1
|
Hastak P, Cromer D, Malycha J, Andersen CR, Raith E, Davenport MP, Plummer M, Sasson SC. Defining the correlates of lymphopenia and independent predictors of poor clinical outcome in adults hospitalized with COVID-19 in Australia. Sci Rep 2024; 14:11102. [PMID: 38750134 PMCID: PMC11096393 DOI: 10.1038/s41598-024-61729-5] [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] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
Lymphopenia is a common feature of acute COVID-19 and is associated with increased disease severity and 30-day mortality. Here we aim to define the demographic and clinical characteristics that correlate with lymphopenia in COVID-19 and determine if lymphopenia is an independent predictor of poor clinical outcome. We analysed the ENTER-COVID (Epidemiology of hospitalized in-patient admissions following planned introduction of Epidemic SARS-CoV-2 to highly vaccinated COVID-19 naïve population) dataset of adults (N = 811) admitted for COVID-19 treatment in South Australia in a retrospective registry study, categorizing them as (a) lymphopenic (lymphocyte count < 1 × 109/L) or (b) non-lymphopenic at hospital admission. Comorbidities and laboratory parameters were compared between groups. Multiple regression analysis was performed using a linear or logistic model. Intensive care unit (ICU) patients and non-survivors exhibited lower median lymphocyte counts than non-ICU patients and survivors respectively. Univariate analysis revealed that low lymphocyte counts associated with hypertension and correlated with haemoglobin, platelet count and negatively correlated with urea, creatinine, bilirubin, and aspartate aminotransferase (AST). Multivariate analysis identified age, male, haemoglobin, platelet count, diabetes, creatinine, bilirubin, alanine transaminase, c-reactive protein (CRP) and lactate dehydrogenase (LDH) as independent predictors of poor clinical outcome in COVID-19, while lymphopenia did not emerge as a significant predictor.
Collapse
Affiliation(s)
- Priyanka Hastak
- The Kirby Institute, University of New South Wales, Sydney, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW, 2052, Australia.
| | - Deborah Cromer
- The Kirby Institute, University of New South Wales, Sydney, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW, 2052, Australia
| | - James Malycha
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Christopher R Andersen
- The Kirby Institute, University of New South Wales, Sydney, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW, 2052, Australia
- The George Institute for Global Health, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | - Eamon Raith
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Miles P Davenport
- The Kirby Institute, University of New South Wales, Sydney, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW, 2052, Australia
| | - Mark Plummer
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Sarah C Sasson
- The Kirby Institute, University of New South Wales, Sydney, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW, 2052, Australia
| |
Collapse
|
2
|
Dharan NJ, Sasson SC, Ahlenstiel G, Andersen CR, Bloch M, Buckland G, Hamad N, Han WM, Kelleher AD, Long GV, Matthews GV, Mina MM, Papot E, Petoumenos K, Swaminathan S, Withers B, Yun J, Polizzotto MN. Clinical and laboratory features of COVID-19 illness and outcomes in immunocompromised individuals during the first pandemic wave in Sydney, Australia. PLoS One 2023; 18:e0289907. [PMID: 37910527 PMCID: PMC10619805 DOI: 10.1371/journal.pone.0289907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
People with immunocompromising conditions are at increased risk of SARS-CoV-2 infection and mortality, however early in the pandemic it was challenging to collate data on this heterogenous population. We conducted a registry study of immunocompromised individuals with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection from March-October 2020 in Sydney, Australia to understand clinical and laboratory outcomes in this population prior to the emergence of the Delta variant. 27 participants were enrolled into the study including people with a haematologic oncologic conditions (n = 12), secondary immunosuppression (N = 8) and those with primary or acquired immunodeficiency (i.e. HIV; N = 7). All participants had symptomatic COVID-19 with the most common features being cough (64%), fever (52%) and headache (40%). Five patients demonstrated delayed SARS-CoV-2 clearance lasting three weeks to three months. The mortality rate in this study was 7% compared to 1.3% in the state of New South Wales Australia during the same period. This study provides data from the first eight months of the pandemic on COVID-19 outcomes in at-risk patient groups.
Collapse
Affiliation(s)
- Nila J. Dharan
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sarah C. Sasson
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology, Newcastle, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Golo Ahlenstiel
- Blacktown Hospital, Blacktown, New South Wales, Australia
- Western Sydney University, Penrith, New South Wales, Australia
| | - Christopher R. Andersen
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Mark Bloch
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Holdsworth House Medical Practice, Darlinghurst, New South Wales, Australia
| | | | - Nada Hamad
- St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- School of Medicine, Sydney, University of Notre Dame, Chippendale, New South Wales, Australia
| | - Win Min Han
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Anthony D. Kelleher
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - Georgina V. Long
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gail V. Matthews
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - Michael M. Mina
- Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia
| | - Emmanuelle Papot
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kathy Petoumenos
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sanjay Swaminathan
- Westmead Hospital, Westmead, New South Wales, Australia
- Blacktown Hospital, Blacktown, New South Wales, Australia
- Western Sydney University, Penrith, New South Wales, Australia
| | - Barbara Withers
- St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - James Yun
- School of Medicine, Sydney, University of Notre Dame, Chippendale, New South Wales, Australia
- Nepean Hospital, Kingswood, New South Wales, Australia
| | - Mark N. Polizzotto
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
| | | |
Collapse
|
3
|
van der Linde R, Gatt PN, Smith S, Fernandez MA, Vaughan L, Blyth E, Curnow J, Brown DA, Tegg E, Sasson SC. Measurable Residual Disease (MRD) by Flow Cytometry in Adult B-Acute Lymphoblastic Leukaemia (B-ALL) and Acute Myeloid Leukaemia (AML): Correlation with Molecular MRD Testing and Clinical Outcome at One Year. Cancers (Basel) 2023; 15:5064. [PMID: 37894431 PMCID: PMC10605425 DOI: 10.3390/cancers15205064] [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: 09/15/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Measurable residual disease (MRD) detected by flow cytometry (FC) is well established in paediatric B- lymphoblastic leukaemia (B-ALL) and adult chronic lymphocytic leukaemia (CLL), but its utility in adult B-ALL and adult acute myeloid leukaemia (AML) is less clear. In this prospective MRD study, one of the largest in Australia to date, we examined consecutive bone marrow aspirates from adult participants with B-ALL (n = 47) and AML (n = 87) sent for FC-MRD testing at a quaternary referral hospital in Sydney. FC-MRD results were correlated to corresponding Mol-MRD testing where available and clinical outcomes at three-month intervals over 1 year. B-ALL showed a moderate positive correlation (rs = 0.401, p < 0.001), while there was no correlation between FC-MRD and Mol-MRD for AML (rs = 0.13, p = 0.237). Five FC-MRD patterns were identified which had significant associations with relapse (X2(4) = 31.17(4), p > 0.001) and survival (X2(4) = 13.67, p = 0.008) in AML, but not in B-ALL. The three-month MRD results were also strongly associated with survival in AML, while the association in B-ALL was less evident. There was a moderate correlation between FC-MRD and Mol-MRD in B-ALL but not AML. The association of FC-MRD with relapse and survival was stronger in AML than in B-ALL. Overall, these findings suggest divergent utilities of FC-MRD in AML and B-ALL.
Collapse
Affiliation(s)
- Riana van der Linde
- Department of Laboratory Haematology, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia; (L.V.); (E.T.)
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Camperdown, NSW 2050, Australia; (P.N.G.); (E.B.); (J.C.); (D.A.B.); (S.C.S.)
| | - Prudence N. Gatt
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Camperdown, NSW 2050, Australia; (P.N.G.); (E.B.); (J.C.); (D.A.B.); (S.C.S.)
- Westmead Institute for Medical Research, University of Sydney, Sydney, NSW 2145, Australia
| | - Sandy Smith
- Flow Cytometry Unit, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia; (S.S.); (M.A.F.)
| | - Marian A. Fernandez
- Flow Cytometry Unit, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia; (S.S.); (M.A.F.)
| | - Lachlin Vaughan
- Department of Laboratory Haematology, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia; (L.V.); (E.T.)
- Department of Haematology, Western Sydney Local Health District, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Emily Blyth
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Camperdown, NSW 2050, Australia; (P.N.G.); (E.B.); (J.C.); (D.A.B.); (S.C.S.)
- Westmead Institute for Medical Research, University of Sydney, Sydney, NSW 2145, Australia
- Department of Haematology, Western Sydney Local Health District, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Jennifer Curnow
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Camperdown, NSW 2050, Australia; (P.N.G.); (E.B.); (J.C.); (D.A.B.); (S.C.S.)
- Department of Haematology, Western Sydney Local Health District, Westmead Hospital, Westmead, NSW 2145, Australia
| | - David A. Brown
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Camperdown, NSW 2050, Australia; (P.N.G.); (E.B.); (J.C.); (D.A.B.); (S.C.S.)
- Westmead Institute for Medical Research, University of Sydney, Sydney, NSW 2145, Australia
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Elizabeth Tegg
- Department of Laboratory Haematology, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia; (L.V.); (E.T.)
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Camperdown, NSW 2050, Australia; (P.N.G.); (E.B.); (J.C.); (D.A.B.); (S.C.S.)
| | - Sarah C. Sasson
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Camperdown, NSW 2050, Australia; (P.N.G.); (E.B.); (J.C.); (D.A.B.); (S.C.S.)
- Department of Clinical Immunology and Immunopathology, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW 2145, Australia
| |
Collapse
|
4
|
Rankin K, Hastak P, Wong A, Sasson SC, Beaton B, Yeola A, Warden A, Turville S, Kelleher AD, Brilot F, Trotman J. Immune response to COVID-19 vaccination in patients with Waldenström macroglobulinaemia who pause their BTKi therapy. EJHaem 2023; 4:728-732. [PMID: 37601863 PMCID: PMC10435711 DOI: 10.1002/jha2.724] [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] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 08/22/2023]
Abstract
Patients with Waldenström macroglobulinaemia (WM) are at increased risk of severe COVID-19 infection and have poor immune responses to COVID-19 vaccination. This study assessed whether a closely monitored pause in Bruton's Tyrosine Kinase inhibitor (BTKi) therapy might result in an improved humoral response to a 3rd COVID-19 vaccine dose. Improved response was observed in WM patients who paused their BTKi, compared to a group who did not pause their BTKi. However, the response was attenuated after BTKi recommencement. This data contributes to our understanding of vaccination strategies in this patient group and may help inform consensus approaches in the future.
Collapse
Affiliation(s)
- Katherine Rankin
- Haematology DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Priyanka Hastak
- The Kirby InstituteThe University of New South WalesSydneyNew South WalesAustralia
| | - Alexander Wong
- Haematology DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Concord Clinical SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Sarah C. Sasson
- The Kirby InstituteThe University of New South WalesSydneyNew South WalesAustralia
- Department of Clinical Immunology and ImmunopathologyICPMR Westmead HospitalSydneyNew South WalesAustralia
| | - Brendan Beaton
- Haematology DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Concord Clinical SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Avani Yeola
- Brain Autoimmunity GroupKids Neuroscience CentreKids ResearchThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Andrew Warden
- WMozzies: Australian Patient Support Group for Waldenström's MacroglobulinemiaSydneyNew South WalesAustralia
| | - Stuart Turville
- The Kirby InstituteThe University of New South WalesSydneyNew South WalesAustralia
| | - Anthony D. Kelleher
- The Kirby InstituteThe University of New South WalesSydneyNew South WalesAustralia
| | - Fabienne Brilot
- Brain Autoimmunity GroupKids Neuroscience CentreKids ResearchThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Sydney Institute of Infectious DiseaseThe University of SydneySydneyNew South WalesAustralia
- The School of Medical SciencesFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Judith Trotman
- Haematology DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Concord Clinical SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| |
Collapse
|
5
|
Wu L, Tsang V, Menzies AM, Sasson SC, Carlino MS, Brown DA, Clifton-Bligh R, Gunton JE. Risk Factors and Characteristics of Checkpoint Inhibitor-Associated Autoimmune Diabetes Mellitus (CIADM): A Systematic Review and Delineation From Type 1 Diabetes. Diabetes Care 2023; 46:1292-1299. [PMID: 37220262 DOI: 10.2337/dc22-2202] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/27/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Checkpoint inhibitor-associated autoimmune diabetes mellitus (CIADM) is a distinct form of autoimmune diabetes that is a rare complication of immune checkpoint inhibitor therapy. Data regarding CIADM are limited. PURPOSE To systematically review available evidence to identify presentation characteristics and risk factors for early or severe presentations of adult patients with CIADM. DATA SOURCES MEDLINE and PubMed databases were reviewed. STUDY SELECTION English full text articles from 2014 to April 2022 were identified with a predefined search strategy. Patients meeting diagnostic criteria for CIADM with evidence of hyperglycemia (blood glucose level >11 mmol/L or HbA1c ≥6.5%) and insulin deficiency (C-peptide <0.4 nmol/L and/or diabetic ketoacidosis [DKA]) were included for analysis. DATA EXTRACTION With the search strategy we identified 1,206 articles. From 146 articles, 278 patients were labeled with "CIADM," with 192 patients meeting our diagnostic criteria and included in analysis. DATA SYNTHESIS Mean ± SD age was 63.4 ± 12.4 years. All but one patient (99.5%) had prior exposure to either anti-PD1 or anti-PD-L1 therapy. Of the 91 patients tested (47.3%), 59.3% had susceptibility haplotypes for type 1 diabetes (T1D). Median time to CIADM onset was 12 weeks (interquartile range 6-24). DKA occurred in 69.7%, and initial C-peptide was low in 91.6%. T1D autoantibodies were present in 40.4% (73 of 179) and were significantly associated with DKA (P = 0.0009) and earlier time to CIADM onset (P = 0.02). LIMITATIONS Reporting of follow-up data, lipase, and HLA haplotyping was limited. CONCLUSIONS CIADM commonly presents in DKA. While T1D autoantibodies are only positive in 40.4%, they associate with earlier, more severe presentations.
Collapse
Affiliation(s)
- Linda Wu
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia Sydney, New South Wales, Australia
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Venessa Tsang
- University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia Sydney, New South Wales, Australia
| | - Alexander M Menzies
- University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia Sydney, New South Wales, Australia
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- Mater Hospital, Sydney, New South Wales, Australia
| | - Sarah C Sasson
- University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, Sydney, New South Wales, Australia
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Matteo S Carlino
- University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- Mater Hospital, Sydney, New South Wales, Australia
| | - David A Brown
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, Sydney, New South Wales, Australia
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Roderick Clifton-Bligh
- University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia Sydney, New South Wales, Australia
| | - Jenny E Gunton
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Barreto SG, Kaambwa B, Venkatesh K, Sasson SC, Andersen C, Delaney A, Bihari S, Pilcher D. Mortality and costs related to severe acute pancreatitis in the intensive care units of Australia and New Zealand (ANZ), 2003-2020. Pancreatology 2023:S1424-3903(23)00100-X. [PMID: 37121877 DOI: 10.1016/j.pan.2023.04.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/21/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Comprehensive data on the burden of severe acute pancreatitis (SAP) in global intensive care units (ICUs) and trends over time are lacking. Our objective was to compare trends in hospital and ICU mortality, in-hospital and ICU length of stay, and costs related to ICU admission in Australia and New Zealand (ANZ) for SAP. METHODS We performed a retrospective, observational, cohort study of ICU admissions reported to the ANZ Intensive Care Society Adult Patient Database over three consecutive six-year time periods from 2003 to 2020. RESULTS 12,635 patients with SAP from 189 ICUs in ANZ were analysed. No difference in adjusted hospital mortality (11.4% vs 11.5% vs 11.0%, p = 0.85) and ICU mortality rates (7.5% vs 8.0% vs 8.1%, p = 0.73) were noted over the study period. Median length of hospital admission reduced over time (13.9 days in 2003-08, 13.1 days in 2009-14 and 12.5 days in 2015-20; p < 0.01). No difference in length of ICU stay was noted over the study period (p = 0.13). The cost of managing SAP in ANZ ICUs remained constant over the three time periods. CONCLUSIONS In critically-ill SAP patients in ANZ, no change in mortality has been noted over nearly two decades. There was a slight reduction in hospital stay (1 day), while the length of ICU stay remained unchanged. Given the significant costs related to care of patients with SAP in ICU, these findings highlight the need to prioritise resource allocation for healthcare delivery and targeted clinical research to identify treatments aimed at reducing mortality.
Collapse
Affiliation(s)
- Savio George Barreto
- Division of Surgery and Perioperative Medicine, Flinders Medical Center, Bedford Park, Adelaide, South Australia, Australia; College of Medicine and Public Health, Flinders University, South Australia, Australia.
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Karthik Venkatesh
- Malcolm Fisher Department of Intensive Care, The Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; The Kirby Institute, UNSW, Sydney, Australia
| | - Sarah C Sasson
- The Kirby Institute, UNSW, Sydney, Australia; NSW Health Pathology I.C.P.M.R, Westmead Hospital, Sydney, Australia
| | - Christopher Andersen
- Malcolm Fisher Department of Intensive Care, The Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; The Kirby Institute, UNSW, Sydney, Australia; Northern Clinical School, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, King Street, Newtown, NSW, 2042, Australia
| | - Anthony Delaney
- Malcolm Fisher Department of Intensive Care, The Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Shailesh Bihari
- College of Medicine and Public Health, Flinders University, South Australia, Australia; Department of ICCU, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - David Pilcher
- Department of Intensive Care, The Alfred Hospital, Commercial Road, Prahran, Melbourne, Victoria, 3004, Australia; The Australian and New Zealand Intensive Care-Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia; The Australian and New Zealand Intensive Care Society (ANZICS), Centre for Outcome and Resource Evaluation (CORE), 277 Camberwell Road, Camberwell, Victoria, 3124, Australia
| |
Collapse
|
7
|
Cromer D, Steain M, Reynaldi A, Schlub TE, Khan SR, Sasson SC, Kent SJ, Khoury DS, Davenport MP. Predicting vaccine effectiveness against severe COVID-19 over time and against variants: a meta-analysis. Nat Commun 2023; 14:1633. [PMID: 36964146 PMCID: PMC10036966 DOI: 10.1038/s41467-023-37176-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/06/2023] [Indexed: 03/26/2023] Open
Abstract
Vaccine protection from symptomatic SARS-CoV-2 infection has been shown to be strongly correlated with neutralising antibody titres; however, this has not yet been demonstrated for severe COVID-19. To explore whether this relationship also holds for severe COVID-19, we performed a systematic search for studies reporting on protection against different SARS-CoV-2 clinical endpoints and extracted data from 15 studies. Since matched neutralising antibody titres were not available, we used the vaccine regimen, time since vaccination and variant of concern to predict corresponding neutralising antibody titres. We then compared the observed vaccine effectiveness reported in these studies to the protection predicted by a previously published model of the relationship between neutralising antibody titre and vaccine effectiveness against severe COVID-19. We find that predicted neutralising antibody titres are strongly correlated with observed vaccine effectiveness against symptomatic (Spearman [Formula: see text] = 0.95, p < 0.001) and severe (Spearman [Formula: see text] = 0.72, p < 0.001 for both) COVID-19 and that the loss of neutralising antibodies over time and to new variants are strongly predictive of observed vaccine protection against severe COVID-19.
Collapse
Affiliation(s)
- Deborah Cromer
- Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Megan Steain
- Sydney Institute of Infectious Diseases and Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Arnold Reynaldi
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Timothy E Schlub
- Kirby Institute, University of New South Wales, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Shanchita R Khan
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Sarah C Sasson
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Melbourne Sexual Health Centre and Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - David S Khoury
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | |
Collapse
|
8
|
Reardon B, Smith S, Van Der Linde R, Sasson SC. Use of anti-JOVI.1 antibodies to detect clonal T cell populations: implementation into a diagnostic flow cytometry laboratory and correlation with clinical findings. Pathology 2023. [DOI: 10.1016/j.pathol.2022.12.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
9
|
Venkatesh K, Glenn H, Delaney A, Andersen CR, Sasson SC. Fire in the belly: A scoping review of the immunopathological mechanisms of acute pancreatitis. Front Immunol 2023; 13:1077414. [PMID: 36713404 PMCID: PMC9874226 DOI: 10.3389/fimmu.2022.1077414] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/22/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Acute pancreatitis (AP) is characterised by an inflammatory response that in its most severe form can cause a systemic dysregulated immune response and progression to acute multi-organ dysfunction. The pathobiology of the disease is unclear and as a result no targeted, disease-modifying therapies exist. We performed a scoping review of data pertaining to the human immunology of AP to summarise the current field and to identify future research opportunities. Methods A scoping review of all clinical studies of AP immunology was performed across multiple databases. Studies were included if they were human studies of AP with an immunological outcome or intervention. Results 205 studies met the inclusion criteria for the review. Severe AP is characterised by significant immune dysregulation compared to the milder form of the disease. Broadly, this immune dysfunction was categorised into: innate immune responses (including profound release of damage-associated molecular patterns and heightened activity of pattern recognition receptors), cytokine profile dysregulation (particularly IL-1, 6, 10 and TNF-α), lymphocyte abnormalities, paradoxical immunosuppression (including HLA-DR suppression and increased co-inhibitory molecule expression), and failure of the intestinal barrier function. Studies including interventions were also included. Several limitations in the existing literature have been identified; consolidation and consistency across studies is required if progress is to be made in our understanding of this disease. Conclusions AP, particularly the more severe spectrum of the disease, is characterised by a multifaceted immune response that drives tissue injury and contributes to the associated morbidity and mortality. Significant work is required to develop our understanding of the immunopathology of this disease if disease-modifying therapies are to be established.
Collapse
Affiliation(s)
- Karthik Venkatesh
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia,The Kirby Institute, The University of New South Wales, Kensington, NSW, Australia,*Correspondence: Karthik Venkatesh,
| | - Hannah Glenn
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Anthony Delaney
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia,Division of Critical Care, The George Institute for Global Health, Newtown, NSW, Australia
| | - Christopher R. Andersen
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia,The Kirby Institute, The University of New South Wales, Kensington, NSW, Australia,Division of Critical Care, The George Institute for Global Health, Newtown, NSW, Australia
| | - Sarah C. Sasson
- The Kirby Institute, The University of New South Wales, Kensington, NSW, Australia,Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| |
Collapse
|
10
|
Hewavisenti RV, Arena J, Ahlenstiel CL, Sasson SC. Human papillomavirus in the setting of immunodeficiency: Pathogenesis and the emergence of next-generation therapies to reduce the high associated cancer risk. Front Immunol 2023; 14:1112513. [PMID: 36960048 PMCID: PMC10027931 DOI: 10.3389/fimmu.2023.1112513] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 11/30/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
Human papillomavirus (HPV), a common sexually transmitted virus infecting mucosal or cutaneous stratified epithelia, is implicated in the rising of associated cancers worldwide. While HPV infection can be cleared by an adequate immune response, immunocompromised individuals can develop persistent, treatment-refractory, and progressive disease. Primary immunodeficiencies (PIDs) associated with HPV-related disease include inborn errors of GATA, EVER1/2, and CXCR4 mutations, resulting in defective cellular function. People living with secondary immunodeficiency (e.g. solid-organ transplants recipients of immunosuppression) and acquired immunodeficiency (e.g. concurrent human immunodeficiency virus (HIV) infection) are also at significant risk of HPV-related disease. Immunocompromised people are highly susceptible to the development of cutaneous and mucosal warts, and cervical, anogenital and oropharyngeal carcinomas. The specific mechanisms underlying high-risk HPV-driven cancer development in immunocompromised hosts are not well understood. Current treatments for HPV-related cancers include surgery with adjuvant chemotherapy and/or radiotherapy, with clinical trials underway to investigate the use of anti-PD-1 therapy. In the setting of HIV co-infection, persistent high-grade anal intraepithelial neoplasia can occur despite suppressive antiretroviral therapy, resulting in an ongoing risk for transformation to overt malignancy. Although therapeutic vaccines against HPV are under development, the efficacy of these in the setting of PID, secondary- or acquired- immunodeficiencies remains unclear. RNA-based therapeutic targeting of the HPV genome or mRNA transcript has become a promising next-generation therapeutic avenue. In this review, we summarise the current understanding of HPV pathogenesis, immune evasion, and malignant transformation, with a focus on key PIDs, secondary immunodeficiencies, and HIV infection. Current management and vaccine regimes are outlined in relation to HPV-driven cancer, and specifically, the need for more effective therapeutic strategies for immunocompromised hosts. The recent advances in RNA-based gene targeting including CRISPR and short interfering RNA (siRNA), and the potential application to HPV infection are of great interest. An increased understanding of both the dysregulated immune responses in immunocompromised hosts and of viral persistence is essential for the design of next-generation therapies to eliminate HPV persistence and cancer development in the most at-risk populations.
Collapse
Affiliation(s)
- Rehana V. Hewavisenti
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Joshua Arena
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- UNSW RNA Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Chantelle L. Ahlenstiel
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- UNSW RNA Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Sarah C. Sasson
- Immunovirology and Pathogenesis Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- *Correspondence: Sarah C. Sasson,
| |
Collapse
|
11
|
Finfer S, Venkatesh B, Hotchkiss RS, Sasson SC. Lymphopenia in sepsis—an acquired immunodeficiency? Immunol Cell Biol 2022. [DOI: 10.1111/imcb.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Simon Finfer
- The George Institute for Global Health University of New South Wales Sydney NSW Australia
- School of Public Health Imperial College London London UK
| | - Balasubramanian Venkatesh
- The George Institute for Global Health University of New South Wales Sydney NSW Australia
- Princess Alexandria and Wesley Hospitals Brisbane QLD Australia
| | - Richard S Hotchkiss
- Departments of Anesthesiology, Medicine, and Surgery Washington University School of Medicine St Louis MO USA
| | - Sarah C Sasson
- Department of Clinical Immunology and Immunopathology, Westmead Hospital Sydney NSW Australia
- The Kirby Institute University of New South Wales Sydney NSW Australia
| |
Collapse
|
12
|
Gupta M, Balachandran H, Louie RHY, Li H, Agapiou D, Keoshkerian E, Christ D, Rawlinson W, Mina MM, Post JJ, Hudson B, Gilroy N, Konecny P, Bartlett AW, Sasson SC, Ahlenstiel G, Dwyer D, Lloyd AR, Martinello M, Luciani F, Bull RA. High activation levels maintained in receptor-binding domain-specific memory B cells in people with severe coronavirus disease 2019. Immunol Cell Biol 2022; 101:142-155. [PMID: 36353774 PMCID: PMC9878167 DOI: 10.1111/imcb.12607] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/02/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022]
Abstract
The long-term health consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are still being understood. The molecular and phenotypic properties of SARS-CoV-2 antigen-specific T cells suggest a dysfunctional profile that persists in convalescence in those who were severely ill. By contrast, the antigen-specific memory B-cell (MBC) population has not yet been analyzed to the same degree, but phenotypic analysis suggests differences following recovery from mild or severe coronavirus disease 2019 (COVID-19). Here, we performed single-cell molecular analysis of the SARS-CoV-2 receptor-binding domain (RBD)-specific MBC population in three patients after severe COVID-19 and four patients after mild/moderate COVID-19. We analyzed the transcriptomic and B-cell receptor repertoire profiles at ~2 months and ~4 months after symptom onset. Transcriptomic analysis revealed a higher level of tumor necrosis factor-alpha (TNF-α) signaling via nuclear factor-kappa B in the severe group, involving CD80, FOS, CD83 and TNFAIP3 genes that was maintained over time. We demonstrated the presence of two distinct activated MBCs subsets based on expression of CD80hi TNFAIP3hi and CD11chi CD95hi at the transcriptome level. Both groups revealed an increase in somatic hypermutation over time, indicating progressive evolution of humoral memory. This study revealed distinct molecular signatures of long-term RBD-specific MBCs in convalescence, indicating that the longevity of these cells may differ depending on acute COVID-19 severity.
Collapse
Affiliation(s)
- Money Gupta
- Faculty of Medicine, School of Medical SciencesUniversity of New South Wales AustraliaSydneyNSWAustralia,The Kirby Institute, University of New South Wales, AustraliaSydneyNSWAustralia
| | - Harikrishnan Balachandran
- Faculty of Medicine, School of Medical SciencesUniversity of New South Wales AustraliaSydneyNSWAustralia,The Kirby Institute, University of New South Wales, AustraliaSydneyNSWAustralia
| | - Raymond H Y Louie
- Faculty of Medicine, School of Medical SciencesUniversity of New South Wales AustraliaSydneyNSWAustralia,The Kirby Institute, University of New South Wales, AustraliaSydneyNSWAustralia
| | - Hui Li
- The Kirby Institute, University of New South Wales, AustraliaSydneyNSWAustralia
| | - David Agapiou
- The Kirby Institute, University of New South Wales, AustraliaSydneyNSWAustralia
| | | | - Daniel Christ
- Antibody Therapeutics LabGarvan Institute of Medical ResearchDarlinghurstNSWAustralia
| | - William Rawlinson
- Faculty of Medicine, School of Medical SciencesUniversity of New South Wales AustraliaSydneyNSWAustralia,Serology and Virology Division, Department of MicrobiologyNSW Health Pathology, Prince of Wales HospitalSydneyNSWAustralia
| | | | - Jeffrey J Post
- Prince of Wales Clinical SchoolUniversity of New South Wales, AustraliaSydneyNSWAustralia
| | - Bernard Hudson
- Infectious diseasesRoyal North Shore HospitalSydneyNSWAustralia
| | - Nicky Gilroy
- Infectious DiseasesWestmead HospitalSydneyNSWAustralia
| | - Pamela Konecny
- St George and Sutherland Clinical SchoolUniversity of New South Wales, SydneySydneyNSWAustralia
| | - Adam W Bartlett
- Faculty of Medicine, School of Medical SciencesUniversity of New South Wales AustraliaSydneyNSWAustralia,The Kirby Institute, University of New South Wales, AustraliaSydneyNSWAustralia,Sydney Children's Hospital RandwickSydneyNSWAustralia
| | - Sarah C Sasson
- The Kirby Institute, University of New South Wales, AustraliaSydneyNSWAustralia
| | | | - Dominic Dwyer
- Infectious DiseasesWestmead HospitalSydneyNSWAustralia
| | - Andrew R Lloyd
- The Kirby Institute, University of New South Wales, AustraliaSydneyNSWAustralia
| | - Marianne Martinello
- The Kirby Institute, University of New South Wales, AustraliaSydneyNSWAustralia,Infectious DiseasesWestmead HospitalSydneyNSWAustralia,Blacktown Mount Druitt HospitalBlacktownNSWAustralia
| | - Fabio Luciani
- Faculty of Medicine, School of Medical SciencesUniversity of New South Wales AustraliaSydneyNSWAustralia,The Kirby Institute, University of New South Wales, AustraliaSydneyNSWAustralia
| | - Rowena A Bull
- Faculty of Medicine, School of Medical SciencesUniversity of New South Wales AustraliaSydneyNSWAustralia,The Kirby Institute, University of New South Wales, AustraliaSydneyNSWAustralia
| | | |
Collapse
|
13
|
Adhikari A, Abayasingam A, Rodrigo C, Agapiou D, Pandzic E, Brasher NA, Fernando BSM, Keoshkerian E, Li H, Kim HN, Lord M, Popovic G, Rawlinson W, Mina M, Post JJ, Hudson B, Gilroy N, Dwyer D, Sasson SC, Grubor-Bauk B, Lloyd AR, Martinello M, Bull RA, Tedla N. Longitudinal Characterization of Phagocytic and Neutralization Functions of Anti-Spike Antibodies in Plasma of Patients after Severe Acute Respiratory Syndrome Coronavirus 2 Infection. J I 2022; 209:1499-1512. [DOI: 10.4049/jimmunol.2200272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022]
|
14
|
Hastak PS, Andersen CR, Kelleher AD, Sasson SC. Frontline workers: Mediators of mucosal immunity in community acquired pneumonia and COVID-19. Front Immunol 2022; 13:983550. [PMID: 36211412 PMCID: PMC9539803 DOI: 10.3389/fimmu.2022.983550] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
The current COVID-19 pandemic has highlighted a need to further understand lung mucosal immunity to reduce the burden of community acquired pneumonia, including that caused by the SARS-CoV-2 virus. Local mucosal immunity provides the first line of defence against respiratory pathogens, however very little is known about the mechanisms involved, with a majority of literature on respiratory infections based on the examination of peripheral blood. The mortality for severe community acquired pneumonia has been rising annually, even prior to the current pandemic, highlighting a significant need to increase knowledge, understanding and research in this field. In this review we profile key mediators of lung mucosal immunity, the dysfunction that occurs in the diseased lung microenvironment including the imbalance of inflammatory mediators and dysbiosis of the local microbiome. A greater understanding of lung tissue-based immunity may lead to improved diagnostic and prognostic procedures and novel treatment strategies aimed at reducing the disease burden of community acquired pneumonia, avoiding the systemic manifestations of infection and excess morbidity and mortality.
Collapse
Affiliation(s)
- Priyanka S. Hastak
- The Kirby Institute, Immunovirology and Pathogenesis Program, University of New South Wales, Sydney, NSW, Australia
| | - Christopher R. Andersen
- The Kirby Institute, Immunovirology and Pathogenesis Program, University of New South Wales, Sydney, NSW, Australia
- Intensive Care Unit, Royal North Shore Hospital, Sydney, NSW, Australia
- Critical Care and Trauma Division, The George Institute for Global Health, Sydney, NSW, Australia
| | - Anthony D. Kelleher
- The Kirby Institute, Immunovirology and Pathogenesis Program, University of New South Wales, Sydney, NSW, Australia
| | - Sarah C. Sasson
- The Kirby Institute, Immunovirology and Pathogenesis Program, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
15
|
Beaton B, Sasson SC, Rankin K, Raedemaeker J, Wong A, Hastak P, Phetsouphanh C, Warden A, Klemm V, Munier CML, Hoppe AC, Tea F, Pillay A, Stella AO, Aggarwal A, Lavee O, Caterson ID, Turville S, Kelleher AD, Brilot F, Trotman J. Patients with treated indolent lymphomas immunized with BNT162b2 have reduced anti-spike neutralizing IgG to SARS-CoV-2 variants, but preserved antigen-specific T cell responses. Am J Hematol 2022; 98:131-139. [PMID: 35607995 PMCID: PMC9349368 DOI: 10.1002/ajh.26619] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/08/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Abstract
Patients with indolent lymphoma undertaking recurrent or continuous B cell suppression are at risk of severe COVID-19. Patients and healthy controls (HC; N = 13) received two doses of BNT162b2: follicular lymphoma (FL; N = 35) who were treatment naïve (TN; N = 11) or received immunochemotherapy (ICT; N = 23) and Waldenström's macroglobulinemia (WM; N = 37) including TN (N = 9), ICT (N = 14), or treated with Bruton's tyrosine kinase inhibitors (BTKi; N = 12). Anti-spike immunoglobulin G (IgG) was determined by a high-sensitivity flow-cytometric assay, in addition to live-virus neutralization. Antigen-specific T cells were identified by coexpression of CD69/CD137 and CD25/CD134 on T cells. A subgroup (N = 29) were assessed for third mRNA vaccine response, including omicron neutralization. One month after second BNT162b2, median anti-spike IgG mean fluorescence intensity (MFI) in FL ICT patients (9977) was 25-fold lower than TN (245 898) and HC (228 255, p = .0002 for both). Anti-spike IgG correlated with lymphocyte count (r = .63; p = .002), and time from treatment (r = .56; p = .007), on univariate analysis, but only with lymphocyte count on multivariate analysis (p = .03). In the WM cohort, median anti-spike IgG MFI in BTKi patients (39 039) was reduced compared to TN (220 645, p = .0008) and HC (p < .0001). Anti-spike IgG correlated with neutralization of the delta variant (r = .62, p < .0001). Median neutralization titer for WM BTKi (0) was lower than HC (40, p < .0001) for early-clade and delta. All cohorts had functional T cell responses. Median anti-spike IgG decreased 4-fold from second to third dose (p = .004). Only 5 of 29 poor initial responders assessed after third vaccination demonstrated seroconversion and improvement in neutralization activity, including to the omicron variant.
Collapse
Affiliation(s)
- Brendan Beaton
- Haematology Department, Concord Repatriation General HospitalSydneyNew South WalesAustralia,Concord Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Sarah C. Sasson
- The Kirby InstituteThe University of New South WalesSydneyNew South WalesAustralia,Department of Clinical Immunology and ImmunopathologyICPMR Westmead HospitalSydneyNew South WalesAustralia
| | - Katherine Rankin
- Haematology Department, Concord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Juliette Raedemaeker
- Haematology Department, Concord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Alexander Wong
- Haematology Department, Concord Repatriation General HospitalSydneyNew South WalesAustralia,Concord Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Priyanka Hastak
- The Kirby InstituteThe University of New South WalesSydneyNew South WalesAustralia
| | | | - Andrew Warden
- WMozzies: Australian Patient Support Group for Waldenström's MacroglobulinemiaSydneyNew South WalesAustralia
| | - Vera Klemm
- The Kirby InstituteThe University of New South WalesSydneyNew South WalesAustralia
| | - C. Mee Ling Munier
- The Kirby InstituteThe University of New South WalesSydneyNew South WalesAustralia
| | | | - Fiona Tea
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids ResearchThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Aleha Pillay
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids ResearchThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | | | - Anupriya Aggarwal
- The Kirby InstituteThe University of New South WalesSydneyNew South WalesAustralia
| | - Orly Lavee
- St Vincent's HospitalSydneyNew South WalesAustralia
| | - Ian D. Caterson
- COVID Vaccination Hub, Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Stuart Turville
- The Kirby InstituteThe University of New South WalesSydneyNew South WalesAustralia
| | - Anthony D. Kelleher
- The Kirby InstituteThe University of New South WalesSydneyNew South WalesAustralia
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids ResearchThe Children's Hospital at WestmeadSydneyNew South WalesAustralia,Sydney Institute of Infectious DiseaseThe University of SydneySydneyNew South WalesAustralia,The School of Medical Sciences, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Judith Trotman
- Haematology Department, Concord Repatriation General HospitalSydneyNew South WalesAustralia,Concord Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| |
Collapse
|
16
|
Kent SJ, Khoury DS, Reynaldi A, Juno JA, Wheatley AK, Stadler E, John Wherry E, Triccas J, Sasson SC, Cromer D, Davenport MP. Disentangling the relative importance of T cell responses in COVID-19: leading actors or supporting cast? Nat Rev Immunol 2022; 22:387-397. [PMID: 35484322 PMCID: PMC9047577 DOI: 10.1038/s41577-022-00716-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [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] [Accepted: 03/29/2022] [Indexed: 12/13/2022]
Abstract
The rapid development of multiple vaccines providing strong protection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been a major achievement. There is now compelling evidence for the role of neutralizing antibodies in protective immunity. T cells may play a role in resolution of primary SARS-CoV-2 infection, and there is a widely expressed view that T cell-mediated immunity also plays an important role in vaccine-mediated protection. Here we discuss the role of vaccine-induced T cells in two distinct stages of infection: firstly, in protection from acquisition of symptomatic SARS-CoV-2 infection following exposure; secondly, if infection does occur, the potential for T cells to reduce the risk of developing severe COVID-19. We describe several lines of evidence that argue against a direct impact of vaccine-induced memory T cells in preventing symptomatic SARS-CoV-2 infection. However, the contribution of T cell immunity in reducing the severity of infection, particularly in infection with SARS-CoV-2 variants, remains to be determined. A detailed understanding of the role of T cells in COVID-19 is critical for next-generation vaccine design and development. Here we discuss the challenges in determining a causal relationship between vaccine-induced T cell immunity and protection from COVID-19 and propose an approach to gather the necessary evidence to clarify any role for vaccine-induced T cell memory in protection from severe COVID-19.
Collapse
Affiliation(s)
- Stephen J Kent
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
- Melbourne Sexual Health Centre, Monash University, Melbourne, VIC, Australia.
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - David S Khoury
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Arnold Reynaldi
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jennifer A Juno
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Adam K Wheatley
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Eva Stadler
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - E John Wherry
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - James Triccas
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Sarah C Sasson
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Deborah Cromer
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Miles P Davenport
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| |
Collapse
|
17
|
Balachandran H, Phetsouphanh C, Agapiou D, Adhikari A, Rodrigo C, Hammoud M, Shrestha LB, Keoshkerian E, Gupta M, Turville S, Christ D, King C, Sasson SC, Bartlett A, Grubor-Bauk B, Rawlinson W, Aggarwal A, Stella AO, Klemm V, Mina MM, Post JJ, Hudson B, Gilroy N, Konecny P, Ahlenstiel G, Dwyer DE, Sorrell TC, Kelleher A, Tedla N, Lloyd AR, Martinello M, Bull RA. Maintenance of broad neutralising antibodies and memory B cells 12 months post-infection is predicted by SARS-CoV-2 specific CD4+ T cell responses. Cell Rep 2022; 38:110345. [PMID: 35090598 PMCID: PMC8768427 DOI: 10.1016/j.celrep.2022.110345] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/01/2021] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
Understanding the long-term maintenance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity is critical for predicting protection against reinfection. In an age- and gender-matched cohort of 24 participants, the association of disease severity and early immune responses on the maintenance of humoral immunity 12 months post-infection is examined. All severely affected participants maintain a stable subset of SARS-CoV-2 receptor-binding domain (RBD)-specific memory B cells (MBCs) and good neutralizing antibody breadth against the majority of the variants of concern, including the Delta variant. Modeling these immune responses against vaccine efficacy data indicate a 45%–76% protection against symptomatic infection (variant dependent). Overall, these findings indicate durable humoral responses in most participants after infection, reasonable protection against reinfection, and implicate baseline antigen-specific CD4+ T cell responses as a predictor of maintenance of antibody neutralization breadth and RBD-specific MBC levels at 12 months post-infection.
Collapse
|
18
|
Sasson SC, Slevin SM, Cheung VT, Nassiri I, Olsson-Brown A, Fryer E, Ferreira RC, Trzupek D, Gupta T, Al-Hillawi L, Issaias ML, Easton A, Campo L, FitzPatrick ME, Adams J, Chitnis M, Protheroe A, Tuthill M, Coupe N, Simmons A, Payne M, Middleton MR, Travis SP, Fairfax BP, Klenerman P, Brain O. Interferon-Gamma-Producing CD8 + Tissue Resident Memory T Cells Are a Targetable Hallmark of Immune Checkpoint Inhibitor-Colitis. Gastroenterology 2021; 161:1229-1244.e9. [PMID: 34147519 PMCID: PMC8527886 DOI: 10.1053/j.gastro.2021.06.025] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS The pathogenesis of immune checkpoint inhibitor (ICI)-colitis remains incompletely understood. We sought to identify key cellular drivers of ICI-colitis and their similarities to idiopathic ulcerative colitis, and to determine potential novel therapeutic targets. METHODS We used a cross-sectional approach to study patients with ICI-colitis, those receiving ICI without the development of colitis, idiopathic ulcerative colitis, and healthy controls. A subset of patients with ICI-colitis were studied longitudinally. We applied a range of methods, including multiparameter and spectral flow cytometry, spectral immunofluorescence microscopy, targeted gene panels, and bulk and single-cell RNA sequencing. RESULTS We demonstrate CD8+ tissue resident memory T (TRM) cells are the dominant activated T cell subset in ICI-colitis. The pattern of gastrointestinal immunopathology is distinct from ulcerative colitis at both the immune and epithelial-signaling levels. CD8+ TRM cell activation correlates with clinical and endoscopic ICI-colitis severity. Single-cell RNA sequencing analysis confirms activated CD8+ TRM cells express high levels of transcripts for checkpoint inhibitors and interferon-gamma in ICI-colitis. We demonstrate similar findings in both anti-CTLA-4/PD-1 combination therapy and in anti-PD-1 inhibitor-associated colitis. On the basis of our data, we successfully targeted this pathway in a patient with refractory ICI-colitis, using the JAK inhibitor tofacitinib. CONCLUSIONS Interferon gamma-producing CD8+ TRM cells are a pathological hallmark of ICI-colitis and a novel target for therapy.
Collapse
Affiliation(s)
- Sarah C. Sasson
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stephanie M. Slevin
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Vincent T.F. Cheung
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Isar Nassiri
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Anna Olsson-Brown
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom,The Clatterbridge Cancer Centre National Health Service Foundation Trust, Wirral, United Kingdom
| | - Eve Fryer
- Department of Cellular Pathology, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ricardo C. Ferreira
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Dominik Trzupek
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Tarun Gupta
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Lulia Al-Hillawi
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Mari-lenna Issaias
- Department of Oncology, University of Oxford and Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Alistair Easton
- Department of Cellular Pathology, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Leticia Campo
- Translational Histopathology Laboratory, Department of Oncology, University of Oxford, United Kingdom
| | - Michael E.B. FitzPatrick
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Joss Adams
- Berkshire Cancer Centre, Royal Berkshire Hospital, Reading, United Kingdom
| | - Meenali Chitnis
- Department of Oncology, University of Oxford and Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Andrew Protheroe
- Department of Oncology, University of Oxford and Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Mark Tuthill
- Department of Oncology, University of Oxford and Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Nicholas Coupe
- Department of Oncology, University of Oxford and Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Alison Simmons
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Miranda Payne
- Department of Oncology, University of Oxford and Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Mark R. Middleton
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom,Department of Oncology, University of Oxford and Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Simon P.L. Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Benjamin P. Fairfax
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,Department of Oncology, University of Oxford and Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Paul Klenerman
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Oliver Brain
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
| |
Collapse
|
19
|
Sasson SC, Wilkins LE, Watson RA, Jolly C, Brain O, Klenerman P, Olsson-Brown A, Fairfax BP. Identification of neutralising pembrolizumab anti-drug antibodies in patients with melanoma. Sci Rep 2021; 11:19253. [PMID: 34584157 PMCID: PMC8478874 DOI: 10.1038/s41598-021-98700-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/14/2021] [Indexed: 11/09/2022] Open
Abstract
Development of anti-drug antibodies (ADAs) can interfere with therapeutic monoclonal antibodies and may lead to drug neutralisation and clinical disease progression. Measurement of circulating drug levels and development of ADAs in the setting of anti-programmed cell death-1 agent pembrolizumab has not been well-studied. Enzyme-linked immunosorbent assays were used to measure pembrolizumab drug level and ADAs in 41 patients with melanoma at baseline, Time-point 1 (3 weeks) and Time-point 2 (21 weeks). Assay results were related to patient demographics and clinical outcome data at 6 months. The median pembrolizumab drug level at 3 weeks was 237 ng/μL and did not correlate with age, sex or body surface area.17/41 patients had an ADA detected at any timepoint, with the highest prevalence at Timepoint 1 (median concentration = 17 ng/μL). The presence of an ADA did not correlate with clinical progression at 6 months. 3/41 (7%) of patients displayed a falling pembrolizumab drug level and rising ADA titre between Timepoint 1 and 2 suggestive of a neutralising ADA. Pembrolizumab drug levels and ADAs can be readily measured. The rates of total and treatment-emergent ADAs may be higher in “real-word” settings than those previously reported. Larger studies are needed to determine effect of neutralising ADAs on long-term clinical outcome.
Collapse
Affiliation(s)
- S C Sasson
- Nuffield Department of Medicine, The University of Oxford, Oxford, UK.
| | - L E Wilkins
- The University of Oxford Medical School, Oxford, UK
| | - R A Watson
- MRC Weatherall Institute of Molecular Medicine, The University of Oxford, Oxford, UK
| | - C Jolly
- The Clatterbridge Cancer Centre, Liverpool, UK
| | - O Brain
- Nuffield Department of Medicine, The University of Oxford, Oxford, UK
| | - P Klenerman
- Nuffield Department of Medicine, The University of Oxford, Oxford, UK
| | | | - B P Fairfax
- MRC Weatherall Institute of Molecular Medicine, The University of Oxford, Oxford, UK
| |
Collapse
|
20
|
Hargreaves CE, Salatino S, Sasson SC, Charlesworth JEG, Bateman E, Patel AM, Anzilotti C, Broxholme J, Knight JC, Patel SY. Decreased ATM Function Causes Delayed DNA Repair and Apoptosis in Common Variable Immunodeficiency Disorders. J Clin Immunol 2021; 41:1315-1330. [PMID: 34009545 PMCID: PMC8310859 DOI: 10.1007/s10875-021-01050-2] [Citation(s) in RCA: 3] [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: 12/16/2020] [Accepted: 04/20/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Common variable immunodeficiency disorders (CVID) is characterized by low/absent serum immunoglobulins and susceptibility to bacterial infection. Patients can develop an infections-only phenotype or a complex disease course with inflammatory, autoimmune, and/or malignant complications. We hypothesized that deficient DNA repair mechanisms may be responsible for the antibody deficiency and susceptibility to inflammation and cancer in some patients. METHODS Germline variants were identified following targeted sequencing of n = 252 genes related to DNA repair in n = 38 patients. NanoString nCounter PlexSet assay measured gene expression in n = 20 CVID patients and n = 7 controls. DNA damage and apoptosis were assessed by flow cytometry in n = 34 CVID patients and n = 11 controls. RESULTS Targeted sequencing supported enrichment of rare genetic variants in genes related to DNA repair pathways with novel and rare likely pathogenic variants identified and an altered gene expression signature that distinguished patients from controls and complex patients from those with an infections-only phenotype. Consistent with this, flow cytometric analyses of lymphocytes following DNA damage revealed a subset of CVID patients whose immune cells have downregulated ATM, impairing the recruitment of other repair factors, delaying repair and promoting apoptosis. CONCLUSION These data suggest that germline genetics and altered gene expression predispose a subset of CVID patients to increased sensitivity to DNA damage and reduced DNA repair capacity.
Collapse
Affiliation(s)
- Chantal E Hargreaves
- Nuffield Department of Medicine and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, OX3 9DU, UK.
| | - Silvia Salatino
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Sarah C Sasson
- Nuffield Department of Medicine and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, OX3 9DU, UK
| | - James E G Charlesworth
- Oxford University Clinical Academic Graduate School, Medical Sciences Office, John Radcliffe Hospital, University of Oxford, OX3 9DU, Oxford, UK
| | - Elizabeth Bateman
- Department of Immunology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, OX3 7LE, UK
| | - Arzoo M Patel
- Nuffield Department of Medicine and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, OX3 9DU, UK
| | - Consuelo Anzilotti
- Clinical Immunology Department, Oxford University Hospitals Trust, Oxford, OX3 9DU, UK
| | - John Broxholme
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Julian C Knight
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Smita Y Patel
- Nuffield Department of Medicine and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, OX3 9DU, UK
- Clinical Immunology Department, Oxford University Hospitals Trust, Oxford, OX3 9DU, UK
| |
Collapse
|
21
|
Sasson SC. Autoimmune toxicities of T cell checkpoint inhibitors. Pathology 2021. [DOI: 10.1016/j.pathol.2021.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
22
|
van der Linde R, Smith S, Sasson SC, Brown D, Tegg E. Use of multidimentional flow cytometry plots to improve measurable residual disease monitoring of acute myeloid leukaemias. Pathology 2021. [DOI: 10.1016/j.pathol.2021.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
23
|
Abayasingam A, Balachandran H, Agapiou D, Hammoud M, Rodrigo C, Keoshkerian E, Li H, Brasher NA, Christ D, Rouet R, Burnet D, Grubor-Bauk B, Rawlinson W, Turville S, Aggarwal A, Stella AO, Fichter C, Brilot F, Mina M, Post JJ, Hudson B, Gilroy N, Dwyer D, Sasson SC, Tea F, Pilli D, Kelleher A, Tedla N, Lloyd AR, Martinello M, Bull RA. Long-term persistence of RBD + memory B cells encoding neutralizing antibodies in SARS-CoV-2 infection. Cell Rep Med 2021; 2:100228. [PMID: 33748788 PMCID: PMC7955929 DOI: 10.1016/j.xcrm.2021.100228] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/08/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022]
Abstract
Considerable concerns relating to the duration of protective immunity against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) exist, with evidence of antibody titers declining rapidly after infection and reports of reinfection. Here, we monitor the antibody responses against SARS-CoV-2 receptor-binding domain (RBD) for up to 6 months after infection. While antibody titers are maintained, ∼13% of the cohort’s neutralizing responses return to background. However, encouragingly, in a selected subset of 13 participants, 12 have detectable RBD-specific memory B cells and these generally are increasing out to 6 months. Furthermore, we are able to generate monoclonal antibodies with SARS-CoV-2 neutralizing capacity from these memory B cells. Overall, our study suggests that the loss of neutralizing antibodies in plasma may be countered by the maintenance of neutralizing capacity in the memory B cell repertoire. Decay of antibody binding to RBD and spike antigen after 6 months 11 of 81 (13.6%) participants revert to background neutralizing levels Despite declining antibody titers, robust memory B cell populations are observed Memory B cells retain potent neutralizing capacity
Collapse
Affiliation(s)
- Arunasingam Abayasingam
- School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Harikrishnan Balachandran
- School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - David Agapiou
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | | | - Chaturaka Rodrigo
- School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | | | - Hui Li
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Nicholas A. Brasher
- School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Daniel Christ
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst 2010, NSW, Australia
| | - Romain Rouet
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst 2010, NSW, Australia
| | - Deborah Burnet
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst 2010, NSW, Australia
| | - Branka Grubor-Bauk
- Virology Laboratory, Discipline of Surgery, The University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide 5011, SA, Australia
| | - William Rawlinson
- School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
- Serology and Virology Division, Department of Microbiology, NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | | | | | | | | | - Fabienne Brilot
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
- Brain Autoimmunity Group, Kids Neurosciences Centre, Kids Research at the Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Michael Mina
- Northern Beaches Hospital, Sydney, NSW, Australia
| | - Jeffrey J. Post
- Prince of Wales Clinical School, UNSW Australia, Sydney, NSW Australia
| | | | | | | | | | - Fiona Tea
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
- Brain Autoimmunity Group, Kids Neurosciences Centre, Kids Research at the Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Deepti Pilli
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
- Brain Autoimmunity Group, Kids Neurosciences Centre, Kids Research at the Children’s Hospital at Westmead, Sydney, NSW, Australia
| | | | - Nicodemus Tedla
- School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
| | | | - Marianne Martinello
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
- Westmead Hospital, Sydney, NSW, Australia
- Blacktown Mt Druitt Hospital, Blacktown, NSW, Australia
| | - Rowena A. Bull
- School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
- Corresponding author
| | | |
Collapse
|
24
|
Wu L, Tsang VHM, Sasson SC, Menzies AM, Carlino MS, Brown DA, Clifton-Bligh R, Gunton JE. Unravelling Checkpoint Inhibitor Associated Autoimmune Diabetes: From Bench to Bedside. Front Endocrinol (Lausanne) 2021; 12:764138. [PMID: 34803927 PMCID: PMC8603930 DOI: 10.3389/fendo.2021.764138] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022] Open
Abstract
Immune checkpoint inhibitors have transformed the landscape of oncological therapy, but at the price of a new array of immune related adverse events. Among these is β-cell failure, leading to checkpoint inhibitor-related autoimmune diabetes (CIADM) which entails substantial long-term morbidity. As our understanding of this novel disease grows, parallels and differences between CIADM and classic type 1 diabetes (T1D) may provide insights into the development of diabetes and identify novel potential therapeutic strategies. In this review, we outline the knowledge across the disciplines of endocrinology, oncology and immunology regarding the pathogenesis of CIADM and identify possible management strategies.
Collapse
Affiliation(s)
- Linda Wu
- Centre for Diabetes, Obesity and Endocrinology, The Westmead Institute for Medical Research, Sydney, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
- Department of Endocrinology, Westmead Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Linda Wu,
| | - Venessa H. M. Tsang
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sarah C. Sasson
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Immunology, Westmead Hospital, Sydney, NSW, Australia
- NSW Health Pathology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney, NSW, Australia
| | - Alexander M. Menzies
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Matteo S. Carlino
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Westmead Hospital, Sydney, NSW, Australia
| | - David A. Brown
- Centre for Diabetes, Obesity and Endocrinology, The Westmead Institute for Medical Research, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Immunology, Westmead Hospital, Sydney, NSW, Australia
- NSW Health Pathology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney, NSW, Australia
| | - Roderick Clifton-Bligh
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jenny E. Gunton
- Centre for Diabetes, Obesity and Endocrinology, The Westmead Institute for Medical Research, Sydney, NSW, Australia
- Department of Endocrinology, Westmead Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
25
|
Sasson SC, Zaunders JJ, Nahar K, Munier CML, Fairfax BP, Olsson-Brown A, Jolly C, Read SA, Ahlenstiel G, Palendira U, Scolyer RA, Carlino MS, Payne MJ, Cheung VTF, Gupta T, Klenerman P, Long GV, Brain O, Menzies AM, Kelleher AD. Mucosal-associated invariant T (MAIT) cells are activated in the gastrointestinal tissue of patients with combination ipilimumab and nivolumab therapy-related colitis in a pathology distinct from ulcerative colitis. Clin Exp Immunol 2020; 202:335-352. [PMID: 32734627 PMCID: PMC7670140 DOI: 10.1111/cei.13502] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 03/16/2020] [Revised: 06/09/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to investigate the pathogenesis of combination ipilimumab and nivolumab-associated colitis (IN-COL) by measuring gut-derived and peripheral blood mononuclear cell (GMNC; PBMC) profiles. We studied GMNC and PBMC from patients with IN-COL, IN-treated with no adverse-events (IN-NAE), ulcerative colitis (UC) and healthy volunteers using flow cytometry. In the gastrointestinal-derived cells we found high levels of activated CD8+ T cells and mucosal-associated invariant T (MAIT) cells in IN-COL, changes that were not evident in IN-NAE or UC. UC, but not IN-C, was associated with a high proportion of regulatory T cells (Treg ). We sought to determine if local tissue responses could be measured in peripheral blood. Peripherally, checkpoint inhibition instigated a rise in activated memory CD4+ and CD8+ T cells, regardless of colitis. Low circulating MAIT cells at baseline was associated with IN-COL patients compared with IN-NAE in one of two cohorts. UC, but not IN-COL, was associated with high levels of circulating plasmablasts. In summary, the alterations in T cell subsets measured in IN-COL-affected tissue, characterized by high levels of activated CD8+ T cells and MAIT cells and a low proportion of Treg , reflected a pathology distinct from UC. These tissue changes differed from the periphery, where T cell activation was a widespread on-treatment effect, and circulating MAIT cell count was low but not reliably predictive of colitis.
Collapse
Affiliation(s)
- S C Sasson
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J J Zaunders
- Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia
| | - K Nahar
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia
| | - C M L Munier
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - B P Fairfax
- Department of Oncology, Churchill Hospital, Oxford, UK.,Department of Oncology, University of Oxford, Oxford, UK.,MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - A Olsson-Brown
- The Clatterbridge Cancer Centre NHS Foundation Trust and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - C Jolly
- The Clatterbridge Cancer Centre NHS Foundation Trust and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - S A Read
- Westmead Institute of Medical Research, Sydney, Australia.,Western Sydney University, Sydney, Australia
| | - G Ahlenstiel
- Westmead Institute of Medical Research, Sydney, Australia.,Department of Gastroenterology, Blacktown Hospital, Sydney, Australia
| | - U Palendira
- Discipline of Infectious Diseases and Immunology, The University of Sydney, Sydney, Australia
| | - R A Scolyer
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - M S Carlino
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Westmead and Blacktown Hospitals, Sydney, Australia
| | - M J Payne
- Department of Oncology, Churchill Hospital, Oxford, UK
| | - V T F Cheung
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - T Gupta
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - P Klenerman
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Peter Medawar Building of Pathogen Research, University of Oxford, Oxford, UK
| | - G V Long
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital and Mater Hospitals, Sydney, Australia
| | - O Brain
- Translational Gastroenterology Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Gastroenterology, John Radcliffe Hospital, Oxford, UK
| | - A M Menzies
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital and Mater Hospitals, Sydney, Australia
| | - A D Kelleher
- Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia.,The Kirby Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
26
|
Sasson SC, Corbett A, McLachlan AJ, Chen R, Adelstein SA, Riminton S, Limaye S. Enhanced serum immunoglobulin G clearance in myotonic dystrophy-associated hypogammaglobulinemia: a case series and review of the literature. J Med Case Rep 2019; 13:338. [PMID: 31744540 PMCID: PMC6864924 DOI: 10.1186/s13256-019-2285-3] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 10/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myotonic dystrophy type 1 is an autosomal dominant disorder characterized by muscle weakness, myotonia, cataracts, and cardiac conduction defects; it is associated with expansions of cytosine-thymine-guanine repeats in the myotonic dystrophy protein kinase. Hypogammaglobulinemia is a lesser known association of myotonic dystrophy type 1 and the underlying pathogenesis of immunoglobulin G depletion remains unclear. CASE PRESENTATION Here we report a kindred of two members (a 62-year-old white woman and a 30-year-old white man; mother and son) with myotonic dystrophy type 1-associated hypogammaglobulinemia associated with altered intravenous immunoglobulin elimination kinetics and reduced half-life. There was no history of systemic immunosuppression or renal or gastrointestinal protein loss in either patient, and no underlying case for a secondary immunodeficiency could be found. One patient required fortnightly intravenous immunoglobulin to maintain adequate trough immunoglobulin G levels. CONCLUSIONS Ongoing study of myotonic dystrophy type 1-associated hypogammaglobulinemia using contemporary tools of genomic medicine may help to further delineate the pathogenesis of this entity.
Collapse
Affiliation(s)
- Sarah C Sasson
- Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, Level 5, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | | | | | - R Chen
- Immunopathology Laboratory, Department of Clinical Immunology, Royal Prince Alfred Hospital, Sydney, Australia
| | - S A Adelstein
- Immunopathology Laboratory, Department of Clinical Immunology, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sean Riminton
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Clinical Immunology, Concord Hospital, Sydney, Australia
| | - Sandhya Limaye
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Clinical Immunology, Concord Hospital, Sydney, Australia
| |
Collapse
|
27
|
Deenick EK, Morey A, Danta M, Emmett L, Fay K, Gracie G, Ma CS, Macintosh R, Smith SABC, Sasson SC, Sewell WA, Cowley M, Tangye SG, Kelleher AD, Phan TG. Reversible Suppression of Lymphoproliferation and Thrombocytopenia with Rapamycin in a Patient with Common Variable Immunodeficiency. J Clin Immunol 2018; 38:159-162. [PMID: 29350338 DOI: 10.1007/s10875-018-0477-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/10/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Elissa K Deenick
- Immunology Division, Garvan Institute of Medical Research, Sydney, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, Australia
| | - Adrienne Morey
- Department of Anatomical Pathology, ACT Pathology, Canberra Hospital, Garran, Canberra, Australia
| | - Mark Danta
- St Vincent's Clinical School, UNSW Sydney, Sydney, Australia
| | - Louise Emmett
- Department of Nuclear Medicine, St Vincent's Hospital, Sydney, Australia
| | - Keith Fay
- Department of Haematology, Kinghorn Cancer Centre, Sydney, Australia
| | - Gary Gracie
- Department of Anatomical Pathology, St Vincent's Hospital, Sydney, Australia
| | - Cindy S Ma
- Immunology Division, Garvan Institute of Medical Research, Sydney, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, Australia
| | | | | | | | | | - Mark Cowley
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Stuart G Tangye
- Immunology Division, Garvan Institute of Medical Research, Sydney, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, Australia
| | | | | | - Tri G Phan
- Immunology Division, Garvan Institute of Medical Research, Sydney, Australia. .,St Vincent's Clinical School, UNSW Sydney, Sydney, Australia.
| |
Collapse
|
28
|
Sasson SC, Davies S, Chan R, Davies L, Garsia R. Cerebral toxoplasmosis in a patient with myasthenia gravis and thymoma with immunodeficiency/Good's syndrome: a case report. BMC Infect Dis 2016; 16:457. [PMID: 27576953 PMCID: PMC5004299 DOI: 10.1186/s12879-016-1801-y] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 08/23/2016] [Indexed: 01/01/2023] Open
Abstract
Background Patients with thymoma with immunodeficiency (TWI)/Good’s syndrome characteristically have evidence of combined immunodeficiency including low or absent B-cells, hypogammaglobulinemia and defects in T-cell mediated immunity. These patients can present with common or opportunistic infections. Case presentation A 54-year-old female was diagnosed with cerebral toxoplasmosis. This occurred on a background of metastatic thymoma previously treated with chemotherapy and myasthenia gravis (MG) treated with mycophenolate mofetil, monthly intravenous immunoglobulin (IVIG) and pyridostigmine. She reported recurrent herpes zoster infection. The patient had clinical and radiological progression of cerebral infection despite completing standard induction and maintenance therapy with sulfadiazine and pyrimethamine. Investigations found a complete absence of B-cells and evidence for hypogammaglobulinemia which, together with evidence of defects in T-cell mediated immunity and thymoma, lead to a diagnosis of TWI/Good’s Syndrome. The patient has undergone prolonged high-dose therapy for toxoplasmosis and a reduction in immunosuppression with no evidence of recurrent toxoplasmosis or flare of MG. Conclusions TWI/Good’s Syndrome should be suspected in patients with thymoma and recurrent, persistent or unusual infections. If suspected serum immunoglobulins and lymphocyte subsets should be measured. These patients may need closer monitoring, higher dose and prolonged treatment of infections, and weaning of concurrent immunosuppression may be considered.
Collapse
Affiliation(s)
- Sarah C Sasson
- Department of Clinical Immunology, Level 6 Laboratory Services Building, Royal Prince Alfred Hospital, Missenden Rd Camperdown, Sydney, NSW, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Sarah Davies
- Department of Infectious Diseases, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Raymond Chan
- Department of Infectious Diseases, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Leo Davies
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Roger Garsia
- Department of Clinical Immunology, Level 6 Laboratory Services Building, Royal Prince Alfred Hospital, Missenden Rd Camperdown, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| |
Collapse
|
29
|
Anderson S, Sasson SC, Lee FJ, Cooper W, Larsen S, Garsia R. Episodic fevers and vasodilatory shock mimicking urosepsis in a patient with HIV-associated multicentric Castleman's Disease: a case report. BMC Infect Dis 2016; 16:53. [PMID: 26831502 PMCID: PMC4736249 DOI: 10.1186/s12879-016-1378-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background Multicentric Castleman’s disease (MCD) is a pre-malignancy that presents with lymphadenopathy and features of systemic inflammation. Human immunodeficiency virus (HIV)-associated MCD is associated with human herpesvirus-8 (HHV-8) infection. If untreated MCD has a relapsing and remitting course that is eventually fatal. Case presentation A 67-year-old man had six hospital admissions over 20 months characterised by fever, urinary frequency and CRP >100 mg/L. The final admission was complicated by hypotension requiring intensive care unit admission and ionotropic support. His history included HIV and Hepatitis B virus (HBV) co-infection on suppressive therapy. Each presentation was managed as presumed urosepsis with use of empirical antibiotics, however numerous blood and urine cultures failed to identify a pathogen. A bone-marrow aspirate and trephine found no evidence of haematological malignancy. A positron emission tomography scan found active lymph nodes, one of which was biopsied and found to contain the plasma-cell variant of Castleman’s disease. Ultimately the cause for the recurrent presentations was attributed to progressive MCD. The patient received rituximab monotherapy and has had no further related admissions. Conclusions MCD should be considered in patients with chronic HIV infection presenting with recurrent sepsis-like episodes and/or vasodilatory shock, particularly if no pathogen is identified or lymphadenopathy is evident.
Collapse
Affiliation(s)
- Stephanie Anderson
- Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Sarah C Sasson
- Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. .,Sydney Medical School, University of Sydney, Sydney, NSW, Australia. .,Level 6 Laboratory Services Building, Royal Prince Alfred Hospital, Missenden Rd Camperdown, Sydney, NSW, Australia.
| | - Frederick J Lee
- Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. .,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Wendy Cooper
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia. .,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. .,School of Medicine, University of Western Sydney, Parramatta, NSW, Australia.
| | - Stephen Larsen
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia. .,Haematology Department Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Roger Garsia
- Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. .,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
30
|
Sasson SC, Oon A, Chagantri J, Brew BJ, Carr A. Posterior reversible encephalopathy syndrome (PRES) in an HIV-1 infected patient with disseminated varicella zoster virus: a case report. BMC Infect Dis 2013; 13:396. [PMID: 23981526 PMCID: PMC3766018 DOI: 10.1186/1471-2334-13-396] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 08/26/2013] [Indexed: 11/10/2022] Open
Abstract
Background Posterior reversible encephalopathy syndrome (PRES) is an uncommon pathology characterized by the acute onset of headache, vomiting, altered consciousness, seizures and focal neurological deficits. It was initially described in the setting of hypertension, uremia and immunosuppression. In the last decade there have been emerging reports of PRES in patients with advanced human immunodeficiency virus (HIV)-infection in the presence of hypertension, dialysis, hypercalcaemia and two opportunistic infections: blastomycosis and tuberculosis (TB). Case presentation Here we present the case of a 54 year old male being treated for disseminated varicella zoster virus (VZV) and vasculopathy in the setting of HIV infection who acutely deteriorated to the point of requiring intubation. His clinicoradiological diagnosis was of PRES and he subsequently improved within 72 h with supportive management. Serial neuroimaging correlated with the clinical findings. The pathogenesis of PRES is poorly understood but is thought to stem from vasogenic oedema either as a result of loss of endothelial integrity and transudate of fluid across the blood–brain barrier, or secondary to vasospasm resulting in tissue oedema in the absence of infarction. How HIV infection impacts on this model is unclear. It is possible the HIV infection causes endothelial dysfunction and disruption of the blood–brain barrier that may be further exacerbated by infections in the central nervous system. Conclusion The phenomenon of PRES in advanced HIV is an important clinical entity for both physicians and critical care doctors to recognize firstly given its potential mortality but also because of its favourable prognosis and reversibility with supportive care and treatment of underlying causes.
Collapse
Affiliation(s)
- Sarah C Sasson
- HIV, Immunology and Infectious Diseases Unit, St Vincent's Hospital, 390 Victoria Street Darlinghurst, 2010, Sydney, NSW, Australia.
| | | | | | | | | |
Collapse
|
31
|
Sasson SC, Zaunders JJ, Seddiki N, Bailey M, McBride K, Koelsch KK, Merlin KM, Smith DE, Cooper DA, Kelleher AD. Progressive activation of CD127+132- recent thymic emigrants into terminally differentiated CD127-132+ T-cells in HIV-1 infection. PLoS One 2012; 7:e31148. [PMID: 22348045 PMCID: PMC3278435 DOI: 10.1371/journal.pone.0031148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 01/03/2012] [Indexed: 12/11/2022] Open
Abstract
Aim HIV infection is associated with distortion of T-cell homeostasis and the IL-7/IL7R axis. Progressive infection results in loss of CD127+132− and gains in CD127−132+ CD4+ and CD8+ T-cells. We investigated the correlates of loss of CD127 from the T-cell surface to understand mechanisms underlying this homeostatic dysregulation. Methods Peripheral and cord blood mononuclear cells (PBMCs; CBMC) from healthy volunteers and PBMC from patients with HIV infection were studied. CD127+132−, CD127+132+ and CD127−132+ T-cells were phenotyped by activation, differentiation, proliferation and survival markers. Cellular HIV-DNA content and signal-joint T-cell receptor excision circles (sjTRECs) were measured. Results CD127+132− T-cells were enriched for naïve cells while CD127−132+ T-cells were enriched for activated/terminally differentiated T-cells in CD4+ and CD8+ subsets in health and HIV infection. HIV was associated with increased proportions of activated/terminally differentiated CD127−132+ T-cells. In contrast to CD127+132− T-cells, CD127−132+ T-cells were Ki-67+Bcl-2low and contained increased levels of HIV-DNA. Naïve CD127+132− T-cells contained a higher proportion of sjTRECs. Conclusion The loss of CD127 from the T-cell surface in HIV infection is driven by activation of CD127+132− recent thymic emigrants into CD127−132+ activated/terminally differentiated cells. This process likely results in an irreversible loss of CD127 and permanent distortion of T-cell homeostasis.
Collapse
Affiliation(s)
- Sarah C Sasson
- The Kirby Institute, The University of New South Wales, Sydney, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Sasson SC, Smith S, Seddiki N, Zaunders JJ, Bryant A, Koelsch KK, Weatherall C, Munier ML, McGinley C, Yeung J, Mulligan SP, Moore J, Cooper DA, Milliken S, Kelleher AD. IL-7 receptor is expressed on adult pre-B-cell acute lymphoblastic leukemia and other B-cell derived neoplasms and correlates with expression of proliferation and survival markers. Cytokine 2010; 50:58-68. [DOI: 10.1016/j.cyto.2009.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 11/23/2009] [Accepted: 12/01/2009] [Indexed: 11/24/2022]
|
33
|
Seddiki N, Sasson SC, Santner-Nanan B, Munier M, van Bockel D, Ip S, Marriott D, Pett S, Nanan R, Cooper DA, Zaunders JJ, Kelleher AD. Proliferation of weakly suppressive regulatory CD4+ T cells is associated with over-active CD4+ T-cell responses in HIV-positive patients with mycobacterial immune restoration disease. Eur J Immunol 2009; 39:391-403. [DOI: 10.1002/eji.200838630] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
34
|
Sasson SC, Zaunders JJ, Kelleher AD. The IL-7/IL-7 Receptor Axis: Understanding its Central Role in T-Cell Homeostasis and the Challenges Facing its Utilization as a Novel Therapy. Curr Drug Targets 2006; 7:1571-82. [PMID: 17168832 DOI: 10.2174/138945006779025365] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Interleukin-7 (IL-7) is a cytokine produced predominantly by stromal cells of the thymus and bone marrow and is essential for lymphopoiesis. This paper reviews the importance of IL-7 and its receptor (IL-7R) in T-cell genesis, peripheral survival, expansion and memory T-cell development. IL-7 is of particular importance in lymphopenic conditions. Its expression is up-regulated in a number of lymphopenic conditions including: marrow ablation prior to bone marrow transplantation, marrow suppression following chemotherapy and human immuno-deficiency virus (HIV) infection. Plasma IL-7 levels inversely correlate with CD4+ T-cell counts in these conditions. Animal models suggest that IL-7 improves immune reconstitution through increasing thymic output and, perhaps more importantly, through antigen-independent homeostatic driven proliferation in the periphery. Given the promising preliminary data on the use of IL-7 adjuvant therapy in simian immuno-deficiency virus (SIV) infected non-human primates, IL-7 has recently moved into Phase I/II clinical trials of its role as a possible adjuvant therapy for cancer and HIV infection. This paper discusses important considerations such as the possible negative impacts of IL-7 on increased viral infectivity, the induction of autoimmunity and risk of neoplastic events. Successful use of IL-7 will rely on further understanding of the regulation of the component parts of the IL-7R system. Ultimately this understanding may lead to therapeutics that manipulate and optimise signalling through the IL-7/IL-7R system.
Collapse
Affiliation(s)
- Sarah C Sasson
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia.
| | | | | |
Collapse
|
35
|
Zaunders JJ, Ip S, Munier ML, Kaufmann DE, Suzuki K, Brereton C, Sasson SC, Seddiki N, Koelsch K, Landay A, Grey P, Finlayson R, Kaldor J, Rosenberg ES, Walker BD, Fazekas de St Groth B, Cooper DA, Kelleher AD. Infection of CD127+ (interleukin-7 receptor+) CD4+ cells and overexpression of CTLA-4 are linked to loss of antigen-specific CD4 T cells during primary human immunodeficiency virus type 1 infection. J Virol 2006; 80:10162-72. [PMID: 17005693 PMCID: PMC1617311 DOI: 10.1128/jvi.00249-06] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
We recently found that human immunodeficiency virus (HIV)-specific CD4+ T cells express coreceptor CCR5 and activation antigen CD38 during early primary HIV-1 infection (PHI) but then rapidly disappear from the circulation. This cell loss may be due to susceptibility to infection with HIV-1 but could also be due to inappropriate apoptosis, an expansion of T regulatory cells, trafficking out of the circulation, or dysfunction. We purified CD38+++CD4+ T cells from peripheral blood mononuclear cells, measured their level of HIV-1 DNA by PCR, and found that about 10% of this population was infected. However, a small subset of HIV-specific CD4+) T cells also expressed CD127, a marker of long-term memory cells. Purified CD127+CD4+ lymphocytes contained fivefold more copies of HIV-1 DNA per cell than did CD127-negative CD4+ cells, suggesting preferential infection of long-term memory cells. We observed no apoptosis of antigen-specific CD4+ T cells in vitro and only a small increase in CD45RO+CD25+CD127dimCD4+ T regulatory cells during PHI. However, 40% of CCR5+CD38+++ CD4+ T cells expressed gut-homing integrins, suggesting trafficking through gut-associated lymphoid tissue (GALT). Furthermore, 80% of HIV-specific CD4+ T cells expressed high levels of the negative regulator CTLA-4 in response to antigen stimulation in vitro, which was probably contributing to their inability to produce interleukin-2 and proliferate. Taken together, the loss of HIV-specific CD4+ T cells is associated with a combination of an infection of CCR5+ CD127+ memory CD4+ T cells, possibly in GALT, and a high expression of the inhibitory receptor CTLA-4.
Collapse
Affiliation(s)
- John J Zaunders
- Centre for Immunology, St. Vincent's Hospital, Victoria Street, Darlinghurst, NSW 2010, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Sasson SC, Zaunders JJ, Zanetti G, King EM, Merlin KM, Smith DE, Stanley KK, Cooper DA, Kelleher AD. Increased plasma interleukin-7 level correlates with decreased CD127 and Increased CD132 extracellular expression on T cell subsets in patients with HIV-1 infection. J Infect Dis 2006; 193:505-14. [PMID: 16425129 DOI: 10.1086/499309] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Accepted: 08/17/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Interleukin (IL)-7 levels are increased in patients with human immunodeficiency virus type 1 (HIV-1)-associated lymphopenia; however, the effects of this on IL-7 receptor (IL-7R) expression, disease progression, and immune reconstitution remain unclear. METHODS Plasma IL-7 levels were measured, by enzyme-linked immunoassay, in patients with primary, chronic, or long-term nonprogressive HIV-1 infection (PHI, CHI, and LTNP, respectively) before and after 40-48 weeks of antiretroviral therapy (ART). Cell-surface expression and intracellular expression of the IL-7R components CD127 and CD132 were measured by flow cytometry. The effects of IL-7 and cycloheximide on IL-7R expression by peripheral blood mononuclear cells were examined in vitro. RESULTS Plasma IL-7 levels were increased in both patients with PHI and those with CHI; administration of ART resulted in normalized plasma IL-7 levels in patients with PHI but not in those with CHI. Plasma IL-7 levels positively correlated with CD4(+) T cell immune reconstitution in patients with PHI. In vitro, exogenous IL-7 rapidly down-regulated cell-surface CD127 expression, but not CD132 expression, whereas subsequent reexpression required active protein synthesis. HIV-1 infection resulted in progressive decreases in the CD127(+)132(-) subset and increases in the CD127(-)132(+) subset of CD4(+) and CD8(+) T cells. Changes in CD4(+) T cell expression of IL-7R components were evident in patients with LTNP who lost viral control, and these changes preceded increases in plasma IL-7 levels. CONCLUSIONS Perturbations in the IL-7/IL-7R system were clearly associated with disease progression but did not reliably predict immune reconstitution.
Collapse
Affiliation(s)
- Sarah C Sasson
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Sasson SC, Kelleher AD, Cooper DA. The Modern ART of HIV Infection Management: Towards a Tailored Approach to Maximize CD4 T Cell Reconstitution. Clin Infect Dis 2005; 41:373-5. [PMID: 16007535 DOI: 10.1086/431489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 04/04/2005] [Indexed: 11/03/2022] Open
|