Glucocorticoid use as a cause of non-cellular immune response to SARS-Cov2 Spike in patients with immune system diseases. Issue 133 (December 2022)

• Record Type: Journal Article
• Authors: Renaudineau, Yves; Sailler, Laurent; Abravanel, Florence; Izopet, Jacques; Delourme, Adrien; Biotti, Damien; Ciron, Jonathan; Treiner, Emmanuel; Congy-Jolivet, Nicolas; Bost, Chloé; Blancher, Antoine
• Is Part Of: Journal of autoimmunity. Issue 133(2022)
• Publication Date: 2022-12
• Subjects: COVID-19 -- Immune system diseases -- Spike -- IGRA -- Antibody -- Systemic lupus erythematosus -- Multiple sclerosis -- Vasculitis -- Sarcoidosis -- Glucocorticoids; Autoimmunity -- Periodicals; Autoimmune diseases -- Periodicals; Autoantibodies -- Periodicals; Autoimmune Diseases -- Periodicals; Auto-immunité -- Périodiques; Maladies auto-immunes -- Périodiques; Electronic journals; 616.978005
• DOI: 10.1016/j.jaut.2022.102912
• Languages: English
• ISSNs: 0896-8411

Abstract

Abstract: Disease modifying therapies compromise immune response to SARS-Cov2 or its vaccine in patients with immune system diseases (ISD). Therefore, analysis of the humoral and cellular responses against Spike is of utmost importance to manage ISD patients. A single-center retrospective study was conducted to evaluate the impact of COVID-19 immunization in 87 ISD patients and 81 healthy controls. We performed a whole blood interferon gamma release assay using SARS-Cov2 Spike and Nucleocapsid recombinant proteins in order to evaluate T-cell memory response, and an IgG anti-Spike ELISA to evaluate humoral response. Cellular (26.4%) and humoral (44.8%) responses were negative against Spike in ISD patients following COVID-19 immunization. In univariate analysis, an anti-Spike T cell defective response was associated with the use of glucocorticoids (Odds ratio [OR] = 10.0; p < 10 −4 ), serum albumin level ≤40 g/L (OR = 18.9; p < 10 −4 ), age over 55 years old (OR = 3.9, p = 0.009) and ≤2 vaccine injections (OR = 4.9; p = 0.001). The impact of glucocorticoids persisted after adjustment for age and number of vaccine injections (OR = 8.38, p < 0.001). In contrast, the humoral response was impacted by the use of anti-CD20 mAb (OR = 24.8, p < 10 −4 ), and an extended time since immunization (≥75 days; OR = 4.3, p = 0.002). Double defective cellular/humoral responses (6.9%) were typically encountered in glucocorticoids and/or anti-CD20 mAb treated ISD with a serum albumin level ≤40 g/L (OR = 17.5; p = 0.002). Glucocorticoid usage, B cell depleting therapies, and a low serum albumin level were the main factors associated with a non-response to COVID-19 immunization in ISD patients. These results need further confirmation in larger studies. Highlights: Anti-Spike cellular and humoral responses are altered in immune system diseases. Anti-Spike cellular response is affected by long-term glucocorticoid usage. Anti-Spike humoral response is impaired by B-cell depleting and glucocorticoid therapies. Serum albumin level, time from immunization, and >55 years old constitute additional risks for defective immune responses.