Factors Influencing Longevity of Humoral Response to SARS-CoV-2 Vaccination in Patients with End Stage Kidney Disease Receiving Renal Replacement Therapy

COVID-19 has severely affected the population of patients with end stage renal disease. Current data have proved a two-dose vaccination schedule against SARS-CoV-2 to be effective among dialyzed patients. There are limited data on the longevity and modulating factors of humoral response after vaccination. We performed a prospective longitudinal cohort study to determine longevity of the humoral response after SARS-CoV-2 vaccine. The study included 191 adult patients on hemodialysis and peritoneal dialysis. All participants had been vaccinated with three doses, either with BNT162b2 (Pfizer-BioNTech) (n = 109) or mRNA-1273 (Moderna) (n = 82). Anti-spike protein receptor-binding domain antibodies (anti-S IgG) were assessed using SARS-CoV-2 (RBD) IgG ELISA EIA-6150 IVD assay at baseline, on the 21st day and 43rd day, before a booster dose and two weeks thereafter. We found that before vaccination, 37.7% of the cohort had anti-S IgG titres concordant with seroconversion. After two-dose vaccination, seroconversion occurred in 97% of patients. The booster dose evoked a ~12-fold increase in antibody level. Obesity increased more than two-fold the odds for a decrease in anti-S IgG. Previous COVID-19 infection enhanced longevity of the humoral response following vaccination. In patients with previous COVID-19 infection, the BNT162b2 vaccine was associated with a higher odds of anti-S IgG waning compared to the mRNA-1273 vaccine. In conclusion, we report that obesity predisposes patients to protective antibody waning, hybrid immunity enhances odds for higher anti-S IgG concentrations and vaccine efficacy may be influenced by previous SARS-CoV-2 infection. The results might provide a rationale for vaccination protocol design.

Serum Levels of Interleukin-18 (IL-18), Interleukin-1β (IL-1β), its Soluble Receptor sIL-1RII and C-reactive Protein (CRP) in Patients with Lyme Arthritis

BACKGROUND

In recent years, the role of pro- and antiinflammatory cytokines in the development of Lyme arthritis (LA) has been widely discussed. The purpose of the present study was to determine the concentration of interleukin-18 (IL-18), interleukin-1beta (IL-beta) and its soluble receptor sIL-1RII in serum of patients with LA as well as the usefulness of serum C-reactive protein (CRP) determination in LA diagnosis and monitoring of its treatment.

PATIENTS AND METHODS

The study group consisted of 20 patients with LA. Before and after antibiotic treatment, the serum levels of IL-18, IL-1beta and sIL-1RII were measured immunoenzymatically using standard kits and the CRP level was measured by immunoturbidimetric method.

RESULTS

Before treatment, the serum levels of IL-18, IL-1beta and sIL-1RII were significantly higher than in control group and after treatment the concentrations of IL-18, IL-1beta and sIL-1RII decreased significantly, but the level of IL-18 and sIL-1RII still remained higher than in control group. The elevated serum level of CRP was detected only in 6 of 20 patients and in 5 of them it returned to the baseline after treatment.

CONCLUSION

The results of our study suggest that IL-18, IL-1beta and sIL-1RII might be involved in the development of LA. CRP may be useful in differential diagnosis in patients with suspicion of Lyme arthritis.

[Vascular adhesion protein-1 (VAP-1) in inflammatory process]

VAP-1 is an adhesion molecule expressed on the surface of endothelial cells. It plays an important role in the adhesion and migration of leukocytes to the sites of inflammation. The purpose of this article is to present current knowledge of structure, biological function of VAP-1 and its use in clinical practice.

[Intercellular adhesion molecules sICAM-1, sICAM-2, sICAM-3 and IFNgamma in neuroborreliosis and tick-borne encephalitis]

OBJECTIVE

The aim of this study was to evaluate the serum and CSF concentration of soluble intercellular adhesion molecules sICAM-1, sICAM-2, sICAM-3 and proinflammatory cytokine IFNgamma in patients with tick-borne encephalitis (TBE) and neuroborreliosis.

METHODS

The study group consisted of 40: 20 with TBE meningitis and 20 with Lyme meningitis. The serum and CSF levels of adhesion molecules and IFNgamma were determined by ELISA assay twice: before and after treatment.

RESULTS

Before treatment the concentrations of adhesion molecules and IFNgamma in serum as well as in CSF were significantly higher in both studied groups than in control group (with the exception of the serum level of sICAM-2 in TBE group). After the treatment, the serum parameters in TBE group decreased to the control level. CSF levels were also reduced, but still remained higher than in the control group. In patients with neuroborreliosis serum concentration of sICAM-1 and sICAM-2 did not change as compared with its level before treatment but other studied parameters in serum and CSF decreased significantly.

CONCLUSIONS

The results of our study confirm the participation of intercellular adhesion molecules in the pathogenesis of viral (TBE) and bacterial (neuroborreliosis) neuroinfections.

[Concentration of interleukin-18, interleukin-1beta, soluble receptor for interleukin-1 (sIL-1RII) and C-reactive protein in patients with neuroborreliosis]

BACKGROUND AND PURPOSE

The aim of the present study was to determine the role of interleukin-18 (IL-18), interleukin-1beta (IL-1beta) and its soluble receptor sIL-1RII in the pathogenesis of neuroborreliosis as well as the usefulness of C-reactive protein (CRP) determination in the diagnosis and monitoring of treatment of Lyme neuroborreliosis.

MATERIAL AND METHODS

The study group consisted of 20 patients with Lyme meningitis (age range 16-72 years, mean age 42.6 years). For measurements of IL-18, IL-1beta and sIL-1RII levels in serum and cerebrospinal fluid (CSF) the control group consisted of 10 healthy volunteers and 10 patients with infection of the central nervous system ruled out, respectively. Cytokines and sIL-1RII levels in serum and CSF were measured twice, before and after the 30-day treatment period. Serum and CSF levels of IL-18, IL-1beta and sIL-1RII were measured using ELISA, and CRP serum levels were measured using the immunoturbidimetric method.

RESULTS

Before the treatment the concentration of IL-18, IL-1beta and sIL-1RII in serum as well as in CSF was significantly higher as compared to the controls. After the treatment end the level of IL-18, IL-1beta and sIL-1RII was reduced but the serum level of sIL-1RII and CSF level of IL-18 and sIL-1RII remained significantly higher than in the control group. The serum level of CRP was increased only in 15% of patients and after the treatment CRP concentration returned to a basal level (except one patient in whom CRP was slightly higher than in the control group). No correlation between CRP and IL-18, IL-1beta and sIL-1RII was observed.

CONCLUSIONS

Our results confirm the involvement of IL-18, IL-1beta and sIL-1RII in the pathogenesis of neuroborreliosis and uselessness of CRP determination in the diagnosis of Lyme meningitis.

[Role of interleukin-18, interleukin-1beta and its soluble receptor (sIL-1RII) in early and late Lyme borreliosis]

Although borreliosis was first described as a separate entity more than 20 years ago its pathogenesis still remains unknown. In recent years the role of pro- and antiinflammatory cytokines in the pathogenesis of borreliosis has been discussed. The purpose of the present study was to evaluate the role of IL-1beta, IL-18 and sIL-1RII in the development of early and late stages of borreliosis. The study group consisted of 60 patients divided into 3 groups: patients with erythema migrans, Lyme arthritis and neuroborreliosis. In all groups serum levels of IL-1beta, IL-18 and sIL-1RII were determined and in the patients with neuroborreliosis additionally in cerebrospinal fluid (CSF). The levels of cytokines and sIL-1RII were measured before the start of treatment and after its termination. Before the treatment the levels of IL-1beta, IL-18 and sIL-1RII in serum and CSF were significantly higher in all studied groups compared with the control. After the treatment, despite the regression of the clinical symptoms and significant reduction of initially high levels of the cytokines and sIL-1RII, only the levels of IL-1beta in all patients and the serum level of IL-18 in the patients with neuroborreliosis were comparable with the values in the control group. It could suggest that the inflammatory process was not inhibited completely and confirms the role of IL-1beta, IL-18 and sIL-1RII in the pathogenesis of borreliosis.

[ICAM-1: structure, biological role and clinical significance]

ICAM-1 is an immunoglobulin-like protein expressed on the surface of several cell types including endothelial cells and cells involved in the immune response. It plays an important role in the adhesion and migration of leukocytes to the sites of inflammation. ICAM-1 is expressed as membrane-bound and soluble form. The latter was detected in blood serum and cerebrospinal fluid in the course of infectious, autoimmune as well as proliferative diseases. This article describes the role of ICAM-1 in the pathogenesis of various disease entities and its clinical significance.

[Proinflammatory cytokines in humoral immune response]

Proinflammatory cytokines secreted by cells involved in inflammatory process play a key role in the regulation of immune responses, both cellular and humoral immune response. Through their influence on T-helper lymphocytes and antigen presenting cells including lymphocytes B, they induce secretion of secondary cytokines and, in cooperation with them, promote activation and proliferation of lymphocytes B and production of variety of classes of immunoglobulins. Cytokines interact with their specific receptors which usually occur both in membrane bound and soluble form. The purpose of this article was to evaluate the relationships between primary cytokines such as interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) and other cytokines, lymphocytes T-helper and lymphocytes B in the light of current opinions regarding this matter.