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Functionally impaired antibody response to BNT162b2 booster vaccination in CVID IgG responders - 05/04/23

Doi : 10.1016/j.jaci.2022.11.013 
Kai M.T. Sauerwein, MSc a, b, c, Christoph B. Geier, MD a, Roman F. Stemberger, MSc a, Raphael Rossmanith, MSc a, Hüseyin Akyaman, BSc a, Peter Illes, MD d, Michael B. Fischer, MD c, e, Martha M. Eibl, MD a, b, Jolan E. Walter, MD f, g, Hermann M. Wolf, MD a, h,
a Immunology Outpatient Clinic, Vienna, Austria 
b Biomedizinische Forschung & Bio-Produkte AG, Vienna, Austria 
c Department for Biomedical Research, Center of Experimental Medicine, Danube University Krems, Krems an der Donau, Austria 
d USF Health Department of Pediatrics, Division of Allergy/Immunology, Children’s Research Institute, St Petersburg, Fla 
e Clinic for Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria 
f Division of Allergy and Immunology, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Fla 
g Division of Allergy/Immunology, Department of Pediatrics, Johns Hopkins All Children’s Hospital, St Petersburg, Fla 
h Sigmund Freud Private University, Medical School, Vienna, Austria 

Corresponding author: Hermann M. Wolf, MD, Immunology Outpatient Clinic, Schwarzspanierstraße 15, 1090 Vienna, Austria.mmunology Outpatient ClinicISchwarzspanierstraße 15Vienna1090Austria

Abstract

Background

Although previous studies described the production of IgG antibodies in a subgroup of patients with common variable immunodeficiency (CVID) following messenger RNA vaccinations with BNT162b2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (CVID responders), the functionality of these antibodies in terms of avidity as measured by the dissociation rate constant (kdis) and the antibody response to booster immunization has not been studied.

Objective

We sought to analyze in CVID responders and healthy individuals, the avidity of anti–SARS-CoV-2 serum antibodies and their neutralization capacity as measured by surrogate virus–neutralizing antibodies in addition to IgG-, IgM-, and IgA-antibody levels and the response of circulating (peripheral blood) follicular T-helper cells after a third vaccination with BNT162b2 SARS-CoV-2 messenger RNA vaccine.

Methods

Binding IgG, IgA, and IgM serum levels were analyzed by ELISA in patients with CVID responding to the primary vaccination (CVID responders, n = 10) and healthy controls (n = 41). The binding avidity of anti–spike antibodies was investigated using biolayer interferometry in combination with biotin-labeled receptor-binding-domain of SARS-CoV-2 spike protein and streptavidin-labeled sensors. Antigen-specific recall T-cell responses were assessed by measuring activation-induced markers by flow cytometry.

Results

After the third vaccination with BNT162b2, IgG-, IgM-, and IgA-antibody levels, surrogate virus–neutralizing antibody levels, and antibody avidity were lower in CVID responders than in healthy controls. In contrast, anti–SARS-CoV-2 spike protein avidity was comparable in CVID responders and healthy individuals following primary vaccination. Follicular T-helper cell response to booster vaccination in CVID responders was significantly reduced when compared with that in healthy individuals.

Conclusions

Impaired affinity maturation during booster response provides new insight into CVID pathophysiology.

El texto completo de este artículo está disponible en PDF.

Key words : BNT162b2 booster vaccination, CVID, antibody avidity, cTfh, biolayer interferometry

Abbreviations used : αSpike, cTfh, CVID, CVID R, HC, IQR, IVIG, kdis, SARS-CoV-2, sVNT


Esquema


 This study was supported by the Österreichische Forschungsförderungsgesellschaft mbH (grant no. 881639), and by the Jeffrey Modell Foundation, the Johns Hopkins Research Foundation, and the Robert A. Good Endowment.
 Ethics statement: The study was conducted in accordance with the Declaration of Helsinki and fulfils the guidelines of the Austrian Agency of Research Integrity (OeAWI). With respect to the patient analyses, this study was approved by the Ethics Committee of the Immunology Outpatient Clinic as a study using the biobank of residual specimen of the Immunology Outpatient Clinic. According to the Ethics Committee of the City of Vienna and the legal regulations to be applied (§15a Abs. 3a Wiener Krankenanstaltengesetz), no additional ethics committee evaluation is required for a noninterventional study using data and material collected as part of the routine medical care the patients received. The patients gave their informed consent that anonymized data collected as part of the routine medical attendance (serum antibody measurements and T-cell activation assays) could be included in a scientific publication. All patient information in this study is anonymized and deidentified. No extra intervention was carried out.
 Disclosure of potential conflict of interest: K. M. T. Sauerwein and M. M. Eibl were employed by the company Biomedizinische Forschung & Bio-Produkte AG, which had no role in the design of this study or during its execution, and was not involved in the analyses, interpretation of the data, and the decision to submit the present manuscript for publication. The rest of the authors declare that they have no relevant conflicts of interest.


© 2022  American Academy of Allergy, Asthma & Immunology. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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