The following is a summary of “Humoral and cellular immunity in patients with rare autoimmune rheumatic diseases following SARS-CoV-2 vaccination,” published in the June 2023 issue of Rheumatology by Gumber, et al.
For a study, researchers sought to assess the humoral and cell-mediated T-cell response after the second dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in patients with rare autoimmune rheumatic diseases (RAIRDs) and compare it with healthy controls (HCs).
After receiving the second vaccine dose, blood samples were collected from 50 RAIRD patients (including 31 with AAV, 4 with other systemic vasculitis, 9 with SLE, and 6 with myositis). Anti-spike and anti-nucleocapsid antibody levels and SARS-CoV-2-specific T-cell responses were measured and compared with those of HCs. Activation-induced marker and deep phenotyping assays were utilized to identify differences in T cells between high and no/low antibody response groups, followed by multidimensional clustering.
RAIRD patients showed significantly lower median anti-spike antibody levels than HCs (P < 0.0001). Approximately 33% of RAIRD patients had undetectable antibody levels, and 57% had levels lower than the lowest HC. Reduced immunogenicity was observed in patients who received rituximab within the last 12 months compared to those with a longer pre-vaccination period (P = 0.003). Furthermore, differences were noted in B cell percentages (P = 0.03) and spike-specific CD4+ T cells (P = 0.02) between the no/low antibody and high antibody response groups. Patients in the no/low antibody group exhibited a higher percentage of terminally differentiated (exhausted) T cells.
After two vaccine doses, most RAIRD patients showed lower antibody levels than HCs and decreased anti-spike T cell responses. RAIRD patients with no/low antibody responses exhibited a reduction in memory T cells with impaired proliferative and functional capacities. The findings highlighted the potential challenges in achieving an optimal vaccine response in RAIRD patients and underscored the importance of further understanding vaccine responses in the population.
Source: academic.oup.com/rheumatology/article/62/6/2294/6762096