individual with a genetic inability to produce antibodies and severe COVID-19, receiving no other specific anti-viral treatment than convalescent COVID-19 plasma, illustrating that hyperinflammation can occur in the absence of a humoral anti-viral response. In addition, the
case illustrates that the assessment of SARS-CoV-2 T cell responses can facilitate clinical decision making in patients with COVID-19 and weak or absent humoral immune responses.
METHODS: A male with X-linked agammaglobulinemia on regular immunoglobulin replacement therapy, hospitalized for 35 days due to severe COVID-19. Systemic inflammatory parameters were highly elevated. After treatment with convalescent COVID-19 plasma he became afebrile and the fatigue diminished. He was discharged on day 42 and nasopharyngeal SARS-CoV-2 PCR eventually was negative on day 49. Evidence of SARS-CoV-2 specific T cells prior to administration of plasma therapy suggested that antibodies were crucial for viral clearance. Regular assessment showed robust and persistent SARS-CoV-2 specific T-cell responses after recovery suggested that prophylactic administration of convalescent COVID-19 plasma was unnecessary.
CONCLUSIONS: Assessment of SARS-CoV-2T-cell responses can facilitate the clinical management of COVID-19 patients with humoral immunodeficiencies.