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Hajmohammadi H, Talaei M, Fecht D, Wang W, Vivaldi G, Faustini SE, Richter AG, Shaheen SO, Martineau AR, Sheikh A, Mudway IS, Griffiths CJ. Long-term air pollution exposure and risk of SARS-CoV-2 infection: A UK-wide cohort study. Respir Med 2024; 224:107567. [PMID: 38423343 DOI: 10.1016/j.rmed.2024.107567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The association between air quality and risk of SARS-CoV-2 infection is poorly understood. We investigated this association using serological individual-level data adjusting for a wide range of confounders, in a large population-based cohort (COVIDENCE UK). METHODS We assessed the associations between long-term (2015-19) nitrogen dioxide (NO2) and fine particulate matter with an aerodynamic diameter of ≤2.5 μm (PM2.5), exposures with SARS-CoV-2 infection, level of antibody response among those infected, and COVID-19 disease severity. We used serological data from 10,489 participants in the COVIDENCE UK cohort, and estimated annual average air pollution exposure at each participant's home postcode. RESULTS After controlling for potential confounders, we found a positive association between 5-year NO2 and PM2.5 exposures and the risk of seropositivity: 10 unit increase in NO2 (μg/m3) was associated with an increasing risk of seropositivity by 1.092 (95% CI 1.02 to 1.17; p-for-trend 0.012). For PM2.5, 10 unit increase (μg/m3) was associated with an increasing risk of seropositivity by 1.65 (95% CI 1.015-2.68; p-for-trend 0·049). In addition, we found that NO2 was positively associated with higher antibody titres (p-for-trend 0·013) among seropositive participants, with no evidence of an association for PM2.5. CONCLUSION Our findings suggest that the long-term burden of air pollution increased the risks of SARS-CoV-2 infection and has important implications for future pandemic preparedness. This evidence strengthens the case for reducing long-term air pollution exposures to reduce the vulnerability of individuals to respiratory viruses.
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Affiliation(s)
- Hajar Hajmohammadi
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Mohammad Talaei
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Heath, Imperial College London, London, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Imperial College London, London, UK
| | - Weiyi Wang
- MRC Centre for Environment and Health, School of Public Heath, Imperial College London, London, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Imperial College London, London, UK
| | - Giulia Vivaldi
- Centre for Immunobiology, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, UK
| | - Sian E Faustini
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Seif O Shaheen
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adrian R Martineau
- Centre for Immunobiology, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ian S Mudway
- MRC Centre for Environment and Health, School of Public Heath, Imperial College London, London, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Imperial College London, London, UK; NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Christopher J Griffiths
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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2
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Standing JF, Buggiotti L, Guerra-Assuncao JA, Woodall M, Ellis S, Agyeman AA, Miller C, Okechukwu M, Kirkpatrick E, Jacobs AI, Williams CA, Roy S, Martin-Bernal LM, Williams R, Smith CM, Sanderson T, Ashford FB, Emmanuel B, Afzal ZM, Shields A, Richter AG, Dorward J, Gbinigie O, Van Hecke O, Lown M, Francis N, Jani B, Richards DB, Rahman NM, Yu LM, Thomas NPB, Hart ND, Evans P, Andersson M, Hayward G, Hood K, Nguyen-Van-Tam JS, Little P, Hobbs FDR, Khoo S, Butler C, Lowe DM, Breuer J. Randomized controlled trial of molnupiravir SARS-CoV-2 viral and antibody response in at-risk adult outpatients. Nat Commun 2024; 15:1652. [PMID: 38396069 PMCID: PMC10891158 DOI: 10.1038/s41467-024-45641-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Viral clearance, antibody response and the mutagenic effect of molnupiravir has not been elucidated in at-risk populations. Non-hospitalised participants within 5 days of SARS-CoV-2 symptoms randomised to receive molnupiravir (n = 253) or Usual Care (n = 324) were recruited to study viral and antibody dynamics and the effect of molnupiravir on viral whole genome sequence from 1437 viral genomes. Molnupiravir accelerates viral load decline, but virus is detectable by Day 5 in most cases. At Day 14 (9 days post-treatment), molnupiravir is associated with significantly higher viral persistence and significantly lower anti-SARS-CoV-2 spike antibody titres compared to Usual Care. Serial sequencing reveals increased mutagenesis with molnupiravir treatment. Persistence of detectable viral RNA at Day 14 in the molnupiravir group is associated with higher transition mutations following treatment cessation. Viral viability at Day 14 is similar in both groups with post-molnupiravir treated samples cultured up to 9 days post cessation of treatment. The current 5-day molnupiravir course is too short. Longer courses should be tested to reduce the risk of potentially transmissible molnupiravir-mutated variants being generated. Trial registration: ISRCTN30448031.
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Affiliation(s)
- Joseph F Standing
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK.
- Great Ormond Street Hospital for Children NHS Trust, London, UK.
| | - Laura Buggiotti
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Jose Afonso Guerra-Assuncao
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Maximillian Woodall
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Samuel Ellis
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Akosua A Agyeman
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Charles Miller
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Mercy Okechukwu
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Emily Kirkpatrick
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Amy I Jacobs
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Charlotte A Williams
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sunando Roy
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Luz M Martin-Bernal
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rachel Williams
- Genetics and Genomic Medicine Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Claire M Smith
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Fiona B Ashford
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Beena Emmanuel
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Zaheer M Afzal
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Adrian Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Alex G Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jienchi Dorward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Oghenekome Gbinigie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Oliver Van Hecke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Lown
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Nick Francis
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Bhautesh Jani
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Duncan B Richards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Najib M Rahman
- Respiratory Trials Unit and Oxford NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Nigel D Hart
- School of Medicine, Dentistry and Biomedical Sciences. Queen's University Belfast, Belfast, UK
| | - Philip Evans
- APEx (Exeter Collaboration for Academic Primary Care), University of Exeter Medical School, Exeter, UK
- National Institute of Health and Care Research, Clinical Research Network, University of Leeds, Leeds, UK
| | | | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Wales, UK
| | | | - Paul Little
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Saye Khoo
- Department of Pharmacology, University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Christopher Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David M Lowe
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, UK
- Institute of Immunity and Transplantation, University College London, London, UK
| | - Judith Breuer
- Infection, Immunity and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
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3
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Lord JM, Veenith T, Sullivan J, Sharma-Oates A, Richter AG, Greening NJ, McAuley HJC, Evans RA, Moss P, Moore SC, Turtle L, Gautam N, Gilani A, Bajaj M, Wain LV, Brightling C, Raman B, Marks M, Singapuri A, Elneima O, Openshaw PJM, Duggal NA. Accelarated immune ageing is associated with COVID-19 disease severity. Immun Ageing 2024; 21:6. [PMID: 38212801 PMCID: PMC10782727 DOI: 10.1186/s12979-023-00406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The striking increase in COVID-19 severity in older adults provides a clear example of immunesenescence, the age-related remodelling of the immune system. To better characterise the association between convalescent immunesenescence and acute disease severity, we determined the immune phenotype of COVID-19 survivors and non-infected controls. RESULTS We performed detailed immune phenotyping of peripheral blood mononuclear cells isolated from 103 COVID-19 survivors 3-5 months post recovery who were classified as having had severe (n = 56; age 53.12 ± 11.30 years), moderate (n = 32; age 52.28 ± 11.43 years) or mild (n = 15; age 49.67 ± 7.30 years) disease and compared with age and sex-matched healthy adults (n = 59; age 50.49 ± 10.68 years). We assessed a broad range of immune cell phenotypes to generate a composite score, IMM-AGE, to determine the degree of immune senescence. We found increased immunesenescence features in severe COVID-19 survivors compared to controls including: a reduced frequency and number of naïve CD4 and CD8 T cells (p < 0.0001); increased frequency of EMRA CD4 (p < 0.003) and CD8 T cells (p < 0.001); a higher frequency (p < 0.0001) and absolute numbers (p < 0.001) of CD28-ve CD57+ve senescent CD4 and CD8 T cells; higher frequency (p < 0.003) and absolute numbers (p < 0.02) of PD-1 expressing exhausted CD8 T cells; a two-fold increase in Th17 polarisation (p < 0.0001); higher frequency of memory B cells (p < 0.001) and increased frequency (p < 0.0001) and numbers (p < 0.001) of CD57+ve senescent NK cells. As a result, the IMM-AGE score was significantly higher in severe COVID-19 survivors than in controls (p < 0.001). Few differences were seen for those with moderate disease and none for mild disease. Regression analysis revealed the only pre-existing variable influencing the IMM-AGE score was South Asian ethnicity ([Formula: see text] = 0.174, p = 0.043), with a major influence being disease severity ([Formula: see text] = 0.188, p = 0.01). CONCLUSIONS Our analyses reveal a state of enhanced immune ageing in survivors of severe COVID-19 and suggest this could be related to SARS-Cov-2 infection. Our data support the rationale for trials of anti-immune ageing interventions for improving clinical outcomes in these patients with severe disease.
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Affiliation(s)
- Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Office 6, University of Birmingham Research Labs, Institute of Inflammation and Ageing, Queen Elizabeth Hospital, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham, Birmingham, UK
| | - Tonny Veenith
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham, Birmingham, UK
| | - Jack Sullivan
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Office 6, University of Birmingham Research Labs, Institute of Inflammation and Ageing, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Neil J Greening
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Hamish J C McAuley
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Rachael A Evans
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Shona C Moore
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Lance Turtle
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Nandan Gautam
- Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ahmed Gilani
- Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Manan Bajaj
- Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Louise V Wain
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Christopher Brightling
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Michael Marks
- London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Amisha Singapuri
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Omer Elneima
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | | | - Niharika A Duggal
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Office 6, University of Birmingham Research Labs, Institute of Inflammation and Ageing, Queen Elizabeth Hospital, Birmingham, UK.
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4
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Faustini SE, Cook A, Hill H, Al-Taei S, Heaney J, Efstathiou E, Tanner C, Townsend N, Ahmed Z, Dinally M, Hoque M, Goodall M, Stamataki Z, Plant T, Chapple I, Cunningham AF, Drayson MT, Shields AM, Richter AG. Saliva antiviral antibody levels are detectable but correlate poorly with serum antibody levels following SARS-CoV-2 infection and/or vaccination. J Infect 2023; 87:328-335. [PMID: 37543310 DOI: 10.1016/j.jinf.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/12/2023] [Accepted: 07/29/2023] [Indexed: 08/07/2023]
Abstract
The importance of salivary SARS-CoV-2 antibodies, following infection and vaccination, has not been fully established. 875 healthcare workers were sampled during the first wave in 2020 and 66 longitudinally in response to Pfizer BioNTech 162b2 vaccination. We measured SARS-CoV-2 total IgGAM and individual IgG, IgA and IgM antibodies. IgGAM seroprevalence was 39.9%; however, only 34.1% of seropositive individuals also had salivary antibodies. Infection generated serum IgG antibodies in 51.4% and IgA antibodies in 34.1% of individuals. In contrast, the salivary antibody responses were dominated by IgA (30.9% and 12% generating IgA and IgG antibodies, respectively). Post 2nd vaccination dose, in serum, 100% of infection naïve individuals had IgG and 82.8% had IgA responses; in saliva, 65.5% exhibited IgG and 55.2% IgA antibodies. Prior infection enhanced the vaccine antibody response in serum but no such difference was observed in saliva. Strong neutralisation responses were seen for serum 6 months post 2nd-vaccination dose (median 87.1%) compared to low neutralisation responses in saliva (median 1%). Intramuscular vaccination induces significant serum antibodies and to a lesser extent, salivary antibodies; however, salivary antibodies are typically non-neutralising. This study provides further evidence for the need of mucosal vaccines to elicit nasopharyngeal/oral protection. Although saliva is an attractive non-invasive sero-surveillance tool, due to distinct differences between systemic and oral antibody responses, it cannot be used as a proxy for serum antibody measurement.
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Affiliation(s)
- Siân E Faustini
- University of Birmingham, Clinical Immunology Service, United Kingdom.
| | - Alex Cook
- University of Birmingham, Institute of Immunology and Immunotherapy, United Kingdom; The Binding Site Ltd, United Kingdom
| | - Harriet Hill
- University of Birmingham, Institute of Immunology and Immunotherapy, United Kingdom
| | - Saly Al-Taei
- University of Birmingham, Clinical Immunology Service, United Kingdom
| | - Jennifer Heaney
- University of Birmingham, Clinical Immunology Service, United Kingdom
| | - Elena Efstathiou
- University of Birmingham, Clinical Immunology Service, United Kingdom
| | - Chloe Tanner
- University of Birmingham, Clinical Immunology Service, United Kingdom
| | - Neal Townsend
- University of Birmingham, Clinical Immunology Service, United Kingdom
| | - Zahra Ahmed
- University of Birmingham, Clinical Immunology Service, United Kingdom
| | - Mohammad Dinally
- University of Birmingham, Clinical Immunology Service, United Kingdom
| | - Madeeha Hoque
- University of Birmingham, Clinical Immunology Service, United Kingdom
| | - Margaret Goodall
- University of Birmingham, Clinical Immunology Service, United Kingdom
| | - Zania Stamataki
- University of Birmingham, Institute of Immunology and Immunotherapy, United Kingdom
| | - Timothy Plant
- University of Birmingham, Clinical Immunology Service, United Kingdom
| | - Iain Chapple
- Periodontal Research Group, Institute of Clinical Sciences, University of Birmingham, United Kingdom; University of Birmingham, School of Dentistry, United Kingdom; Birmingham Biomedical Research Centre, United Kingdom
| | - Adam F Cunningham
- University of Birmingham, Institute of Immunology and Immunotherapy, United Kingdom
| | - Mark T Drayson
- University of Birmingham, Clinical Immunology Service/QE UHB Hospital Trust, United Kingdom
| | - Adrian M Shields
- University of Birmingham, Clinical Immunology Service/QE UHB Hospital Trust, United Kingdom
| | - Alex G Richter
- University of Birmingham, Clinical Immunology Service/QE UHB Hospital Trust, United Kingdom.
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5
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Elhaj MO, Richter AG, Goddard S, Shields AM. Dose reductions in immunoglobulin replacement are associated with increased antibiotic usage in patients with antibody deficiency. Br J Haematol 2023; 202:900-903. [PMID: 37339874 DOI: 10.1111/bjh.18910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Mohammed Omer Elhaj
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alex G Richter
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sarah Goddard
- Department of Clinical Immunology, University Hospitals North Midlands, Stoke-on-Trent, UK
| | - Adrian M Shields
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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6
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Ward KE, Steadman L, Karim AR, Reynolds GM, Pugh M, Chua W, Faustini SE, Veenith T, Thwaites RS, Openshaw PJM, Drayson MT, Shields AM, Cunningham AF, Wraith DC, Richter AG. SARS-CoV-2 infection is associated with anti-desmoglein 2 autoantibody detection. Clin Exp Immunol 2023; 213:243-251. [PMID: 37095599 PMCID: PMC10651225 DOI: 10.1093/cei/uxad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/08/2023] [Accepted: 04/24/2023] [Indexed: 04/26/2023] Open
Abstract
Post-acute cardiac sequelae, following SARS-CoV-2 infection, are well recognized as complications of COVID-19. We have previously shown the persistence of autoantibodies against antigens in skin, muscle, and heart in individuals following severe COVID-19; the most common staining on skin tissue displayed an inter-cellular cement pattern consistent with antibodies against desmosomal proteins. Desmosomes play a critical role in maintaining the structural integrity of tissues. For this reason, we analyzed desmosomal protein levels and the presence of anti-desmoglein (DSG) 1, 2, and 3 antibodies in acute and convalescent sera from patients with COVID-19 of differing clinical severity. We find increased levels of DSG2 protein in sera from acute COVID-19 patients. Furthermore, we find that DSG2 autoantibody levels are increased significantly in convalescent sera following severe COVID-19 but not in hospitalized patients recovering from influenza infection or healthy controls. Levels of autoantibody in sera from patients with severe COVID-19 were comparable to levels in patients with non-COVID-19-associated cardiac disease, potentially identifying DSG2 autoantibodies as a novel biomarker for cardiac damage. To determine if there was any association between severe COVID-19 and DSG2, we stained post-mortem cardiac tissue from patients who died from COVID-19 infection. This confirmed DSG2 protein within the intercalated discs and disruption of the intercalated disc between cardiomyocytes in patients who died from COVID-19. Our results reveal the potential for DSG2 protein and autoimmunity to DSG2 to contribute to unexpected pathologies associated with COVID-19 infection.
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Affiliation(s)
- Kerensa E Ward
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Lora Steadman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Abid R Karim
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Gary M Reynolds
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Matthew Pugh
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Sian E Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Tonny Veenith
- Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Adrian M Shields
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Adam F Cunningham
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - David C Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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7
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Shields AM, Faustini SE, Young S, Terjesen S, McCarthy NI, Anderson RL, Drayson MT, Richter AG. Clinical and laboratory characteristics of patients with symptomatic secondary immunodeficiency following the treatment of haematological malignancies. EJHaem 2023; 4:339-349. [PMID: 37206270 PMCID: PMC10188475 DOI: 10.1002/jha2.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 05/21/2023]
Abstract
Secondary immunodeficiency (SID), manifesting as increased susceptibility to infection, is an emergent clinical problem in haematoncology. Management of SID includes vaccination, prophylactic antibiotics (pAbx) and immunoglobulin replacement therapy (IgRT). We report clinical and laboratory parameters of 75 individuals, treated for haematological malignancy, who were referred for immunological assessment due to recurrent infections. Forty-five were managed with pAbx while thirty required IgRT after failing to improve on pAbx. Individuals requiring IgRT had significantly more bacterial, viral and fungal infections resulting in hospitalization at least 5 years after their original haemato-oncological diagnosis. Following immunological assessment and intervention, a 4.39-fold reduction in the frequency of hospital admissions to treat infection was observed in the IgRT cohort and a 2.30-fold reduction in the pAbx cohort. Significant reductions in outpatient antibiotic use were also observed in both cohorts following immunology input. Patients requiring IgRT were more hypogammaglobulinaemic and had lower titres of pathogen-specific antibodies and smaller memory B cell populations than those requiring pAbx. Test vaccination with pneumococcal conjugate vaccine discriminated poorly between the two groups. Patients requiring IgRT could be distinguished by combining wider pathogen-specific serology with a frequency of hospital admissions for infection. If validated in larger cohorts, this approach may circumvent the need for test vaccination and enhance patient selection for IgRT.
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Affiliation(s)
- Adrian M. Shields
- Clinical Immunology ServiceInstitute of Immunology and ImmunotherapyUniversity of Birmingham Medical SchoolBirminghamUK
- Department of Clinical ImmunologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Sian E. Faustini
- Clinical Immunology ServiceInstitute of Immunology and ImmunotherapyUniversity of Birmingham Medical SchoolBirminghamUK
| | - Siobhan Young
- Clinical Immunology ServiceInstitute of Immunology and ImmunotherapyUniversity of Birmingham Medical SchoolBirminghamUK
| | - Sarah Terjesen
- Clinical Immunology ServiceInstitute of Immunology and ImmunotherapyUniversity of Birmingham Medical SchoolBirminghamUK
| | - Nicholas I. McCarthy
- Clinical Immunology ServiceInstitute of Immunology and ImmunotherapyUniversity of Birmingham Medical SchoolBirminghamUK
| | - Rachel L. Anderson
- Clinical Immunology ServiceInstitute of Immunology and ImmunotherapyUniversity of Birmingham Medical SchoolBirminghamUK
| | - Mark T. Drayson
- Clinical Immunology ServiceInstitute of Immunology and ImmunotherapyUniversity of Birmingham Medical SchoolBirminghamUK
- Department of Clinical ImmunologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Alex G. Richter
- Clinical Immunology ServiceInstitute of Immunology and ImmunotherapyUniversity of Birmingham Medical SchoolBirminghamUK
- Department of Clinical ImmunologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
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8
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Patel AJ, Khan N, Richter AG, Naidu B, Drayson MT, Middleton GW. Abstract 5943: Plasma cell repertoire in the lung cancer tumor microenvironment. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Post-operative recurrence in lung cancer continues to pose a major clinical challenge. B cell and plasma cell presence has been shown to correlate with improved survival and lower relapse rates in solid cancers and with improved response to checkpoint blockade. The aim of this study was to identify distinct immune cell compositions in the circulation and tumor microenvironment and make correlations with clinical and disease specific outcomes.
Methods: In this study, utilizing high-dimensional deep immunophenotyping techniques (mass cytometry), multispectral immunofluorescence based imaging and bulk RNA sequencing, we explored the B cell repertoire in the circulation and tumor microenvironment in early-stage lung cancer patients undergoing radical surgical resection.
Results: We demonstrate using high-dimensional deep phenotyping, clear differences in B cell composition between the circulation and the intratumoural microenvironment. Intratumoural predominant populations include plasma cells, from CD38var immature to CD138+ mature cells. B cells undergoing germinal center and follicular maturation as well as class-switched memory cells were predominantly found in the circulation. Eight key populations were significantly differentially abundant between compartments on generalized linear mixed modelling (p<0.0001 with BH correction). These differences were observed in an external validation set. Plasma cell infiltration existed on a phenotypic spectrum from natural regulatory suppressive cells to antibody producing effector phenotypes. The latter correlating with better outcomes. Higher B cell expression of CD138 and Ig was noted within the tumor microenvironment in patients who did not experience early relapse. Significantly higher levels of circulating ki67+ CD27hi CD38hi CD95hi IL10int plasmablasts were noted in recurrence patients (p=0.02). Geospatial mapping identified clusters of suppressive plasma cells localized to the tumor stroma, likely regulating entry of effector cells into the tumor nest.
Conclusions: Our data has demonstrated the unique roles of effector and suppressive B cell subsets in NSCLC and the clear difference in surrogacy between tissue compartments. The lesser infiltration of suppressive phenotypes into the tumor nest may be to prevent the subsequent infiltration of effector plasma and effector B cells into the tumor nest. This tumor line of defense would be in keeping with the observation that higher levels of suppressive B cell subsets in the circulation links to higher rates of recurrence and a higher tumor effector plasma cell infiltrate correlates with protection against recurrent disease. The ambiguous role of B cells in the tumor environment predetermines the multidirectional development of immunotherapeutic approaches, either supporting positive B cell types or inhibiting the suppressive B cell phenotypes.
Citation Format: Akshay J. Patel, Naeem Khan, Alex G. Richter, Babu Naidu, Mark T. Drayson, Gary W. Middleton. Plasma cell repertoire in the lung cancer tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5943.
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Affiliation(s)
- Akshay J. Patel
- 1Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
| | - Naeem Khan
- 1Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
| | - Alex G. Richter
- 1Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
| | - Babu Naidu
- 2Institute of Inflammation and Ageing, Birmingham, United Kingdom
| | - Mark T. Drayson
- 1Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
| | - Gary W. Middleton
- 1Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
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9
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Reynolds JA, Faustini SE, Tosounidou S, Plant T, Ubhi M, Gilman R, Richter AG, Gordon C. Anti-SARS-CoV-2 antibodies following vaccination are associated with lymphocyte count and serum immunoglobulins in SLE. Lupus 2023; 32:431-437. [PMID: 36631440 PMCID: PMC9843147 DOI: 10.1177/09612033231151603] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/20/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Patients with Systemic Lupus Erythematosus are known to have dysregulated immune responses and may have reduced response to vaccination against COVID-19 while being at risk of severe COVID-19 disease. The aim of this study was to identify whether vaccine responses were attenuated in SLE and to assess disease- and treatment-specific associations. METHODS Patients with SLE were matched by age, sex and ethnic background to healthcare worker healthy controls (HC). Anti-SARS-CoV-2 spike glycoprotein antibodies were measured at 4-8 weeks following the second COVID-19 vaccine dose (either BNT162b2 or ChAdOx1 nCoV-19) using a CE-marked combined ELISA detecting IgG, IgA and IgM (IgGAM). Antibody levels were considered as a continuous variable and in tertiles and compared between SLE patients and HC and associations with medication, disease activity and serological parameters were determined. RESULTS Antibody levels were lower in 43 SLE patients compared to 40 HC (p < 0.001). There was no association between antibody levels and medication, lupus disease activity, vaccine type or prior COVID infection. Higher serum IgA, but not IgG or IgM, was associated with being in a higher anti-SARS-CoV-2 antibody level tertile (OR [95% CI] 1.820 [1.050, 3.156] p = 0.033). Similarly, higher lymphocyte count was also associated with being in a higher tertile of anti-SARS-CoV-2 (OR 3.330 [1.505, 7.366] p = 0.003). CONCLUSION Patients with SLE have lower antibody levels following 2 doses of COVID-19 vaccines compared to HC. In SLE lower lymphocyte counts and serum IgA levels are associated with lower antibody levels post vaccination, potentially identifying a subgroup of patients who may therefore be at increased risk of infection.
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Affiliation(s)
- John A Reynolds
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Rheumatology Department, Sandwell and West Birmingham NHS Trust, Birmingham UK
| | - Sian E Faustini
- Clinical Immunology Service, Institute for Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sofia Tosounidou
- Rheumatology Department, Sandwell and West Birmingham NHS Trust, Birmingham UK
| | - Tim Plant
- Clinical Immunology Service, Institute for Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Mandeep Ubhi
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rebecca Gilman
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Rheumatology Department, Sandwell and West Birmingham NHS Trust, Birmingham UK
| | - Alex G Richter
- Clinical Immunology Service, Institute for Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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10
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Holt H, Jolliffe DA, Talaei M, Faustini S, Vivaldi G, Greenig M, Richter AG, Lyons RA, Griffiths CJ, Kee F, Sheikh A, Davies GA, Shaheen SO, Martineau AR. Incidence determinants and serological correlates of reactive symptoms following SARS-CoV-2 vaccination. NPJ Vaccines 2023; 8:26. [PMID: 36841835 PMCID: PMC9959934 DOI: 10.1038/s41541-023-00614-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/27/2023] [Indexed: 02/27/2023] Open
Abstract
Prospective population-based studies investigating associations between reactive symptoms following SARS-CoV-2 vaccination and serologic responses to vaccination are lacking. We therefore conducted a study in 9003 adults from the UK general population receiving SARS-CoV-2 vaccines as part of the national vaccination programme. Titres of combined IgG/IgA/IgM responses to SARS-CoV-2 spike (S) glycoprotein were determined in eluates of dried blood spots collected from all participants before and after vaccination. 4262 (47.3%) participants experienced systemic reactive symptoms after a first vaccine dose. Factors associating with lower risk of such symptoms included older age (aOR per additional 10 years of age 0.85, 95% CI: 0.81-0.90), male vs. female sex (0.59, 0.53-0.65) and receipt of an mRNA vaccine vs. ChAdOx1 nCoV-19 (0.29, 0.26-0.32 for BNT162b2; 0.06, 0.01-0.26 for mRNA-1273). Higher risk of such symptoms was associated with SARS-CoV-2 seropositivity and COVID-19 symptoms prior to vaccination (2.23, 1.78-2.81), but not with SARS-CoV-2 seropositivity in the absence of COVID-19 symptoms (0.94, 0.81-1.09). Presence vs. absence of self-reported anxiety or depression at enrolment associated with higher risk of such symptoms (1.24, 1.12-1.39). Post-vaccination anti-S titres were higher among participants who experienced reactive symptoms after vaccination vs. those who did not (P < 0.001). We conclude that factors influencing risk of systemic symptoms after SARS-CoV-2 vaccination include demographic characteristics, pre-vaccination SARS-CoV-2 serostatus and vaccine type. Participants experiencing reactive symptoms following SARS-CoV-2 vaccination had higher post-vaccination titres of IgG/A/M anti-S antibodies. Improved public understanding of the frequency of reactogenic symptoms and their positive association with vaccine immunogenicity could potentially increase vaccine uptake.
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Affiliation(s)
- Hayley Holt
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. .,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. .,Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK.
| | - David A. Jolliffe
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK ,grid.4868.20000 0001 2171 1133Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Mohammad Talaei
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sian Faustini
- grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Giulia Vivaldi
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK ,grid.4868.20000 0001 2171 1133Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Matthew Greenig
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alex G. Richter
- grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ronan A. Lyons
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Christopher J. Griffiths
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK ,grid.4868.20000 0001 2171 1133Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Frank Kee
- grid.4777.30000 0004 0374 7521Centre for Public Health Research (NI), Queen’s University Belfast, Belfast, UK
| | - Aziz Sheikh
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Gwyneth A. Davies
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Seif O. Shaheen
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adrian R. Martineau
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK ,grid.4868.20000 0001 2171 1133Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK ,grid.4868.20000 0001 2171 1133Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
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11
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Khan AO, Reyat JS, Hill H, Bourne JH, Colicchia M, Newby ML, Allen JD, Crispin M, Youd E, Murray PG, Taylor G, Stamataki Z, Richter AG, Cunningham AF, Pugh M, Rayes J. Preferential uptake of SARS-CoV-2 by pericytes potentiates vascular damage and permeability in an organoid model of the microvasculature. Cardiovasc Res 2022; 118:3085-3096. [PMID: 35709328 PMCID: PMC9214165 DOI: 10.1093/cvr/cvac097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS Thrombotic complications and vasculopathy have been extensively associated with severe COVID-19 infection; however, the mechanisms inducing endotheliitis and the disruption of endothelial integrity in the microcirculation are poorly understood. We hypothesized that within the vessel wall, pericytes preferentially take up viral particles and mediate the subsequent loss of vascular integrity. METHODS AND RESULTS Immunofluorescence of post-mortem patient sections was used to assess pathophysiological aspects of COVID-19 infection. The effects of COVID-19 on the microvasculature were assessed using a vascular organoid model exposed to live viral particles or recombinant viral antigens. We find increased expression of the viral entry receptor angiotensin-converting enzyme 2 on pericytes when compared to vascular endothelium and a reduction in the expression of the junctional protein CD144, as well as increased cell death, upon treatment with both live virus and/or viral antigens. We observe a dysregulation of genes implicated in vascular permeability, including Notch receptor 3, angiopoietin-2, and TEK. Activation of vascular organoids with interleukin-1β did not have an additive effect on vascular permeability. Spike antigen was detected in some patients' lung pericytes, which was associated with a decrease in CD144 expression and increased platelet recruitment and von Willebrand factor (VWF) deposition in the capillaries of these patients, with thrombi in large vessels rich in VWF and fibrin. CONCLUSION Together, our data indicate that direct viral exposure to the microvasculature modelled by organoid infection and viral antigen treatment results in pericyte infection, detachment, damage, and cell death, disrupting pericyte-endothelial cell crosstalk and increasing microvascular endothelial permeability, which can promote thrombotic and bleeding complications in the microcirculation.
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Affiliation(s)
- Abdullah O Khan
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK
| | - Jasmeet S Reyat
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK
| | - Harriet Hill
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Joshua H Bourne
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK
| | - Martina Colicchia
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK
| | - Maddy L Newby
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Joel D Allen
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Max Crispin
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Esther Youd
- Forensic Medicine and Science, University of Glasgow, Glasgow G12 8QQ, UK
| | - Paul G Murray
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
- Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
| | - Graham Taylor
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Zania Stamataki
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Adam F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Matthew Pugh
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Julie Rayes
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK
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12
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Shields AM, Anantharachagan A, Arumugakani G, Baker K, Bahal S, Baxendale H, Bermingham W, Bhole M, Boules E, Bright P, Chopra C, Cliffe L, Cleave B, Dempster J, Devlin L, Dhalla F, Diwakar L, Drewe E, Duncan C, Dziadzio M, Elcombe S, Elkhalifa S, Gennery A, Ghanta H, Goddard S, Grigoriadou S, Hackett S, Hayman G, Herriot R, Herwadkar A, Huissoon A, Jain R, Jolles S, Johnston S, Khan S, Laffan J, Lane P, Leeman L, Lowe DM, Mahabir S, Lochlainn DJM, McDermott E, Misbah S, Moghaddas F, Morsi H, Murng S, Noorani S, O'Brien R, Patel S, Price A, Rahman T, Seneviratne S, Shrimpton A, Stroud C, Thomas M, Townsend K, Vaitla P, Verma N, Williams A, Burns SO, Savic S, Richter AG. Outcomes following SARS-CoV-2 infection in patients with primary and secondary immunodeficiency in the UK. Clin Exp Immunol 2022; 209:247-258. [PMID: 35641155 PMCID: PMC8807296 DOI: 10.1093/cei/uxac008] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/16/2021] [Accepted: 01/25/2022] [Indexed: 12/29/2022] Open
Abstract
In March 2020, the United Kingdom Primary Immunodeficiency Network (UKPIN) established a registry of cases to collate the outcomes of individuals with PID and SID following SARS-CoV-2 infection and treatment. A total of 310 cases of SARS-CoV-2 infection in individuals with PID or SID have now been reported in the UK. The overall mortality within the cohort was 17.7% (n = 55/310). Individuals with CVID demonstrated an infection fatality rate (IFR) of 18.3% (n = 17/93), individuals with PID receiving IgRT had an IFR of 16.3% (n = 26/159) and individuals with SID, an IFR of 27.2% (n = 25/92). Individuals with PID and SID had higher inpatient mortality and died at a younger age than the general population. Increasing age, low pre-SARS-CoV-2 infection lymphocyte count and the presence of common co-morbidities increased the risk of mortality in PID. Access to specific COVID-19 treatments in this cohort was limited: only 22.9% (n = 33/144) of patients admitted to the hospital received dexamethasone, remdesivir, an anti-SARS-CoV-2 antibody-based therapeutic (e.g. REGN-COV2 or convalescent plasma) or tocilizumab as a monotherapy or in combination. Dexamethasone, remdesivir, and anti-SARS-CoV-2 antibody-based therapeutics appeared efficacious in PID and SID. Compared to the general population, individuals with PID or SID are at high risk of mortality following SARS-CoV-2 infection. Increasing age, low baseline lymphocyte count, and the presence of co-morbidities are additional risk factors for poor outcome in this cohort.
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Affiliation(s)
- Adrian M Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | | | - Gururaj Arumugakani
- Department of Clinical Immunology and Allergy, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Kenneth Baker
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sameer Bahal
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | | | | | - Malini Bhole
- The Dudley Group NHS Foundation Trust, Birmingham, UK
| | - Evon Boules
- Clinical Immunology and Allergy Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Philip Bright
- Clinical Immunology, North Bristol NHS Trust, Bristol, UK
| | - Charu Chopra
- Department of Haematology & Immunology, Royal Infirmary of Edinburgh, NHS Lothian, UK
| | - Lucy Cliffe
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Betsy Cleave
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - John Dempster
- Specialist Allergy and Clinical Immunology, University College London Hospitals, London, UK
| | - Lisa Devlin
- Regional Immunology Service, The Royal Hospitals, Belfast, UK
| | - Fatima Dhalla
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lavanya Diwakar
- Department of Immunology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Elizabeth Drewe
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Christopher Duncan
- Translational and Clinical Research Institute, Immunity and Inflammation Theme, Newcastle University, Newcastle upon Tyne, UK
| | | | - Suzanne Elcombe
- Regional Department of Clinical Immunology & Allergy, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Shuayb Elkhalifa
- Immunology Department, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrew Gennery
- Translational and Clinical Research Institute, Newcastle University, and Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Harichandrana Ghanta
- Department of Allergy and Clinical Immunology, University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK
| | - Sarah Goddard
- Department of Immunology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Sofia Grigoriadou
- Immunology Department, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Scott Hackett
- Paediatric Immunology Department, University Hospitals of Birmingham, Birmingham, UK
| | - Grant Hayman
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Richard Herriot
- Immunology Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Archana Herwadkar
- Immunology Department, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Aarnoud Huissoon
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rashmi Jain
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Sarah Johnston
- Clinical Immunology, North Bristol NHS Trust, Bristol, UK
| | - Sujoy Khan
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - James Laffan
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Peter Lane
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Lucy Leeman
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David M Lowe
- Institute of Immunity and Transplantation, University College London, London, UK.,Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Shanti Mahabir
- Clinical Immunology and Allergy Department, Leicester Royal Infirmary, Leicester, UK
| | | | - Elizabeth McDermott
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Siraj Misbah
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Hadeil Morsi
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sai Murng
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Sadia Noorani
- Clinical Immunology Department, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Rachael O'Brien
- Department of Clinical Immunology, Frimley Park Hospital, Frimley, Surrey, UK
| | - Smita Patel
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Arthur Price
- Clinical Immunology and Allergy Department, Leicester Royal Infirmary, Leicester, UK
| | - Tasneem Rahman
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | | | - Anna Shrimpton
- Clinical Immunology and Allergy Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Catherine Stroud
- Regional Department of Clinical Immunology & Allergy, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Moira Thomas
- Clinical Immunology Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Katie Townsend
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Prashantha Vaitla
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Nisha Verma
- Institute of Immunity and Transplantation, University College London, London, UK
| | - Anthony Williams
- Department of Allergy and Clinical Immunology, University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK
| | - Siobhan O Burns
- Institute of Immunity and Transplantation, University College London, London, UK.,Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Alex G Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
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13
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Shields AM, Tadros S, Al-Hakim A, Nell JM, Lin MMN, Chan M, Goddard S, Dempster J, Dziadzio M, Patel SY, Elkalifa S, Huissoon A, Duncan CJA, Herwadkar A, Khan S, Bethune C, Elcombe S, Thaventhiran J, Klenerman P, Lowe DM, Savic S, Burns SO, Richter AG. Impact of vaccination on hospitalization and mortality from COVID-19 in patients with primary and secondary immunodeficiency: The United Kingdom experience. Front Immunol 2022; 13:984376. [PMID: 36211396 PMCID: PMC9539662 DOI: 10.3389/fimmu.2022.984376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/18/2022] [Indexed: 12/29/2022] Open
Abstract
Background Individuals with primary and secondary immunodeficiency (PID/SID) were shown to be at risk of poor outcomes during the early stages of the SARS-CoV-2 pandemic. SARS-CoV-2 vaccines demonstrate reduced immunogenicity in these patients. Objectives To understand whether the risk of severe COVID-19 in individuals with PID or SID has changed following the deployment of vaccination and therapeutics in the context of the emergence of novel viral variants of concern. Methods The outcomes of two cohorts of patients with PID and SID were compared: the first, infected between March and July 2020, prior to vaccination and treatments, the second after these intervention became available between January 2021 and April 2022. Results 22.7% of immunodeficient patients have been infected at least once with SARS-CoV-2 since the start of the pandemic, compared to over 70% of the general population. Immunodeficient patients were typically infected later in the pandemic when the B.1.1.529 (Omicron) variant was dominant. This delay was associated with receipt of more vaccine doses and higher pre-infection seroprevalence. Compared to March-July 2020, hospitalization rates (53.3% vs 17.9%, p<0.0001) and mortality (Infection fatality rate 20.0% vs 3.4%, p=0.0003) have significantly reduced for patients with PID but remain elevated compared to the general population. The presence of a serological response to vaccination was associated with a reduced duration of viral detection by PCR in the nasopharynx. Early outpatient treatment with antivirals or monoclonal antibodies reduced hospitalization during the Omicron wave. Conclusions Most individuals with immunodeficiency in the United Kingdom remain SARS-CoV-2 infection naïve. Vaccination, widespread availability of outpatient treatments and, possibly, the emergence of the B.1.1.529 variant have led to significant improvements in morbidity and mortality followings SARS-CoV-2 infection since the start of the pandemic. However, individuals with PID and SID remain at significantly increased risk of poor outcomes compared to the general population; mitigation, vaccination and treatment strategies must be optimized to minimize the ongoing burden of the pandemic in these vulnerable cohorts.
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Affiliation(s)
- Adrian M. Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- Department of Clinical Immunology, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom
| | - Susan Tadros
- Department of Immunology, Royal Free London National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Adam Al-Hakim
- Department of Allergy and Clinical Immunology, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, United Kingdom
| | - Jeremy M. Nell
- Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Me Me Nay Lin
- Department of Immunology, Royal Free London National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Michele Chan
- Department of Immunology, Royal Free London National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Sarah Goddard
- Department of Clinical Immunology, University Hospitals North Midlands, Stoke-on-Trent, United Kingdom
| | - John Dempster
- Department of Clinical Immunology, University College London Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Magdalena Dziadzio
- Department of Clinical Immunology, University College London Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Smita Y. Patel
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) Oxford Biomedical Centre, University of Oxford, Oxford, United Kingdom
- Department of Clinical Immunology, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Shuayb Elkalifa
- Department of Immunology, Salford Royal National Health Service (NHS) Foundation Trust, Salford, United Kingdom
| | - Aarnoud Huissoon
- Department of Clinical Immunology, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom
| | - Christopher J. A. Duncan
- Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Archana Herwadkar
- Department of Immunology, Salford Royal National Health Service (NHS) Foundation Trust, Salford, United Kingdom
| | - Sujoy Khan
- Department of Clinical Immunology, Hull University Teaching Hospitals National Health Service (NHS) Trust, Hull, United Kingdom
| | - Claire Bethune
- Department of Allergy and Clinical Immunology, University Hospitals Plymouth National Health Service (NHS) Trust, Plymouth, United Kingdom
| | - Suzanne Elcombe
- Department of Allergy and Clinical Immunology, Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne, Newcastle, United Kingdom
| | - James Thaventhiran
- Medical Research Council Toxicology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - David M. Lowe
- Department of Immunology, Royal Free London National Health Service (NHS) Foundation Trust, London, United Kingdom
- Institute of Immunity and Transplantation, University College London, London, United Kingdom
| | - Sinisa Savic
- Department of Allergy and Clinical Immunology, Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, United Kingdom
| | - Siobhan O. Burns
- Department of Immunology, Royal Free London National Health Service (NHS) Foundation Trust, London, United Kingdom
- Institute of Immunity and Transplantation, University College London, London, United Kingdom
| | - Alex G. Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- Department of Clinical Immunology, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom
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14
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Jolliffe DA, Faustini SE, Holt H, Perdek N, Maltby S, Talaei M, Greenig M, Vivaldi G, Tydeman F, Symons J, Davies GA, Lyons RA, Griffiths CJ, Kee F, Sheikh A, Shaheen SO, Richter AG, Martineau AR. Determinants of Antibody Responses to SARS-CoV-2 Vaccines: Population-Based Longitudinal Study (COVIDENCE UK). Vaccines (Basel) 2022; 10:1601. [PMID: 36298466 PMCID: PMC9610049 DOI: 10.3390/vaccines10101601] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Antibody responses to SARS-CoV-2 vaccines vary for reasons that remain poorly understood. A range of sociodemographic, behavioural, clinical, pharmacologic and nutritional factors could explain these differences. To investigate this hypothesis, we tested for presence of combined IgG, IgA and IgM (IgGAM) anti-Spike antibodies before and after 2 doses of ChAdOx1 nCoV-19 (ChAdOx1, AstraZeneca) or BNT162b2 (Pfizer-BioNTech) in UK adults participating in a population-based longitudinal study who received their first dose of vaccine between December 2020 and July 2021. Information on sixty-six potential sociodemographic, behavioural, clinical, pharmacologic and nutritional determinants of serological response to vaccination was captured using serial online questionnaires. We used logistic regression to estimate multivariable-adjusted odds ratios (aORs) for associations between independent variables and risk of seronegativity following two vaccine doses. Additionally, percentage differences in antibody titres between groups were estimated in the sub-set of participants who were seropositive post-vaccination using linear regression. Anti-spike antibodies were undetectable in 378/9101 (4.2%) participants at a median of 8.6 weeks post second vaccine dose. Increased risk of post-vaccination seronegativity associated with administration of ChAdOx1 vs. BNT162b2 (adjusted odds ratio (aOR) 6.6, 95% CI 4.2−10.4), shorter interval between vaccine doses (aOR 1.6, 1.2−2.1, 6−10 vs. >10 weeks), poor vs. excellent general health (aOR 3.1, 1.4−7.0), immunodeficiency (aOR 6.5, 2.5−16.6) and immunosuppressant use (aOR 3.7, 2.4−5.7). Odds of seronegativity were lower for participants who were SARS-CoV-2 seropositive pre-vaccination (aOR 0.2, 0.0−0.6) and for those taking vitamin D supplements (aOR 0.7, 0.5−0.9). Serologic responses to vaccination did not associate with time of day of vaccine administration, lifestyle factors including tobacco smoking, alcohol intake and sleep, or use of anti-pyretics for management of reactive symptoms after vaccination. In a sub-set of 8727 individuals who were seropositive post-vaccination, lower antibody titres associated with administration of ChAdOx1 vs. BNT162b2 (43.4% lower, 41.8−44.8), longer duration between second vaccine dose and sampling (12.7% lower, 8.2−16.9, for 9−16 weeks vs. 2−4 weeks), shorter interval between vaccine doses (10.4% lower, 3.7−16.7, for <6 weeks vs. >10 weeks), receiving a second vaccine dose in October−December vs. April−June (47.7% lower, 11.4−69.1), older age (3.3% lower per 10-year increase in age, 2.1−4.6), and hypertension (4.1% lower, 1.1−6.9). Higher antibody titres associated with South Asian ethnicity (16.2% higher, 3.0−31.1, vs. White ethnicity) or Mixed/Multiple/Other ethnicity (11.8% higher, 2.9−21.6, vs. White ethnicity), higher body mass index (BMI; 2.9% higher, 0.2−5.7, for BMI 25−30 vs. <25 kg/m2) and pre-vaccination seropositivity for SARS-CoV-2 (105.1% higher, 94.1−116.6, for those seropositive and experienced COVID-19 symptoms vs. those who were seronegative pre-vaccination). In conclusion, we identify multiple determinants of antibody responses to SARS-CoV-2 vaccines, many of which are modifiable.
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Affiliation(s)
- David A. Jolliffe
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Sian E. Faustini
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Hayley Holt
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London E1 2AB, UK
| | - Natalia Perdek
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Sheena Maltby
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Mohammad Talaei
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
| | - Matthew Greenig
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Giulia Vivaldi
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Florence Tydeman
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | | | - Gwyneth A. Davies
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK
| | - Ronan A. Lyons
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK
| | - Christopher J. Griffiths
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London E1 2AB, UK
| | - Frank Kee
- Centre for Public Health Research (NI), Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh EH16 4UX, UK
| | - Seif O. Shaheen
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
| | - Alex G. Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Adrian R. Martineau
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London E1 2AB, UK
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15
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Jolliffe DA, Vivaldi G, Chambers ES, Cai W, Li W, Faustini SE, Gibbons JM, Pade C, Coussens AK, Richter AG, McKnight Á, Martineau AR. Vitamin D Supplementation Does Not Influence SARS-CoV-2 Vaccine Efficacy or Immunogenicity: Sub-Studies Nested within the CORONAVIT Randomised Controlled Trial. Nutrients 2022; 14:3821. [PMID: 36145196 PMCID: PMC9506404 DOI: 10.3390/nu14183821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 12/23/2022] Open
Abstract
Vitamin D deficiency has been reported to associate with the impaired development of antigen-specific responses following vaccination. We aimed to determine whether vitamin D supplements might boost the immunogenicity and efficacy of SARS-CoV-2 vaccination by conducting three sub-studies nested within the CORONAVIT randomised controlled trial, which investigated the effects of offering vitamin D supplements at a dose of 800 IU/day or 3200 IU/day vs. no offer on risk of acute respiratory infections in UK adults with circulating 25-hydroxyvitamin D concentrations <75 nmol/L. Sub-study 1 (n = 2808) investigated the effects of vitamin D supplementation on the risk of breakthrough SARS-CoV-2 infection following two doses of SARS-CoV-2 vaccine. Sub-study 2 (n = 1853) investigated the effects of vitamin D supplementation on titres of combined IgG, IgA and IgM (IgGAM) anti-Spike antibodies in eluates of dried blood spots collected after SARS-CoV-2 vaccination. Sub-study 3 (n = 100) investigated the effects of vitamin D supplementation on neutralising antibody and cellular responses in venous blood samples collected after SARS-CoV-2 vaccination. In total, 1945/2808 (69.3%) sub-study 1 participants received two doses of ChAdOx1 nCoV-19 (Oxford−AstraZeneca); the remainder received two doses of BNT162b2 (Pfizer). Mean follow-up 25(OH)D concentrations were significantly elevated in the 800 IU/day vs. no-offer group (82.5 vs. 53.6 nmol/L; mean difference 28.8 nmol/L, 95% CI 22.8−34.8) and in the 3200 IU/day vs. no offer group (105.4 vs. 53.6 nmol/L; mean difference 51.7 nmol/L, 45.1−58.4). Vitamin D supplementation did not influence the risk of breakthrough SARS-CoV-2 infection in vaccinated participants (800 IU/day vs. no offer: adjusted hazard ratio 1.28, 95% CI 0.89 to 1.84; 3200 IU/day vs. no offer: 1.17, 0.81 to 1.70). Neither did it influence IgGAM anti-Spike titres, neutralising antibody titres or IFN-γ concentrations in the supernatants of S peptide-stimulated whole blood. In conclusion, vitamin D replacement at a dose of 800 or 3200 IU/day effectively elevated 25(OH)D concentrations, but it did not influence the protective efficacy or immunogenicity of SARS-CoV-2 vaccination when given to adults who had a sub-optimal vitamin D status at baseline.
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Affiliation(s)
- David A. Jolliffe
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
| | - Giulia Vivaldi
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Emma S. Chambers
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Weigang Cai
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Wenhao Li
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Sian E. Faustini
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Joseph M. Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Anna K. Coussens
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Alex G. Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Adrian R. Martineau
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London E1 2AB, UK
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16
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Jolliffe DA, Holt H, Greenig M, Talaei M, Perdek N, Pfeffer P, Vivaldi G, Maltby S, Symons J, Barlow NL, Normandale A, Garcha R, Richter AG, Faustini SE, Orton C, Ford D, Lyons RA, Davies GA, Kee F, Griffiths CJ, Norrie J, Sheikh A, Shaheen SO, Relton C, Martineau AR. Effect of a test-and-treat approach to vitamin D supplementation on risk of all cause acute respiratory tract infection and covid-19: phase 3 randomised controlled trial (CORONAVIT). BMJ 2022; 378:e071230. [PMID: 36215226 PMCID: PMC9449358 DOI: 10.1136/bmj-2022-071230] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the effect of population level implementation of a test-and-treat approach to correction of suboptimal vitamin D status (25-hydroxyvitamin D (25(OH)D) <75 nmol/L) on risk of all cause acute respiratory tract infection and covid 19. DESIGN Phase 3 open label randomised controlled trial. SETTING United Kingdom. PARTICIPANTS 6200 people aged ≥16 years who were not taking vitamin D supplements at baseline. INTERVENTIONS Offer of a postal finger prick test of blood 25(OH)D concentration with provision of a six month supply of lower dose vitamin D (800 IU/day, n=1550) or higher dose vitamin D (3200 IU/day, n=1550) to those with blood 25(OH)D concentration <75 nmol/L, compared with no offer of testing or supplementation (n=3100). Follow-up was for six months. MAIN OUTCOME MEASURES The primary outcome was the proportion of participants with at least one swab test or doctor confirmed acute respiratory tract infection of any cause. A secondary outcome was the proportion of participants with swab test confirmed covid-19. Logistic regression was used to calculate odds ratios and associated 95% confidence intervals. The primary analysis was conducted by intention to treat. RESULTS Of 3100 participants offered a vitamin D test, 2958 (95.4%) accepted and 2674 (86.3%) had 25(OH)D concentrations <75 nmol/L and received vitamin D supplements (n=1328 lower dose, n=1346 higher dose). Compared with 136/2949 (4.6%) participants in the no offer group, at least one acute respiratory tract infection of any cause occurred in 87/1515 (5.7%) in the lower dose group (odds ratio 1.26, 95% confidence interval 0.96 to 1.66) and 76/1515 (5.0%) in the higher dose group (1.09, 0.82 to 1.46). Compared with 78/2949 (2.6%) participants in the no offer group, 55/1515 (3.6%) developed covid-19 in the lower dose group (1.39, 0.98 to 1.97) and 45/1515 (3.0%) in the higher dose group (1.13, 0.78 to 1.63). CONCLUSIONS Among people aged 16 years and older with a high baseline prevalence of suboptimal vitamin D status, implementation of a population level test-and-treat approach to vitamin D supplementation was not associated with a reduction in risk of all cause acute respiratory tract infection or covid-19. TRIAL REGISTRATION ClinicalTrials.gov NCT04579640.
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Affiliation(s)
- David A Jolliffe
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Hayley Holt
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Matthew Greenig
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Mohammad Talaei
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Natalia Perdek
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Paul Pfeffer
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Giulia Vivaldi
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Sheena Maltby
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | | | - Nicola L Barlow
- Clinical Biochemistry Department, Black Country Pathology Services, City Hospital, Birmingham, UK
| | - Alexa Normandale
- Clinical Biochemistry Department, Black Country Pathology Services, City Hospital, Birmingham, UK
| | - Rajvinder Garcha
- Clinical Biochemistry Department, Black Country Pathology Services, City Hospital, Birmingham, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sian E Faustini
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Christopher Orton
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
| | - David Ford
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
| | - Gwyneth A Davies
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
| | - Frank Kee
- Centre for Public Health (NI), Queen's University Belfast, Belfast, UK
| | - Christopher J Griffiths
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
- Health Data Research UK BREATHE Hub, Queen Mary University of London, London, UK
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Data Research UK BREATHE Hub, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Data Research UK BREATHE Hub, University of Edinburgh, Edinburgh, UK
| | - Seif O Shaheen
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Clare Relton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Adrian R Martineau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
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17
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Lugg ST, Mackay WR, Faniyi AA, Faustini SE, Webster C, Duffy JE, Hewison M, Shields AM, Parekh D, Richter AG, Scott A, Thickett DR. Vitamin D status: a U-shaped relationship for SARS-CoV-2 seropositivity in UK healthcare workers. BMJ Open Respir Res 2022; 9:9/1/e001258. [PMID: 36167472 PMCID: PMC9515459 DOI: 10.1136/bmjresp-2022-001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/17/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is increasing evidence that vitamin D (VD) deficiency may increase individuals' risk of COVID-19 infection and susceptibility. We aimed to determine the relationship between VD deficiency and sufficiency and COVID-19 seropositivity within healthcare workers. METHODS The study included an observational cohort of healthcare workers who isolated due to COVID-19 symptoms from 12 May to 22 May 2020, from the University Hospitals Birmingham National Health Service Foundation Trust. Data collected included SARS-CoV-2 seroconversion status, serum 25(OH)D3 levels, age, body mass index (BMI), sex, ethnicity, job role and comorbidities. Participants were grouped into four VD categories: (1) Severe VD deficiency (VD<30 nmol/L); (2) VD deficiency (30 nmol/L ≤VD<50 nmol/L); (3) VD insufficiency (50 nmol/L ≤VD<75 nmol/L); (4) VD sufficiency (VD≥75 nmol/L). RESULTS When VD levels were compared against COVID-19 seropositivity rate, a U-shaped curve was identified. This trend repeated when participants were split into subgroups of age, sex, ethnicity, BMI and comorbidity status. Significant difference was identified in the COVID-19 seropositivity rate between VD groups in the total population and between groups of men and women; black, Asian and minority ethnic (BAME) group; BMI<30 (kg/m2); 0 and +1 comorbidities; the majority of which were differences when the severely VD deficient category were compared with the other groups. A larger proportion of those within the BAME group (vs white ethnicity) were severely VD deficient (p<0.00001). A larger proportion of the 0 comorbidity subgroup were VD deficient in comparison to the 1+ comorbidity subgroup (p=0.046). CONCLUSIONS Our study has shown a U-shaped relationship for COVID-19 seropositivity in UK healthcare workers. Further investigation is required to determine whether high VD levels can have a detrimental effect on susceptibility to COVID-19 infection. Future randomised clinical trials of VD supplementation could potentially identify 'optimal' VD levels, allowing for targeted therapeutic treatment for those at risk.
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Affiliation(s)
- Sebastian T Lugg
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - William R Mackay
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Aduragbemi A Faniyi
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sian E Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Craig Webster
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joanne E Duffy
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Adrian M Shields
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Dhruv Parekh
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Aaron Scott
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - David R Thickett
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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18
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Vivaldi G, Jolliffe DA, Faustini S, Shields AM, Holt H, Perdek N, Talaei M, Tydeman F, Chambers ES, Cai W, Li W, Gibbons JM, Pade C, McKnight Á, Shaheen SO, Richter AG, Martineau AR. Correlation Between Postvaccination Anti-Spike Antibody Titers and Protection Against Breakthrough Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Population-Based Longitudinal Study. J Infect Dis 2022; 226:1903-1908. [PMID: 35906930 PMCID: PMC9384605 DOI: 10.1093/infdis/jiac321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/28/2022] [Indexed: 12/31/2022] Open
Abstract
In this population-based cohort of 7538 adults, combined immunoglobulin (Ig) G, IgA, and IgM (IgG/A/M) anti-spike titers measured after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination were predictive of protection against breakthrough SARS-CoV-2 infection. Discrimination was significantly improved by adjustment for factors influencing risk of SARS-CoV-2 exposure, including household overcrowding, public transport use, and visits to indoor public places. Anti-spike IgG/A/M titers showed positive correlation with neutralizing antibody titers (rs = 0.80 [95% confidence interval, .72-.86]; P < .001) and S peptide-stimulated interferon-γ concentrations (rs = 0.31 [.13-.47]; P < .001).
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Affiliation(s)
- Giulia Vivaldi
- Correspondence: Giulia Vivaldi, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London E1 2AT, UK ()
| | | | - Sian Faustini
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Adrian M Shields
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hayley Holt
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom,Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom,Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Natalia Perdek
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mohammad Talaei
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Florence Tydeman
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom,Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Emma S Chambers
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Weigang Cai
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Wenhao Li
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Joseph M Gibbons
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Corinna Pade
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Áine McKnight
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Seif O Shaheen
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Adrian R Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom,Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom,Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
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19
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Lamerton RE, Marcial-Juarez E, Faustini SE, Perez-Toledo M, Goodall M, Jossi SE, Newby ML, Chapple I, Dietrich T, Veenith T, Shields AM, Harper L, Henderson IR, Rayes J, Wraith DC, Watson SP, Crispin M, Drayson MT, Richter AG, Cunningham AF. SARS-CoV-2 Spike- and Nucleoprotein-Specific Antibodies Induced After Vaccination or Infection Promote Classical Complement Activation. Front Immunol 2022; 13:838780. [PMID: 35860286 PMCID: PMC9289266 DOI: 10.3389/fimmu.2022.838780] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/07/2022] [Indexed: 12/19/2022] Open
Abstract
Antibodies specific for the spike glycoprotein (S) and nucleocapsid (N) SARS-CoV-2 proteins are typically present during severe COVID-19, and induced to S after vaccination. The binding of viral antigens by antibody can initiate the classical complement pathway. Since complement could play pathological or protective roles at distinct times during SARS-CoV-2 infection we determined levels of antibody-dependent complement activation along the complement cascade. Here, we used an ELISA assay to assess complement protein binding (C1q) and the deposition of C4b, C3b, and C5b to S and N antigens in the presence of antibodies to SARS-CoV-2 from different test groups: non-infected, single and double vaccinees, non-hospitalised convalescent (NHC) COVID-19 patients and convalescent hospitalised (ITU-CONV) COVID-19 patients. C1q binding correlates strongly with antibody responses, especially IgG1 levels. However, detection of downstream complement components, C4b, C3b and C5b shows some variability associated with the subject group from whom the sera were obtained. In the ITU-CONV, detection of C3b-C5b to S was observed consistently, but this was not the case in the NHC group. This is in contrast to responses to N, where median levels of complement deposition did not differ between the NHC and ITU-CONV groups. Moreover, for S but not N, downstream complement components were only detected in sera with higher IgG1 levels. Therefore, the classical pathway is activated by antibodies to multiple SARS-CoV-2 antigens, but the downstream effects of this activation may differ depending the disease status of the subject and on the specific antigen targeted.
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Affiliation(s)
- Rachel E. Lamerton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Edith Marcial-Juarez
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Sian E. Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Marisol Perez-Toledo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Margaret Goodall
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Siân E. Jossi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Maddy L. Newby
- School of Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Iain Chapple
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, University of Birmingham, and Birmingham Community Healthcare National Health Service Trust, Birmingham, United Kingdom
| | - Thomas Dietrich
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, University of Birmingham, and Birmingham Community Healthcare National Health Service Trust, Birmingham, United Kingdom
| | - Tonny Veenith
- Department of Critical Care Medicine, University Hospitals Birmingham National Health Service (NHS) Trust, Birmingham, United Kingdom
| | - Adrian M. Shields
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Lorraine Harper
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ian R. Henderson
- Institute for Molecular Bioscience, University of Queensland, St Lucia, QLD, Australia
| | - Julie Rayes
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - David C. Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Steve P. Watson
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Max Crispin
- School of Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Mark T. Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Alex G. Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Adam F. Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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20
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Shields AM, Faustini SE, Hill HJ, Al-Taei S, Tanner C, Ashford F, Workman S, Moreira F, Verma N, Wagg H, Heritage G, Campton N, Stamataki Z, Klenerman P, Thaventhiran JED, Goddard S, Johnston S, Huissoon A, Bethune C, Elcombe S, Lowe DM, Patel SY, Savic S, Burns SO, Richter AG. SARS-CoV-2 Vaccine Responses in Individuals with Antibody Deficiency: Findings from the COV-AD Study. J Clin Immunol 2022; 42:923-934. [PMID: 35420363 PMCID: PMC9008380 DOI: 10.1007/s10875-022-01231-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/10/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Vaccination prevents severe morbidity and mortality from COVID-19 in the general population. The immunogenicity and efficacy of SARS-CoV-2 vaccines in patients with antibody deficiency is poorly understood. OBJECTIVES COVID-19 in patients with antibody deficiency (COV-AD) is a multi-site UK study that aims to determine the immune response to SARS-CoV-2 infection and vaccination in patients with primary or secondary antibody deficiency, a population that suffers from severe and recurrent infection and does not respond well to vaccination. METHODS Individuals on immunoglobulin replacement therapy or with an IgG less than 4 g/L receiving antibiotic prophylaxis were recruited from April 2021. Serological and cellular responses were determined using ELISA, live-virus neutralisation and interferon gamma release assays. SARS-CoV-2 infection and clearance were determined by PCR from serial nasopharyngeal swabs. RESULTS A total of 5.6% (n = 320) of the cohort reported prior SARS-CoV-2 infection, but only 0.3% remained PCR positive on study entry. Seropositivity, following two doses of SARS-CoV-2 vaccination, was 54.8% (n = 168) compared with 100% of healthy controls (n = 205). The magnitude of the antibody response and its neutralising capacity were both significantly reduced compared to controls. Participants vaccinated with the Pfizer/BioNTech vaccine were more likely to be seropositive (65.7% vs. 48.0%, p = 0.03) and have higher antibody levels compared with the AstraZeneca vaccine (IgGAM ratio 3.73 vs. 2.39, p = 0.0003). T cell responses post vaccination was demonstrable in 46.2% of participants and were associated with better antibody responses but there was no difference between the two vaccines. Eleven vaccine-breakthrough infections have occurred to date, 10 of them in recipients of the AstraZeneca vaccine. CONCLUSION SARS-CoV-2 vaccines demonstrate reduced immunogenicity in patients with antibody deficiency with evidence of vaccine breakthrough infection.
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Affiliation(s)
- Adrian M Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Sian E Faustini
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Harriet J Hill
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Saly Al-Taei
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Chloe Tanner
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Fiona Ashford
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sarita Workman
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Fernando Moreira
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Nisha Verma
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Hollie Wagg
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Gail Heritage
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Naomi Campton
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
| | - Zania Stamataki
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - James E D Thaventhiran
- Medical Research Council Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QW, UK
| | - Sarah Goddard
- Department of Clinical Immunology, University Hospitals North Midlands, Stoke-on-Trent, UK
| | - Sarah Johnston
- Department of Clinical Immunology, North Bristol NHS Trust, Bristol, UK
| | - Aarnoud Huissoon
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claire Bethune
- Department of Allergy and Clinical Immunology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Suzanne Elcombe
- Department of Allergy and Clinical Immunology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - David M Lowe
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
- Institute of Immunity and Transplantation, University College London, London, UK
| | - Smita Y Patel
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR BRC Oxford Biomedical Centre, University of Oxford, Oxford, UK
| | - Sinisa Savic
- Department of Allergy and Clinical Immunology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Siobhan O Burns
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK.
- Institute of Immunity and Transplantation, University College London, London, UK.
| | - Alex G Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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21
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Shields AM, Faustini SE, Hill HJ, Al-Taei S, Tanner C, Ashford F, Workman S, Moreira F, Verma N, Wagg H, Heritage G, Campton N, Stamataki Z, Drayson MT, Klenerman P, Thaventhiran JED, Elkhalifa S, Goddard S, Johnston S, Huissoon A, Bethune C, Elcombe S, Lowe DM, Patel SY, Savic S, Richter AG, Burns SO. Increased Seroprevalence and Improved Antibody Responses Following Third Primary SARS-CoV-2 Immunisation: An Update From the COV-AD Study. Front Immunol 2022; 13:912571. [PMID: 35720400 PMCID: PMC9201027 DOI: 10.3389/fimmu.2022.912571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Patients with primary and secondary antibody deficiency are vulnerable to COVID-19 and demonstrate diminished responses following two-dose SARS-CoV-2 vaccine schedules. Third primary vaccinations have been deployed to enhance their humoral and cellular immunity. Objectives To determine the immunogenicity of the third primary SARS-CoV-2 immunisation in a heterogeneous cohort of patients with antibody deficiency. Methods Participants enrolled in the COV-AD study were sampled before and after their third vaccine dose. Serological and cellular responses were determined using ELISA, live-virus neutralisation and ELISPOT assays. Results Following a two-dose schedule, 100% of healthy controls mounted a serological response to SARS-CoV-2 vaccination, however, 38.6% of individuals with antibody deficiency remained seronegative. A third primary SARS-CoV-2 vaccine significantly increased anti-spike glycoprotein antibody seroprevalence from 61.4% to 76.0%, the magnitude of the antibody response, its neutralising capacity and induced seroconversion in individuals who were seronegative after two vaccine doses. Vaccine-induced serological responses were broadly cross-reactive against the SARS-CoV-2 B.1.1.529 variant of concern, however, seroprevalence and antibody levels remained significantly lower than healthy controls. No differences in serological responses were observed between individuals who received AstraZeneca ChAdOx1 nCoV-19 and Pfizer BioNTech 162b2 during their initial two-dose vaccine schedule. SARS-CoV-2 infection-naive participants who had received a heterologous vaccine as a third dose were significantly more likely to have a detectable T cell response following their third vaccine dose (61.5% vs 11.1%). Conclusion These data support the widespread use of third primary immunisations to enhance humoral immunity against SARS-CoV-2 in individuals with antibody deficiency.
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Affiliation(s)
- Adrian M. Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Sian E. Faustini
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Harriet J. Hill
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Saly Al-Taei
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Chloe Tanner
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Fiona Ashford
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Sarita Workman
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Fernando Moreira
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Nisha Verma
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Hollie Wagg
- Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Gail Heritage
- Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Naomi Campton
- Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Zania Stamataki
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Mark T. Drayson
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Shuayb Elkhalifa
- Department of Immunology, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Sarah Goddard
- Department of Clinical Immunology, University Hospitals North Midlands, Stoke-on-Trent, United Kingdom
| | - Sarah Johnston
- Department of Clinical Immunology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Aarnoud Huissoon
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Claire Bethune
- Department of Allergy and Clinical Immunology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Suzanne Elcombe
- Department of Allergy and Clinical Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - David M. Lowe
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
- Institute of Immunity and Transplantation, University College London, London, United Kingdom
| | - Smita Y. Patel
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) Oxford Biomedical Centre, University of Oxford, Oxford, United Kingdom
| | - Sinisa Savic
- Department of Allergy and Clinical Immunology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Alex G. Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Siobhan O. Burns
- Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
- Institute of Immunity and Transplantation, University College London, London, United Kingdom
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22
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Talaei M, Faustini S, Holt H, Jolliffe DA, Vivaldi G, Greenig M, Perdek N, Maltby S, Bigogno CM, Symons J, Davies GA, Lyons RA, Griffiths CJ, Kee F, Sheikh A, Richter AG, Shaheen SO, Martineau AR. Determinants of pre-vaccination antibody responses to SARS-CoV-2: a population-based longitudinal study (COVIDENCE UK). BMC Med 2022; 20:87. [PMID: 35189888 PMCID: PMC8860623 DOI: 10.1186/s12916-022-02286-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prospective population-based studies investigating multiple determinants of pre-vaccination antibody responses to SARS-CoV-2 are lacking. METHODS We did a prospective population-based study in SARS-CoV-2 vaccine-naive UK adults recruited between May 1 and November 2, 2020, without a positive swab test result for SARS-CoV-2 prior to enrolment. Information on 88 potential sociodemographic, behavioural, nutritional, clinical and pharmacological risk factors was obtained through online questionnaires, and combined IgG/IgA/IgM responses to SARS-CoV-2 spike glycoprotein were determined in dried blood spots obtained between November 6, 2020, and April 18, 2021. We used logistic and linear regression to estimate adjusted odds ratios (aORs) and adjusted geometric mean ratios (aGMRs) for potential determinants of SARS-CoV-2 seropositivity (all participants) and antibody titres (seropositive participants only), respectively. RESULTS Of 11,130 participants, 1696 (15.2%) were seropositive. Factors independently associated with higher risk of SARS-CoV-2 seropositivity included frontline health/care occupation (aOR 1.86, 95% CI 1.48-2.33), international travel (1.20, 1.07-1.35), number of visits to shops and other indoor public places (≥ 5 vs. 0/week: 1.29, 1.06-1.57, P-trend = 0.01), body mass index (BMI) ≥ 25 vs. < 25 kg/m2 (1.24, 1.11-1.39), South Asian vs. White ethnicity (1.65, 1.10-2.49) and alcohol consumption ≥15 vs. 0 units/week (1.23, 1.04-1.46). Light physical exercise associated with lower risk (0.80, 0.70-0.93, for ≥ 10 vs. 0-4 h/week). Among seropositive participants, higher titres of anti-Spike antibodies associated with factors including BMI ≥ 30 vs. < 25 kg/m2 (aGMR 1.10, 1.02-1.19), South Asian vs. White ethnicity (1.22, 1.04-1.44), frontline health/care occupation (1.24, 95% CI 1.11-1.39), international travel (1.11, 1.05-1.16) and number of visits to shops and other indoor public places (≥ 5 vs. 0/week: 1.12, 1.02-1.23, P-trend = 0.01); these associations were not substantially attenuated by adjustment for COVID-19 disease severity. CONCLUSIONS Higher alcohol consumption and lower light physical exercise represent new modifiable risk factors for SARS-CoV-2 infection. Recognised associations between South Asian ethnic origin and obesity and higher risk of SARS-CoV-2 seropositivity were independent of other sociodemographic, behavioural, nutritional, clinical, and pharmacological factors investigated. Among seropositive participants, higher titres of anti-Spike antibodies in people of South Asian ancestry and in obese people were not explained by greater COVID-19 disease severity in these groups.
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Affiliation(s)
- Mohammad Talaei
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sian Faustini
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Hayley Holt
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - David A Jolliffe
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Giulia Vivaldi
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Matthew Greenig
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Perdek
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sheena Maltby
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carola M Bigogno
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Gwyneth A Davies
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Christopher J Griffiths
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Frank Kee
- Centre for Public Health Research (NI), Queen's University Belfast, Belfast, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Seif O Shaheen
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adrian R Martineau
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK.
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23
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Chawla H, Jossi SE, Faustini SE, Samsudin F, Allen JD, Watanabe Y, Newby ML, Marcial-Juárez E, Lamerton RE, McLellan JS, Bond PJ, Richter AG, Cunningham AF, Crispin M. Glycosylation and Serological Reactivity of an Expression-enhanced SARS-CoV-2 Viral Spike Mimetic. J Mol Biol 2022; 434:167332. [PMID: 34717971 PMCID: PMC8550889 DOI: 10.1016/j.jmb.2021.167332] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 02/06/2023]
Abstract
Extensive glycosylation of viral glycoproteins is a key feature of the antigenic surface of viruses and yet glycan processing can also be influenced by the manner of their recombinant production. The low yields of the soluble form of the trimeric spike (S) glycoprotein from SARS-CoV-2 has prompted advances in protein engineering that have greatly enhanced the stability and yields of the glycoprotein. The latest expression-enhanced version of the spike incorporates six proline substitutions to stabilize the prefusion conformation (termed SARS-CoV-2 S HexaPro). Although the substitutions greatly enhanced expression whilst not compromising protein structure, the influence of these substitutions on glycan processing has not been explored. Here, we show that the site-specific N-linked glycosylation of the expression-enhanced HexaPro resembles that of an earlier version containing two proline substitutions (2P), and that both capture features of native viral glycosylation. However, there are site-specific differences in glycosylation of HexaPro when compared to 2P. Despite these discrepancies, analysis of the serological reactivity of clinical samples from infected individuals confirmed that both HexaPro and 2P protein are equally able to detect IgG, IgA, and IgM responses in all sera analysed. Moreover, we extend this observation to include an analysis of glycan engineered S protein, whereby all N-linked glycans were converted to oligomannose-type and conclude that serological activity is not impacted by large scale changes in glycosylation. These observations suggest that variations in glycan processing will not impact the serological assessments currently being performed across the globe.
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Affiliation(s)
- Himanshi Chawla
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Sian E Jossi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Sian E Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Firdaus Samsudin
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore 138671, Singapore
| | - Joel D Allen
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Yasunori Watanabe
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK; Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, South Parks Road, Oxford OX1 3QU, UK
| | - Maddy L Newby
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Edith Marcial-Juárez
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Rachel E Lamerton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Jason S McLellan
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Peter J Bond
- Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore 138671, Singapore; Department of Biological Sciences, National University of Singapore, Singapore 117543, Singapore
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Adam F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Max Crispin
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, UK.
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24
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Shields AM, Venkatachalam S, Shafeek S, Paneesha S, Ford M, Sheeran T, Kelly M, Qureshi I, Salhan B, Karim F, De Silva N, Stones J, Lee S, Khawaja J, Kaudlay PK, Whitmill R, Kakepoto GN, Parry HM, Moss P, Faustini SE, Richter AG, Drayson MT, Basu S. SARS-CoV-2 vaccine responses following CD20-depletion treatment in patients with haematological and rheumatological disease: a West Midlands Research Consortium study. Clin Exp Immunol 2021; 207:3-10. [PMID: 35020852 PMCID: PMC8767851 DOI: 10.1093/cei/uxab018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022] Open
Abstract
B-cell-depleting agents are among the most commonly used drugs to treat haemato-oncological and autoimmune diseases. They rapidly induce a state of peripheral B-cell aplasia with the potential to interfere with nascent vaccine responses, particularly to novel antigens. We have examined the relationship between B-cell reconstitution and SARS-CoV-2 vaccine responses in two cohorts of patients previously exposed to B-cell-depleting agents: a cohort of patients treated for haematological B-cell malignancy and another treated for rheumatological disease. B-cell depletion severely impairs vaccine responsiveness in the first 6 months after administration: SARS-CoV-2 antibody seroprevalence was 42.2% and 33.3% in the haemato-oncological patients and rheumatology patients, respectively and 22.7% in patients vaccinated while actively receiving anti-lymphoma chemotherapy. After the first 6 months, vaccine responsiveness significantly improved during early B-cell reconstitution; however, the kinetics of reconstitution was significantly faster in haemato-oncology patients. The AstraZeneca ChAdOx1 nCoV-19 vaccine and the Pfizer BioNTech 162b vaccine induced equivalent vaccine responses; however, shorter intervals between vaccine doses (<1 m) improved the magnitude of the antibody response in haeamto-oncology patients. In a subgroup of haemato-oncology patients, with historic exposure to B-cell-depleting agents (>36 m previously), vaccine non-responsiveness was independent of peripheral B-cell reconstitution. The findings have important implications for primary vaccination and booster vaccination strategies in individuals clinically vulnerable to SARS-CoV-2.
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Affiliation(s)
- Adrian M Shields
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK,Department of Clinical Immunology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK,Correspondence: Adrian M. Shields, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
| | | | - Salim Shafeek
- Department of Haematology, Worcestershire Acute NHS Trust, Worcester, UK
| | - Shankara Paneesha
- Department of Haematology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Ford
- Department of Rheumatology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Tom Sheeran
- Department of Rheumatology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Melanie Kelly
- Department of Haematology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Iman Qureshi
- Department of Haematology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Beena Salhan
- Department of Haematology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Farheen Karim
- Department of Haematology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Neelakshi De Silva
- Department of Haematology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Jacqueline Stones
- Department of Haematology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Sophie Lee
- Department of Haematology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Jahanzeb Khawaja
- Department of Haematology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Richard Whitmill
- Department of Haematology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Helen M Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK,Department of Haematology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK,Department of Haematology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sian E Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK,Department of Clinical Immunology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK,Department of Clinical Immunology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK,Mark T. Drayson, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
| | - Supratik Basu
- Department of Haematology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK,Faculty of Science & Engineering, University of Wolverhampton, Wolverhampton, UK,Supratik Basu, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
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25
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Faustini SE, Jossi SE, Perez‐Toledo M, Shields AM, Allen JD, Watanabe Y, Newby ML, Cook A, Willcox CR, Salim M, Goodall M, Heaney JL, Marcial‐Juarez E, Morley GL, Torlinska B, Wraith DC, Veenith TV, Harding S, Jolles S, Ponsford MJ, Plant T, Huissoon A, O'Shea MK, Willcox BE, Drayson MT, Crispin M, Cunningham AF, Richter AG. Development of a high-sensitivity ELISA detecting IgG, IgA and IgM antibodies to the SARS-CoV-2 spike glycoprotein in serum and saliva. Immunology 2021; 164:135-147. [PMID: 33932228 PMCID: PMC8242512 DOI: 10.1111/imm.13349] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
Detecting antibody responses during and after SARS-CoV-2 infection is essential in determining the seroepidemiology of the virus and the potential role of antibody in disease. Scalable, sensitive and specific serological assays are essential to this process. The detection of antibody in hospitalized patients with severe disease has proven relatively straightforward; detecting responses in subjects with mild disease and asymptomatic infections has proven less reliable. We hypothesized that the suboptimal sensitivity of antibody assays and the compartmentalization of the antibody response may contribute to this effect. We systematically developed an ELISA, optimizing different antigens and amplification steps, in serum and saliva from non-hospitalized SARS-CoV-2-infected subjects. Using trimeric spike glycoprotein, rather than nucleocapsid, enabled detection of responses in individuals with low antibody responses. IgG1 and IgG3 predominate to both antigens, but more anti-spike IgG1 than IgG3 was detectable. All antigens were effective for detecting responses in hospitalized patients. Anti-spike IgG, IgA and IgM antibody responses were readily detectable in saliva from a minority of RT-PCR confirmed, non-hospitalized symptomatic individuals, and these were mostly subjects who had the highest levels of anti-spike serum antibodies. Therefore, detecting antibody responses in both saliva and serum can contribute to determining virus exposure and understanding immune responses after SARS-CoV-2 infection.
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Affiliation(s)
- Sian E. Faustini
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Sian E. Jossi
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | | | - Adrian M. Shields
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Joel D. Allen
- School of Biological SciencesUniversity of SouthamptonSouthamptonUK
| | - Yasunori Watanabe
- School of Biological SciencesUniversity of SouthamptonSouthamptonUK
- Department of BiochemistryOxford Glycobiology InstituteUniversity of OxfordOxfordUK
| | - Maddy L. Newby
- School of Biological SciencesUniversity of SouthamptonSouthamptonUK
| | | | - Carrie R. Willcox
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Mahboob Salim
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Margaret Goodall
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Jennifer L. Heaney
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | | | | | - Barbara Torlinska
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - David C. Wraith
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Tonny V. Veenith
- Department of Critical Care MedicineUniversity Hospitals Birmingham NHS TrustBirminghamUK
| | | | | | | | - Tim Plant
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Aarnoud Huissoon
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
- Department of ImmunologyUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Matthew K. O'Shea
- Institute of Microbiology and InfectionUniversity of BirminghamBirminghamUK
| | - Benjamin E. Willcox
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Mark T. Drayson
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Max Crispin
- School of Biological SciencesUniversity of SouthamptonSouthamptonUK
| | - Adam F. Cunningham
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Alex G. Richter
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
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26
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Shields AM, Faustini SE, Perez-Toledo M, Jossi S, Allen JD, Al-Taei S, Backhouse C, Dunbar LA, Ebanks D, Emmanuel B, Faniyi AA, Garvey M, Grinbergs A, McGinnell G, O'Neill J, Watanabe Y, Crispin M, Wraith DC, Cunningham AF, Drayson MT, Richter AG. Serological responses to SARS-CoV-2 following non-hospitalised infection: clinical and ethnodemographic features associated with the magnitude of the antibody response. BMJ Open Respir Res 2021; 8:e000872. [PMID: 34561239 PMCID: PMC8474079 DOI: 10.1136/bmjresp-2020-000872] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/30/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To determine clinical and ethnodemographic correlates of serological responses against the SARS-CoV-2 spike glycoprotein following mild-to-moderate COVID-19. DESIGN A retrospective cohort study of healthcare workers who had self-isolated due to COVID-19. SETTING University Hospitals Birmingham NHS Foundation Trust, UK (UHBFT). PARTICIPANTS 956 healthcare workers were recruited by open invitation via UHBFT trust email and social media between 27 April 2020 and the 8 June 2020. INTERVENTION Participants volunteered a venous blood sample that was tested for the presence of anti-SARS-CoV-2 spike glycoprotein antibodies. Results were interpreted in the context of the symptoms of their original illness and ethnodemographic variables. RESULTS Using an assay that simultaneously measures the combined IgG, IgA and IgM response against the spike glycoprotein (IgGAM), the overall seroprevalence within this cohort was 46.2% (n=442/956). The seroprevalence of immunoglobulin isotypes was 36.3%, 18.7% and 8.1% for IgG, IgA and IgM, respectively. IgGAM identified serological responses in 40.6% (n=52/128) of symptomatic individuals who reported a negative SARS-CoV-2 PCR test. Increasing age, non-white ethnicity and obesity were independently associated with greater IgG antibody response against the spike glycoprotein. Self-reported fever and fatigue were associated with greater IgG and IgA responses against the spike glycoprotein. The combination of fever and/or cough and/or anosmia had a positive predictive value of 92.3% for seropositivity in self-isolating individuals a time when Wuhan strain SARS-CoV-2 was predominant. CONCLUSIONS AND RELEVANCE Assays employing combined antibody detection demonstrate enhanced seroepidemiological sensitivity and can detect prior viral exposure even when PCR swabs have been negative. We demonstrate an association between known ethnodemographic risk factors associated with mortality from COVID-19 and the magnitude of serological responses in mild-to-moderate disease.
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Affiliation(s)
- Adrian M Shields
- Department of Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sian E Faustini
- Department of Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Marisol Perez-Toledo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sian Jossi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Joel D Allen
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - Saly Al-Taei
- Department of Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Claire Backhouse
- Department of Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Lynsey A Dunbar
- Department of Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Daniel Ebanks
- Department of Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Beena Emmanuel
- Department of Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Aduragbemi A Faniyi
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Mark Garvey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Annabel Grinbergs
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Golaleh McGinnell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joanne O'Neill
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Yasunori Watanabe
- School of Biological Sciences, University of Southampton, Southampton, UK
- Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford, UK
| | - Max Crispin
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - David C Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Adam F Cunningham
- MRC Centre for Immune Regulation, University of Birmingham, Birmingham, UK
| | - Mark T Drayson
- Department of Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Alex G Richter
- Department of Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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27
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Richter AG, Shields AM, Karim A, Birch D, Faustini SE, Steadman L, Ward K, Plant T, Reynolds G, Veenith T, Cunningham AF, Drayson MT, Wraith DC. Establishing the prevalence of common tissue-specific autoantibodies following severe acute respiratory syndrome coronavirus 2 infection. Clin Exp Immunol 2021; 205:99-105. [PMID: 34082475 PMCID: PMC8239842 DOI: 10.1111/cei.13623] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022] Open
Abstract
Coronavirus 19 (COVID-19) has been associated with both transient and persistent systemic symptoms that do not appear to be a direct consequence of viral infection. The generation of autoantibodies has been proposed as a mechanism to explain these symptoms. To understand the prevalence of autoantibodies associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we investigated the frequency and specificity of clinically relevant autoantibodies in 84 individuals previously infected with SARS-CoV-2, suffering from COVID-19 of varying severity in both the acute and convalescent setting. These were compared with results from 32 individuals who were on the intensive therapy unit (ITU) for non-COVID reasons. We demonstrate a higher frequency of autoantibodies in the COVID-19 ITU group compared with non-COVID-19 ITU disease control patients and that autoantibodies were also found in the serum 3-5 months post-COVID-19 infection. Non-COVID patients displayed a diverse pattern of autoantibodies; in contrast, the COVID-19 groups had a more restricted panel of autoantibodies including skin, skeletal muscle and cardiac antibodies. Our results demonstrate that respiratory viral infection with SARS-CoV-2 is associated with the detection of a limited profile of tissue-specific autoantibodies, detectable using routine clinical immunology assays. Further studies are required to determine whether these autoantibodies are specific to SARS-CoV-2 or a phenomenon arising from severe viral infections and to determine the clinical significance of these autoantibodies.
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Affiliation(s)
- Alex G. Richter
- Clinical Immunology ServiceInstitute for Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Adrian M. Shields
- Clinical Immunology ServiceInstitute for Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Abid Karim
- Clinical Immunology ServiceInstitute for Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - David Birch
- Clinical Immunology ServiceInstitute for Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Sian E. Faustini
- Clinical Immunology ServiceInstitute for Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Lora Steadman
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Kerensa Ward
- Clinical Immunology ServiceInstitute for Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Timothy Plant
- Clinical Immunology ServiceInstitute for Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Gary Reynolds
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Tonny Veenith
- Department of Critical Care MedicineUniversity Hospitals Birmingham NHS TrustBirminghamUK
| | - Adam F. Cunningham
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Mark T. Drayson
- Clinical Immunology ServiceInstitute for Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - David C. Wraith
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
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28
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Perez‐Toledo M, Faustini SE, Jossi SE, Shields AM, Marcial‐Juarez E, Kanthimathinathan HK, Allen JD, Watanabe Y, Goodall M, Willcox BE, Willcox CR, Salim M, Wraith DC, Veenith TV, Syrimi E, Drayson MT, Jyothish D, Al‐Abadi E, Chikermane A, Welch SB, Masilamani K, Hackett S, Crispin M, Scholefield BR, Cunningham AF, Richter AG. SARS-CoV-2-specific IgG1/IgG3 but not IgM in children with Pediatric Inflammatory Multi-System Syndrome. Pediatr Allergy Immunol 2021; 32:1125-1129. [PMID: 33724541 PMCID: PMC8250256 DOI: 10.1111/pai.13504] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 12/24/2022]
Affiliation(s)
| | - Sian E. Faustini
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Sian E. Jossi
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Adrian M. Shields
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | | | - Hari Krishnan Kanthimathinathan
- Birmingham Clinical Trials UnitUniversity of BirminghamBirminghamUK
- Paediatric Intensive Care UnitBirmingham Women's and Children's NHS Foundation TrustBirminghamUK
| | - Joel D. Allen
- School of Biological SciencesUniversity of SouthamptonSouthamptonUK
| | - Yasunori Watanabe
- Oxford Glycobiology InstituteDepartment of BiochemistryUniversity of OxfordOxfordUK
| | - Margaret Goodall
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Benjamin E. Willcox
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Carrie R. Willcox
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Mahboob Salim
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - David C. Wraith
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Tonny V. Veenith
- Department of Critical Care MedicineUniversity Hospitals Birmingham NHS TrustBirminghamUK
| | - Eleni Syrimi
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Mark T. Drayson
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Deepthi Jyothish
- Department of General PaediatricsBirmingham Women's and Children's NHS Foundation TrustBirminghamUK
| | - Eslam Al‐Abadi
- Birmingham Clinical Trials UnitUniversity of BirminghamBirminghamUK
- Childhood Arthritis and Rheumatic Diseases UnitBirmingham Women's and Children's NHS Foundation TrustBirminghamUK
| | - Ashish Chikermane
- Department of CardiologyBirmingham Women's and Children's NHS Foundation TrustBirminghamUK
| | - Steven B. Welch
- Department of PaediatricsBirmingham Chest Clinic and Heartlands HospitalUniversity Hospitals BirminghamBirminghamUK
| | - Kavitha Masilamani
- Department of General PaediatricsBirmingham Women's and Children's NHS Foundation TrustBirminghamUK
| | - Scott Hackett
- West Midlands Immunodeficiency CentreHeartlands HospitalUniversity Hospitals BirminghamBirminghamUK
| | - Max Crispin
- School of Biological SciencesUniversity of SouthamptonSouthamptonUK
| | - Barnaby R. Scholefield
- Paediatric Intensive Care UnitBirmingham Women's and Children's NHS Foundation TrustBirminghamUK
- Institute of Inflammation and AgeingUniversity of BirminghamBirminghamUK
| | - Adam F. Cunningham
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
| | - Alex G. Richter
- Institute of Immunology and ImmunotherapyUniversity of BirminghamBirminghamUK
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29
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McKemey E, Shields AM, Faustini SE, Hill HJ, Baranskaya A, Stamataki Z, Gompertz S, Richter AG, Dosanjh D, Madathil S. Correction to: Resolution of Persistent COVID-19 After Convalescent Plasma in a Patient with B Cell Aplasia. J Clin Immunol 2021; 41:930. [PMID: 33788084 PMCID: PMC8009759 DOI: 10.1007/s10875-021-01029-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Emily McKemey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Adrian M Shields
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
| | - Sian E Faustini
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Harriet J Hill
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Zania Stamataki
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Simon Gompertz
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alex G Richter
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Davinder Dosanjh
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shyam Madathil
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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30
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Faniyi AA, Lugg ST, Faustini SE, Webster C, Duffy JE, Hewison M, Shields A, Nightingale P, Richter AG, Thickett DR. Genetic polymorphisms, vitamin D binding protein and vitamin D deficiency in COVID-19. Eur Respir J 2021; 57:13993003.00653-2021. [PMID: 33888522 PMCID: PMC8100329 DOI: 10.1183/13993003.00653-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/05/2022]
Abstract
We thank M.M. Speeckaert and co-workers for their interest in our paper about vitamin D status and seroconversion for coronavirus disease 2019 (COVID-19) in UK healthcare workers [1]. We agree with the authors that vitamin D binding protein (DBP) is important in determining serum 25(OH)D3 levels. The majority of vitamin D in the circulation is bound to DBP, also known as gc-globulin, which has actin-binding and immunomodulatory functions independent of vitamin D carriage [2]. DBP levels may be particularly relevant to determining 25(OH)D3 levels in severely ill COVID-19 patients with acute respiratory distress syndrome (ARDS), as we have previously demonstrated that DBP is a negative acute phase protein with levels dropping by about a third in patients with ARDS [3]. This tends to lower circulating total vitamin D but releases free 25(OH)D that can be taken up by cells of the immune system and epithelial cells. The consequences of changes in serum 25(OH)D during illness are, therefore, complex and difficult to interpret [4]. Genome-wide association analyses have shown that single nucleotide polymorphisms (SNPs) in the gene for DBP (GC) are important contributors to the genetic component of circulating 25D concentrations, but this is still a relatively small proportion of overall serum 25D levels, and it is unclear how these SNPs impact DBP/25D homeostasis in the setting of disease. This work outlines the potential importance of vitamin D binding protein and vitamin D in immune function and COVID-19 infectionhttps://bit.ly/3byTaO5
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Affiliation(s)
- Aduragbemi A Faniyi
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Joint first authors
| | - Sebastian T Lugg
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Joint first authors
| | - Sian E Faustini
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Craig Webster
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joanne E Duffy
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Adrian Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Nightingale
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alex G Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Joint last authors
| | - David R Thickett
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Joint last authors
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Faniyi AA, Lugg ST, Faustini SE, Webster C, Duffy JE, Hewison M, Shields A, Nightingale P, Richter AG, Thickett DR. Vitamin D status and seroconversion for COVID-19 in UK healthcare workers. Eur Respir J 2021; 57:13993003.04234-2020. [PMID: 33303541 PMCID: PMC7736751 DOI: 10.1183/13993003.04234-2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 12/14/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a global health emergency, resulting in over 50 million infections and over 1.2 million deaths as of mid-November 2020 [1]. Healthcare workers are at a high risk of COVID-19 with large numbers of deaths reported around Europe and the UK, particularly among staff in the Black, Asian and minority ethnic (BAME) demographic group [2]. COVID-19 has disproportionately affected BAME individuals even after accounting for age, sex, social deprivation and comorbidity [3]. NHS staff with vitamin D deficiency were more likely to have developed COVID-19, with staff from BAME ethnicity being the most vitamin D deficienthttps://bit.ly/2J3kVTc
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Affiliation(s)
- Aduragbemi A Faniyi
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Joint first authors
| | - Sebastian T Lugg
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Joint first authors
| | - Sian E Faustini
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Craig Webster
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joanne E Duffy
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Adrian Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Nightingale
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alex G Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Joint last authors
| | - David R Thickett
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Joint last authors
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Shields AM, Burns SO, Savic S, Richter AG. COVID-19 in patients with primary and secondary immunodeficiency: The United Kingdom experience. J Allergy Clin Immunol 2021; 147:870-875.e1. [PMID: 33338534 PMCID: PMC7737531 DOI: 10.1016/j.jaci.2020.12.620] [Citation(s) in RCA: 146] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND As of November 2020, severe acute respiratory syndrome coronavirus 2 has resulted in 55 million infections worldwide and more than 1.3 million deaths from coronavirus disease 2019 (COVID-19). Outcomes following severe acute respiratory syndrome coronavirus 2 infection in individuals with primary immunodeficiency (PID) or symptomatic secondary immunodeficiency (SID) remain uncertain. OBJECTIVES We sought to document the outcomes of individuals with PID or symptomatic SID following COVID-19 in the United Kingdom. METHODS At the start of the COVID-19 pandemic, the United Kingdom Primary Immunodeficiency Network established a registry of cases to collate the nationwide outcomes of COVID-19 in individuals with PID or symptomatic SID and determine risk factors associated with morbidity and mortality from COVID-19 in these patient groups. RESULTS A total of 100 patients had been enrolled by July 1, 2020, 60 with PID, 7 with other inborn errors of immunity including autoinflammatory diseases and C1 inhibitor deficiency, and 33 with symptomatic SID. In individuals with PID, 53.3% (32 of 60) were hospitalized, the infection-fatality ratio was 20.0% (12 of 60), the case-fatality ratio was 31.6% (12 of 38), and the inpatient mortality was 37.5% (12 of 32). Individuals with SID had worse outcomes than those with PID; 75.8% (25 of 33) were hospitalized, the infection-fatality ratio was 33.3% (11 of 33), the case-fatality ratio was 39.2% (11 of 28), and inpatient mortality was 44.0% (11 of 25). CONCLUSIONS In comparison to the general population, adult patients with PID and symptomatic SID display greater morbidity and mortality from COVID-19. This increased risk must be reflected in public health guidelines to adequately protect vulnerable patients from exposure to the virus.
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Affiliation(s)
- Adrian M Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Siobhan O Burns
- Institute of Immunity and Transplantation, University College London, London, United Kingdom; Department of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Alex G Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom.
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Shields AM, Brown H, Phillips N, Drayson MT, Richter AA, Richter AG. Health Care Professionals' Confidence and Preferences for Diagnostic Assays for SARS-CoV-2: A Global Study. Front Public Health 2021; 9:569315. [PMID: 33718315 PMCID: PMC7952327 DOI: 10.3389/fpubh.2021.569315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/02/2021] [Indexed: 12/18/2022] Open
Abstract
Background: The COVID-19 pandemic has led to an urgent requirement for novel diagnostic tests that determine infection with SARS-CoV-2 and the development of an immune response against it. The perspective of end users on the characteristics and clinical use of these assays has not been previously considered. Methods: We surveyed 17,186 health care professions (HCPs) in 29 countries to gauge opinion on the design, use, diagnostic impact and diagnostic accuracy of COVID-19 tests. Results were correlated with national statistics on the burden of disease and testing in individual countries. Results: HCPs overwhelmingly recognized the importance of COVID-19 tests but 37.1% were unsure of the appropriate timing of investigations relative to disease symptoms. Confidence in the diagnostic accuracy of assays varied inversely with COVID-19-related mortality in individual countries but had no relationship with the total number of tests performed. There was global consensus that the most important impact of positive antigen and antibody testing was confidence in returning to work following recovery. Saliva was the preferred sampling fluid for COVID-19 diagnostic tests in all groups surveyed. Conclusions: HCP input can ensure novel assays are fit for purpose in varied global health care settings, but HCPs may require support to effectively use novel diagnostics thus minimizing waste when supplies are limited.
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Affiliation(s)
- Adrian M. Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | | | | | - Mark T. Drayson
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | | | - Alex G. Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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McKemey E, Shields AM, Faustini SE, Hill HJ, Barnskaya A, Stamataki Z, Gompertz S, Richter AG, Dosanjh D, Madathil S. Resolution of Persistent COVID-19 After Convalescent Plasma in a Patient with B Cell Aplasia. J Clin Immunol 2021; 41:926-929. [PMID: 33611660 PMCID: PMC7896874 DOI: 10.1007/s10875-021-00996-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Emily McKemey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Adrian M Shields
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
| | - Sian E Faustini
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Harriet J Hill
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Zania Stamataki
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Simon Gompertz
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alex G Richter
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Davinder Dosanjh
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shyam Madathil
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Richens N, Kanthimathinathan HK, Sontakke S, Chikermane A, Jyothish D, Hackett S, Welch SB, Al-Abadi E, Duncan HP, Richter AG, Scholefield BR. Critical Care Course of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 and Response to Immunomodulation. J Pediatr Intensive Care 2020; 11:124-129. [DOI: 10.1055/s-0040-1721456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/31/2020] [Indexed: 01/09/2023] Open
Abstract
AbstractWe describe the critical care course of children with a novel hyperinflammatory syndrome associated with coronavirus disease 2019 (COVID-19) pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with focus on trajectory before and after immunomodulation. Overall, 10 patients who met the U.K. Royal College of Pediatrics and Child Health case definition during a 2-month study period were analyzed. All tested positive for SARS-CoV-2 IgG antibody. Although only 20% were ventilated, 100% required inotropic or vasopressor support. All children had significantly raised inflammatory markers with a median C-reactive protein of 248 (175–263) mg/L, ferritin of 1,561 (726–2,255) µg/L, and troponin-I of 723 (351–2,235) ng/L. Six patients had moderately impaired myocardial function and two had severe impairment. None needed extracorporeal membrane oxygenation. Despite severe illness only a brief period of critical care support of 3 to 5 days was required. Eight received at least one dose of intravenous immunoglobulin. Six received high-dose steroids. Clinical improvement including cardiovascular stability and reduction in inflammatory markers may have occurred with and without immunomodulation.
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Affiliation(s)
- Nicholas Richens
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Hari Krishnan Kanthimathinathan
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Sanket Sontakke
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Ashish Chikermane
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Deepthi Jyothish
- Department of Paediatrics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Scott Hackett
- Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Steven B. Welch
- Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Eslam Al-Abadi
- Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Heather P. Duncan
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Alex G. Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Barnaby R. Scholefield
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
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Shields A, Faustini SE, Perez-Toledo M, Jossi S, Aldera E, Allen JD, Al-Taei S, Backhouse C, Bosworth A, Dunbar LA, Ebanks D, Emmanuel B, Garvey M, Gray J, Kidd IM, McGinnell G, McLoughlin DE, Morley G, O'Neill J, Papakonstantinou D, Pickles O, Poxon C, Richter M, Walker EM, Wanigasooriya K, Watanabe Y, Whalley C, Zielinska AE, Crispin M, Wraith DC, Beggs AD, Cunningham AF, Drayson MT, Richter AG. SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study. Thorax 2020; 75:1089-1094. [PMID: 32917840 PMCID: PMC7462045 DOI: 10.1136/thoraxjnl-2020-215414] [Citation(s) in RCA: 183] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers. DESIGN A cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020. SETTING University Hospitals Birmingham NHS Foundation Trust (UHBFT), UK. PARTICIPANTS 545 asymptomatic healthcare workers were recruited while at work. Participants were invited to participate via the UHBFT social media. Exclusion criteria included current symptoms consistent with COVID-19. No potential participants were excluded. INTERVENTION Participants volunteered a nasopharyngeal swab and a venous blood sample that were tested for SARS-CoV-2 RNA and anti-SARS-CoV-2 spike glycoprotein antibodies, respectively. Results were interpreted in the context of prior illnesses and the hospital departments in which participants worked. MAIN OUTCOME MEASURE Proportion of participants demonstrating infection and positive SARS-CoV-2 serology. RESULTS The point prevalence of SARS-CoV-2 viral carriage was 2.4% (n=13/545). The overall seroprevalence of SARS-CoV-2 antibodies was 24.4% (n=126/516). Participants who reported prior symptomatic illness had higher seroprevalence (37.5% vs 17.1%, χ2=21.1034, p<0.0001) and quantitatively greater antibody responses than those who had remained asymptomatic. Seroprevalence was greatest among those working in housekeeping (34.5%), acute medicine (33.3%) and general internal medicine (30.3%), with lower rates observed in participants working in intensive care (14.8%). BAME (Black, Asian and minority ethnic) ethnicity was associated with a significantly increased risk of seropositivity (OR: 1.92, 95% CI 1.14 to 3.23, p=0.01). Working on the intensive care unit was associated with a significantly lower risk of seropositivity compared with working in other areas of the hospital (OR: 0.28, 95% CI 0.09 to 0.78, p=0.02). CONCLUSIONS AND RELEVANCE We identify differences in the occupational risk of exposure to SARS-CoV-2 between hospital departments and confirm asymptomatic seroconversion occurs in healthcare workers. Further investigation of these observations is required to inform future infection control and occupational health practices.
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Affiliation(s)
- Adrian Shields
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sian E Faustini
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Marisol Perez-Toledo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sian Jossi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Erin Aldera
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Joel D Allen
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - Saly Al-Taei
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Claire Backhouse
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Andrew Bosworth
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lyndsey A Dunbar
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Daniel Ebanks
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Beena Emmanuel
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Mark Garvey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Joanna Gray
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - I Michael Kidd
- Public Health England Midlands and East Region, Birmingham, UK
| | - Golaleh McGinnell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dee E McLoughlin
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Gabriella Morley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Joanna O'Neill
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Oliver Pickles
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Charlotte Poxon
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Megan Richter
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Eloise M Walker
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Kasun Wanigasooriya
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Yasunori Watanabe
- School of Biological Sciences, University of Southampton, Southampton, UK
- Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford, UK
| | - Celina Whalley
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Max Crispin
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - David C Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, NIHR Biomedical Research Centre, Birmingham, UK
| | - Andrew D Beggs
- Surgical Research Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Adam F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Mark T Drayson
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, NIHR Biomedical Research Centre, Birmingham, UK
| | - Alex G Richter
- Clinical Immunology Service, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Shields AM, Faustini SE, Perez-Toledo M, Jossi S, Allen JD, Al-Taei S, Backhouse C, Dunbar L, Ebanks D, Emmanuel B, Faniyi AA, Garvey MI, Grinbergs A, McGinnell G, O'Neill J, Watanabe Y, Crispin M, Wraith DC, Cunningham AF, Drayson MT, Richter AG. Serological responses to SARS-CoV-2 following non-hospitalised infection: clinical and ethnodemographic features associated with the magnitude of the antibody response. medRxiv 2020:2020.11.12.20230763. [PMID: 33236029 PMCID: PMC7685342 DOI: 10.1101/2020.11.12.20230763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine clinical and ethnodemographic correlates of serological responses against the SARS-CoV-2 spike glycoprotein following mild-to-moderate COVID-19. DESIGN A retrospective cohort study of healthcare workers who had self-isolated due to COVID-19. SETTING University Hospitals Birmingham NHS Foundation Trust, UK (UHBFT). PARTICIPANTS 956 health care workers were recruited by open invitation via UHBFT trust email and social media. INTERVENTION Participants volunteered a venous blood sample that was tested for the presence of anti-SARS-CoV-2 spike glycoprotein antibodies. Results were interpreted in the context of the symptoms of their original illness and ethnodemographic variables. RESULTS Using an assay that simultaneously measures the combined IgG, IgA and IgM response against the spike glycoprotein (IgGAM), the overall seroprevalence within this cohort was 46.2% (n=442/956). The seroprevalence of immunoglobulin isotypes was 36.3%, 18.7% and 8.1% for IgG, IgA and IgM respectively. IgGAM identified serological responses in 40.6% (n=52/128) of symptomatic individuals who reported a negative SARS-CoV-2 PCR test. Increasing age, non-white ethnicity and obesity were independently associated with greater IgG antibody response against the spike glycoprotein. Self-reported fever and fatigue were associated with greater IgG and IgA responses against the spike glycoprotein. The combination of fever and/or cough and/or anosmia had a positive predictive value of 92.3% for seropositivity. CONCLUSIONS AND RELEVANCE Assays employing combined antibody detection demonstrate enhanced seroepidemiological sensitivity and can detect prior viral exposure even when PCR swabs have been negative. We demonstrate an association between known ethnodemographic risk factors associated with mortality from COVID-19 and the magnitude of serological responses in mild-to-moderate disease. The combination of cough, and/or fever and/or anosmia identifies the majority of individuals who should self-isolate for COVID-19.
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Affiliation(s)
- Adrian M Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, B15 2TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Sian E Faustini
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, B15 2TT, UK
| | - Marisol Perez-Toledo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sian Jossi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Joel D Allen
- School of Biological Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Saly Al-Taei
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, B15 2TT, UK
| | - Claire Backhouse
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, B15 2TT, UK
| | - Lynsey Dunbar
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, B15 2TT, UK
| | - Daniel Ebanks
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, B15 2TT, UK
| | - Beena Emmanuel
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, B15 2TT, UK
| | - Aduragbemi A Faniyi
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Mark I Garvey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Annabel Grinbergs
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Golaleh McGinnell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Joanne O'Neill
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Yasunori Watanabe
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford, OX1 3QU, UK
| | - Max Crispin
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - David C Wraith
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK
| | - Adam F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Mark T Drayson
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, B15 2TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK
| | - Alex G Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, B15 2TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
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Morley GL, Taylor S, Jossi S, Perez-Toledo M, Faustini SE, Marcial-Juarez E, Shields AM, Goodall M, Allen JD, Watanabe Y, Newby ML, Crispin M, Drayson MT, Cunningham AF, Richter AG, O’Shea MK. Sensitive Detection of SARS-CoV-2-Specific Antibodies in Dried Blood Spot Samples. Emerg Infect Dis 2020; 26:2970-2973. [PMID: 32969788 PMCID: PMC7706975 DOI: 10.3201/eid2612.203309] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Dried blood spot (DBS) samples can be used for the detection of severe acute respiratory syndrome coronavirus 2 spike antibodies. DBS sampling is comparable to matched serum samples with a relative 98.1% sensitivity and 100% specificity. Thus, DBS sampling offers an alternative for population-wide serologic testing in the coronavirus pandemic.
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Faustini SE, Jossi SE, Perez-Toledo M, Shields AM, Allen JD, Watanabe Y, Newby ML, Cook A, Willcox CR, Salim M, Goodall M, Heaney JL, Marcial-Juarez E, Morley GL, Torlinska B, Wraith DC, Veenith TV, Harding S, Jolles S, Ponsford MJ, Plant T, Huissoon A, O'Shea MK, Willcox BE, Drayson MT, Crispin M, Cunningham AF, Richter AG. Detection of antibodies to the SARS-CoV-2 spike glycoprotein in both serum and saliva enhances detection of infection. medRxiv 2020:2020.06.16.20133025. [PMID: 32588002 PMCID: PMC7310662 DOI: 10.1101/2020.06.16.20133025] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Detecting antibody responses during and after SARS-CoV-2 infection is essential in determining the seroepidemiology of the virus and the potential role of antibody in disease. Scalable, sensitive and specific serological assays are essential to this process. The detection of antibody in hospitalized patients with severe disease has proven straightforward; detecting responses in subjects with mild disease and asymptomatic infections has proven less reliable. We hypothesized that the suboptimal sensitivity of antibody assays and the compartmentalization of the antibody response may contribute to this effect. METHODS We systemically developed an ELISA assay, optimising different antigens and amplification steps, in serum and saliva from symptomatic and asymptomatic SARS-CoV-2-infected subjects. RESULTS Using trimeric spike glycoprotein, rather than nucleocapsid enabled detection of responses in individuals with low antibody responses. IgG1 and IgG3 predominate to both antigens, but more anti-spike IgG1 than IgG3 was detectable. All antigens were effective for detecting responses in hospitalized patients. Anti-spike, but not nucleocapsid, IgG, IgA and IgM antibody responses were readily detectable in saliva from non-hospitalized symptomatic and asymptomatic individuals. Antibody responses in saliva and serum were largely independent of each other and symptom reporting. CONCLUSIONS Detecting antibody responses in both saliva and serum is optimal for determining virus exposure and understanding immune responses after SARS-CoV-2 infection. FUNDING This work was funded by the University of Birmingham, the National Institute for Health Research (UK), the NIH National Institute for Allergy and Infectious Diseases, the Bill and Melinda Gates Foundation and the University of Southampton.
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Affiliation(s)
- Sian E Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Sian E Jossi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Marisol Perez-Toledo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Adrian M Shields
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Joel D Allen
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, U.K
| | - Yasunori Watanabe
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, U.K
- Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford OX1 3QU, U.K
| | - Maddy L Newby
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, U.K
| | - Alex Cook
- Binding Site Group Ltd, Birmingham, U.K
| | - Carrie R Willcox
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Mahboob Salim
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Margaret Goodall
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Jennifer L Heaney
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Edith Marcial-Juarez
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Gabriella L Morley
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Barbara Torlinska
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, U.K
| | - David C Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Tonny V Veenith
- Department of Critical Care Medicine, University Hospitals Birmingham NHS Trust, Birmingham, B15 2TH, U.K
| | | | | | | | - Tim Plant
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Aarnoud Huissoon
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
- Department of Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - Matthew K O'Shea
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Benjamin E Willcox
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Max Crispin
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, U.K
| | - Adam F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
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Perez-Toledo M, Faustini SE, Jossi SE, Shields AM, Kanthimathinathan HK, Allen JD, Watanabe Y, Goodall M, Wraith DC, Veenith TV, Drayson MT, Jyothish D, Al-Abadi E, Chikermane A, Welch SB, Masilamani K, Hackett S, Crispin M, Scholefield BR, Cunningham AF, Richter AG. Serology confirms SARS-CoV-2 infection in PCR-negative children presenting with Paediatric Inflammatory Multi-System Syndrome. medRxiv 2020. [PMID: 32577677 PMCID: PMC7302282 DOI: 10.1101/2020.06.05.20123117] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background During the COVID-19 outbreak, reports have surfaced of children who present with features of a multisystem inflammatory syndrome with overlapping features of Kawasaki disease and toxic shock syndrome - Paediatric Inflammatory Multisystem Syndrome- temporally associated with SARS-CoV-2 pandemic (PIMS-TS). Initial reports find that many of the children are PCR-negative for SARS-CoV-2, so it is difficult to confirm whether this syndrome is a late complication of viral infection in an age group largely spared the worst consequences of this infection, or if this syndrome reflects enhanced surveillance. Methods Children hospitalised for symptoms consistent with PIMS-TS between 28 April and 8 May 2020, and who were PCR-negative for SARS-CoV-2, were tested for antibodies to viral spike glycoprotein using an ELISA test. Results Eight patients (age range 7-14 years, 63% male) fulfilled case-definition for PIMS-TS during the study period. Six of the eight patients required admission to intensive care. All patients exhibited significant IgG and IgA responses to viral spike glycoprotein. Further assessment showed that the IgG isotypes detected in children with PIMS-TS were of the IgG1 and IgG3 subclasses, a distribution similar to that observed in samples from hospitalised adult COVID-19 patients. In contrast, IgG2 and IgG4 were not detected in children or adults. IgM was not detected in children, which contrasts with adult hospitalised adult COVID-19 patients of whom all had positive IgM responses. Conclusions Strong IgG antibody responses can be detected in PCR-negative children with PIMS-TS. The low detection rate of IgM in these patients is consistent with infection having occurred weeks previously and that the syndrome onset occurs well after the control of SARS-CoV-2 viral load. This implies that the disease is largely immune-mediated. Lastly, this indicates that serology can be an appropriate diagnostic tool in select patient groups.
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Affiliation(s)
- Marisol Perez-Toledo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Sian E Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Sian E Jossi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Adrian M Shields
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Hari Krishnan Kanthimathinathan
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT, U.K.,Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, U.K
| | - Joel D Allen
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, U.K
| | - Yasunori Watanabe
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, U.K.,Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford OX1 3QU, U.K
| | - Margaret Goodall
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - David C Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Tonny V Veenith
- Department of Critical Care Medicine, University Hospitals Birmingham NHS Trust, Birmingham, B15 2TH, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Deepthi Jyothish
- Department of General Paediatrics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, U.K
| | - Eslam Al-Abadi
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT, U.K.,Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, U.K
| | - Ashish Chikermane
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, U.K
| | - Steven B Welch
- Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, B9 5SS, U.K
| | - Kavitha Masilamani
- Department of General Paediatrics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, U.K
| | - Scott Hackett
- West Midlands Immunodeficiency Centre, Heartlands Hospital, University Hospitals Birmingham, Birmingham, B9 5SS, U.K
| | - Max Crispin
- School of Biological Sciences, University of Southampton, Southampton SO17 1BJ, U.K
| | - Barnaby R Scholefield
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, U.K.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Adam F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, U.K
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Atkin C, Reddy-Kolanu V, Drayson MT, Sapey E, Richter AG. The prevalence and significance of monoclonal gammopathy of undetermined significance in acute medical admissions. Br J Haematol 2020; 189:1127-1135. [PMID: 31999849 DOI: 10.1111/bjh.16487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/23/2019] [Indexed: 12/31/2022]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) affects 3·2% of adults aged >50 years. MGUS carries a life-long risk of progression to multiple myeloma and causes complications including infection and renal impairment; common causes of hospital admission. This study aimed to assess MGUS prevalence in emergency medical hospital admissions. Patients were recruited from unselected emergency medical admissions in a hospital in the United Kingdom. Serum protein electrophoresis was performed, with immunofixation of abnormal results. Reason for admission and routine test results were recorded. After education about MGUS and myeloma, patients chose whether they wished to be informed of new diagnoses. A total of 660 patients were tested and 35 had a paraprotein suggestive of MGUS. The overall rate of MGUS was 5·3%. MGUS prevalence in those aged >50 years was 6·94%, higher than the previously published rate of 3·2% (P < 0·0005). There were higher rates in those with chronic kidney disease (13·75% vs. 4·14%, P = 0·002), heart failure (14% vs. 4·59%, P = 0·012), anaemia (8·96% vs. 3·41%, P = 0·003) or leucocytosis (9·33% vs. 3·04%, P = 0·002). In all, 96% of patients wished to be informed of their screening results. The prevalence of MGUS in emergency hospital admissions is higher than expected based on previous population-based rates. This may suggest a selected population for screening.
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Affiliation(s)
- Catherine Atkin
- Birmingham Acute Care Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Elizabeth Sapey
- Birmingham Acute Care Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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42
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Ramcharan T, Nolan O, Lai CY, Prabhu N, Krishnamurthy R, Richter AG, Jyothish D, Kanthimathinathan HK, Welch SB, Hackett S, Al-Abadi E, Scholefield BR, Chikermane A. Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol 2020; 41:1391-1401. [PMID: 32529358 PMCID: PMC7289638 DOI: 10.1007/s00246-020-02391-2] [Citation(s) in RCA: 221] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
Children were relatively spared during COVID-19 pandemic. However, the recently reported hyperinflammatory syndrome with overlapping features of Kawasaki disease and toxic shock syndrome-"Paediatric Inflammatory Multisystem Syndrome-temporally associated with SARS-CoV-2" (PIMS-TS) has caused concern. We describe cardiac findings and short-term outcomes in children with PIMS-TS at a tertiary children's hospital. Single-center observational study of children with PIMS-TS from 10th April to 9th May 2020. Data on ECG and echocardiogram were retrospectively analyzed along with demographics, clinical features and blood parameters. Fifteen children with median age of 8.8 (IQR 6.4-11.2) years were included, all were from African/Afro-Caribbean, South Asian, Mixed or other minority ethnic groups. All showed raised inflammatory/cardiac markers (CRP, ferritin, Troponin I, CK and pro-BNP). Transient valve regurgitation was present in 10 patients (67%). Left Ventricular ejection fraction was reduced in 12 (80%), fractional shortening in 8 (53%) with resolution in all but 2. Fourteen (93%) had coronary artery abnormalities, with normalization in 6. ECG abnormalities were present in 9 (60%) which normalized in 6 by discharge. Ten (67%) needed inotropes and/or vasopressors. None needed extracorporeal life support. Improvement in cardiac biochemical markers was closely followed by improvement in ECG/echocardiogram. All patients were discharged alive and twelve (80%) have been reviewed since. Our entire cohort with PIMS-TS had cardiac involvement and this degree of involvement is significantly more than other published series and emphasizes the need for specialist cardiac review. We believe that our multi-disciplinary team approach was crucial for the good short-term outcomes.
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Affiliation(s)
- Tristan Ramcharan
- Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Oscar Nolan
- Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Chui Yi Lai
- Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH UK
| | - Nanda Prabhu
- Department of Cardiology, Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH UK
| | | | - Alex G. Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT UK
| | - Deepthi Jyothish
- Department of Paediatrics, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, B4 6NH UK
| | - Hari Krishnan Kanthimathinathan
- Paediatric Intensive Care Unit, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, B4 6NH UK ,Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - Steven B. Welch
- Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS UK
| | - Scott Hackett
- Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS UK
| | - Eslam Al-Abadi
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK ,Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, B4 6NH UK
| | - Barnaby R. Scholefield
- Paediatric Intensive Care Unit, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, B4 6NH UK ,Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT UK
| | - Ashish Chikermane
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.
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Stark AK, Chandra A, Chakraborty K, Alam R, Carbonaro V, Clark J, Sriskantharajah S, Bradley G, Richter AG, Banham-Hall E, Clatworthy MR, Nejentsev S, Hamblin JN, Hessel EM, Condliffe AM, Okkenhaug K. PI3Kδ hyper-activation promotes development of B cells that exacerbate Streptococcus pneumoniae infection in an antibody-independent manner. Nat Commun 2018; 9:3174. [PMID: 30093657 PMCID: PMC6085315 DOI: 10.1038/s41467-018-05674-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023] Open
Abstract
Streptococcus pneumoniae is a major cause of pneumonia and a leading cause of death world-wide. Antibody-mediated immune responses can confer protection against repeated exposure to S. pneumoniae, yet vaccines offer only partial protection. Patients with Activated PI3Kδ Syndrome (APDS) are highly susceptible to S. pneumoniae. We generated a conditional knock-in mouse model of this disease and identify a CD19+B220- B cell subset that is induced by PI3Kδ signaling, resides in the lungs, and is correlated with increased susceptibility to S. pneumoniae during early phases of infection via an antibody-independent mechanism. We show that an inhaled PI3Kδ inhibitor improves survival rates following S. pneumoniae infection in wild-type mice and in mice with activated PI3Kδ. These results suggest that a subset of B cells in the lung can promote the severity of S. pneumoniae infection, representing a potential therapeutic target.
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Affiliation(s)
- Anne-Katrien Stark
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, CB21 3AT, UK
- Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - Anita Chandra
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, CB21 3AT, UK
- Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
- Department of Medicine, University of Cambridge, Cambridge, CB2 OQQ, UK
- Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Krishnendu Chakraborty
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, CB21 3AT, UK
- Department of Medicine, University of Cambridge, Cambridge, CB2 OQQ, UK
| | - Rafeah Alam
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, CB21 3AT, UK
| | - Valentina Carbonaro
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, CB21 3AT, UK
| | - Jonathan Clark
- Biological Chemistry Laboratory, Babraham Institute, Cambridge, CB21 3AT, UK
| | - Srividya Sriskantharajah
- Refractory Respiratory Inflammation Discovery Performance Unit, Respiratory Therapy Area, GlaxoSmithKline, Stevenage, SG1 2NY, UK
| | - Glyn Bradley
- Computational Biology and Statistics, Target Sciences, GlaxoSmithKline, Stevenage, SG1 2NY, UK
| | - Alex G Richter
- Department of Immunology, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
| | - Edward Banham-Hall
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, CB21 3AT, UK
- Department of Medicine, University of Cambridge, Cambridge, CB2 OQQ, UK
- Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Menna R Clatworthy
- Molecular Immunity Unit, MRC Laboratory of Molecular Biology, University of Cambridge Department of Medicine, MRC Laboratory of Molecular Biology, Cambridge, CB2 OQQ, UK
| | - Sergey Nejentsev
- Department of Medicine, University of Cambridge, Cambridge, CB2 OQQ, UK
| | - J Nicole Hamblin
- Refractory Respiratory Inflammation Discovery Performance Unit, Respiratory Therapy Area, GlaxoSmithKline, Stevenage, SG1 2NY, UK
| | - Edith M Hessel
- Refractory Respiratory Inflammation Discovery Performance Unit, Respiratory Therapy Area, GlaxoSmithKline, Stevenage, SG1 2NY, UK
| | - Alison M Condliffe
- Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, Sheffield, S10 2RX, UK
| | - Klaus Okkenhaug
- Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, CB21 3AT, UK.
- Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK.
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44
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Beck SC, Huissoon AP, Collins D, Richter AG, Krishna MT. The concordance between component tests and clinical history in British adults with suspected pollen-food syndrome to peanut and hazelnut. J Clin Pathol 2017; 71:239-245. [PMID: 28780515 DOI: 10.1136/jclinpath-2017-204573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Mild oropharyngeal symptoms to peanut/hazelnut occur in ~30% of patients with pollen-food syndrome (PFS). Component tests are considered a useful adjunct to the diagnosis and may help differentiate PFS from those at a risk of anaphylaxis due to storage protein/lipid transfer protein (LTP) sensitisation. AIMS To assess concordance between component tests and clinical history in suspected PFS to peanut/hazelnut in a specialist clinic. METHODS Adult patients were classified into PFS (group 1, n=69) and PFS with mild systemic symptoms (group 2, n=45) based on clinical history. Specific IgE (sIgE) of ≥0.35 kUA/L was considered positive as per manufacturers' recommendation. Kappa (κ) inter-rater agreement was calculated for concordance between clinical classification and test profiles. RESULTS Group 1 hazelnut: 85% monosensitised to Cor a1, 12% to storage protein/s or LTP and 3% negative to all components. Group 1 peanut: 41% monosensitised to Ara h8, 44% to storage protein/s or ±LTP and 15% negative to all components. Group 2 hazelnut: 67% monosensitised to Cor a1, 16% sensitised to storage protein/s and 17% negative to all components. Group 2 peanut: 19% monosensitised to Ara h8, 62% sensitised to storage protein/s and/or LTP and 19% negative to all components.SIgE to Ara h8 and Cor a1 were greater in group 1 versus group 2: (median (IQR) kUA/L; hazelnut: 12.1 (7.8-25.2) vs 2.4 (0.36-6.3), p<0.001; peanut: 2.4 (0.10-21.1) vs 0.3 (0-3), p<0.01)). CONCLUSION Concordance between component tests and clinical history for adults with PFS was good for hazelnut (κ=0.63) but poor for peanut (κ=-0.12). Food challenges are warranted in discordant cases for an accurate diagnosis.
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Affiliation(s)
- Sarah C Beck
- Department of Allergy and Immunology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
| | - Aarnoud P Huissoon
- Department of Allergy and Immunology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
| | - Donna Collins
- Department of Allergy and Immunology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK
| | - Alex G Richter
- Department of Immunology, Queen Elizabeth Hospital, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Mamidipudi T Krishna
- Department of Allergy and Immunology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, UK
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45
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Affiliation(s)
- Debashis Haldar
- Centre for Liver Research (Haldar, Hirschfield), National Institute for Health Research Liver Biomedical Research Unit, University of Birmingham; Department of Renal Medicine (Cockwell), Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston; Institute of Immunology and Immunotherapy (Haldar, Richter, Hirschfield), College of Medical and Dental Sciences, University of Birmingham; Department of Hepatobiliary Surgery (Roberts), Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Paul Cockwell
- Centre for Liver Research (Haldar, Hirschfield), National Institute for Health Research Liver Biomedical Research Unit, University of Birmingham; Department of Renal Medicine (Cockwell), Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston; Institute of Immunology and Immunotherapy (Haldar, Richter, Hirschfield), College of Medical and Dental Sciences, University of Birmingham; Department of Hepatobiliary Surgery (Roberts), Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Alex G Richter
- Centre for Liver Research (Haldar, Hirschfield), National Institute for Health Research Liver Biomedical Research Unit, University of Birmingham; Department of Renal Medicine (Cockwell), Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston; Institute of Immunology and Immunotherapy (Haldar, Richter, Hirschfield), College of Medical and Dental Sciences, University of Birmingham; Department of Hepatobiliary Surgery (Roberts), Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Keith J Roberts
- Centre for Liver Research (Haldar, Hirschfield), National Institute for Health Research Liver Biomedical Research Unit, University of Birmingham; Department of Renal Medicine (Cockwell), Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston; Institute of Immunology and Immunotherapy (Haldar, Richter, Hirschfield), College of Medical and Dental Sciences, University of Birmingham; Department of Hepatobiliary Surgery (Roberts), Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Gideon M Hirschfield
- Centre for Liver Research (Haldar, Hirschfield), National Institute for Health Research Liver Biomedical Research Unit, University of Birmingham; Department of Renal Medicine (Cockwell), Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston; Institute of Immunology and Immunotherapy (Haldar, Richter, Hirschfield), College of Medical and Dental Sciences, University of Birmingham; Department of Hepatobiliary Surgery (Roberts), Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Edgbaston, Birmingham, UK
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Mirakian R, Leech SC, Krishna MT, Richter AG, Huber PAJ, Farooque S, Khan N, Pirmohamed M, Clark AT, Nasser SM. Management of allergy to penicillins and other beta-lactams. Clin Exp Allergy 2015; 45:300-27. [PMID: 25623506 DOI: 10.1111/cea.12468] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 10/29/2014] [Accepted: 11/07/2014] [Indexed: 12/15/2022]
Abstract
The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.
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Affiliation(s)
- R Mirakian
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Parry HM, Birtwistle J, Whitelegg A, Hudson C, McSkeane T, Hazlewood P, Mudongo N, Pratt G, Moss P, Drayson MT, Murray J, Richter AG. Poor functional antibody responses are present in nearly all patients with chronic lymphocytic leukaemia, irrespective of total IgG concentration, and are associated with increased risk of infection. Br J Haematol 2015; 171:887-90. [DOI: 10.1111/bjh.13455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Helen M. Parry
- Cancer Sciences; University of Birmingham; Birmingham UK
| | - Jane Birtwistle
- Department of Immunology; University of Birmingham; Birmingham UK
| | - Alison Whitelegg
- Department of Immunology; University of Birmingham; Birmingham UK
| | - Chris Hudson
- School of Medicine and Veterinary Science; University of Nottingham; Nottingham UK
| | - Tina McSkeane
- Cancer Research UK Clinical Trials Unit; University of Birmingham; Birmingham UK
| | - Peter Hazlewood
- Cancer Research UK Clinical Trials Unit; University of Birmingham; Birmingham UK
| | | | - Guy Pratt
- Cancer Sciences; University of Birmingham; Birmingham UK
| | - Paul Moss
- Cancer Sciences; University of Birmingham; Birmingham UK
| | - Mark T. Drayson
- Department of Immunology; University of Birmingham; Birmingham UK
| | - Jim Murray
- Department of Haematology; University Hospital Birmingham; Birmingham UK
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Richter AG, Nasser SM, Krishna MT. A UK national survey of investigations for beta-lactam hypersensitivity - heterogeneity in practice and a need for national guidelines - on behalf of British Society for Allergy and Clinical Immunology (BSACI). Clin Exp Allergy 2014; 43:941-9. [PMID: 23889247 DOI: 10.1111/cea.12134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 02/21/2013] [Accepted: 04/04/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Beta lactams (BL) are the most widely prescribed antibiotics in the UK and the commonest cause of hypersensitivity reactions. There are no UK guidelines for BL testing and the most relevant guidelines were devised by the European Network for Drug Allergy (ENDA) on behalf of the European Academy of Allergy and Clinical Immunology. OBJECTIVE Delivery of allergy services differs across Europe, so this survey was designed to investigate how closely UK practice adhered to these guidelines. METHODS An online survey, using surveymonkey.com software, was sent to all consultants offering an allergy service in the UK and who were members of either BSACI or 'Travellers' (Immunology consultant group). RESULTS The response rate was 48% (n=81/165) and BL allergy testing was undertaken by 78% of respondents. All responders requested SsIgE, although four responders stated they rarely requested. Skin testing was undertaken by 87% of respondents who perform beta lactam testing with 17% undertaking skin prick testing (SPT) only, 77% SPT followed by intra-dermal testing (IDT) if the former were negative or indeterminate and 6% SPT and IDT in all cases. The drugs, doses and protocols for skin testing varied considerably. Drug provocation testing was undertaken by 87% of respondents who undertake beta lactam testing with significant heterogeneity in protocols. Respondents that investigated ≤ 20 patients per year demonstrated lower adherence to ENDA recommendations compared to those who saw > 20. Following positive testing, 79% advised avoidance of all penicillins only and the remainder advised additional drug avoidance. CONCLUSION AND CLINICAL RELEVANCE This survey revealed variation in the investigation and management of BL hypersensitivity in the UK with some centres reporting procedures that could potentially put patients at risk of anaphylaxis if allergy was falsely excluded. This survey highlights an urgent need for evidence based national guidelines and standardisation of practice.
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Affiliation(s)
- A G Richter
- School of Immunity and Infection, University of Birmingham, Birmingham, UK.
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Richter AG, Perkins GD, Chavda A, Sapey E, Harper L, Thickett DR. Neutrophil chemotaxis in granulomatosis with polyangiitis (Wegener's) and idiopathic pulmonary fibrosis. Eur Respir J 2011; 38:1081-8. [PMID: 21885400 DOI: 10.1183/09031936.00161910] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The presence of antineutrophil cytoplasmic antibodies in granulomatosis with polyangiitis (Wegener's) (GPA) implicates the neutrophil as a key effector cell. Previous studies have reported elevated neutrophil counts in the lung, although the determinants of neutrophil chemotaxis in the GPA lung are unknown. Bronchoalveolar lavage fluid (BALF) cell counts, myeloperoxidase (MPO) and chemokines were measured in 27 patients with GPA, 20 disease controls with idiopathic pulmonary fibrosis (IPF) and six healthy controls. CXC chemokine ligand (CXCL)8, interleukin (IL)-1β, epithelial neutrophil-activating protein 78, granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor were measured by ELISA. The neutrophil chemotactic potential of BALF was investigated using the under-agarose method, and specific antibodies were used to examine the role of CXCL8 and IL-1β. GPA BALF had an increased neutrophil percentage, and elevated MPO, CXCL8 and G-CSF concentrations compared with healthy controls. Chemotaxis of control neutrophils towards BALF from patients with active (p=0.006) and remission (p=0.077) GPA, and IPF (p=0.001) patients was increased compared with normal controls. BALF-induced chemotaxis correlated with BALF IL-1β (r=0.761, p=0.001) and CXCL8 (r=0.640, p=0.012) in GPA, and was inhibited by anti-CXCL8 (85%; p<0.001) and anti-IL-1β (69%; p<0.001). Our study confirms a neutrophilia and pro-inflammatory alveolar milieu that persists in clinical remission. CXCL8 and IL-1β appear to play important roles in the neutrophil chemotactic response to BALF.
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Affiliation(s)
- A G Richter
- Lung Injury and Fibrosis Treatment Programme, Dept of Medical Sciences, University ofBirmingham, Birmingham, UK
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Richter AG, Wong G, Goddard S, Heslegrave J, Derbridge C, Srivastava S, Diwakar L, Huissoon AP, Krishna MT. Retrospective case series analysis of penicillin allergy testing in a UK specialist regional allergy clinic. J Clin Pathol 2011; 64:1014-8. [PMID: 21742749 DOI: 10.1136/jcp.2010.088203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Penicillin allergy is the most common drug allergy. Skin testing for the major (PPL) and minor determinants (MDMs) of penicillin offers increased sensitivity and specificity over in vitro testing alone. Following a worldwide absence of reagents, a new kit was licensed in the UK in 2008 (Diater, Spain) and this report evaluates its use in a UK specialist allergy clinic. METHODS Prospective data on 50 consecutive patients tested with the new reagents were collected. The departmental protocol is adapted from the 2003 EAACI position paper. RESULTS 14% (7/50) and 12% (6/50) of patients were diagnosed with immediate and non-immediate reactions respectively. The negative predictive value of the PPL and MDM reagents at the neat concentration for an immediate reaction was 93% (true negatives 37, false negatives 3). Two patients experienced systemic reactions to DPT in the absence of demonstrable specific IgE. None of the patients were diagnosed using skin prick testing alone or at lower concentrations of IDT. Five patients were diagnosed at the IDT stage and two at the DPT stage in the absence of demonstrable specific IgE. Six patients were diagnosed with non-immediate reactions, two on IDT alone and four following IDT and DPT. CONCLUSION The new PPL and MDM determinants offer enhanced sensitivity when evaluating β-lactam hypersensitivity; however, there are limitations to the current testing regimens. The UK would benefit from local guidelines, which incorporate the new reagents and acknowledge the high amoxicillin prescription rate and the relatively lower specialist-to-patient ratio in this country.
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Affiliation(s)
- A G Richter
- Department of Clinical Immunology, Birmingham Heartlands Hospital, Birmingham, UK.
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