Drip Drip Drip its coming as the rain arrives so are those B cell papers
I recently saw a colleague who was concerned about whether it was OK to cite a pre-print because it was not peer-reviewed….However this is the new norm and in reality you can review it yourself. Also some reviewed papers are not without issues.
You have to determine whether you want to live under a “knowledge rock” for 6-9 months whilst the publication process unfolded or do you want to learn. Now the other important thing that COVID-19 has meant is that any paper that is published soon gets replicated or refuted.
So this paper says “the question remains as whether B-cell depleted patients could still mount a functional T cell response to COVID-19 vaccines, which may provide some level of protection against severe disease”
Natacha et al. medRxiv 2021.07.21.21260928; doi: https://doi.org/10.1101/2021.07.21.21260928
All we have to say to the referees of this one is read the paper already saying the same thing…Yes you do make a T cell reponse and it appears to the case that there is a stronger CD8 response in people who have a weak B cell response
Likewise you can ask do you need to do massive studies….I think alot of small studies saying the same thing add to likihood of a real.
Again we hear “antibody levels in patients correlated with level of circulating CD19+ B cells (measured at day 30 after
So as you can see every one with a 1% CD19+ count made an antibody response of some level, suggesting that if you have this level at the time of vaccination and perhaps boosts then you make an antibody response.
You can see most people made an antibody response but some of there were very low
Sadly they did not give the time window of infusion to vaccine, maybe we have to assume it was 6 monthly)
Madelon N et al. Patients treated with anti-CD20 therapy can mount robust T cell responses
2 to mRNA-based COVID-19 vaccines. medRxiv preprint doi: https://doi.org/10.1101/2021.07.21.21260928
Patients treated with anti-CD20 therapy are particularly at risk of developing severe COVID-19, however little is known regarding COVID-19 vaccine effectiveness in this population. This study assesses humoral and T-cell responses to mRNA-based COVID-19 vaccines in patients treated with rituximab for rheumatic diseases or ocrelizumab for multiple sclerosis (n=37), compared to immunocompetent individuals (n=22). SARS-CoV-2-specific antibodies were detectable in only 69.4% of patients and at levels that were significantly lower compared to controls who all seroconverted. In contrast to antibodies, Spike (S)-specific CD4+ T cells were equally detected in immunocompetent and anti-CD20 treated patients (85-90%) and mostly of a Th1 phenotype. Response rates of S-specific CD8+ T cells were higher in ocrelizumab (96.2%) and rituximab-treated patients (81.8%) as compared to controls (66.7%). Vaccine-specific CD4+ and CD8+ T cells were polyfunctional but expressed more IL-2 in patients than in controls. In summary, our study suggests that patients on anti-CD20 treatment are able to mount potent T-cell responses to mRNA COVID-19 vaccines, despite impaired humoral responses. This could play an important role in the prevention of severe COVID-19.
This view of the B cell levels being a biomarker of antibody response is evident in rheumatoid arthritis
Stefanski et al. B cell numbers predict humoral and cellular response upon SARS-CoV-2 vaccination among patients treated with rituximab. MedRxiv doi: https://doi.org/10.1101/2021.07.19.21260803
Objectives Patients with autoimmune inflammatory rheumatic diseases receiving rituximab (RTX) therapy show substantially impaired anti-SARS-CoV-2 vaccine humoral but partly inducible cellular immune responses. However, the complex relationship between antigen-specific B and T cells and the level of B cell repopulation necessary to achieve anti-vaccine responses remain largely unknown.
Methods Antibody responses to SARS-CoV-2 vaccines and induction of antigen-specific B and CD4/CD8 T cell subsets were studied in 19 rheumatoid arthritis (RA) and ANCA-associated vasculitis (AAV) patients receiving RTX, 12 RA patients on other therapies and 30 healthy controls after SARS-CoV-2 vaccination with either mRNA or vector based vaccines.
Results A minimum of 10 B cells/µL in the peripheral circulation was necessary in RTX patients to mount seroconversion to anti-S1 IgG upon SARS-CoV-2 vaccination. RTX patients lacking IgG seroconversion showed reduced antigen-specific B cells, lower frequency of TfH-like cells as well as less activated CD4 and CD8 T cells compared to IgG seroconverted RTX patients. Functionally relevant B cell depletion resulted in impaired IFNγ secretion by spike-specific CD4 T cells. In contrast, antigen-specific CD8 T cells were reduced in patients independently of IgG formation.
Conclusions Patients receiving rituximab with B cell numbers above 10 B cells/µl were able to mount humoral and more robust cellular responses after SARS-CoV-2 vaccination that may permit optimization of vaccination in these patients. Mechanistically, the data emphasize the crucial role of co-stimulatory B cell functions for the proper induction of CD4 responses propagating vaccine-specific B and plasma cell differentiation.
B cells seem to give a biomarker of antibody responses
It seems to me that the manufacturers/government should investigate this pretty soon…..because it they don’t someone else will. The data is mounting. Measure CD19 B cell levels check there are 2% CD19 B cells (>10cells/microlitre), boost with vaccine and measure antibody response 1-2 weeks later. You may need to delay the ocrelizumab dose to achieve this level in more people. Is it worth the effort. However remember many people with not get this B cell level. Do this before mass boosters occurs
COI Multiple but not relevant.
Disclaimer: Please note that the opinions expressed here are those of the author and do not reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust or Queen Mary Univeristy of London.