Fractional dosing can be a cost-effective vaccination strategy to accelerate individual and herd immunity in a pandemic. We assessed the immunogenicity and safety of primary intradermal (ID)... Show moreFractional dosing can be a cost-effective vaccination strategy to accelerate individual and herd immunity in a pandemic. We assessed the immunogenicity and safety of primary intradermal (ID) vaccination, with a 1/5th dose compared with the standard intramuscular (IM) dose of mRNA-1273 in SARS-CoV-2 naive persons. We conducted an open-label, non-inferiority, randomized controlled trial in the Netherlands between June and December 2021. One hundred and fifty healthy and SARS-CoV-2 naive participants, aged 18-30 years, were randomized (1:1:1) to receive either two doses of 20 mu g mRNA-1273 ID with a standard needle (SN) or the Bella-mu (R) needle (BM), or two doses of 100 mu g IM, 28 days apart. The primary outcome was non-inferiority in seroconversion rates at day 43 (D43), defined as a neutralizing antibody concentration threshold of 465 IU/mL, the lowest response in the IM group. The non-inferiority margin was set at -15%. Neutralizing antibody concentrations at D43 were 1789 (95% CI: 1488-2150) in the IM and 1263 (951-1676) and 1295 (1020-1645) in the ID-SN and ID-BM groups, respectively. The absolute difference in seroconversion proportion between fractional and standard-dose groups was -13.95% (-24.31 to -3.60) for the ID-SN and -13.04% (-22.78 to -3.31) for the ID-BM group and exceeded the predefined non-inferiority margin. Although ID vaccination with 1/5th dose of mRNA-1273 did not meet the predefined non-inferior criteria, the neutralizing antibody concentrations in these groups are far above the proposed proxy for protection against severe disease (100 IU/mL), justifying this strategy in times of vaccine scarcity to accelerate mass protection against severe disease. Show less
It is not exactly clear yet which type of immune response prevails to accomplish viral clearance in coronavirus disease 2019 (COVID-19). Studying a patient with chronic lymphocytic leukemia and... Show moreIt is not exactly clear yet which type of immune response prevails to accomplish viral clearance in coronavirus disease 2019 (COVID-19). Studying a patient with chronic lymphocytic leukemia and hypogammaglobulinemia who suffered from COVID-19 provided insight in the immunological responses after treatment with COVID-19 convalescent plasma (CCP). Treatment consisted of oxygen, repeated glucocorticosteroids and multiple dosages of CCP guided by antibody levels. Retrospectively performed humoral and cellular immunity analysis made clear that not every serological test for COVID-19 is appropriate for follow-up of sufficient neutralizing antibodies after CCP. In retrospect, we think that CCP merely bought time for this patient to develop an adequate cell immune response which led to viral clearance and ultimately clinical recovery. Show less
Pothast, C.R.; Dijk, K. van; Pool, E.S.; Halkes, C.J.M.; Heemskerk, M.H.M.; Tjon, J.M.L. 2022
Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) specific CD4(+ )and CD8(+) T cells in SARS- CoV- 2-unexposed donors has been explained by the presence of T cells primed... Show moreDetection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) specific CD4(+ )and CD8(+) T cells in SARS- CoV- 2-unexposed donors has been explained by the presence of T cells primed by other coronaviruses. However, based on the relatively high frequency and prevalence of cross-reactive T cells, we hypothesized cytomegalovirus (CMV) may induce these cross-reactive T cells. Stimulation of pre-pandemic cryo-preserved peripheral blood mononuclear cells (PBMCs) with SARS- CoV- 2 peptides revealed that frequencies of SARS- CoV- 2-specific T cells were higher in CMVseropositive donors. Characterization of these T cells demonstrated that membrane-specific CD4(+ )and spike-specific CD8(+) T cells originate from cross-reactive CMVspecific T cells. Spike-specific CD8(+ )T cells recognize SARS- CoV- 2 spike peptide FVSNGTHWF (FVS) and dissimilar CMV pp65 peptide IPSINVHHY (IPS) presented by HLA- B*35:01. These dual IPS/FVS-reactive CD8(+) T cells were found in multiple donors as well as severe COVID- 19 patients and shared a common T cell receptor (TCR), illustrating that IPS/FVS- cross-reactivity is caused by a public TCR. In conclusion, CMVspecific T cells cross react with SARS-CoV- 2, despite low sequence homology between the two viruses, and may contribute to the pre-existing immunity against SARS-CoV- 2. Show less
Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) specific CD4(+ )and CD8(+) T cells in SARS- CoV- 2-unexposed donors has been explained by the presence of T cells primed... Show moreDetection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) specific CD4(+ )and CD8(+) T cells in SARS- CoV- 2-unexposed donors has been explained by the presence of T cells primed by other coronaviruses. However, based on the relatively high frequency and prevalence of cross-reactive T cells, we hypothesized cytomegalovirus (CMV) may induce these cross-reactive T cells. Stimulation of pre-pandemic cryo-preserved peripheral blood mononuclear cells (PBMCs) with SARS- CoV- 2 peptides revealed that frequencies of SARS- CoV- 2-specific T cells were higher in CMVseropositive donors. Characterization of these T cells demonstrated that membrane-specific CD4(+ )and spike-specific CD8(+) T cells originate from cross-reactive CMVspecific T cells. Spike-specific CD8(+ )T cells recognize SARS- CoV- 2 spike peptide FVSNGTHWF (FVS) and dissimilar CMV pp65 peptide IPSINVHHY (IPS) presented by HLA- B*35:01. These dual IPS/FVS-reactive CD8(+) T cells were found in multiple donors as well as severe COVID- 19 patients and shared a common T cell receptor (TCR), illustrating that IPS/FVS- cross-reactivity is caused by a public TCR. In conclusion, CMVspecific T cells cross react with SARS-CoV- 2, despite low sequence homology between the two viruses, and may contribute to the pre-existing immunity against SARS-CoV- 2. Show less
Virus-specific cellular and humoral responses are major determinants for protection from critical illness after SARS-CoV-2 infection. However, the magnitude of the contribution of each of the... Show moreVirus-specific cellular and humoral responses are major determinants for protection from critical illness after SARS-CoV-2 infection. However, the magnitude of the contribution of each of the components to viral clearance remains unclear. Here, we studied the timing of viral clearance in relation to 122 immune parameters in 102 hospitalised patients with moderate and severe COVID-19 in a longitudinal design. Delayed viral clearance was associated with more severe disease and was associated with higher levels of SARS-CoV-2-specific (neutralising) antibodies over time, increased numbers of neutrophils, monocytes, basophils, and a range of pro-inflammatory cyto-/chemokines illustrating ongoing, partially Th2 dominating, immune activation. In contrast, early viral clearance and less critical illness correlated with the peak of neutralising antibodies, higher levels of CD4 T cells, and in particular naive CD4+ T cells, suggesting their role in early control of SARS-CoV-2 possibly by proving appropriate B cell help. Higher counts of naive CD4+ T cells also correlated with lower levels of MIF, IL-9, and TNF-beta, suggesting an indirect role in averting prolonged virus-induced tissue damage. Collectively, our data show that naive CD4+ T cell play a critical role in rapid viral T cell control, obviating aberrant antibody and cytokine profiles and disease deterioration. These data may help in guiding risk stratification for severe COVID-19. Show less
Roukens, A.H.E.; Pothast, C.R.; Konig, M.; Huisman, W.; Dalebout, T.; Tak, T.; ... ; Collaboration COVID-19 LUMC Grp 2021
Systemic immune cell dynamics during coronavirus disease 2019 (COVID-19) are extensively documented, but these are less well studied in the (upper) respiratory tract, where severe acute respiratory... Show moreSystemic immune cell dynamics during coronavirus disease 2019 (COVID-19) are extensively documented, but these are less well studied in the (upper) respiratory tract, where severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replicates(1-6). Here, we characterized nasal and systemic immune cells in individuals with COVID-19 who were hospitalized or convalescent and compared the immune cells to those seen in healthy donors. We observed increased nasal granulocytes, monocytes, CD11c(+) natural killer (NK) cells and CD4(+) T effector cells during acute COVID-19. The mucosal proinflammatory populations positively associated with peripheral blood human leukocyte antigen (HLA)-DRlow monocytes, CD38(+)PD1(+)CD4(+) T effector (T-eff) cells and plasmablasts. However, there was no general lymphopenia in nasal mucosa, unlike in peripheral blood. Moreover, nasal neutrophils negatively associated with oxygen saturation levels in blood. Following convalescence, nasal immune cells mostly normalized, except for CD127(+) granulocytes and CD38(+)CD8(+) tissue-resident memory T cells (T-RM). SARS-CoV-2-specific CD8(+) T cells persisted at least 2 months after viral clearance in the nasal mucosa, indicating that COVID-19 has both transient and long-term effects on upper respiratory tract immune responses. Show less
