Common variable immunodeficiency disorder (CVID) is the most common form of primary antibody immunodeficiency. Due to low antibody levels, CVID patients receive intravenous or subcutaneous immunoglobulin replacement therapy as treatment. CVID is associated with the chronic activation of granulocytes, including an increased percentage of low-density neutrophils (LDNs). In this study, we examined changes in the percentage of LDNs and the expression of their surface markers in 25 patients with CVID and 27 healthy donors (HD) after in vitro stimulation of whole blood using IVIg. An oxidative burst assay was used to assess the functionality of LDNs. CVID patients had increased both relative and absolute LDN counts with a higher proportion of mLDNs compared to iLDNs, distinguished based on the expression of CD10 and CD16. Immature LDNs in the CVID and HD groups had significantly reduced oxidative burst capacity compared to mature LDNs. Interestingly we observed reduced oxidative burst capacity, reduced expression of CD10 after stimulation of WB, and higher expression of PD-L1 in mature LDNs in CVID patients compared to HD cells. Our data indicate that that the functional characteristics of LDNs are closely linked to their developmental stage. The observed reduction in oxidative burst capacity in mLDNs in CVID patients could contribute to an increased susceptibility to recurrent bacterial infections among CVID patients.
- MeSH
- běžná variabilní imunodeficience * MeSH
- fenotyp MeSH
- lidé MeSH
- neutrofily * MeSH
- průtoková cytometrie MeSH
- respirační vzplanutí MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Common variable immunodeficiency (CVID) is characterized by an impaired postvaccination response, high susceptibility to respiratory tract infections, and a broad spectrum of noninfectious complications. Thus, patients with CVID may be at high risk for COVID-19, and vaccination's role in prevention is questionable. OBJECTIVE: We evaluated the clinical outcomes, safety, and dynamics of humoral and T-cell immune responses induced by the mRNA vaccine BNT162b2 in CVID. METHODS: This prospective observational cohort study focused on the clinical outcomes (proportion of infected patients and disease severity), safety (incidences of adverse events and changes in laboratory parameters), and dynamics of humoral (specific postvaccination and virus-neutralizing antibody assessment) and T-cell immune responses (anti-SARS-CoV-2-specific T-cell detection) in 21 patients with CVID after a two-dose administration of BNT162b2. The patients were observed for 6 months. RESULTS: Humoral response was observed in 52% of patients (11 of 21) at month 1 after vaccination but continuously decreased to 33.3% at month 6 (five of 15). Nevertheless, they had a remarkably lower anti-SARS-CoV-2 neutralizing antibody titer compared with healthy controls. The T-cell response was measurable in 46% of patients with CVID (six of 13) at month 1 and persisted over the study period. Mild infection occurred in three patients within the follow-up period (14.3%). The vaccine also exhibited a favorable safety profile. CONCLUSIONS: The BNT162b2 vaccine elicited a measurable antibody response in a high proportion of patients, but it was limited by low titer of virus-neutralizing antibodies and rapid waning of anti-receptor-binding domain SARS-CoV-2-specific antibodies. T-cell response was detected in one-third of patients and remained stable within the follow-up period. Vaccination has favorable safety and clinical-related outcomes in preventing severe COVID-19.
- MeSH
- běžná variabilní imunodeficience * MeSH
- COVID-19 * prevence a kontrola MeSH
- lidé MeSH
- neutralizující protilátky MeSH
- primární imunodeficience * MeSH
- prospektivní studie MeSH
- protilátky blokující MeSH
- protilátky virové MeSH
- SARS-CoV-2 MeSH
- vakcína BNT162 MeSH
- vakcíny * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
PURPOSE: About 15% of patients with common variable immunodeficiency (CVID) develop a small intestinal enteropathy, which resembles celiac disease with regard to histopathology but evolves from a distinct, poorly defined pathogenesis that has been linked in some cases to chronic norovirus (NV) infection. Interferon-driven inflammation is a prominent feature of CVID enteropathy, but it remains unknown how NV infection may contribute. METHODS: Duodenal biopsies of CVID patients, stratified according to the presence of villous atrophy (VA), IgA plasma cells (PCs), and chronic NV infection, were investigated by flow cytometry, multi-epitope-ligand cartography, bulk RNA-sequencing, and RT-qPCR of genes of interest. RESULTS: VA development was connected to the lack of intestinal (IgA+) PC, a T helper 1/T helper 17 cell imbalance, and increased recruitment of granzyme+CD8+ T cells and pro-inflammatory macrophages to the affected site. A mixed interferon type I/III and II signature occurred already in the absence of histopathological changes and increased with the severity of the disease and in the absence of (IgA+) PCs. Chronic NV infection exacerbated this signature when compared to stage-matched NV-negative samples. CONCLUSIONS: Our study suggests that increased IFN signaling and T-cell cytotoxicity are present already in mild and are aggravated in severe stages (VA) of CVID enteropathy. NV infection preempts local high IFN-driven inflammation, usually only seen in VA, at milder disease stages. Thus, revealing the impact of different drivers of the pathological mixed IFN type I/III and II signature may allow for more targeted treatment strategies in CVID enteropathy and supports the goal of viral elimination.
- MeSH
- atrofie komplikace patologie MeSH
- běžná variabilní imunodeficience * komplikace imunologie MeSH
- CD8-pozitivní T-lymfocyty MeSH
- imunoglobulin A MeSH
- infekce viry z čeledi Caliciviridae * imunologie MeSH
- interferony MeSH
- lidé MeSH
- Norovirus * fyziologie MeSH
- zánět komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- agamaglobulinemie diagnóza farmakoterapie MeSH
- běžná variabilní imunodeficience diagnóza imunologie terapie MeSH
- deficience IgA MeSH
- imunodeficience s hyper-IgM diagnóza terapie MeSH
- imunologické testy metody MeSH
- lidé MeSH
- novorozenecký screening MeSH
- primární imunodeficience diagnóza terapie MeSH
- protilátky analýza krev MeSH
- syndromy imunologické nedostatečnosti * diagnóza terapie MeSH
- vakcinace metody MeSH
- Check Tag
- lidé MeSH
Common variable immune deficiency (CVID) is a heterogeneous disorder characterized by recurrent infections, low levels of serum immunoglobulins, and impaired vaccine responses. Autoimmune manifestations are common, but B cell central and peripheral selection mechanisms in CVID are incompletely understood. Here, we find that receptor editing, a measure of central tolerance, is increased in transitional B cells from CVID patients and that these cells have a higher immunoglobulin κ:λ ratio in CVID patients with autoimmune manifestations than in those with infection only. Contrariwise, the selection pressure in the germinal center on CD27bright memory B cells is decreased in CVID patients with autoimmune manifestations. Finally, functionally, T cell-dependent activation showed that naive B cells in CVID patients are badly equipped for activation and induction of mismatch repair genes. We conclude that central tolerance is functional whereas peripheral selection is defective in CVID patients with autoimmune manifestations, which could underpin the development of autoimmunity.
- MeSH
- autoprotilátky * MeSH
- běžná variabilní imunodeficience * diagnóza epidemiologie MeSH
- imunologické testy MeSH
- lidé MeSH
- prevalence MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
- práce podpořená grantem MeSH
Bežná variabilná imunodeficiencia je heterogénnou skupinou ochorení, ktoré spája podobný laboratórny nález v imunoprofile. Hoci ide o prevažne protilátkovú poruchu imunity, zmeny a odchýlky nachádzame aj v oblasti celulárnej imunity. Diagnostické kritériá a klasifikačné systémy zatiaľ nie sú schopné stanoviť klinicky plne využiteľné fenotypové rozdelenie pacientov. V tejto problematike by mohla kľúčovú úlohu zohrať genotypová klasifikácia. Zoznam kauzálnych génov pre vznik ochorenia sa neustále rozširuje. Mutácie v známych génoch sa ale potvrdia len u približne 10–25 % pacientov. Aj tieto nálezy je potrebné správne interpretovať, čo je často značne komplikované. Medzi ďalšie zvažované príčinné faktory vzniku patria epigenetické zmeny, oligogénna a polygénna dedičnosť alebo vplyv vonkajšieho prostredia.
Common variable immunodeficiency is heterogeneous group of disorders that belongs to primary immunodeficiency disorders. Combined defect of humoral and cellular immunity is the main sign. Diagnostic criteria and classification are still insufficient for optimal clinical use. This problem can be solved by genotype classification. There are many causal genes but these are found only in 10 % to 25 % of the patients. Moreover, these findings have to be interpreted correctly, which is complicated. Other possible causes are epigenetics, oligogenic, polygenic inheritance and environmental factors.
INTRODUCTION: Reports on the immunogenicity and efficacy of the Spikevax® vaccine against SARS-CoV-2 in immunodeficient patients are still scarce. We aimed to evaluate the safety and immunogenicity of the vaccine in patients with primary humoral immunodeficiency. METHODS: We enrolled 46 patients, including 34 patients with common variable immunodeficiency (CVID), 10 patients with unclassified hypogammaglobulinemia (HypoIg), and 2 patients with X-linked agammaglobulinemia. We collected the blood samples before vaccination (D 0), and 10 days (D +38) and 90 days (D +118) after the second vaccination. Further, we quantified SARS-CoV-2-specific T-cell response (QuantiFERON ELISA test), serum anti-RBD IgG, and anti-RBD IgA-specific antibodies (enzyme immunoassay). RESULTS: We found that the vaccination elicited predominantly mild adverse events, comparable to healthy population. Vaccination response negatively correlated with a value of Immune Deficiency and Dysregulation Activity in all measured parameters. D +38, seroconversion for anti-RBD IgG and anti-RBD IgA was observed in 65% and 21% CVID patients, respectively. SARS-CoV-2-specific T-cell response was detected in less than 50% of CVID patients. Meanwhile, HypoIg patients had 100%, 90%, and 60% positivity rates for anti-RBD IgG, anti-RBD IgA, and T-cell response, respectively. Three months after the second vaccination, 82% of the responders remained positive for anti-RBD IgG, but only less than 50% remained positive for T-cell activity in CVIDs. Low immunogenicity was observed in patients with lung involvement and/or rituximab treatment history. No SARS-CoV-2 infection was reported within 6 months after the second vaccination. CONCLUSION: Spikevax® seems to be safe with satisfactory immunogenicity in patients with primary humoral immunodeficiency.
- MeSH
- běžná variabilní imunodeficience * terapie MeSH
- COVID-19 * prevence a kontrola MeSH
- imunoglobulin A MeSH
- imunoglobulin G MeSH
- lidé MeSH
- messenger RNA MeSH
- SARS-CoV-2 MeSH
- syndromy imunologické nedostatečnosti * MeSH
- vakcinace MeSH
- vakcíny proti COVID-19 * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- běžná variabilní imunodeficience komplikace MeSH
- genetické nemoci vrozené MeSH
- intersticiální plicní nemoci * diagnóza etiologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- syndromy imunologické nedostatečnosti * genetika komplikace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Klíčová slova
- Goodův syndrom,
- MeSH
- běžná variabilní imunodeficience imunologie komplikace MeSH
- deficience IgA imunologie komplikace MeSH
- dospělí * MeSH
- lidé MeSH
- opožděná diagnóza MeSH
- primární imunodeficience * diagnóza terapie MeSH
- Check Tag
- dospělí * MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
