9-Month observational Dia-Vacc study of vaccine type influence on SARS-CoV-2 immunity in dialysis and kidney transplant patients

BACKGROUND

SARS-CoV-2mRNA vaccination related seroconversion rates are reduced in dialysis and kidney transplant patients.

METHODS

We evaluated nine months follow up data in our observational Dia-Vacc study exploring specific cellular (interferon-γ release assay) or/and humoral immune responses after 2x SARS-CoV-2mRNA vaccination in 880 participants including healthy medical personnel (125-MP), dialysis patients (595-DP), kidney transplant recipients (111-KTR), and apheresis patients (49-AP) with positive seroconversion (de novo IgA or IgG antibody positivity by ELISA) after eight weeks.

FINDINGS

Nine months after first vaccination, receptor binding domain (RBD) antibodies were still positive in 90 % of MP, 86 % of AP, but only 55 %/48 % of DP/KTR, respectively. Seroconversion remained positive in 100 % of AP and 99·2 % of MP, but 86 %/81 % of DP/KTR, respectively. Compared to MP, DP but not KTR or AP were at risk for a strong RBD decline, while KTR kept lowest RBD values over time. By multivariate analysis, BNT162b2mRNA versus 1273-mRNA vaccine type was an independent risk factor for a strong decline of RBD antibodies. Within the DP group, only time on dialysis was another (inverse) risk factor for the DP group. Compared to humoral immunity, T-cell immunity decline was less prominent.

INTERPRETATION

While seroconverted KTR reach lowest RBD values over time, DP are at specific risk for a strong decline of RBD antibodies after successful SARS-CoV-2mRNA vaccination, which also depends on the vaccine type being used. Therefore, booster vaccinations for DP should be considered earlier compared to normal population.

Risk of strong antibody decline in dialysis and transplant patients after SARS-CoV-2mRNA vaccination: Six months data from the observational Dia-Vacc study

Background

Vulnerable dialysis and kidney transplant patients show impaired seroconversion rates compared to medical personnel eight weeks after SARS-CoV-2mRNA vaccination.

Methods

We evaluated six months follow up data in our observational Dia-Vacc study exploring specific cellular (interferon-γ release assay) or/and humoral immune responses after 2x SARS-CoV-2mRNA vaccination in 1205 participants including medical personnel (125 MP), dialysis patients (970 DP) and kidney transplant recipients (110 KTR) with seroconversion (de novo IgA or IgG antibody positivity by ELISA) after eight weeks.

Findings

Six months after vaccination, seroconversion remained positive in 98% of MP, but 91%/87% of DP/KTR (p = 0·005), respectively. Receptor binding domain-IgG (RBD-IgG) antibodies were positive in 98% of MP, but only 68%/57% of DP/KTR (p < 0·001), respectively. Compared to MP, DP and KTR were at risk for a strong IgG or RBD-IgG decline (p < 0·001). Within the DP but not KTR group male gender, peritoneal dialysis, short time on dialysis, BNT162b2mRNA vaccine, immunosuppressive drug use and diabetes mellitus were independent risk factors for a strong decline of IgG or RBD antibodies. The percentage of cellular immunity decline was similar in all groups.

Interpretation

Both vulnerable DP and KTR groups are at risk for a strong decline for IgG and RBD antibodies. In KTR, antibody titres peak at a markedly lower level and accelerated antibody decline is mixed with a delayed/increasing IgG, RBD-IgG, or cellular immune response in a 16% fraction of patients. In both populations, immune monitoring should be used for early timing of additional booster vaccinations.

Funding

This study was funded by the Else Kröner Fresenius Stiftung, Bad Homburg v. d. H., grant number Fördervertrag EKFS 2021_EKSE.27.

Humoral and cellular immunity to SARS-CoV-2 vaccination in renal transplant versus dialysis patients: A prospective, multicenter observational study using mRNA-1273 or BNT162b2 mRNA vaccine

Background

Dialysis and kidney transplant patients are vulnerable populations for COVID-19 related disease and mortality.

Methods

We conducted a prospective study exploring the eight week time course of specific cellular (interferon-γ release assay and flow cytometry) or/and humoral immune responses (ELISA) to SARS-CoV-2 boost vaccination in more than 3100 participants including medical personnel, dialysis patients and kidney transplant recipients using mRNA vaccines BNT162b2 or mRNA-1273.

Results

SARS-CoV-2-vaccination induced seroconversion efficacy in dialysis patients was similar to medical personnel (> 95%), but markedly impaired in kidney transplant recipients (42%). T-cellular immunity largely mimicked humoral results. Major risk factors of seroconversion failure were immunosuppressive drug number and type (belatacept, MMF-MPA, calcineurin-inhibitors) as well as vaccine type (BNT162b2 mRNA). Seroconversion rates induced by mRNA-1273 compared to BNT162b2 vaccine were 97% to 88% (p < 0.001) in dialysis and 49% to 26% in transplant patients, respectively. Specific IgG directed against the new binding domain of the spike protein (RDB) were significantly higher in dialysis patients vaccinated by mRNA-1273 (95%) compared to BNT162b2 (85%, p < 0.001). Vaccination appeared safe and highly effective demonstrating an almost complete lack of symptomatic COVID-19 disease after boost vaccination as well as ceased disease incidences during third pandemic wave in dialysis patients.

Conclusion

Dialysis patients exhibit a remarkably high seroconversion rate of 95% after boost vaccination, while humoral response is impaired in the majority of transplant recipients. Immunosuppressive drug number and type as well as vaccine type (BNT162b2) are major determinants of seroconversion failure in both dialysis and transplant patients suggesting immune monitoring and adaption of vaccination protocols.

Randomized clinical trial shows no substantial modulation of empathy-related neural activation by intranasal oxytocin in autism

Evidence suggests that intranasal application of oxytocin facilitates empathy and modulates its underlying neural processes, which are often impaired in individuals with autism spectrum disorders (ASD). Oxytocin has therefore been considered a promising candidate for the treatment of social difficulties in ASD. However, evidence linking oxytocin treatment to social behavior and brain function in ASD is limited and heterogeneous effects might depend on variations in the oxytocin-receptor gene (OXTR). We examined 25 male ASD patients without intellectual disability in a double-blind, cross-over, placebo-controlled fMRI-protocol, in which a single dose of oxytocin or placebo was applied intranasally. Patients performed three experiments in the MRI examining empathy for other's physical pain, basic emotions, and social pain. All participants were genotyped for the rs53576 single-nucleotide polymorphism of the OXTR. Oxytocin increased bilateral amygdala responsiveness during the physical pain task for both painful and neutral stimuli. Other than that, there were no effects of oxytocin treatment. OXTR genotype did not significantly interact with oxytocin treatment. Our results contribute to the growing body of empirical literature suggesting heterogenous effects of oxytocin administration in ASD. To draw clinically relevant conclusions regarding the usefulness of oxytocin treatment, however, empirical studies need to consider methods of delivery, dose, and moderating individual factors more carefully in larger samples.

[Autism spectrum disorder in childhood and adults: diagnosis and differential diagnoses]

Autistic disorders are summarized in DSM‑5 under the term autism spectrum disorder (ASD) and are severe, lifelong, pervasive neurodevelopmental disorders. Core features manifested even in childhood are impairments in social interaction and communication as well as restricted and repetitive behavior. The intensity of symptoms, language and cognitive impairments vary but the majority of affected individuals have below average intelligence and 80% have at least one comorbid disorder. The diverse pathology and heterogeneity in phenotypes are caused by a complex genetic etiology, which is associated with a reduced synaptic plasticity of neural networks. The disorder is associated with a clearly reduced quality of life as well as a high familial burden. The differential diagnostics have a high relevance and the diagnosis should be carried out by specialized institutions. Behavioral therapeutic interventions are indicated.

Segen oder Fluch? Das Internet als Informationsquelle über Autismus und Asperger-Syndrom

Zusammenfassung. Fragestellung: Sehr viele Menschen informieren sich heutzutage über gesundheitsrelevante Themen im Internet, wobei die Qualität dieser Informationen fraglich ist. In der vorliegenden Studie soll beispielhaft für ein psychisches Störungsbild (Autismus-Spektrum-Störung) die Qualität der Informationsquelle Internet sowie die sich daraus ergebenden Implikationen diskutiert werden. Methodik: Es wurde eine systematische Auswertung von 96 deutschsprachigen Internetseiten durchgeführt mit dem Ziel, neben konkreten Charakteristika der Internetseiten auch die Zuverlässigkeit der Publikationen, die Informationsdarstellung sowie die Gesamtqualität der Internetseiten zu bewerten und die sich aus der Darstellung ergebenden klinischen Implikationen zu analysieren. Ergebnisse: Nur bei 39 % der Internetseiten ließen sich Referenzen für wissenschaftlich fundierte Informationen feststellen, Werbung war hingegen auf 53 % der Internetseiten vorhanden. Die meisten falschen Informationen wurden im Bereich der „Behandlung“ (17 %) verbreitet. Bei 75 % der Internetseiten traf die Vollständigkeit nicht zu. Lediglich 10 % der Internetseiten thematisierte die Beeinträchtigung bzw. Belastung der Familien. Die Qualität der Seiten wurde bei 30 % als ungenügend, bei 41 % als mangelhaft und nur bei 6 % als gut beurteilt. Schlussfolgerungen: Ähnlich wie durch die bereits vorliegenden Analysen zu englischsprachigen Internetseiten festgestellt, können für viele der deutschsprachigen Seiten deutliche Qualitätsmängel konstatiert werden. Die Implikationen in Bezug auf Bestätigungsfehler, Stigmatisierung, Überidentifikation, Ingroup-Outgroup-Effekte, Kontrast- und Schneeballeffekte werden diskutiert.

Zur Validität der deutschen Fassung der ADOS-2 unter Berücksichtigung von Geschlechtseffekten

Zusammenfassung. Fragestellung: Die deutschsprachige Version der Diagnostischen Beobachtungsskala für Autistische Störungen – 2 (ADOS-2) ist eine Revision der standardisierten Verhaltensbeobachtung für Personen mit dem Verdacht auf Vorliegen einer Autismus-Spektrum-Störung (ASS). Die Studie untersucht die diagnostische Güte der originalen und revidierten Algorithmen für die Module 1 bis 3. Methodik: An einer großen Inanspruchnahmepopulation (N = 1080, Alter 1.7–20.5 Jahre) wurde die Unterscheidungsfähigkeit der ADOS-2 zu relevanten Differenzialdiagnosen untersucht. Außerdem wurden Vergleiche bezüglich der diagnostischen Güte für beide Geschlechter getrennt vorgenommen. Ergebnisse: Der revidierte Algorithmus weist eine verbesserte Sensitivität (84.9 %) bei jedoch leicht reduzierter Spezifität (85.7 %) auf. Verbesserungen der ADOS-2 betreffen vor allem Fälle von frühkindlichem Autismus und die korrekte Klassifizierung von Mädchen. Der Einschluss von repetitiven, stereotypen Verhaltensweisen in den Algorithmus erhöht die korrekte Klassifikation in den Modulen 2 und 3. Für jüngere Kinder im Modul 1 ist dies jedoch nicht der Fall. Es zeigt sich darüber hinaus eine geringere Differenzierungsfähigkeit zu internalisierenden Störungen und Störungen des Sozialverhaltens. Schlussfolgerungen: Eine gute diagnostische Güte der ADOS-2 wurde vor allem für Kinder mit durchschnittlichen kognitiven Fähigkeiten gefunden. Die Ergebnisse sprechen für eine gute Anwendbarkeit der ADOS-2 für klinische Populationen. Voraussetzung ist jedoch eine sorgfältige und breite Diagnostik durch erfahrene Untersucher.

Schlüsselwörter: ADOS, Diagnostik von Autismus-Spektrum-Störungen, Sensitivität, Spezifität

Thyroid hormone resistance without mutations in thyroid hormone receptor beta

BACKGROUND

Resistance to thyroid hormone (RTH) is a rare autosomal dominant disorder that leads to elevated free thyroid hormone levels in the presence of normal or increased serum thyroid-stimulating hormone (TSH) concentrations if it is generalized because both the pituitary and peripheral tissues are then partially resistant. In approximately 85% of patients with RTH, mutations in the thyroid hormone receptor beta (TR beta) gene can be identified.

CASE REPORT

A 68-year-old German man presented for surgical hernia repair. He was found to have elevated free T3 and T4 plasma concentrations in coexistence with goiter, unsuppressed TSH, arterial hypertension, and arthritis urica/gout. An electrocardiogram showed a normal sinus rhythm with 69 beats per minute. There were neither signs or symptoms of hyper- or hypothyroidism nor psychological abnormalities. Generalized RTH was suspected.

CONCLUSIONS

Generalized RTH should be considered in patients presenting with elevated free thyroid hormone levels and normal or increased TSH concentrations, especially if these patients appear clinically euthyroid. Signs and symptoms of hyper- and hypothyroidism should be evaluated to assure that these patients are candidates for surgical procedures such as hernia repair. Subsequent mutation analysis of the TR beta gene should be conducted to help identify family members. In approximately 15% of patients, mutations in the TR beta gene cannot be identified and raise the possibility of mosaicism.