Passive immunization with mAbs has been employed in COVID-19. We performed a systematic review of the literature assessing the endogenous humoral immune response against SARS-CoV-2 in patients treated with mAbs. Administration of mAbs in seronegative patients led to a reduction in both antibody titres and neutralizing activity against the virus.
The decline in vaccine efficacy and the risk of reinfection by SARS-CoV-2 make new studies important to better characterize the immune response against the virus and its components. Here, we investigated the pattern of activation of T-cells and the expression of inflammatory factors by PBMCs obtained from naïve and previously infected subjects following COVID-19 vaccination, after PBMCs stimulation with S1, RBD, and N-RBD SARS-CoV-2 proteins. PBMCs showed low levels of ACE2 and TMPRSS2 transcripts, which were not modulated by the exposure of these cells to SARS-CoV-2 proteins. Compared to S1 and RBD, N-RBD stimulation showed a greater ability to stimulate T-cell reactivity, according to CD25 and CD69 markers. Interestingly, T-cell reactivity was more pronounced in vaccinated subjects with prior SARS-CoV-2 infection than in vaccinated donors who never had been diagnosed with COVID-19. Finally, N-RBD stimulation promoted greater expression of IL-6 and IFN-γ in PBMCs, which reinforces the greater immunogenic potential of this protein in the vaccinated subjects. These data suggest that PBMCs from previously infected and vaccinated subjects are more reactive than those derived from just vaccinated donors. Moreover, the N-RBD together viral proteins showed a greater stimulatory capacity than S1 and RBD viral proteins.
Introduction: The AbC-19™ lateral flow immunoassay (LFIA) performance was evaluated on plasma samples from a SARS-CoV-2 vaccination cohort, WHO international standards for anti-SARS-CoV-2 IgG (human), individuals ≥2 weeks from infection of RT-PCR confirmed SARS-CoV-2 genetic variants, as well as microorganism serology.
Methods: Pre-vaccination to three weeks post-booster samples were collected from a cohort of 111 patients (including clinically extremely vulnerable patients) from Northern Ireland. All patients received Oxford-AstraZeneca COVID-19 vaccination for the first and second dose, and Pfizer-BioNTech for the third (first booster). WHO international standards, 15 samples from 2 variants of concern (Delta and Omicron) and cross-reactivity with plasma samples from other microorganism infections were also assessed on AbC-19™.
Results: All 80 (100%) participants sampled post-booster had high positive IgG responses, compared to 38/95 (40%) participants at 6 months post-first vaccination. WHO standard results correlated with information from corresponding biological data sheets, and antibodies to all genetic variants were detected by LFIA. No cross-reactivity was found with exception of one (of five) Dengue virus samples.
Conclusion: These findings suggest BNT162b2 booster vaccination enhanced humoral immunity to SARS-CoV-2 from pre-booster levels, and that this antibody response was detectable by the LFIA. In combination with cross-reactivity, standards and genetic variant results would suggest LFIA may be a cost-effective measure to assess SARS-CoV-2 antibody status.
The 2019 Coronavirus disease (COVID-19) vaccine is a major weapon in the fight against the severe acute respiratory syndrome brought about by coronavirus 2 (SARS-CoV-2). The vaccine significantly reduces the risk and severity of infection by SARS-CoV-2. Patients with systemic lupus erythematosus (SLE) need protection from vaccine-preventable diseases including COVID-19. SLE patients have higher rates of severe infections due to immunosuppressive therapies and multiple immunologic defects – both of which are capable of blunting the immune responses after vaccination. In the management of COVID-19, recommendations have been developed to guide adjustments and/or continuation of immunosuppressive therapies for an effective immune response following vaccination with mRNA-based or viral vector-delivered vaccines. Monoclonal antibodies have also become available since December 2021. Here we present three cases of SLE patients who contracted COVID-19 after vaccination. One was managed in ambulatory settings and two required inpatient hospital admission.
Little is known about the efficacy and safety of the anti-interleukin 5 monoclonal antibody mepolizumab (MPZ) in patients with eosinophilic granulomatosis with polyangiitis (EGPA) in real-life. We thus evaluated disease activity, damage and disease-related complications in 14 patients with EGPA receiving MPZ for refractory disease for a median time of 16 months in comparison with up to five years before MPZ start. Asthma exacerbation rates, the Birmingham Vasculitis Activity Score and corticosteroid dosage decreased during MPZ (p < 0.001, p < 0.001 and p = 0.001, respectively). Five patients could discontinue prednisone. Infection rates were higher during MPZ (p < 10–6), but no rises in hospitalizations, asthma exacerbations or damage accrual were observed. Real-life data confirm the effectiveness of MPZ in refractory EGPA with active asthma. Higher infections rates are in line with other studies and might be due to relative overreporting secondary to increased visit frequency, although a pharmacological effect could not be ruled out.
The use of immunoglobulin treatment has been increasing for various indications. The objective of this study was to evaluate clinical use of immunoglobulin therapy in Iceland, estimate off-label usage and describe possible changes in this treatment option.
All prescriptions for intravenous or subcutaneous immunoglobulin treatment require authorisation from Landspitali University Hospital. Patient information is registered and was retrieved for the period 2010 to 2019.
A total of 921 patients received immunoglobulin treatment in the study period, intravenous therapy was given in 895 (97.2%) of the cases. Registered indications were 667, off-label indications were 245 and uncertain were nine. The total annual number of patients receiving immunoglobulin treatment increased from 87 in 2010 to 392 in 2019. The increase in immunoglobulin usage was both for registered and off-label indications, 61 to 309 and 26 to 83, respectively.
Continually increasing demand and global shortage dictates careful consideration of indications before initiating or continuing treatment with immunoglobulins.
With global shortage of immunoglobulins, careful consideration and patient selection is important.
Increasing immunoglobulin usage improves treatment for many patients. However, immunoglobulins are a limited resource and prudent use is imperative.
Evidence suggests vitamin D3 resistance with gene polymorphisms related to its metabolism to have a potential role in the patho-prognosis of psoriasis. We report 6 cases of psoriasis treated with daily oral Vitamin D3 (25 hydroxy cholecalciferol) in doses ranging from 30,000 IU to 60,000 IU over a period of 2 to 6 months and then followed by lower daily maintenance dose. The dose of vitamin D3 was adjusted based on the drop in the level of parathyroid hormone as the ionized calcium levels were also periodically monitored to prevent hypercalcemia. Complete control of psoriasis was observed within a span of 2–6 months, which was measured by Psoriasis Area and Severity Index (PASI) and a symptom Visual analog scale. Our observations suggest that supervised, daily oral higher than usual Vitamin D3 can be given safely as an effective therapeutic modality for treating psoriasis.
Salivary duct carcinoma (SDC) is a high-grade malignant tumor that mainly develops in the salivary glands, and SDC patients have a 5-year survival rate of less than 50%. Thirteen SDC patients (11 male and 2 female, average age 67.2 years) with primary salivary gland carcinoma who received primary treatment in our department from 2005 to 2016.
Although markers such as androgen receptors and gross cystic disease fluid protein-15 are effective in diagnosing SDC, there are no effective tumor-specific markers for prognosis prediction. Therefore, we investigated the expressions of human epidermal growth factor receptor 2 (Her2), Ki-67, EGFR, p16, P53 and PD-L1, and examined their prognostic effect.
Multivariate analysis showed that high Her2 expression was an exacerbating prognostic factor. In the future, the use of molecular-targeted drugs and immune checkpoint inhibitors for salivary gland malignancies may become more frequent. Her2 expression could be used as a predictor of prognosis.
Influenza is an infectious respiratory disease caused by influenza A and B, which is a virus characterized by a high mutation rate with new strains appearing regularly, making regular booster vaccinations necessary.
In this study, we evaluated the immune status of Influenza A and B by using ELISA. A questionnaire was utilized to appraise the immunization anamnesis and the stance on vaccination.
In total, 202 probands participated in this study. 35.6% of the probands were vaccinated, 10.9% indicated a confirmed influenza infection. 88.1% had a positive influenza A titer, whereas a positive influenza B titer was determined in only 38.6%. Additionally, a correlation between vaccination and titer could be observed.
In this study, we were able to show a higher vaccination rate in our cohort than the Austrian average. Additionally, a higher percentage showed a positive influenza A titer compared to influenza B titer.
IL-10 receptor (IL-10R) deficiency is a rare immune dysregulation disorder that is characterized by early-onset and life-threatening inflammatory bowel disease (IBD). Activation of the IL-10R inhibits the release of pro-inflammatory cytokines resulting in decreased inflammation. Herein, we present a case of novel homozygous IL-10RA mutation (c.243T>A; p.Y81*) resulting in early-onset Crohn's disease and failure to thrive who was treated with anakinra (IL-1 blocker). His disease course was complicated with IgA nephropathy while anakinra was held for the treatment of osteomyelitis and improved when anakinra was restarted. A year later, he developed inflammatory brain disease and Hemophagocytic Lymphohistiocytosis (HLH), which was treated with high dose steroid and hematopoietic stem cell transplant (HSCT). This case highlights IgA nephropathy, CNS autoinflammation, and HLH as possible extraintestinal manifestations of IL-10 receptor deficiency, especially in the setting of delayed stem cell transplantation.
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