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Triebelhorn J, Schneider J, Spinner CD, Iakoubov R, Voit F, Wagner L, Erber J, Rothe K, Berthele A, Pernpeintner V, Strauß EM, Renders L, Willmann A, Minic M, Vogel E, Christa C, Hoffmann D, Protzer U, Jeske SD. Clinical and immunological outcomes of SARS-CoV-2-infected vaccine responders, vaccine non-responders, and unvaccinated patients evaluated for neutralizing monoclonal antibody treatment at a single German tertiary care center: a retrospective cohort study with prospective follow-up. Infection 2024:10.1007/s15010-023-02171-z. [PMID: 38305828 DOI: 10.1007/s15010-023-02171-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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE This study assessed the clinical and immunological outcomes of SARS-CoV-2-infected patients with risk factors for severe disease depending on their immunological status. METHODS In this retrospective study with single follow-up visit, clinical outcome and humoral immunity was monitored in SARS-CoV-2 infected patients at risk. The results were compared based on the patients' initial immunological status: unvaccinated (UV), patients who did not develop neutralizing antibodies after vaccination (vaccine non-responders, VNR), and patients who expressed neutralizing antibodies after vaccination (vaccine responders, VR). Patients who lacked neutralizing antibodies (VNR and UV) were treated with nMABs. RESULTS In total, 113 patients at risk of severe COVID-19 consented to participate in the study. VR and UV were not admitted to the hospital. During the observation period, UVs had the highest rate of SARS-CoV-2 re-infections. Three of 41 VNRs (7.3%) were hospitalized due to severe COVID-19, with two of them having undergone iatrogenic B-cell depletion. The humoral immune response after infection was significantly lower in the VNR group than in the VR group in terms of anti-N, anti-receptor-binding domain (RBD), anti-S antibody titers, and anti-S antibody avidity. In a sub-analysis of VNR, B cell-deficient non-responders had significantly lower levels of anti-N antibodies and anti-S avidity after infection than other VNRs. CONCLUSION VNR, particularly B-cell-depleted VNR, remained at risk of hospitalization due to COVID-19. In the VR group, however, no clinical complications or severe disease were observed, despite not receiving nMAbs. Tailoring the administration of nMABs according to patient vaccination and immunological status may be advisable.
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Affiliation(s)
- J Triebelhorn
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - J Schneider
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - C D Spinner
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - R Iakoubov
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - F Voit
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - L Wagner
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - J Erber
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - K Rothe
- Institute of Medical Microbiology, Immunology and Hygiene, School of Medicine, Technical University of Munich, Munich, Germany
| | - A Berthele
- Department of Neurology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - V Pernpeintner
- Department of Neurology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - E-M Strauß
- Department of Neurology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - L Renders
- Department of Nephrology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - A Willmann
- Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany
| | - M Minic
- Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany
| | - E Vogel
- Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany
| | - C Christa
- Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany
| | - D Hoffmann
- Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany
| | - U Protzer
- Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany
| | - S D Jeske
- Institute of Virology, School of Medicine, Technical University of Munich/Helmholtz Centre Munich, Munich, Germany
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Aly L, Havla J, Lepennetier G, Andlauer TFM, Sie C, Strauß EM, Hoshi MM, Kümpfel T, Hiltensperger M, Mitsdoerffer M, Mühlau M, Zimmer C, Hemmer B, Korn T, Knier B. Inner retinal layer thinning in radiologically isolated syndrome predicts conversion to multiple sclerosis. Eur J Neurol 2020; 27:2217-2224. [PMID: 32589804 DOI: 10.1111/ene.14416] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with radiologically isolated syndrome (RIS) are at increased risk of converting to multiple sclerosis (MS). Early identification of later converters is crucial for optimal treatment decisions. The purpose of this study was to assess the predictive potential of optical coherence tomography (OCT) measures in individuals with RIS regarding conversion to MS. METHODS This prospective observational cohort study included 36 individuals with RIS and 36 healthy controls recruited from two German MS centers. All individuals received baseline OCT and clinical examination and were longitudinally followed over up to 6 years. The primary outcome measure was the conversion to MS. RESULTS During clinical follow-up of 46 (26-58) months (median, 25%-75% interquartile range), eight individuals with RIS converted to MS. Individuals converting to MS showed a thinning of the peripapillary retinal nerve fiber layer (pRNFL) and the common ganglion cell and inner plexiform layer (GCIP) at baseline and during follow-up. Individuals with a pRNFL of 99 µm or lower or a GCIP of 1.99 mm3 or lower were at a 7.5- and 8.0-fold risk for MS conversion, respectively, compared to individuals with higher measures. After correction for other known risk factors, Cox proportional hazards regression revealed a hazard ratio of 1.08 for conversion to MS for each 1 µm decline in pRNFL. CONCLUSIONS Reduction of the pRNFL might be a novel and independent risk factor for conversion to MS in individuals with RIS. OCT might be useful for risk stratification and therapeutic decision-making in individuals with RIS.
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Affiliation(s)
- L Aly
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - J Havla
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Technical University of Munich and Ludwig-Maximilians University, Munich, Germany
| | - G Lepennetier
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - T F M Andlauer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Sie
- Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - E-M Strauß
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M-M Hoshi
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Marianne-Strauß-Klinik, Berg, Germany
| | - T Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
| | - M Hiltensperger
- Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M Mitsdoerffer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
| | - M Mühlau
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Technical University of Munich and Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - T Korn
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - B Knier
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Experimental Neuroimmunology, Technical University of Munich, Munich, Germany
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