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Hirai K, Shimotashiro M, Okumura T, Ookawara S, Morishita Y. Anti-SARS-CoV-2 Spike Antibody Response to the Fourth Dose of BNT162b2 mRNA COVID-19 Vaccine and Associated Factors in Japanese Hemodialysis Patients. Int J Nephrol Renovasc Dis 2024; 17:135-149. [PMID: 38774113 PMCID: PMC11108064 DOI: 10.2147/ijnrd.s452964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/04/2024] [Indexed: 05/24/2024] Open
Abstract
Background We assessed the anti-SARS-CoV-2 spike antibody response to four doses of BNT162b2 mRNA COVID-19 vaccine in Japanese hemodialysis patients and determined factors associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose. Methods Fifty-one patients were enrolled in this single-center, prospective, longitudinal study. Change in anti-SARS-CoV-2 spike antibody titers between after the second and fourth doses were evaluated. Multiple linear regression analysis was used to identify factors associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose. Results The anti-SARS-CoV-2 spike antibody titer was higher 4 weeks after the fourth dose compared with 4 weeks after the third dose (30,000 [interquartile range (IQR), 14,000-56,000] vs 18,000 [IQR, 11,000-32,500] AU/mL, p<0.001) and 4 weeks after the second dose (vs 2896 [IQR, 1110-4358] AU/mL, p<0.001). Hypoxia-inducible factor prolyl hydroxylase inhibitor use (standard coefficient [β]=0.217, p=0.011), and the log-anti-SARS-CoV-2 spike antibody titer 1 week before the fourth dose (β=0.810, p<0.001) were correlated with the log-anti-SARS-CoV-2 spike antibody titer 4 weeks after the fourth dose, whereas only the log-anti-SARS-CoV-2 spike antibody titer 1 week before the fourth dose (β=0.677, p<0.001) was correlated with the log-anti-SARS-CoV-2 spike antibody titer 12 weeks after the fourth dose. Conclusion Hypoxia-inducible factor prolyl hydroxylase inhibitor use and the anti-SARS-CoV-2 spike antibody titer before the fourth dose were associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose in Japanese hemodialysis patients.
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Affiliation(s)
- Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | | | | | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Ma BM, Tam AR, Chan KW, Hung IFN, Tang SCW, Chan TM, Yap DYH. Immunogenicity and Safety of the Three-Dose COVID-19 Vaccine Regimen in Patients Receiving Renal Replacement Therapy: A Systematic Review and Meta-Analysis. KIDNEY DISEASES (BASEL, SWITZERLAND) 2024; 10:107-117. [PMID: 38751793 PMCID: PMC11095616 DOI: 10.1159/000536308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 01/12/2024] [Indexed: 05/18/2024]
Abstract
Background A three-dose regimen is the current standard for COVID-19 vaccination, but systematic data on immunogenicity and safety in chronic kidney disease patients remains limited. Objectives We conducted a meta-analysis on the immunogenicity and safety of three-dose COVID-19 vaccination in patients on renal replacement therapy (RRT). Methods Systematic literature search in four electronic databases yielded twenty eligible studies (2,117 patients, 94% of whom received mRNA vaccines) for meta-analysis. Results The overall seropositivity rate of anti-SARS-CoV-2 was 74.2% (95% CI: 65.0-83.4%) after three-dose COVID-19 vaccination. The seropositivity rate of anti-SARS-CoV-2 in kidney transplant recipients (KTRs) was 64.6% (95% CI: 58.7-70.5%), and 43.5% (95% CI: 38.5-48.6%) of non-responders after second dose became seropositive after third dose. The seropositivity rate of anti-SARS-CoV-2 was 92.9% (95% CI: 89.5-96.2%) in dialysis patients, and 64.6% (95% CI: 46.8-82.3%) of non-responders after second dose became seropositive after third dose. In KTRs, each year increase in transplant vintage was associated with 35.6% increase in anti-SARS-CoV-2 seropositivity (95% CI: 15.9-55.4%, p = 0.01). There were no serious adverse events attributed to vaccination in KTRs, and the commonest local and systemic adverse events were injection site pain and fatigue, respectively. Conclusion Three-dose COVID-19 vaccination regimen in patients on RRT is associated with reduced immunogenicity, especially in KTRs. There are no adverse events associated with third-dose COVID-19 vaccine in KTRs.
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Affiliation(s)
- Becky Mingyao Ma
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Anthony Raymond Tam
- Division of Infectious Diseases, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Kam Wa Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Ivan Fan Ngai Hung
- Division of Infectious Diseases, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Sydney Chi Wai Tang
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Tak Mao Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Desmond Yat-Hin Yap
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Fujieda K, Tanaka A, Kikuchi R, Takai N, Saito S, Yasuda Y, Sano Y, Kato M, Furuhashi K, Maruyama S. Changes in antibody titer after four and five doses of the SARS-CoV-2 vaccine in Japanese post-kidney transplant patients. Ther Apher Dial 2024. [PMID: 38385762 DOI: 10.1111/1744-9987.14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Immunosuppressed patients exhibit low antibody acquisition rates following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Kidney transplant recipients previously exhibited low antibody acquisition rates after two vaccine doses, which increased after the third dose. We evaluated antibody titers of Japanese post-kidney transplant patients after the fourth and fifth vaccinations. METHODS Antibody titers for SARS-CoV-2 spike protein were measured between 3 weeks and 3 months after the fourth or fifth vaccination. RESULTS Increased antibody acquisition rates were observed after the fourth (75.0% antibody-positive) and fifth (81.5% antibody-positive) vaccinations. The antibody-acquired group after the fourth vaccination exhibited a higher body mass index and estimated glomerular filtration rate (eGFR) than the non-acquired group. A higher eGFR was associated with antibody acquisition after the fifth vaccination. CONCLUSION In Japanese post-kidney transplant patients, the antibody acquisition rate increased with each vaccine additional dose. Additional vaccinations are recommended to protect against SARS-CoV-2 infection.
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Affiliation(s)
- Kumiko Fujieda
- Department of Nephrology, Nagoya University Hospital, Nagoya, Japan
| | - Akihito Tanaka
- Department of Nephrology, Nagoya University Hospital, Nagoya, Japan
| | - Ryosuke Kikuchi
- Department of Medical Technique, Nagoya University Hospital, Nagoya, Japan
- Division of Clinical Laboratory, Gifu University Hospital, Gifu, Japan
| | - Nami Takai
- Department of Nursing, Nagoya University Hospital, Nagoya, Japan
| | - Shoji Saito
- Department of Nephrology, Nagoya University Hospital, Nagoya, Japan
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Hospital, Nagoya, Japan
| | - Yuta Sano
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Choi H, Han S, Kim JS, Park B, Lee MJ, Shin GT, Kim H, Kim K, Park AY, Shin HJ, Park I. Antibody response in patients undergoing chronic hemodialysis post-severe acute respiratory syndrome coronavirus 2 vaccination: A prospective observational study. Medicine (Baltimore) 2023; 102:e35484. [PMID: 37773791 PMCID: PMC10545368 DOI: 10.1097/md.0000000000035484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/13/2023] [Indexed: 10/01/2023] Open
Abstract
Vaccination is important for patients undergoing hemodialysis (HD) to prevent coronavirus disease 2019 (COVID-19) infection since they are more vulnerable. However, they exhibit a weak response to vaccines, underscoring the importance of understanding whether antibodies are sufficiently produced and their durability post-COVID-19 vaccination. This prospective observational study assessed the antibody response of Korean patients undergoing HD for 1 year. We compared the antibody responses of patients undergoing HD to the COVID-19 vaccine with those of healthy volunteers from 2021 to 2022. The patient and control groups received 2 doses of ChAdOx1 nCoV-19 and mRNA-1273, respectively. Immunoglobulin G (IgG) and neutralizing antibody levels were measured weeks or months apart after 2 doses for 1 year using enzyme-linked immunosorbent and fluorescence-based competitive severe acute respiratory syndrome coronavirus 2 neutralizing assays, respectively. We analyzed the third dose's effect on the patient group by categorizing the group into patients who received the third dose and those who did not since it was initiated midway through the study. In the control group, we enrolled participants who had completed 3 doses of mRNA-1273 since almost all participants received the third dose. Thirty-two patients undergoing HD and 15 healthy participants who received 2 doses of ChAdOx1 nCoV-19 and 3 of mRNA-1273, respectively, were enrolled. Although antibody production was weaker in the patient group than in the control group (P < .001), patients showed an increase in IgG levels (0.408 ± 0.517 optical density (OD) pre-vaccination, 2.175 ± 1.241 OD in patients with 2 doses, and 2.134 ± 1.157 OD in patients with 3 doses 1 year after the second dose) and neutralizing antibodies (23 ± 8% pre-vaccination, 87 ± 23% in patients with 2 doses, and 89 ± 18% in patients with 3 doses 1 year after the second dose) post-vaccination (P < .001). In the patient group, 19 patients received a third dose (BNT162b2 or mRNA-1273); however, it did not increase the antibody levels (P = 1.000). Furthermore, the antibodies produced by the vaccination did not wane until 1 year. Two doses of vaccination resulted in a significant antibody response in patients undergoing HD, and antibody levels did not wane until 1 year.
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Affiliation(s)
- Heejung Choi
- Department of Nephrology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sungdam Han
- Malgundam Internal Medicine Clinic, Suwon, Republic of Korea
| | - Ji Su Kim
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovation, Ajou University Medical Center, Suwon, Republic of Korea
| | - Bumhee Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovation, Ajou University Medical Center, Suwon, Republic of Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min-Jeong Lee
- Department of Nephrology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Gyu-Tae Shin
- Department of Nephrology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Heungsoo Kim
- Department of Nephrology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kyongmin Kim
- Department of Microbiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - A-Young Park
- Department of Microbiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ho-Joon Shin
- Department of Microbiology, Ajou University School of Medicine, Suwon, Republic of Korea
- Department of Molecular Science and Technology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Inwhee Park
- Department of Nephrology, Ajou University School of Medicine, Suwon, Republic of Korea
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Mahallawi WH. COVID-19 vaccine in hemodialysis patients: Time for a boost. Saudi Med J 2023; 44:882-888. [PMID: 37717958 PMCID: PMC10505293 DOI: 10.15537/smj.2023.44.9.20230285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/01/2023] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVES To evaluate anti-spike immunoglobulin G (IgG) antibody levels of hemodialysis patients and correlate them with the patients' demographic data and to evaluate these patients' need for a coronavirus disease-19 (COVID-19) vaccine booster. METHODS A cross-sectional multi-center study carried out at King Abdulaziz Kidney Center, Hasan Tahir Hemodialysis Center, and Hayat Organization Hemodialysis Center in Al-Madinah Al-Munawarah, Saudi Arabia. Patients (n=167) who received a minimum single dose of COVID-19 vaccine were recruited. The samples were collected between March 2022 and January 2023. Anti-spike IgG antibody levels were measured using enzyme-linked immunosorbent assays. RESULTS A significantly higher proportion of patients who received 3 doses of COVID-19 vaccine had positive serostatus compared with patients who received one or 2 doses (3 doses: 87.2%, one dose: 0.0%, 2 doses: 77.3%; p=0.000). Compared with patients who received one dose, significantly higher IgG antibody levels were detected in patients who received 2 (p=0.013) and 3 doses (p=0.025; n=35). In contrast, there was no significant difference in IgG antibody levels between patients who received 2 or 3 doses (p=0.45). Significant IgG antibody levels were detected in patients who received 2 and 3 doses (p=0.0125) compared with those received one vaccine dose (p=0.0004). Furthermore, patients who received 3 doses had significantly higher IgG antibody levels than patients who received 2 doses (p=0.000). CONCLUSION The results show a dose-dependent association between IgG antibody levels and the number COVID-19 vaccines received. The study highlights the need for booster COVID-19 vaccination for patients on hemodialysis.
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Affiliation(s)
- Waleed H. Mahallawi
- From the Department of Medical Laboratory Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia
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He M, Song R, Shaik Z, Gadegbeku CA, Enderle L, Petyo C, Quinn SB, Pfeffer Z, Murphy K, Kelsen S, Mishkin AD, Lee J, Gillespie A. COVID-19 Vaccine Antibody Response in a Single-Center Urban Hemodialysis Unit. Vaccines (Basel) 2023; 11:1252. [PMID: 37515067 PMCID: PMC10384404 DOI: 10.3390/vaccines11071252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The longitudinal response to the COVID-19 vaccines among patients on hemodialysis with and without prior SARS-CoV-2 infection has not been well characterized. METHODS To guide vaccination strategies in patients on hemodialysis, it is critical to characterize the longevity and efficacy of the vaccine; therefore, we conducted a prospective single-center monthly antibody surveillance study between March 2021 and March 2022 to investigate the dynamic humoral response to a series of COVID-19 mRNA vaccines in patients on hemodialysis with and without prior SARS-CoV-2 infection. Monthly quantitative antibody testing was performed using the Beckman Coulter Access SARS-CoV-2 IgG Antibody Test©, which detects IgG antibodies targeting the receptor binding domain (RBD) of the SARS-CoV-2 spike protein. RESULTS This cohort of 30 participants (mean age: 61 ± 3 years) predominantly self-identified as African American (97%) and male (53%). Eight participants (27%) had recovered from COVID-19 (recovered) before the vaccine initiation. All participants received two vaccine doses, and 86.6% received a 6-month booster dose. Among patients naïve to COVID-19, the antibody positivity rate (APR) was 55% post-first-dose, 91% post-second-dose, 50% pre-booster at 6 months, 100% post-booster, and 89% at 6 months post-booster. Recovered patients sustained a consistent 100% APR throughout the year. The naïve patients demonstrated lower peak antibody levels post-second-dose than the recovered patients (17.9 ± 3.2 vs. 44.7 ± 5.6, p < 0.001). The peak antibody levels post-booster showed no significant difference between both groups (27.1 ± 3.9 vs. 37.9 ± 8.2, p = 0.20). Two naïve patients contracted COVID-19 during the follow-up period. CONCLUSIONS The patients naïve to COVID-19 exhibited an attenuated and foreshortened antibody response following two doses of the mRNA vaccines compared with the recovered patients, who maintained 100% APR before the booster dose. The 6-month booster dose counteracted declining immunity and stimulated antibody responses in the naïve patients, even in previously non-responsive patients. This observation implies that different booster vaccination strategies might be required for COVID-19-naïve and -recovered patients. Post-vaccination antibody testing may serve as a valuable tool for guiding vaccination strategies.
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Affiliation(s)
- Mingyue He
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Rui Song
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Zakir Shaik
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Crystal A Gadegbeku
- Cleveland Clinic Glickman Urological, Kidney Institute, Cleveland, OH 44195, USA
| | | | | | - Sally B Quinn
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Zoe Pfeffer
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | | | - Steven Kelsen
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Aaron D Mishkin
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Jean Lee
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Avrum Gillespie
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
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Beilhack G, Monteforte R, Frommlet F, Reindl-Schwaighofer R, Strassl R, Vychytil A. Durable Anti-SARS-CoV-2 Antibody Response after mRNA-1273 Booster in Peritoneal Dialysis Patients during the Omicron Wave. Vaccines (Basel) 2023; 11:1121. [PMID: 37376510 DOI: 10.3390/vaccines11061121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Anti-SARS-CoV-2 vaccination of dialysis patients has been proven to be safe and effective to reduce COVID-19-related morbidity and mortality. However, data on the durability of anti-SARS-CoV-2 antibodies post-vaccination in peritoneal dialysis (PD) patients are scarce. In this prospective single-center cohort study we measured anti-SARS-CoV-2 RBD antibodies 3 and 6 months after the 3rd dose of the mRNA-1273 vaccine in 27 adult PD patients and recorded breakthrough infections. Furthermore, in a mixed model analysis, we analyzed potential factors influencing the humoral response following vaccination. Anti-SARS-CoV-2 RBD antibody levels declined from 21,424 BAU/mL at 1 month to 8397 BAU/mL at 3 months and to 5120 BAU/mL at 6 months after the 3rd dose, but remained higher than pre-3rd dose levels (212 BAU/mL). Eight patients (29.6%) were infected with SARS-CoV-2 within six months from the 3rd dose during the Omicron wave. Previous high antibody levels, high glomerular filtration rate (GFR) and low Davies Comorbidity Score were associated with higher anti-SARS-CoV-2 antibody levels after the booster. In conclusion, PD patients exhibited a robust and durable humoral response after a third dose of the mRNA-1273 vaccine. A high GFR and low comorbidity as well as previous high antibody levels predicted a better humoral response to vaccination.
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Affiliation(s)
- Georg Beilhack
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Rossella Monteforte
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria
| | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Robert Strassl
- Division of Clinical Virology, Medical University of Vienna, 1090 Vienna, Austria
| | - Andreas Vychytil
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
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Cheng Y, Zheng D, Zhang D, Guo D, Wang Y, Liu W, Liang L, Hu J, Luo T. Molecular recognition of SARS-CoV-2 spike protein with three essential partners: exploring possible immune escape mechanisms of viral mutants. J Mol Model 2023; 29:109. [PMID: 36964244 PMCID: PMC10038388 DOI: 10.1007/s00894-023-05509-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/10/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE The COVID-19 epidemic is raging around the world, with the emergence of viral mutant strains such as Delta and Omicron, posing severe challenges to people's health and quality of life. A full understanding life cycle of the virus in host cells helps to reveal inactivation mechanism of antibody and provide inspiration for the development of a new-generation vaccines. METHODS In this work, molecular recognitions and conformational changes of SARS-CoV-2 spike protein mutants (i.e., Delta, Mu, and Omicron) and three essential partners (i.e., membrane receptor hACE2, protease TMPRSS2, and antibody C121) both were compared and analyzed using molecular simulations. RESULTS Water basin and binding free energy calculations both show that the three mutants possess higher affinity for hACE2 than WT, exhibiting stronger virus transmission. The descending order of cleavage ability by TMPRSS2 is Mu, Delta, Omicron, and WT, which is related to the new S1/S2 cutting site induced by transposition effect. The inefficient utilization of TMPRSS2 by Omicron is consistent with its primary entry into cells via the endosomal pathway. In addition, RBD-directed antibody C121 showed obvious resistance to Omicron, which may have originated from high fluctuation of approaching angles, high flexibility of I472-F490 loop, and reduced binding ability. CONCLUSIONS According to the overall characteristics of the three mutants, high infectivity, high immune escape, and low virulence may be the future evolutionary selection of SARS-CoV-2. In a word, this work not only proposes the possible resistance mechanism of SARS-CoV-2 mutants, but also provides theoretical guidance for the subsequent drug design against COVID-19 based on S protein structure.
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Affiliation(s)
- Yan Cheng
- Breast Disease Center, West China Hospital, Sichuan University, Cancer CenterChengdu, 610000, China
| | - Dan Zheng
- Breast Disease Center, West China Hospital, Sichuan University, Cancer CenterChengdu, 610000, China
| | - Derong Zhang
- School of Marxism, Chengdu Vocational & Technical College of Industry, Chengdu, China
| | - Du Guo
- Breast Disease Center, West China Hospital, Sichuan University, Cancer CenterChengdu, 610000, China
| | - Yueteng Wang
- Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, School of Pharmacy, Chengdu University, Chengdu, China
| | - Wei Liu
- Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, School of Pharmacy, Chengdu University, Chengdu, China
| | - Li Liang
- Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, School of Pharmacy, Chengdu University, Chengdu, China
| | - Jianping Hu
- Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, School of Pharmacy, Chengdu University, Chengdu, China
| | - Ting Luo
- Breast Disease Center, West China Hospital, Sichuan University, Cancer CenterChengdu, 610000, China.
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9
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Gaete-Argel A, Saavedra-Alarcón V, Sauré D, Alonso-Palomares L, Acevedo ML, Alarcón M, Bueno SM, Kalergis AM, Soto-Rifo R, Valiente-Echeverría F, Cortes CP. Impact of homologous and heterologous boosters in neutralizing antibodies titers against SARS-CoV-2 Omicron in solid-organ transplant recipients. Front Immunol 2023; 14:1135478. [PMID: 36999018 PMCID: PMC10044136 DOI: 10.3389/fimmu.2023.1135478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
IntroductionBooster doses of SARS-CoV-2 vaccines improve seroconversion rates in solid organ transplant recipients (SOTRs) but the impact of homologous and heterologous booster doses in neutralizing antibody (NAb) titers and their ability to interfere with the variant of concern Omicron are not well studied.MethodsWe designed a prospective, open-label, observational clinical cohort study. 45 participants received two doses of BNT162b2 or CoronaVac (21-day or 28-day intervals, respectively) followed by a first and second booster with BNT162b2 (5-month apart each) and we analyzed the neutralizing antibody titers against SARSCoV-2 D614G (B.1 lineage) and Omicron (BA.1 lineage).ResultsOur results show that SOTRs receiving an initial two-dose scheme of CoronaVac or BNT162b2 generate lower NAbs titers against the ancestral variant of SARS-CoV-2 when compared with healthy controls. Although these NAb titers were further decreased against the SARS-CoV-2 Omicron, a single BNT162b2 booster in both groups was sufficient to increase NAb titers against the variant of concern. More importantly, this effect was only observed in those participants responding to the first two shots but not in those not responding to the initial vaccination scheme.DiscussionThe data provided here demonstrate the importance of monitoring antibody responses in immunocompromised subjects when planning booster vaccination programs in this risk group.
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Affiliation(s)
- Aracelly Gaete-Argel
- Laboratorio de Virología Molecular y Celular, Programa de Virología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Vicente Saavedra-Alarcón
- Laboratorio de Virología Molecular y Celular, Programa de Virología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Denis Sauré
- Departamento de Ingenieria Industrial, Facultad de Ciencias Físicas y Matemáticas, University of Chile and Institutos Sistemas Complejos de Ingenieria, Santiago, Chile
| | - Luis Alonso-Palomares
- Laboratorio de Virología Molecular y Celular, Programa de Virología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Mónica L. Acevedo
- Laboratorio de Virología Molecular y Celular, Programa de Virología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | | | - Susan M. Bueno
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Soto-Rifo
- Laboratorio de Virología Molecular y Celular, Programa de Virología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Fernando Valiente-Echeverría
- Laboratorio de Virología Molecular y Celular, Programa de Virología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
- *Correspondence: Fernando Valiente-Echeverría, ; Claudia P. Cortes,
| | - Claudia P. Cortes
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
- Clínica Santa María, Santiago, Chile
- Departamento de Medicina Interna Centro, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- *Correspondence: Fernando Valiente-Echeverría, ; Claudia P. Cortes,
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Humoral and cellular response after BNT162b2 vaccine booster in hemodialysis patients and kidney transplant recipients. Clin Exp Nephrol 2023; 27:445-453. [PMID: 36795176 PMCID: PMC9933795 DOI: 10.1007/s10157-023-02317-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 01/10/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Vulnerable populations, such as hemodialysis (HD) patients and kidney transplant (RTx) recipients, have priority for anti-COVID-19 vaccination, because of their impaired immune status. Here, we investigated the immune response after vaccination with BNT162b2 (two doses plus booster) in HD and RTx patients. METHODS A prospective, observational study was started in two homogeneous groups of 55 HD and 51 RTx patients previously matched from a cohort of 336 patients. Anti-RBD IgG levels, assayed after the second dose with BNT162b2 mRNA, were used to stratify subjects into quintiles. After the second dose and after booster, anti-RBD and IGRA test were evaluated in RTx and HD, belonging to the first and fifth quintiles. RESULTS After the second dose of vaccine, the median circulating levels of anti-RBD IgG were significantly higher in HD (1456 AU/mL) compared to RTx (27.30 AU/mL). IGRA test showed significantly higher values in the HD (382 mIU/mL) compared with the RTx (73 mIU/mL). After the booster, humoral response increased significantly in both HD (p = 0.0002) and RTx groups (p = 0.009), whereas the T-cellular immunity remained essentially stable in most patients. In RTx patients with a low humoral response after the second dose, the third dose did not significantly strengthen either humoral or cellular immunity. CONCLUSIONS For HD and RTx, there is great variability in the humoral response to anti-COVID-19 vaccination, with a stronger response in the HD group. The booster dose was ineffective at reinforcing the humoral and cellular immune response in most RTx patients hyporesponsive to the second dose.
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11
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Fujieda K, Tanaka A, Kikuchi R, Takai N, Saito S, Yasuda Y, Fujita T, Kato M, Furuhashi K, Maruyama S. Assessment of Antibody-Titer Changes after Second and Third Severe Acute Respiratory Syndrome Coronavirus 2 mRNA Vaccination in Japanese Post-Kidney-Transplant Patients. Vaccines (Basel) 2023; 11:vaccines11010134. [PMID: 36679979 PMCID: PMC9866315 DOI: 10.3390/vaccines11010134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Post-renal-transplant patients have a relatively low antibody-acquisition rate following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccination. In this study, antibody titers were measured 5−6 months and 3 weeks to 3 months after the second and third SARS-CoV-2 mRNA vaccinations, respectively. Post-renal-transplant patients visiting our hospital who had received three SARS-CoV-2 mRNA vaccine doses were included in the study. SARS-CoV-2 immunoglobulin G antibody titers were measured three times: between 3 weeks and 3 months after the second vaccination, 5−6 months after the second vaccination, and between 3 weeks and 3 months after the third vaccination. A total of 62 (40 men and 22 women) were included, 44 of whom (71.0%) were antibody positive after their third vaccination. On comparing the antibody-acquired and antibody-non-acquired groups, body mass index (BMI, odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.07−1.93, p < 0.05) and the estimated glomerular filtration rate (eGFR, OR: 1.14, 95% CI: 1.06−1.24, p < 0.01) were associated with antibody acquisition. Therefore, in Japanese post-kidney-transplant patients, increases in the antibody-acquisition rate and absolute antibody titer after the third vaccination were observed, with BMI and eGFR associated with the antibody-acquisition rate.
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Affiliation(s)
- Kumiko Fujieda
- Department of Nephrology, Nagoya University Hospital, Nagoya 466-8560, Aichi, Japan
| | - Akihito Tanaka
- Department of Nephrology, Nagoya University Hospital, Nagoya 466-8560, Aichi, Japan
| | - Ryosuke Kikuchi
- Department of Medical Technique, Nagoya University Hospital, Nagoya 466-8560, Aichi, Japan
- Division of Clinical Laboratory, Gifu University Hospital, Gifu 501-1194, Gifu, Japan
| | - Nami Takai
- Department of Nursing, Nagoya University Hospital, Nagoya 466-8560, Aichi, Japan
| | - Shoji Saito
- Department of Nephrology, Nagoya University Hospital, Nagoya 466-8560, Aichi, Japan
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Hospital, Nagoya 466-8560, Aichi, Japan
| | - Takashi Fujita
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Aichi, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Aichi, Japan
| | - Kazuhiro Furuhashi
- Department of Nephrology, Nagoya University Hospital, Nagoya 466-8560, Aichi, Japan
- Correspondence: ; Tel.: +81-52-741-2111; Fax: +81-52-744-2209
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Aichi, Japan
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Kurshan A, Snell LB, Prior L, Tam JCH, Graham C, Thangarajah R, Edgeworth JD, Nebbia G, Doores KJ. Endogenous antibody responses in REGN-COV2-treated SARS-CoV-2-infected individuals. OXFORD OPEN IMMUNOLOGY 2023; 4:iqac012. [PMID: 36844257 PMCID: PMC9914479 DOI: 10.1093/oxfimm/iqac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/21/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
Neutralizing monoclonal antibodies (mAbs) targeting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spike glycoprotein have been developed for the treatment of COVID-19. Whilst antibody therapy has been shown to reduce the risk of COVID-19-associated hospitalization and death, there is limited understanding of the endogenous immunity to SARS-CoV-2 generated in mAb-treated patients and therefore ongoing susceptibility to future infections. Here we measure the endogenous antibody response in SARS-CoV-2-infected individuals treated with REGN-COV2 (Ronapreve). We show that in the majority of unvaccinated, delta-infected REGN-COV2-treated individuals, an endogenous antibody response is generated, but, like untreated, delta-infected individuals, there was a limited neutralization breadth. However, some vaccinated individuals who were seronegative at SARS-CoV-2 infection baseline and some unvaccinated individuals failed to produce an endogenous immune response following infection and REGN-COV2 treatment demonstrating the importance of mAb therapy in some patient populations.
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Affiliation(s)
- Ashwini Kurshan
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, UK
| | - Luke B Snell
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, UK
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Lucie Prior
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, UK
| | - Jerry C H Tam
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, UK
| | - Carl Graham
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, UK
| | - Rajeni Thangarajah
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Department of Pharmacy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Jonathan D Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Gaia Nebbia
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, UK
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13
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Bailey AJ, Maganti HB, Cheng W, Shorr R, Arianne Buchan C, Allan DS. Humoral and Cellular Response of Transplant Recipients to a Third Dose of mRNA SARS-CoV-2 Vaccine: A Systematic Review and Meta-analysis. Transplantation 2023; 107:204-215. [PMID: 36398334 PMCID: PMC9746229 DOI: 10.1097/tp.0000000000004386] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND High rates of nonresponse to 2 doses of mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine have been reported in transplant recipients. Several studies have investigated the efficacy of a third dose in this population. However, efficacy remains unclear, as response rates vary across studies. Therefore, we conducted a systematic review and meta-analysis to determine the efficacy of a third dose of any mRNA SARS-CoV-2 vaccine in transplant recipients. METHODS Preferred Reporting Items for Systematic Review and Meta-Analysis reporting guidelines (PROSPERO:CRD42021281498) were followed. Medline, Embase, and CENTRAL were searched from inception to December 2, 2021, without restrictions. All full-text studies reporting on the efficacy of a third dose of any mRNA SARS-CoV-2 vaccine in pediatric and adult transplant recipients were included. The National Institutes of Health quality assessment tool for case series and the Cochrane risk of bias tool determined study quality. Meta-analysis was performed via the DerSimonian-Laird random-effect model. RESULTS Of 84 records, 12 studies totaling 1257 patients met inclusion criteria. One study was a randomized controlled trial, whereas all other studies were observational. Across 7 studies (801 patients), humoral response after 3 doses was observed in 66.1% (95% confidence interval, 62.8%-69.4%; I2 = 0%) of transplant recipients. Triple immunosuppression, mycophenolate, antiproliferatives, and belatacept use were associated with reduced odds of humoral response in studies reporting multivariate analyses. Transplant recipients receiving a third dose displayed higher levels of neutralizing antibodies to SARS-CoV-2 variants (Alpha, Beta, and Delta) compared with placebo. CONCLUSIONS A third dose SARS-CoV-2 mRNA vaccine should be strongly considered in transplant recipients. Limitations included lack of controlled studies and clinically relevant thresholds to determine response to vaccination.
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Affiliation(s)
- Adrian J.M. Bailey
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, ON, Canada
| | - Harinad B. Maganti
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, ON, Canada
- Clinical Epidemiology and Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Wei Cheng
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Risa Shorr
- Library and Information Services, The Ottawa Hospital, Ottawa, ON, Canada
| | - C. Arianne Buchan
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - David S. Allan
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, ON, Canada
- Clinical Epidemiology and Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Blood and Marrow Transplant Program, Division of Hematology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
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14
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Yang X, Zhang H, Bao W, Fu S, Jin H. Immunogenicity Rates after SARS-CoV-2 Three-Dose Vaccination in Patients under Dialysis: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10122070. [PMID: 36560480 PMCID: PMC9782384 DOI: 10.3390/vaccines10122070] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Considering the indeterminate effects following the administration of three doses of the SARS-CoV-2 vaccine to patients under dialysis, the present study aimed to evaluate the immunogenicity rates of patients who received the three-dose vaccine. METHODS MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register for Controlled Trials were searched to select the relevant literature to perform the present review. We included randomized controlled trials, non-randomized trials, prospective, observational cohort, and case-control studies to assess the humoral and cellular immune responses following the administration of the three-dose SARS-CoV-2 vaccine to patients receiving dialysis. RESULTS Overall, 38 studies are included in the meta-analysis presented in this paper. For patients on dialysis, the overall humoral antibody response rate is 97% following three doses of mRNA or viral vector vaccines and 100% following four doses of the SARS-CoV-2 vaccine. A subgroup analysis shows that the antibody response rate is 96% for patients on hemodialysis (HD) and 100% for those receiving peritoneal dialysis (PD). The antibody response rate in the different immunogen-vaccinated groups tends to be higher than that in the same immunogen-vaccinated group (99% vs. 96%). For those who exhibit no response following two doses of the vaccine, the third and fourth doses can elevate the antibody response rate to 81%, and that number for low responders increases to 96%. However, the pooled results obtained from the relatively few trials conducted indicate that the positive T-cell response rate only increases to 59% following three doses of the vaccine. The antibody response rate is not different between dialysis and non-dialysis groups (relative risk = 0.95, 95% CI 0.90-1.02) following three doses of the vaccine. The relative risks for a SARS-CoV-2 breakthrough infection, all-cause mortality, and hospital admissions are 0.59 (95% CI 0.30-1.04), 0.63 (95% CI 0.35-1.12), and 0.53 (95% CI 0.37-0.74), respectively, when comparing three doses with two doses of the vaccine administered to the dialysis population. CONCLUSIONS The third or fourth dose of the SARS-CoV-2 vaccine significantly increases the immunogenicity rates in dialysis patients, and this beneficial effect does not vary with the type of vaccine (the same or different immunogen vaccination), dialysis modality (HD or PD), or previous low response following the administration two doses of the vaccine. We believe that healthcare workers should encourage patients receiving dialysis to receive a third or fourth vaccine dose to strengthen their immunity against SARS-CoV-2.
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15
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Malik SA, Modarage K, Goggolidou P. A systematic review assessing the effectiveness of COVID-19 mRNA vaccines in chronic kidney disease (CKD) individuals. F1000Res 2022; 11:909. [PMID: 36531259 PMCID: PMC9732501 DOI: 10.12688/f1000research.122820.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background: SARS-CoV-2 is a coronavirus that has rapidly spread across the world with a detrimental effect on the global population. Several reports have highlighted an increased mortality rate and a higher severity of COVID-19 infection in chronic kidney disease (CKD) individuals. Upon the development of various SARS-CoV-2 vaccines, mRNA vaccines including BNT162b2 and mRNA-1273 were deemed safe, with a high efficacy in preventing COVID-19 in the general population. This review investigates whether SARS-CoV-2 mRNA vaccines are as effective in triggering an immune response in Dialysis Patients (DPs) and Kidney Transplant Recipients (KTRs) and if a third dose is required in this population. Methods: A systematic search employing the PRISMA criteria was conducted in several major databases, with the data being extracted from publications for the period January 2021 to May 2022 (PROSPERO: CRD42022338514, June 15, 2022). Results: 80 studies were included in this analysis with a total cohort number of 15,059 participants. Overall, 85.29% (OR = 17.08, 95% CI = 15.84-18.42, I 2 = 98%) and 41.06% (OR = 0.52, 95% CI = 0.48-0.5, I 2 = 95%) of DPs and KTRs included in this review showed positive seroconversion after two doses of either mRNA vaccine, respectively. A total 76% (OR = 6.53, 95% CI = 5.63-7.5, I 2 = 96%) of the cohort given a third dose of an mRNA vaccine demonstrated positive seroconversion, with 61.86% (OR = 2.31, 95% CI = 1.95-2.75 I 2 = 95%) of the cohort that was assessed for a cellular response displaying a positive response. Conclusions: This data emphasises a reduced incidence of a positive immune response in DPs and KTRs compared to healthy controls, albeit a better response in DPs than when compared to KTRs alone was observed. A third dose appears to increase the occurrence of an immune response in the overall DP/KTR cohort.
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Affiliation(s)
- Soniya A. Malik
- Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wulfruna Street, Wolverhampton, WV1 1LY, UK
| | - Kavindiya Modarage
- Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wulfruna Street, Wolverhampton, WV1 1LY, UK
| | - Paraskevi Goggolidou
- Research Institute in Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wulfruna Street, Wolverhampton, WV1 1LY, UK,
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16
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Babel N, Hugo C, Westhoff TH. Vaccination in patients with kidney failure: lessons from COVID-19. Nat Rev Nephrol 2022; 18:708-723. [PMID: 35999285 PMCID: PMC9397175 DOI: 10.1038/s41581-022-00617-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 02/06/2023]
Abstract
Infection is the second leading cause of death in patients with chronic kidney disease (CKD). Adequate humoral (antibody) and cellular (T cell-driven) immunity are required to minimize pathogen entry and promote pathogen clearance to enable infection control. Vaccination can generate cellular and humoral immunity against specific pathogens and is used to prevent many life-threatening infectious diseases. However, vaccination efficacy is diminished in patients with CKD. Premature ageing of the immune system and chronic systemic low-grade inflammation are the main causes of immune alteration in these patients. In the case of SARS-CoV-2 infection, COVID-19 can have considerable detrimental effects in patients with CKD, especially in those with kidney failure. COVID-19 prevention through successful vaccination is therefore paramount in this vulnerable population. Although patients receiving dialysis have seroconversion rates comparable to those of patients with normal kidney function, most kidney transplant recipients could not generate humoral immunity after two doses of the COVID-19 vaccine. Importantly, some patients who were not able to produce antibodies still had a detectable vaccine-specific T cell response, which might be sufficient to prevent severe COVID-19. Correlates of protection against SARS-CoV-2 have not been established for patients with kidney failure, but they are urgently needed to enable personalized vaccination regimens.
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Affiliation(s)
- Nina Babel
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
- Center for Translational Medicine and Immune Diagnostics Laboratory, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Center for Advanced Therapies (BeCAT) and Berlin Institute of Health, Berlin, Germany.
| | - Christian Hugo
- Medizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timm H Westhoff
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
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Ponticelli C, Campise M. COVID-19 Vaccination in Kidney Transplant Candidates and Recipients. Vaccines (Basel) 2022; 10:vaccines10111808. [PMID: 36366317 PMCID: PMC9692413 DOI: 10.3390/vaccines10111808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 12/03/2022] Open
Abstract
Kidney transplant candidates and kidney transplant recipients (KTRs) are at particular risk of severe complications of COVID-19 disease. In Western countries, mortality in affected hospitalized KTRs ranges between 19% and 50%. COVID-19 vaccination remains the most important measure to prevent the severity of infection in candidates and recipients of kidney transplant. However, the uraemic condition may affect the vaccine-induced immunity in patients with advanced chronic kidney disease (CKD) and in KTRs. Retention of uraemic toxins, dysbiosis, dysmetabolism, and dialysis can diminish the normal response to vaccination, leading to dysfunction of inflammatory and immune cells. In KTRs the efficacy of vaccines may be reduced by the immunosuppressive medications, and more than half of kidney transplant recipients are unable to build an immune response even after four administrations of anti-COVID-19 vaccines. The lack of antibody response leaves these patients at high risk for SARS-CoV-2 infection and severe COVID-19 disease. The aim of the present review is to focus on the main reasons for the impaired immunological response among candidates and kidney transplant recipients and to highlight some of the present options available to solve the problem.
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Affiliation(s)
| | - Mariarosaria Campise
- Department of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
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18
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Falahi S, Sayyadi H, Kenarkoohi A. Immunogenicity of COVID-19 mRNA vaccines in hemodialysis patients: Systematic review and meta-analysis. Health Sci Rep 2022; 5:e874. [PMID: 36210877 PMCID: PMC9528953 DOI: 10.1002/hsr2.874] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Aims Vaccine response is a concern in hemodialysis patients. Given that hemodialysis patients were not included in clinical trials, we aimed to synthesize the available evidence on the immunogenicity of coronavirus disease 2019 (COVID‐19) mRNA vaccines in hemodialysis patients. Methods We searched Scopus, PubMed, Sciencedirect, and finally google scholar databases for studies on COVID‐19 mRNA‐vaccines immunogenicity in hemodialysis patients up to December 1, 2021. Eligible articles measured antibodies against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) spike or Receptor‐Binding Domain Antibody (S/RBD) postimmunization with COVID‐19 mRNA vaccines. The immunogenicity of the vaccine was evaluated using seroconversion rates measured between 21 and 30 days after the first immunization and between 14 and 36 days post the second dose. We included studies including participants without a history of COVID‐19 before vaccination. Healthy controls or health‐care workers served as the control groups. After selecting eligible articles, the data were finally extracted from included articles. We used a random effects model to estimate the pooled seroconversion rate after COVID‐19 mRNA vaccine administration. We assessed the heterogeneity between studies with the I2 statistical index. Result We selected 39 eligible citations comprising 806 cases and 336 controls for the first dose and 6314 cases and 927 controls for the second dose for statistical analysis. After the first dose of mRNA vaccines, the seroconversion rate was 36% (95% confidence interval [CI]: 0.24–0.47) and 68% (95% CI: 0.45–0.91) in hemodialysis patients and the control group, respectively. While seroconversion rate after the second dose of mRNA vaccines was 86% (95% CI: 0.81–0.91) and 100% (95% CI: 1.00–1.00) in hemodialysis patients and the control group, respectively. Conclusion Although the immune response of hemodialysis patients to the second dose of the SARS‐CoV‐2 mRNA vaccine is very promising, the seroconversion rate of dialysis patients is lower than healthy controls. Periodically assessment of antibody levels of hemodialysis patients at short intervals is recommended.
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Affiliation(s)
- Shahab Falahi
- Zoonotic Diseases Research CenterIlam University of Medical SciencesIlamIran
| | - Hojjat Sayyadi
- Department of Biostatistics, Faculty of HealthIlam University of Medical SciencesIlamIran
| | - Azra Kenarkoohi
- Zoonotic Diseases Research CenterIlam University of Medical SciencesIlamIran,Department of Microbiology, Faculty of MedicineIlam University of Medical SciencesIlamIran
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19
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El-Menyar A, Khan NA, Mekkodathil A, Rizoli S, Consunji R, Elmenyar E, Galwankar S, Al-Thani H. A quick scoping review of the first year of vaccination against the COVID-19 pandemic: Do we need more shots or time? Medicine (Baltimore) 2022; 101:e30609. [PMID: 36123868 PMCID: PMC9477714 DOI: 10.1097/md.0000000000030609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The emergence of new severe acute respiratory syndrome coronavirus 2 variants, along with the waning of vaccine-induced immunity, has increased breakthrough infections and urged booster jabs and debates. In the short term, the administration of booster doses has been reported to be safe and enhance severe acute respiratory syndrome coronavirus 2-specific neutralizing antibody levels. However, the effects of these doses on the pandemic trajectory and herd immunity are unclear. There is insufficient evidence that a third booster shot of the coronavirus disease 2019 (COVID-19) vaccine maintains longer immunity and covers new viral variants. The lack of sufficient evidence, combined with the fact that millions of people have not yet received 1 or 2 jabs of the COVID-19 vaccine, has raised concerns regarding the call for booster vaccinations. METHODS We conducted a quick scoping review to explore the literature on the need for a booster COVID-19 vaccination from January 1, 2021, to April 30, 2022. RESULTS Sixty-one relevant publications were identified, of which 17 were related to waning immunity after 2 doses of the vaccine among the general population or healthcare workers, 19 were related to the third or booster dose of vaccination after the second dose among the general population or healthcare workers, and 25 were related to booster dose among immunocompromised patient. CONCLUSIONS Initially, the need for a booster dose was equivocal; however, several studies demonstrated the benefit of the booster dose over time. Adequate scientific information is required regarding the administration of booster doses to the general population as well as the high-risk individuals.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery Clinical Research, Hamad Medical Corporation, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Naushad Ahmad Khan
- Department of Surgery, Trauma and Vascular Surgery Clinical Research, Hamad Medical Corporation, Qatar
| | - Ahammed Mekkodathil
- Department of Surgery, Trauma and Vascular Surgery Clinical Research, Hamad Medical Corporation, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Qatar
| | - Rafael Consunji
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Qatar
| | | | - Sagar Galwankar
- Department of Emergency Medicine, Sarasota Memorial Hospital, Sarasota, FL
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Qatar
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Gallego-Valcarce E, Shabaka A, Leon-Poo M, Gruss E, Acedo-Sanz JM, Cordón A, Cases-Corona C, Fernandez-Juarez G. Humoral Response Following Triple Dose of mRNA Vaccines Against SARS-CoV-2 in Hemodialysis Patients: Results After 1 Year of Follow-Up. Front Med (Lausanne) 2022; 9:927546. [PMID: 35903310 PMCID: PMC9314744 DOI: 10.3389/fmed.2022.927546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/21/2022] [Indexed: 12/11/2022] Open
Abstract
Introduction COVID-19 is associated with an increased mortality in hemodialysis patients. Therefore, achieving a long-lasting effective immune response to SARS-CoV-2 vaccines is essential. This study describes the humoral immune response in hemodialysis patients following three doses of mRNA vaccines against SARS-CoV-2, and explores the factors associated with a sustained immune response. Materials and Methods We analyzed the monthly serological evolution of SARS-CoV-2 anti-S(RBD) antibodies for 1 year in 178 chronic hemodialysis patients who received three doses of SARS-CoV-2 mRNA vaccines. The primary outcome was sustained effective humoral response defined as anti-S(RBD) levels > 1,000 AU/ml after 4 months from the third dose. Multivariate logistic regression analyses were used to identify features associated with a sustained humoral immune response. Results After the initial two SARS-CoV-2 mRNA vaccine doses, 77.8% of patients showed an immediate effective humoral response, decreasing to 52.5% after 4 months. Antibody levels were significantly higher in COVID-exposed patients and HBV vaccine responders. After the third dose, 97% of patients showed an effective humoral response, and remained in 91.7% after 4 months. The mean monthly rate of antibody titer decline decreased from 33 ± 14.5 to 25 ± 16.7%. Multivariate regression analysis showed that previous exposure to COVID-19 and response to HBV vaccines were associated with an effective sustained humoral immune response. Conclusion Immunization with SARS-CoV-2 mRNA vaccines elicits an effective immediate humoral immune response in hemodialysis patients, with a progressive waning in antibody levels. A third booster dose enhances the immune response with significantly higher antibody levels and more sustained humoral immune response. COVID-naïve patients and patients without previous response to HBV vaccines are likely to benefit from receiving more booster doses to maintain an effective immune response.
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Affiliation(s)
| | - Amir Shabaka
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Mariana Leon-Poo
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Enrique Gruss
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Juan Manuel Acedo-Sanz
- Department of Clinical Analysis, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Alfredo Cordón
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo, Móstoles, Spain
| | - Clara Cases-Corona
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Gema Fernandez-Juarez
- Department of Nephrology, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
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21
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Chu C, Schönbrunn A, Elitok S, Kern F, Schnatbaum K, Wenschuh H, Klemm K, von Baehr V, Krämer BK, Hocher B. T-cell proliferation assay for the detection of SARS-CoV-2-specific T-cells. Clin Chim Acta 2022; 532:130-136. [PMID: 35690083 PMCID: PMC9174102 DOI: 10.1016/j.cca.2022.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/17/2022]
Abstract
Both infection with and vaccination against SARS-CoV-2 trigger a complex B-cell and T-cell response. Methods for the analysis of the B-cell response are now well established. However, reliable methods for measuring the T-cell response are less well established and their usefulness in clinical settings still needs to be proven. Here, we have developed and validated a T-cell proliferation assay based on 3H thymidine incorporation. The assay is using SARS-CoV-2 derived peptide pools that cover the spike (S), the nucleocapsid (N) and the membrane (M) protein for stimulation. We have compared this novel SARS-CoV-2 lymphocyte transformation test (SARS-CoV-2 LTT) to an established ELISA assay detecting Immunoglobulin G (IgG) antibodies to the S1 subunit of the SARS-CoV-2 spike protein. The study was carried out using blood samples from both vaccinated and infected health care workers as well as from a non-infected control group. Our novel SARS-CoV-2 LTT shows excellent discrimination of infected and/or vaccinated individuals versus unexposed controls, with the ROC analysis showing an area under the curve (AUC) of > 0.95. No false positives were recorded as all unexposed controls had a negative LTT result. When using peptide pools not only representing the S protein (found in all currently approved vaccines) but also the N and M proteins (not contained in the vast majority of vaccines), the novel SARS-CoV-2 LTT can also discriminate T-cell responses resulting from vaccination against those induced by infection.
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Affiliation(s)
- Chang Chu
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Germany; Department of Nephrology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Anne Schönbrunn
- Institute of Medical Diagnostics, IMD Berlin-Potsdam, Berlin, Germany
| | - Saban Elitok
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Germany; Department of Nephrology and Endocrinology, Ernst von Bergmann Hospital Potsdam, Potsdam, Germany
| | - Florian Kern
- Brighton and Sussex Medical School, Brighton BN1 9PX, UK; JPT Peptide Technologies, Berlin, Germany
| | | | | | - Kristin Klemm
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Germany; Department of Nephrology and Endocrinology, Ernst von Bergmann Hospital Potsdam, Potsdam, Germany
| | - Volker von Baehr
- Institute of Medical Diagnostics, IMD Berlin-Potsdam, Berlin, Germany
| | - Bernhard K Krämer
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Germany; European Center for Angioscience ECAS, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany; Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Mannheim Institute for Innate Immunoscience, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Berthold Hocher
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology/Pneumology), University Medical Centre Mannheim, University of Heidelberg, Germany; Institute of Medical Diagnostics, IMD Berlin-Potsdam, Berlin, Germany; Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China; Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China.
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22
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Beilhack G, Monteforte R, Frommlet F, Reindl-Schwaighofer R, Strassl R, Vychytil A. Humoral Response to mRNA-1273 SARS-CoV-2 Vaccine in Peritoneal Dialysis Patients: Is Boostering After Six Months Adequate? Front Med (Lausanne) 2022; 9:905798. [PMID: 35814775 PMCID: PMC9263093 DOI: 10.3389/fmed.2022.905798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/23/2022] [Indexed: 12/28/2022] Open
Abstract
In dialysis patients the humoral response to anti-SARS-CoV-2 vaccines is attenuated and rapidly declines over time. However, data on the persistence of the immune response in peritoneal dialysis (PD) patients are scarce, particularly after a third (booster) dose with mRNA-1273 vaccine. In this prospective cohort study, we report anti-SARS-CoV-2 antibody levels in PD patients before and after the third dose of mRNA-1273 vaccine. Six months after the second dose, anti-SARS-CoV-2 antibodies were detected in all patients (n = 34). However, within this time period antibodies substantially declined in 31 of 34 patients (4.5-fold, median = 192 BAU/mL, p = 1.27 × 10–9) and increased in three patients. In accordance with government regulations, a third dose of mRNA-1273 vaccine (50 μg) was given to 27 PD patients 6 months after the second dose which induced a significant increase of anti-SARS-CoV-2 antibody titers (58.6-fold, median = 19405 BAU/mL, p = 1.24 × 10–29). A mixed model analysis showed that a lower Davies Comorbidity Score and a higher GFR were associated with higher antibody titers (p = 0.03 and p = 0.02). The most common adverse events after the third dose were pain at the injection site (77.8%) and fatigue (51.9%). No hospitalizations were reported. In conclusion, 6 months after the second dose of mRNA-1273 vaccine, anti-SARS-CoV-2 antibodies substantially decreased in PD patients, whereas a well-tolerated third dose induced a robust humoral response. Our data suggest that the administration of a booster dose within a shorter interval than 6 months should be considered in PD patients in order to maintain high anti-SARS-CoV-2 antibody levels and assure protection from severe COVID-19 disease.
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Affiliation(s)
- Georg Beilhack
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Rossella Monteforte
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Robert Strassl
- Division of Clinical Virology, Medical University of Vienna, Vienna, Austria
| | - Andreas Vychytil
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- *Correspondence: Andreas Vychytil,
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23
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Ogrič M, Žigon P, Podovšovnik E, Lakota K, Sodin-Semrl S, Rotar Ž, Čučnik S. Differences in SARS-CoV-2-Specific Antibody Responses After the First, Second, and Third Doses of BNT162b2 in Naïve and Previously Infected Individuals: A 1-Year Observational Study in Healthcare Professionals. Front Immunol 2022; 13:876533. [PMID: 35711413 PMCID: PMC9196038 DOI: 10.3389/fimmu.2022.876533] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Safe and effective vaccines against COVID-19 are critical for preventing the spread of SARS-CoV-2, but little is known about the humoral immune response more than 9 months after vaccination. We aimed to assess the humoral immune response after the first, second, and third (booster) doses of BNT162b2 vaccine in SARS-CoV-2 naïve and previously infected healthcare professionals (HCP) and the humoral immune response after infection in vaccinated HCP. Methods We measured anti-spike (anti-S) and anti-nucleocapsid antibodies at different time points up to 12 months in the sera of 300 HCP who had received two or three doses of BNT162b2 vaccine. Mixed-model analyses were used to assess anti-S antibody dynamics and to determine their predictors (age, sex, BMI, and previous infection). Results Naïve individuals had statistically lower anti-S antibody concentrations after the first dose (median 253 BAU/ml) than previously infected individuals (median 3648 BAU/ml). After the second dose, anti-S antibody concentrations increased in naïve individuals (median 3216 BAU/ml), whereas the second dose did not significantly increase concentrations in previously infected individuals (median 4503 BAU/ml). The third dose resulted in an additional increase in concentrations (median 4844 BAU/ml in naïve and median 5845 BAU/ml in previously infected individuals). Anti-S antibody concentrations steadily decreased after the second dose and after the third dose in naïve and previously infected individuals. In addition, we found that age had an effect on the humoral immune response. Younger individuals had higher anti-S antibody concentrations after the first and second doses. After infection with the new variant Omicron, a further increase in anti-S antibody concentrations to a median value of 4794 BAU/ml was observed in three times vaccinated HCP whose anti-S antibody concentrations were relatively high before infection (median 2141 BAU/ml). Our study also showed that individuals with systemic adverse events achieved higher anti-S antibody concentrations. Conclusion In this study, significant differences in humoral immune responses to BNT162b2 vaccine were observed between naïve and previously infected individuals, with age playing an important role, suggesting that a modified vaccination schedule should be practiced in previously infected individuals. In addition, we showed that the high anti-S antibodies were not protective against new variants of SARS-CoV-2.
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Affiliation(s)
- Manca Ogrič
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Polona Žigon
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,University of Primorska, Faculty of Mathematics, Natural Sciences and Information Technologies, Koper, Slovenia
| | | | - Katja Lakota
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,University of Primorska, Faculty of Mathematics, Natural Sciences and Information Technologies, Koper, Slovenia
| | - Snezna Sodin-Semrl
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,University of Primorska, Faculty of Mathematics, Natural Sciences and Information Technologies, Koper, Slovenia
| | - Žiga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Saša Čučnik
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
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24
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Haase M, Lesny P, Anderson M, Cloherty G, Stec M, Haase-Fielitz A, Haarhaus M, Santos-Araújo C, Veiga PM, Macario F. Humoral immunogenicity and tolerability of heterologous ChAd/BNT compared with homologous BNT/BNT and ChAd/ChAd SARS-CoV-2 vaccination in hemodialysis patients : A multicenter prospective observational study. J Nephrol 2022; 35:1467-1478. [PMID: 35084719 PMCID: PMC8792133 DOI: 10.1007/s40620-022-01247-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/01/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND After the reports of severe adverse reactions to the AstraZeneca ChAdOx1-S-nCoV-19 vaccine, patients who had received one dose of ChAdOx1-S-nCoV-19 vaccine were recommended a second dose of Pfizer's BNT162b2 vaccine. In hemodialysis patients, we compared the humoral immunogenicity and tolerability of homologous vaccination with ChAdOx1-nCoV-19/ChAdOx1-nCoV-19 (ChAd/ChAd) and BNT162b2/BNT162b2 (BNT/BNT) with heterologous vaccination of first dose of ChAdOx1-nCoV-19 and a second dose with BNT162b2 (ChAd/BNT). METHODS In a multicenter prospective observational study, SARS-CoV-2 spike-IgG antibody levels, Nucleocapsid-protein-IgG-antibodies, and vaccine tolerability were assessed 6 weeks after second SARS-CoV-2 vaccination in 137 hemodialysis patients and 24 immunocompetent medical personnel. RESULTS In COVID-19-naïve hemodialysis patients, significantly higher median SARS-CoV-2-spike IgG levels were found after ChAd/BNT (N = 16) compared to BNT/BNT (N = 100) or ChAd/ChAd (N = 10) (1744 [25th-75th percentile 276-2840] BAU/mL versus 361 [25th-75th percentile 120-936] BAU/mL; p = 0.009; 1744 [25th-75th percentile 276-2840] BAU/mL versus 100 [25th-75th percentile 41-346] BAU/mL; p = 0.017, respectively). Vaccinated, COVID-19-naïve medical personnel had median SARS-CoV-2 spike-IgG levels of 650 (25th-75th percentile 217-1402) BAU/mL and vaccinated hemodialysis patients with prior COVID-19 7047 (25th-75th percentile 685-10,794) BAU/mL (N = 11). In multivariable regression analysis, heterologous vaccination (ChAd/BNT) of COVID-19-naïve hemodialysis patients was independently associated with SARS-CoV-2 spike-IgG levels. The first dose of ChAd and the second dose of BNT after the first vaccination with ChAd (heterologous vaccination, ChAd/BNT) were associated with more frequent but manageable side effects compared with homologous BNT. CONCLUSIONS Within the limitations of this study, heterologous vaccination with ChAd/BNT appears to induce stronger humoral immunity and more frequent but manageable side effects than homologous vaccination with BNT/BNT or with ChAd/ChAd in COVID-19-naïve hemodialysis patients.
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Affiliation(s)
- Michael Haase
- Diaverum Renal Care Center, Potsdam, Germany.
- Diaverum AB, Hyllie Boulevard 39, 215 37, Malmö, Sweden.
- Medical Faculty, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Paul Lesny
- Diaverum Renal Care Center, Potsdam, Germany
| | - Mark Anderson
- Abbott Infectious Disease Research, Chicago, IL, 60064-3500, USA
| | - Gavin Cloherty
- Abbott Infectious Disease Research, Chicago, IL, 60064-3500, USA
| | - Michael Stec
- Abbott Infectious Disease Research, Chicago, IL, 60064-3500, USA
| | - Anja Haase-Fielitz
- Brandenburg Medical School Theodor Fontane, 16816, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, 14469, Potsdam, Germany
- Institute of Integrated Health Care Systems Research & Social Medicine, Otto-Von-Guericke-University Magdeburg, 39120, Magdeburg, Germany
- Department of Cardiology, Brandenburg Heart Center, Immanuel Hospital, 16321, Bernau, Germany
| | - Mathias Haarhaus
- Diaverum AB, Hyllie Boulevard 39, 215 37, Malmö, Sweden
- Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Carla Santos-Araújo
- Institute of Integrated Health Care Systems Research & Social Medicine, Otto-Von-Guericke-University Magdeburg, 39120, Magdeburg, Germany
- Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pedro Mota Veiga
- School of Education, Polytechnic Institute of Viseu, Viseu, Portugal
- NECE Research Unit in Business Sciences, University of Beira Interior, Covilhã, Portugal
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25
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El Karoui K, De Vriese AS. COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment. Kidney Int 2022; 101:883-894. [PMID: 35176326 PMCID: PMC8842412 DOI: 10.1016/j.kint.2022.01.022] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/01/2022] [Accepted: 01/20/2022] [Indexed: 01/07/2023]
Abstract
The COVID-19 pandemic has profound adverse effects on the population on dialysis. Patients requiring dialysis are at an increased risk of SARS-CoV-2 infection and mortality, and many have experienced psychological distress as well as delayed or suboptimal care. COVID-19 survivors have prolonged viral shedding, but generally develop a robust and long-lasting humoral immune response that correlates with initial disease severity. However, protection against reinfection is incomplete. A growing body of evidence reveals delayed and blunted immune responses to SARS-CoV-2 vaccination. Administration of a third dose within 1 to 2 months of prime-boost vaccination significantly increases antibody levels, in particular in patients with poor initial responses. Patients on dialysis have inferior immune responses to adenoviral vector vaccines than to mRNA vaccines. The immunogenicity of the mRNA-1273 vaccine is markedly better than that of the BNT162b2 vaccine, most likely by virtue of its higher mRNA content. Despite suboptimal immune responses in patients on dialysis, preliminary data suggest that vaccination partially protects against infection and severe disease requiring hospitalization. However, progressive waning of immunity and emergence of SARS-CoV-2 variants with a high potential of immune escape call for a booster dose in all patients on dialysis 4 to 6 months after prime-boost vaccination. Patients with persistent poor vaccine responses may be candidates for primary prophylaxis strategies. In the absence of specific data in patients on dialysis, therapeutic strategies in the event of established COVID-19 must be extrapolated from evidence obtained in the population not on dialysis. Neutralizing monoclonal antibodies may be an attractive option after a high-risk exposure or during the early course of infection.
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Affiliation(s)
- Khalil El Karoui
- Department of Nephrology and Transplantation, Hôpitaux Universitaires Henri Mondor, Fédération Hospitalo-Universitaire TRUE, Université Paris Est, Créteil, France
| | - An S De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium.
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26
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Fujieda K, Tanaka A, Kikuchi R, Takai N, Saito S, Yasuda Y, Fujita T, Kato M, Furuhashi K, Maruyama S. Antibody response to double SARS-CoV-2 mRNA vaccination in Japanese kidney transplant recipients. Sci Rep 2022; 12:6850. [PMID: 35477954 PMCID: PMC9043506 DOI: 10.1038/s41598-022-10510-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/07/2022] [Indexed: 01/07/2023] Open
Abstract
Immunocompromised patients, especially those who undergo kidney transplantation, have lower antibody levels following SARS-CoV-2 mRNA vaccination. The situation of transplant treatment, such as transplant source and immunosuppressive drugs, is different in Japan than that in other countries. Therefore, it is necessary to clarify whether antibody acquisition rates differ between Japan and other countries. This retrospective study included patients with post-kidney transplant who were attending at the Nagoya University Hospital. The anti-SARS-CoV-2 IgG antibody titers were measured between 3 weeks and 3 months after vaccination. Seventy-three patients (45 men and 28 women) were included. Of these, 23 (31.5%) showed antibody presence, and the rates of antibody acquisition were very low than those in the control group (100.0% vs. 31.5%, P < 0.05). Antibody acquisition rates were associated with body mass index (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.04-1.39, P < 0.05) and the duration between transplantation and vaccination (OR: 1.01, 95% CI: 1.00-1.02, P < 0.05). The immunosuppressive drugs used were: prednisolone in all cases, tacrolimus in 89.0%, cyclosporine in 9.6%, and mofetil mycophenolate in 97.3%. None of the patients were excluded from receiving two doses of the vaccine due to adverse effects. The study indicated that vaccination-induced antibody acquisition rates against SARS-CoV-2 were extremely low in Japanese patients who underwent post-kidney transplantation. Thus, despite two doses of vaccination, it is necessary to closely monitor infection control in such patients.
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Affiliation(s)
- Kumiko Fujieda
- Department of Nephrology, Nagoya University Hospital, Tsurumaicho, 65, Showa Ward, Nagoya, Aichi, Japan
| | - Akihito Tanaka
- Department of Nephrology, Nagoya University Hospital, Tsurumaicho, 65, Showa Ward, Nagoya, Aichi, Japan.
| | - Ryosuke Kikuchi
- Department of Medical Technique, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Nami Takai
- Department of Nursing, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Shoji Saito
- Department of Nephrology, Nagoya University Hospital, Tsurumaicho, 65, Showa Ward, Nagoya, Aichi, Japan
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Hospital, Tsurumaicho, 65, Showa Ward, Nagoya, Aichi, Japan
| | - Takashi Fujita
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazuhiro Furuhashi
- Department of Nephrology, Nagoya University Hospital, Tsurumaicho, 65, Showa Ward, Nagoya, Aichi, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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27
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Kitamura M, Takazono T, Yamaguchi K, Tomura H, Yamamoto K, Harada T, Funakoshi S, Mukae H, Nishino T. Favorable Humoral Response to Third Dose of BNT162b2 in Patients Undergoing Hemodialysis. J Clin Med 2022; 11:jcm11082090. [PMID: 35456182 PMCID: PMC9024432 DOI: 10.3390/jcm11082090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023] Open
Abstract
Patients undergoing hemodialysis are known to exhibit low humoral responses to vaccines against severe acute respiratory syndrome coronavirus 2. In this study, we aimed to elucidate the humoral response to the third dose of BNT162b2 (Pfizer) in patients undergoing hemodialysis. We included 279 patients undergoing hemodialysis (69 ± 11 years, 65% male, median dialysis vintage: 69 months) and 189 healthcare workers (45 ± 13 years, 30% male) who received the third dose of BNT162b2. Anti-spike immunoglobulin G (anti-S IgG) antibody levels were measured 3−4.5 months after the second dose and 3 weeks after the third dose and were compared. Despite a significant difference in anti-S IgG antibody levels after the second dose between the two groups (patients: median 215 U/mL and healthcare workers: median 589 U/mL; p < 0.001), no significant difference in anti-S IgG antibody levels after the third dose was observed (patients: median 19,000 U/mL, healthcare workers: median 21,000 U/mL). Except for dialysis vintage (ρ = 0.209, p < 0.001), no other factors correlated with anti-S IgG antibody levels after the third vaccine dose in patients undergoing hemodialysis. Therefore, a favorable response to the third dose of BNT162b2 was observed in patients undergoing hemodialysis, irrespective of their backgrounds.
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Affiliation(s)
- Mineaki Kitamura
- Nagasaki Renal Center, Nagasaki 850-0032, Japan; (K.Y.); (H.T.); (T.H.); (S.F.)
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
- Correspondence: ; Tel.: +81-95-819-7282; Fax: +81-95-849-7274
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan; (T.T.); (K.Y.)
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan;
| | - Kosei Yamaguchi
- Nagasaki Renal Center, Nagasaki 850-0032, Japan; (K.Y.); (H.T.); (T.H.); (S.F.)
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
| | - Hideshi Tomura
- Nagasaki Renal Center, Nagasaki 850-0032, Japan; (K.Y.); (H.T.); (T.H.); (S.F.)
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
| | - Kazuko Yamamoto
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan; (T.T.); (K.Y.)
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan;
| | - Takashi Harada
- Nagasaki Renal Center, Nagasaki 850-0032, Japan; (K.Y.); (H.T.); (T.H.); (S.F.)
| | - Satoshi Funakoshi
- Nagasaki Renal Center, Nagasaki 850-0032, Japan; (K.Y.); (H.T.); (T.H.); (S.F.)
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan;
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan;
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Hsu CM, Lacson EK, Manley HJ, Aweh GN, Miskulin D, Johnson D, Weiner DE. Seroresponse to Third Doses of SARS-CoV-2 Vaccine Among Patients Receiving Maintenance Dialysis. Am J Kidney Dis 2022; 80:151-153. [PMID: 35378208 PMCID: PMC8972976 DOI: 10.1053/j.ajkd.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Eduardo K Lacson
- Tufts Medical Center, Boston, MA; Dialysis Clinic Inc., Nashville, TN
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29
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Humoral Response after Three Doses of mRNA-1273 or BNT162b2 SARS-CoV-2 Vaccines in Hemodialysis Patients. Vaccines (Basel) 2022; 10:vaccines10040522. [PMID: 35455271 PMCID: PMC9030003 DOI: 10.3390/vaccines10040522] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/11/2022] [Accepted: 03/25/2022] [Indexed: 12/10/2022] Open
Abstract
The COVID-19 pandemic continues to be a worldwide health issue. Among hemodialysis (HD) patients, two-dose immunization schemes with mRNA vaccines have contributed to preventing severe COVID-19 cases; however, some have not produced a sufficient humoral response, and most have developed a rapid decline in antibody levels over the months following vaccination. This observational, prospective, multi-center study evaluated the humoral response in terms of presence and levels of IgG antibodies to the receptor-binding domain of the S1 spike antigen of SARS-CoV-2 (anti-S1-RBD IgG) to the third dose of SARS-CoV-2 mRNA vaccines, either the mRNA-1273 (Moderna) or BNT162b2 (Pfizer), in 153 patients from three dialysis units affiliated to Hospital Clínic of Barcelona (Spain). Most hemodialysis patients responded intensely to this third vaccine dose, achieving the seroconversion in three out of four non- or weak responders to two doses. Moreover, 96.1% maintained the upper limit or generated higher titers than after the second. BNT162b2 vaccine, active cancer, and immunosuppressive treatment were related to a worse humoral response. Every hemodialysis patient should be administered a third vaccine dose six months after receiving the second one. Despite the lack of data, immunosuppressed patients and those with active cancer may benefit from more frequent vaccine boosters.
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Biedunkiewicz B, Tylicki L, Ślizień W, Lichodziejewska-Niemierko M, Dąbrowska M, Kubanek A, Rodak S, Polewska K, Tylicki P, Renke M, Dębska-Ślizień A. Waning Humoral Response after COVID-19 mRNA Vaccination in Maintenance Dialysis Patients and Recovery after a Complementary Third Dose. Vaccines (Basel) 2022; 10:vaccines10030433. [PMID: 35335065 PMCID: PMC8950255 DOI: 10.3390/vaccines10030433] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to analyze the waning of anti-spike (S) antibodies after mRNA vaccination against COVID-19 in maintenance dialysis patients, and to assess the safety and effectiveness of the complementary third dose. This was a prospective, longitudinal study in which we analyzed the kinetics of antibodies up to six months after a two-dose vaccination (first protocol) in infection-naïve dialysis patients (IN-Ds), previously infected dialysis patients (PI-Ds) and subjects without chronic kidney disease (the controls), as well as their humoral response to the third dose of the same mRNA vaccine (second protocol). The respective reduction in antibody titer after 3 and 6 months by 82.9% and 93.03% in IN-Ds (n = 109), 73.4% and 93.36% in PI-Ds (n = 32) and 75.5% and 88.8% in the controls (n = 20) was demonstrated. Consequently, a protective antibody titer above 141 BAU/mL was found in only 47.7% and 23.8% of IN-Ds after 3 and 6 months, respectively. After the third vaccine dose, a significant increase in antibody titer was observed in all groups, with increases by a factor of ×51.6 in IN-Ds, ×30.1 in the controls and ×8.4 in PI-Ds. The median antibody titer after the third dose differed significantly between groups, and was the highest in PI-Ds: PI-Ds, 9090 (3300−15,000) BAU/mL; the controls, 6945 (2130−11,800); IN-Ds, 3715 (1470−7325) (p < 0.001). In conclusion, we observed similar degrees of antibody waning in all patients. After 3 months, over half of the infection-naïve dialysis patients had a very low antibody titer, and almost twenty percent of them had no antibodies at all. The humoral response to the third dose was very good, raising their titer of antibodies to a higher level than those in the general population who have received the primary two-dose scheme. The results support the administration of a complementary third dose of the mRNA vaccine for dialysis patients as soon as possible.
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Affiliation(s)
- Bogdan Biedunkiewicz
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
| | - Leszek Tylicki
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
- Correspondence: ; Tel.: +48-58-5844700
| | | | - Monika Lichodziejewska-Niemierko
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
| | | | - Alicja Kubanek
- Department of Occupational, Metabolic and Internal Diseases, Medical University of Gdańsk, 81-519 Gdynia, Poland; (A.K.); (M.R.)
| | - Sylwia Rodak
- NZOZ Diaverum, 81-519 Gdynia, Poland; (W.Ś.); (S.R.)
| | - Karolina Polewska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
| | - Piotr Tylicki
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
| | - Marcin Renke
- Department of Occupational, Metabolic and Internal Diseases, Medical University of Gdańsk, 81-519 Gdynia, Poland; (A.K.); (M.R.)
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (B.B.); (M.L.-N.); (K.P.); (P.T.); (A.D.-Ś.)
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31
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Bruminhent J, Setthaudom C, Kitpermkiat R, Kiertiburanakul S, Malathum K, Assanatham M, Nongnuch A, Phuphuakrat A, Chaumdee P, Janphram C, Thotsiri S, Chuengsaman P, Boongird S. Immunogenicity of ChAdOx1 nCoV-19 vaccine after a two-dose inactivated SARS-CoV-2 vaccination of dialysis patients and kidney transplant recipients. Sci Rep 2022; 12:3587. [PMID: 35246578 PMCID: PMC8897448 DOI: 10.1038/s41598-022-07574-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
Vaccination with inactivated SARS-CoV-2 virus produces suboptimal immune responses among kidney transplant (KT), peritoneal dialyzed (PD), and hemodialyzed (HD) patients. Participants were vaccinated with two-dose inactivated SARS-CoV-2 vaccine (V2) and a third dose of ChAdOx1 nCoV-19 vaccine (V3) at 1–2 months after V2. We enrolled 106 participants: 31 KT, 28 PD, and 31 HD patients and 16 controls. Among KT, PD, and HD groups, median (IQR) of anti-receptor binding domain antibody levels were 1.0 (0.4–26.8), 1092.5 (606.9–1927.2), and 1740.9 (1106–3762.3) BAU/mL, and percent neutralization was 0.9 (0–9.9), 98.8 (95.9–99.5), and 99.4 (98.8–99.7), respectively, at two weeks after V3. Both parameters were significantly increased from V2 across all groups (p < 0.05). Seroconversion and neutralization positivity rates in PD, HD, and control groups were 100% but were impaired in KT patients (39% and 16%, respectively). S1-specific T-cell counts were increased in PD and HD groups (p < 0.05) but not in KT patients. The positive S1-specific T-cell responder rate was > 90% in PD, HD, and control groups, which was higher than that in KT recipients (74%, p < 0.05). The heterologous inactivated virus/ChAdOx1 nCoV-19 vaccination strategy elicited greater immunogenicity among dialysis patients; however, inadequate responses remained among KT recipients (TCTR20210226002).
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Affiliation(s)
- Jackrapong Bruminhent
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Chavachol Setthaudom
- Immunology Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rungthiwa Kitpermkiat
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Sasisopin Kiertiburanakul
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumthorn Malathum
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Montira Assanatham
- Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.,Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Arkom Nongnuch
- Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.,Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Angsana Phuphuakrat
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsathon Chaumdee
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chitimaporn Janphram
- Somdech Phra Debaratana Medical Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sansanee Thotsiri
- Somdech Phra Debaratana Medical Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piyatida Chuengsaman
- Banphaeo Dialysis Group, Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Hospital, Bangkok, Thailand
| | - Sarinya Boongird
- Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand. .,Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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32
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Benning L, Klein K, Morath C, Bartenschlager M, Kim H, Buylaert M, Reineke M, Töllner M, Nusshag C, Kälble F, Reichel P, Schnitzler P, Zeier M, Süsal C, Bartenschlager R, Schaier M, Speer C. Neutralizing Antibody Activity Against the B.1.617.2 (delta) Variant Before and After a Third BNT162b2 Vaccine Dose in Hemodialysis Patients. Front Immunol 2022; 13:840136. [PMID: 35309320 PMCID: PMC8931261 DOI: 10.3389/fimmu.2022.840136] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/11/2022] [Indexed: 12/20/2022] Open
Abstract
Hemodialysis patients are at high risk for severe COVID-19, and impaired seroconversion rates have been demonstrated after COVID-19 vaccination. Humoral immunity wanes over time and variants of concern with immune escape are posing an increasing threat. Little is known about protection against the B.1.617.2 (delta) variant of concern in hemodialysis patients before and after third vaccination. We determined anti-S1 IgG, surrogate neutralizing, and IgG antibodies against different SARS-CoV-2 epitopes in 84 hemodialysis patients directly before and three weeks after a third vaccine dose with BNT162b2. Third vaccination was performed after a median (IQR) of 119 (109–165) days after second vaccination. In addition, neutralizing activity against the B.1.617.2 (delta) variant was assessed in 31 seroconverted hemodialysis patients before and after third vaccination. Triple seropositivity for anti-S1 IgG, surrogate neutralizing, and anti-RBD antibodies increased from 31/84 (37%) dialysis patients after second to 80/84 (95%) after third vaccination. Neutralizing activity against the B.1.617.2 (delta) variant was significantly higher after third vaccination with a median (IQR) ID50 of 1:320 (1:160–1:1280) compared with 1:20 (0–1:40) before a third vaccine dose (P<0.001). The anti-S1 IgG index showed the strongest correlation with the ID50 against the B.1.617.2 (delta) variant determined by live virus neutralization (r=0.91). We demonstrate low neutralizing activity against the B.1.617.2 (delta) variant in dialysis patients four months after standard two-dose vaccination but a substantial increase after a third vaccine dose. Booster vaccination(s) should be considered earlier than 6 months after the second vaccine dose in immunocompromised individuals.
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Affiliation(s)
- Louise Benning
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
- *Correspondence: Louise Benning,
| | - Katrin Klein
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Marie Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
| | - Heeyoung Kim
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
| | - Mirabel Buylaert
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Marvin Reineke
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | | | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Florian Kälble
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paula Reichel
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Virology, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Caner Süsal
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
- Transplant Immunology Research Center of Excellence, Koç University Hospital, Istanbul, Turkey
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, University of Heidelberg, Heidelberg, Germany
- German Center for Infection Research, Partner Site Heidelberg, Heidelberg, Germany
- Division Virus-Associated Carcinogenesis, German Cancer Research Center, Heidelberg, Germany
| | - Matthias Schaier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Claudius Speer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
- Department of Molecular Medicine Partnership Unit Heidelberg, European Molecular Biology Laboratory, Heidelberg, Germany
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33
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Hsu CM, Weiner DE, Manley HJ, Aweh GN, Ladik V, Frament J, Miskulin D, Argyropoulos C, Abreo K, Chin A, Gladish R, Salman L, Johnson D, Lacson EK. Seroresponse to SARS-CoV-2 Vaccines among Maintenance Dialysis Patients over 6 Months. Clin J Am Soc Nephrol 2022; 17:403-413. [PMID: 35144972 PMCID: PMC8975038 DOI: 10.2215/cjn.12250921] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/05/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Although most patients receiving maintenance dialysis exhibit initial seroresponse to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, concerns exist regarding the durability of this antibody response. This study evaluated seroresponse over time. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective cohort study included patients on maintenance dialysis, from a midsize national dialysis provider, who received a complete SARS-CoV-2 vaccine series and had at least one antibody titer checked after full vaccination. IgG spike antibodies (anti-spike IgG) titers were assessed monthly with routine laboratory tests after vaccination; the semiquantitative assay reported a range between zero and ≥20 Index. Descriptive analyses compared trends over time by history of coronavirus disease 2019 (COVID-19) and vaccine type. Time-to-event analyses examined the outcome of loss of seroresponse (anti-spike IgG <1 Index or development of COVID-19). Cox regression adjusted for additional clinical characteristics. RESULTS Among 1870 patients receiving maintenance dialysis, 1569 had no prior COVID-19. Patients without prior COVID-19 had declining titers over time. Among 443 recipients of BNT162b2 (Pfizer), median (interquartile range) anti-spike IgG titer declined from ≥20 (5.89 to ≥20) in month 1 after full vaccination to 1.96 (0.60-5.88) by month 6. Among 778 recipients of mRNA-1273 (Moderna), anti-spike IgG titer declined from ≥20 (interquartile range, ≥20 to ≥20) in month 1 to 7.99 (2.61 to ≥20) by month 6. The 348 recipients of Ad26.COV2.S (Janssen) had a lower titer response than recipients of an mRNA vaccine over all time periods. In time-to-event analyses, recipients of Ad26.COV2.S and mRNA-1273 had the shortest and longest time to loss of seroresponse, respectively. The maximum titer reached in the first 2 months after full vaccination was associated with durability of the anti-spike IgG seroresponse; patients with anti-spike IgG titer 1-19.99 had a shorter time to loss of seroresponse compared with patients with anti-spike IgG titer ≥20 (hazard ratio, 15.5; 95% confidence interval, 11.7 to 20.7). CONCLUSIONS Among patients receiving maintenance dialysis, vaccine-induced seroresponse wanes over time across vaccine types. Early titers after full vaccination are associated with the durability of seroresponse.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kenneth Abreo
- Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Andrew Chin
- University of California, Davis, Sacramento, California
| | | | | | | | - Eduardo K. Lacson
- Tufts Medical Center, Boston, Massachusetts,Dialysis Clinic Inc., Nashville, Tennessee
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34
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Yau K, Chan CT, Abe KT, Jiang Y, Atiquzzaman M, Mullin SI, Shadowitz E, Liu L, Kostadinovic E, Sukovic T, Gonzalez A, McGrath-Chong ME, Oliver MJ, Perl J, Leis JA, Bolotin S, Tran V, Levin A, Blake PG, Colwill K, Gingras AC, Hladunewich MA. Differences in mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine immunogenicity among patients undergoing dialysis. CMAJ 2022; 194:E297-E305. [PMID: 35115375 PMCID: PMC9053976 DOI: 10.1503/cmaj.211881] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Differences in immunogenicity between mRNA SARS-CoV-2 vaccines have not been well characterized in patients undergoing dialysis. We compared the serologic response in patients undergoing maintenance hemodialysis after vaccination against SARS-CoV-2 with BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna). METHODS We conducted a prospective observational cohort study at 2 academic centres in Toronto, Canada, from Feb. 2, 2021, to July 20, 2021, which included 129 and 95 patients who received the BNT162b2 and mRNA-1273 SARS-CoV-2 vaccines, respectively. We measured SARS-CoV-2 immunoglobulin G antibodies to the spike protein (anti-spike), receptor binding domain (anti-RBD) and nucleocapsid protein (anti-NP) at 6-7 and 12 weeks after the second dose of vaccine and compared those levels with the median convalescent serum antibody levels from 211 controls who were previously infected with SARS-CoV-2. RESULTS At 6-7 weeks after 2-dose vaccination, we found that 51 of 70 patients (73%) who received BNT162b2 and 83 of 87 (95%) who received mRNA-1273 attained convalescent levels of anti-spike antibody (p < 0.001). In those who received BNT162b2, 35 of 70 (50%) reached the convalescent level for anti-RBD compared with 69 of 87 (79%) who received mRNA-1273 (p < 0.001). At 12 weeks after the second dose, anti-spike and anti-RBD levels were significantly lower in patients who received BNT162b2 than in those who received mRNA-1273. For anti-spike, 70 of 122 patients (57.4%) who received BNT162b2 maintained the convalescent level versus 68 of 71 (96%) of those who received mRNA-1273 (p < 0.001). For anti-RBD, 47 of 122 patients (38.5%) who received BNT162b2 maintained the anti-RBD convalescent level versus 45 of 71 (63%) of those who received mRNA-1273 (p = 0.002). INTERPRETATION In patients undergoing hemodialysis, mRNA-1273 elicited a stronger humoral response than BNT162b2. Given the rapid decline in immunogenicity at 12 weeks in patients who received BNT162b2, a third dose is recommended in patients undergoing dialysis as a primary series, similar to recommendations for other vulnerable populations.
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Affiliation(s)
- Kevin Yau
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Christopher T Chan
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Kento T Abe
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Yidi Jiang
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Mohammad Atiquzzaman
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Sarah I Mullin
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Ellen Shadowitz
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Lisa Liu
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Ema Kostadinovic
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Tatjana Sukovic
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Anny Gonzalez
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Margaret E McGrath-Chong
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Matthew J Oliver
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Jeffrey Perl
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Jerome A Leis
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Shelly Bolotin
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Vanessa Tran
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Adeera Levin
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Peter G Blake
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Karen Colwill
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Anne-Claude Gingras
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Michelle A Hladunewich
- Division of Nephrology (Yau, Mullin, Shadowitz, Liu, Kostadinovic, Sukovic, Gonzalez, Oliver, Hladunewich) and Division of Infectious Diseases (Leis), Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, University of Toronto; Division of Nephrology (Yau, Chan, McGrath-Chong), Department of Medicine, Temerty Faculty of Medicine, University of Toronto; Department of Molecular Genetics (Abe, Gingras), University of Toronto; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital (Abe, Colwill, Gingras), Sinai Health System; Sunnybrook Research Institute (Jiang), Temerty Faculty of Medicine, University of Toronto; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Tran), University of Toronto; Department of Laboratory Medicine and Pathobiology (Tran), University of Toronto; Ontario Renal Network (Oliver, Blake, Hladunewich), Ontario Health; Li Ka Shing Knowledge Institute (Perl), Unity Health Toronto; Toronto, Ont.; BC Renal Agency (Atiquzzaman, Levin), Vancouver, BC; Division of Nephrology (Blake), Schulich School of Medicine & Dentistry, Western University, London, Ont.
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35
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Jahn M, Korth J, Dorsch O, Anastasiou OE, Krawczyk A, Brochhagen L, van de Sand L, Sorge-Hädicke B, Tyczynski B, Witzke O, Dittmer U, Dolff S, Wilde B, Kribben A. Decline of Humoral Responses 6 Months after Vaccination with BNT162b2 (Pfizer–BioNTech) in Patients on Hemodialysis. Vaccines (Basel) 2022; 10:vaccines10020327. [PMID: 35214785 PMCID: PMC8878048 DOI: 10.3390/vaccines10020327] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
This study analyzed binding and neutralizing antibody titers up to 6 months after standard vaccination with BNT162b2 (two doses of 30 µg each) in SARS-CoV-2 naïve patients (n = 59) on hemodialysis. Humoral vaccine responses were measured before and 6, 12, and 24 weeks after the first vaccination. A chemiluminescent immunoassay (CLIA) was used to quantify SARS-CoV-2 IgG against the spike glycoprotein. SARS-CoV-2 neutralizing activity was tested against the wild-type virus. A multivariable binary regression model was used to identify risk factors for the absence of humoral immune responses at 6 months. At week 6, vaccine-specific seroconversion was detected in 96.6% of all patients with median anti-SARS-CoV-2 IgGs of 918 BAU/mL. At weeks 12 and 24, seroconversion rates decreased to 91.5% and 79.7%, and corresponding median binding antibody titers declined to 298 BAU/mL and 89 BAU/mL, respectively. Neutralizing antibodies showed a decay from 79.6% at week 6 to 32.8% at week 24. The risk factor with the strongest association for vanishing immune responses was low serum albumin (p = 0.018). Regarding vaccine-specific humoral responses 6 months after the standard BNT162b2 vaccination schedule, SARS-CoV-2 naïve patients receiving hemodialysis must be considered at risk of becoming infected with SARS-CoV-2 and being infectious.
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Affiliation(s)
- Michael Jahn
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
- Correspondence:
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Oliver Dorsch
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Friesener Straße 37a, 96317 Kronach, Germany;
| | - Olympia Evdoxia Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Adalbert Krawczyk
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Leonie Brochhagen
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Lukas van de Sand
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Burkhard Sorge-Hädicke
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, Alfried-Krupp-Str. 43, 45131 Essen, Germany;
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (A.K.); (L.B.); (L.v.d.S.); (O.W.); (S.D.)
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (J.K.); (B.T.); (B.W.); (A.K.)
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36
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Bassi J, Giannini O, Silacci-Fregni C, Pertusini L, Hitz P, Terrot T, Franzosi Y, Muoio F, Saliba C, Meury M, Dellota EA, Dillen JR, Hernandez P, Czudnochowski N, Cameroni E, Beria N, Ventresca M, Badellino A, Lavorato-Hadjeres S, Lecchi E, Bonora T, Mattiolo M, Trinci G, Garzoni D, Bonforte G, Forni-Ogna V, Giunzioni D, Berwert L, Gupta RK, Ferrari P, Ceschi A, Cippà P, Corti D, Lanzavecchia A, Piccoli L. Poor neutralization and rapid decay of antibodies to SARS-CoV-2 variants in vaccinated dialysis patients. PLoS One 2022; 17:e0263328. [PMID: 35143540 PMCID: PMC8830698 DOI: 10.1371/journal.pone.0263328] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/14/2022] [Indexed: 12/11/2022] Open
Abstract
Patients on dialysis are at risk of severe course of SARS-CoV-2 infection. Understanding the neutralizing activity and coverage of SARS-CoV-2 variants of vaccine-elicited antibodies is required to guide prophylactic and therapeutic COVID-19 interventions in this frail population. By analyzing plasma samples from 130 hemodialysis and 13 peritoneal dialysis patients after two doses of BNT162b2 or mRNA-1273 vaccines, we found that 35% of the patients had low-level or undetectable IgG antibodies to SARS-CoV-2 Spike (S). Neutralizing antibodies against the vaccine-matched SARS-CoV-2 and Delta variant were low or undetectable in 49% and 77% of patients, respectively, and were further reduced against other emerging variants. The fraction of non-responding patients was higher in SARS-CoV-2-naïve hemodialysis patients immunized with BNT162b2 (66%) than those immunized with mRNA-1273 (23%). The reduced neutralizing activity correlated with low antibody avidity. Patients followed up to 7 months after vaccination showed a rapid decay of the antibody response with an average 21- and 10-fold reduction of neutralizing antibodies to vaccine-matched SARS-CoV-2 and Delta variant, which increased the fraction of non-responders to 84% and 90%, respectively. These data indicate that dialysis patients should be prioritized for additional vaccination boosts. Nevertheless, their antibody response to SARS-CoV-2 must be continuously monitored to adopt the best prophylactic and therapeutic strategy.
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Affiliation(s)
- Jessica Bassi
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
| | - Olivier Giannini
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Department of Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | | | - Laura Pertusini
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Paolo Hitz
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Tatiana Terrot
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Yves Franzosi
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Francesco Muoio
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
| | - Christian Saliba
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
| | - Marcel Meury
- Vir Biotechnology, San Francisco, California, United States of America
| | | | - Josh R. Dillen
- Vir Biotechnology, San Francisco, California, United States of America
| | - Patrick Hernandez
- Vir Biotechnology, San Francisco, California, United States of America
| | | | - Elisabetta Cameroni
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
| | - Nicola Beria
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Alberto Badellino
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Elisabetta Lecchi
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Tecla Bonora
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Matteo Mattiolo
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Guido Trinci
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Daniela Garzoni
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Giuseppe Bonforte
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Davide Giunzioni
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Lorenzo Berwert
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Ravindra K. Gupta
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Paolo Ferrari
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Clinical School, University of New South Wales, Sydney, Australia
| | - Alessandro Ceschi
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Science of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
| | - Pietro Cippà
- Department of Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Davide Corti
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
| | | | - Luca Piccoli
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
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Bassi J, Giannini O, Silacci-Fregni C, Pertusini L, Hitz P, Terrot T, Franzosi Y, Muoio F, Saliba C, Meury M, Dellota EA, Dillen JR, Hernandez P, Czudnochowski N, Cameroni E, Beria N, Ventresca M, Badellino A, Lavorato-Hadjeres S, Lecchi E, Bonora T, Mattiolo M, Trinci G, Garzoni D, Bonforte G, Forni-Ogna V, Giunzioni D, Berwert L, Gupta RK, Ferrari P, Ceschi A, Cippà P, Corti D, Lanzavecchia A, Piccoli L. Poor neutralization and rapid decay of antibodies to SARS-CoV-2 variants in vaccinated dialysis patients. PLoS One 2022. [PMID: 35143540 DOI: 10.1101/2021.10.05.21264054v2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023] Open
Abstract
Patients on dialysis are at risk of severe course of SARS-CoV-2 infection. Understanding the neutralizing activity and coverage of SARS-CoV-2 variants of vaccine-elicited antibodies is required to guide prophylactic and therapeutic COVID-19 interventions in this frail population. By analyzing plasma samples from 130 hemodialysis and 13 peritoneal dialysis patients after two doses of BNT162b2 or mRNA-1273 vaccines, we found that 35% of the patients had low-level or undetectable IgG antibodies to SARS-CoV-2 Spike (S). Neutralizing antibodies against the vaccine-matched SARS-CoV-2 and Delta variant were low or undetectable in 49% and 77% of patients, respectively, and were further reduced against other emerging variants. The fraction of non-responding patients was higher in SARS-CoV-2-naïve hemodialysis patients immunized with BNT162b2 (66%) than those immunized with mRNA-1273 (23%). The reduced neutralizing activity correlated with low antibody avidity. Patients followed up to 7 months after vaccination showed a rapid decay of the antibody response with an average 21- and 10-fold reduction of neutralizing antibodies to vaccine-matched SARS-CoV-2 and Delta variant, which increased the fraction of non-responders to 84% and 90%, respectively. These data indicate that dialysis patients should be prioritized for additional vaccination boosts. Nevertheless, their antibody response to SARS-CoV-2 must be continuously monitored to adopt the best prophylactic and therapeutic strategy.
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Affiliation(s)
- Jessica Bassi
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
| | - Olivier Giannini
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Department of Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | | | - Laura Pertusini
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Paolo Hitz
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Tatiana Terrot
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Yves Franzosi
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Francesco Muoio
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
| | - Christian Saliba
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
| | - Marcel Meury
- Vir Biotechnology, San Francisco, California, United States of America
| | | | - Josh R Dillen
- Vir Biotechnology, San Francisco, California, United States of America
| | - Patrick Hernandez
- Vir Biotechnology, San Francisco, California, United States of America
| | | | - Elisabetta Cameroni
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
| | - Nicola Beria
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Alberto Badellino
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Elisabetta Lecchi
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Tecla Bonora
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Matteo Mattiolo
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Guido Trinci
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Daniela Garzoni
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Giuseppe Bonforte
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Davide Giunzioni
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Lorenzo Berwert
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Ravindra K Gupta
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Paolo Ferrari
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Clinical School, University of New South Wales, Sydney, Australia
| | - Alessandro Ceschi
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Science of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
| | - Pietro Cippà
- Department of Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Davide Corti
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
| | | | - Luca Piccoli
- Humabs BioMed SA, A Subsidiary of Vir Biotechnology, Bellinzona, Switzerland
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Antibody Response to mRNA Vaccines against SARS-CoV-2 with Chronic Kidney Disease, Hemodialysis, and after Kidney Transplantation. J Clin Med 2021; 11:jcm11010148. [PMID: 35011888 PMCID: PMC8745313 DOI: 10.3390/jcm11010148] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/21/2021] [Accepted: 12/26/2021] [Indexed: 02/07/2023] Open
Abstract
Most trials on mRNA vaccines against SARS-CoV-2 did not include patients with chronic kidney disease (CKD), hemodialysis (HD) patients, or kidney transplant recipients (KTR). However, those patients have a higher risk for a severe course of COVID-19 disease and mortality. Available literature has demonstrated a reduced efficacy of mRNA vaccines in HD patients and KTR, while data on CKD patients is scarce. Additionally, factors associated with non-response are poorly understood and not well characterized. We assessed antibody (AB) response (n = 582, 160 CKD patients, 206 patients on HD, 216 KTR) after the administration of two doses of a mRNA-vaccine with either BNT162b2 or mRNA-1273. AB measurements were carried out after a median of 91 days after first vaccinations, demonstrating non-response in 12.5% of CKD patients, 12.1% of HD patients, and 50% of KTR. AB titers were significantly higher in CKD patients than in HD patients or KTR. Factors associated with non-response were treated with rituximab in CKD patients, the use of calcineurin inhibitors in HD patients and older age, and the use of BNT162b2, mycophenolic acid, or glucocorticoids and lower hemoglobin levels in KTR. This study contributes to the understanding of the extent and conditions that predispose for non-response in patients with impaired kidney function.
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Alfano G, Fontana F, Mori G, Cappelli G, Magistroni R, Donati G. Ethical challenges in managing unvaccinated patients receiving chronic in-center hemodialysis. Clin Kidney J 2021; 15:615-617. [PMID: 35371469 PMCID: PMC8967673 DOI: 10.1093/ckj/sfab276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Indexed: 12/01/2022] Open
Abstract
Insufficient vaccine coverage and dominance of the more transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are the leading causes of the continued spread of coronavirus disease 2019 (COVID-19) worldwide. To curb the surge in infections, COVID-19 vaccination has been advocated as a priority measure, especially for frail populations and people at high risk of exposure. Patients on in-centre maintenance haemodialysis (HD) embody both conditions. They are at high risk of severe COVID-19 consequences due to their advanced age and weakened immune system and carry an increased risk of SARS-CoV-2 transmission within shared dialysis rooms and public vehicles. Vaccination of the entire HD population is therefore the most effective strategy to protect patients from the dire consequences of COVID-19. Unfortunately, a minority of patients still express COVID-19 vaccine hesitancy. The management of this group of patients, who have the full right to HD treatment, poses demanding problems from a patient safety perspective. The placement of unvaccinated patients within the dialysis room and the protection of all vaccinated patients are some of the most urgent problems the nephrologist faces during the COVID-19 pandemic. In light of these COVID-19-driven changes, an ethical reflection on the management of unvaccinated patients appears crucial to act responsibly and contribute to the health promotion of dialysis patients.
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Affiliation(s)
- Gaetano Alfano
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Fontana
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Giacomo Mori
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Gianni Cappelli
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Magistroni
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriele Donati
- Nephrology, Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
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Drożdżal S, Rosik J, Lechowicz K, Machaj F, Szostak B, Przybyciński J, Lorzadeh S, Kotfis K, Ghavami S, Łos MJ. An update on drugs with therapeutic potential for SARS-CoV-2 (COVID-19) treatment. Drug Resist Updat 2021; 59:100794. [PMID: 34991982 PMCID: PMC8654464 DOI: 10.1016/j.drup.2021.100794] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic is one of the greatest threats to human health in the 21st century with more than 257 million cases and over 5.17 million deaths reported worldwide (as of November 23, 2021. Various agents were initially proclaimed to be effective against SARS-CoV-2, the etiological agent of COVID-19. Hydroxychloroquine, lopinavir/ritonavir, and ribavirin are all examples of therapeutic agents, whose efficacy against COVID-19 was later disproved. Meanwhile, concentrated efforts of researchers and clinicians worldwide have led to the identification of novel therapeutic options to control the disease including PAXLOVID™ (PF-07321332). Although COVID-19 cases are currently treated using a comprehensive approach of anticoagulants, oxygen, and antibiotics, the novel Pfizer agent PAXLOVID™ (PF-07321332), an investigational COVID-19 oral antiviral candidate, significantly reduced hospitalization time and death rates, based on an interim analysis of the phase 2/3 EPIC-HR (Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients) randomized, double-blind study of non-hospitalized adult patients with COVID-19, who are at high risk of progressing to severe illness. The scheduled interim analysis demonstrated an 89 % reduction in risk of COVID-19-related hospitalization or death from any cause compared to placebo in patients treated within three days of symptom onset (primary endpoint). However, there still exists a great need for the development of additional treatments, as the recommended therapeutic options are insufficient in many cases. Thus far, mRNA and vector vaccines appear to be the most effective modalities to control the pandemic. In the current review, we provide an update on the progress that has been made since April 2020 in clinical trials concerning the effectiveness of therapies available to combat COVID-19. We focus on currently recommended therapeutic agents, including steroids, various monoclonal antibodies, remdesivir, baricitinib, anticoagulants and PAXLOVID™ summarizing the latest original studies and meta-analyses. Moreover, we aim to discuss other currently and previously studied agents targeting COVID-19 that either show no or only limited therapeutic activity. The results of recent studies report that hydroxychloroquine and convalescent plasma demonstrate no efficacy against SARS-CoV-2 infection. Lastly, we summarize the studies on various drugs with incoherent or insufficient data concerning their effectiveness, such as amantadine, ivermectin, or niclosamide.
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Affiliation(s)
- Sylwester Drożdżal
- Department of Nephrology, Transplantation and Internal Medicine, Pomeranian Medical University in Szczecin, Poland
| | - Jakub Rosik
- Department of Physiology, Pomeranian Medical University in Szczecin, Poland
| | - Kacper Lechowicz
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Filip Machaj
- Department of Physiology, Pomeranian Medical University in Szczecin, Poland
| | - Bartosz Szostak
- Department of Physiology, Pomeranian Medical University in Szczecin, Poland
| | - Jarosław Przybyciński
- Department of Nephrology, Transplantation and Internal Medicine, Pomeranian Medical University in Szczecin, Poland
| | - Shahrokh Lorzadeh
- Department of Molecular Genetics, Science and Research Branch, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Saeid Ghavami
- Department of Human Anatomy and Cell Science, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Research Institutes of Oncology and Hematology, Cancer Care Manitoba-University of Manitoba, Winnipeg, MB R3E 0V9, Canada; Biology of Breathing Theme, Children Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3E 0V9, Canada; Autophagy Research Center, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran; Faculty of Medicine, Katowice School of Technology, 40-555 Katowice, Poland
| | - Marek J Łos
- Biotechnology Centre, Silesian University of Technology, 44-100 Gliwice, Poland.
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