Do Patients With Antibody Deficiency Benefit From COVID-19 Vaccine?

Patients with antibody deficiency due to X-linked agammaglobulinemia (XLA) and common variable immunodeficiency (CVID) may benefit from SARS-CoV-2 vaccination because of specific T cell immunity generation, according to a study of patients at 2 academic centers in the US. Results of the study were presented during the American Academy of Allergy, Asthma & Immunology (AAAAI) 2022 Annual Meeting, held in Phoenix, Arizona, February 25 to 28.

XLA is characterized by very low levels of immunoglobulins, and CVID is typified by low levels of protective antibodies and an increased risk of infections. Both are primary immune deficiency diseases. Patients with antibody deficiency are highly susceptible to SARS-Co V-2 infection, but current data is lacking on the effectiveness of SARS­CoV-2 vaccination in patients with XLA and CVID. Because T cell responses are essential for antiviral control, the researchers sought to explore whether individuals who are antibody deficient can produce SARS-CoV-2-specific CD4+ and CD8+ T cell responses to vaccination or infection.

The researchers recruited XLA and CVID patients 2 months to 65  years of age from the Primary Immune Deficiency Diseases Registry and obtained blood samples before vaccination and at 7, 21, and 120 days after vaccination with the Pfizer/BioNTech or Moderna mRNA vaccines. Samples also were obtained from patients with a history of COVID-19. The investigators then measured spike (S) protein-specific T cell responses after stimulation with peptide pools of S proteins from the Wuhan strain, or alpha, beta, and delta variants by intracellular cytokine staining utilizing flow cytometry.

Of the 3 XLA and 3 CVID patients, 2 participants from each group showed post-vaccine responses. All vaccinated patients demonstrated detectable, specific CD4+ and CD8+ T cell responses between days 7 and 21 to the Wuhan and variant strains. In the cohort of 2 XLA and 2 CVID patients who had a history of COVID-19, the 2 XLA patients developed CD4 + but no CD8+ T cell responses. The CVID patients displayed greater CD8+ T cell responses, however.

“Despite antibody deficiency, our preliminary data suggest that XLA and CVID patients may benefit from SARS-CoV-2 vaccination by generating specific T cell immunity with the potential to limit disease severity,” the authors determined.

Reference

Wonnaparhown A, Curtis A, Fischer B, et al. T Cell Responses to SARS-CoV-2 Vaccination and Infection in Antibody Deficiency Diseases. Presented at: American Academy of Allergy, Asthma & Immunology (AAAAI) 2022 Annual Meeting; February 25–28, 2022; Phoenix, AZ.  Abstract 197.