Same again from Sweden…The Hare arrives

S

This first surfaced many moons ago on SSRN as a preprint when only people taking anti-CD20 who were naturally infected were included. It suggested that most people made an anybody response when infected with SARS-CoV-2 (Only about 25% seroconverted on anti-CD20 (which has been shonw by many others) and not on anti-CD20) and that vaccines were not going to be a problem….How wrong that turned out to be, but the paper now surfaces with vaccine data. Guess what.?…Yep the antibody responses after vaccination is blunted and there is a T cell response so it supports a number of studies by the tortoises…so this is yet another paper saying the same thing. So we can be increasingly confident that this story is correct. What it means is the question I can’t answer.

They show you can make antibodies when there are no B cells in the blood

They also say “When analyzing the percentages of B-cells, all seronegative samples displayed less than 0.2% B-cells of live lymphocytes. Interestingly, among the seropositive pwMS, there were also two samples with less than 0.2% B-cells (Figure 6D), indicating that a virtual absence of B-cells in peripheral blood is not a good predictor of not producing detectable antibodies after vaccination”. However you can see that if you have 1% B cells you are more likely to seroconvert. Those over 6 months delay are more likely to seroconvert 5/5 verse 2/5 less than 6 months

  • B cell depleting therapy might blunt antibody responses after COVID-19 infection or vaccination
  • Patients with no detectable B cells in the blood might still produce antibodies
  • A majority of patients that do not develop antibodies still display a T-cell response
  • SARS-CoV-2 T-cells produce Th1 cytokines both in patients on BCDT and untreated

Klara Asplund Högelin, Nicolas Ruffin, Elisa Pin, Anna Månberg, Sophia Hober, Guro
Gafvelin, Hans Grönlund, Peter Nilsson, Mohsen Khademi, Tomas Olsson, Fredrik
Piehl, Faiez Al Nimer Development of humoral and cellular immunological memory against SARS-CoV-2 despite B-cell depleting treatment in multiple sclerosis.PII: S2589-0042(21)01046-4 ISCIENCE DOI: https://doi.org/10.1016/j.isci.2021.103078

B-cell depleting therapies (BCDTs) are widely used as immunomodulating agents for
autoimmune diseases such as multiple sclerosis. Their possible impact on development of
immunity to SARS-CoV-2 has raised concerns with the COVID-19 pandemic. We here
evaluated the frequency of COVID-19-like symptoms and determined immunological
responses in participants of an observational trial comprising several multiple sclerosis disease
modulatory drugs, (COMBAT-MS; NCT03193866) and in eleven patients after vaccination,
with a focus on BCDT. Almost all seropositive and 17.9% of seronegative patients on BCDT,
enriched for a history of COVID-19-like symptoms, developed anti-SARS-CoV-2 T-cell
memory and T-cells displayed functional similarity to controls producing IFN-γ and TNF.
Following vaccination, vaccine-specific humoral memory was impaired, while all patients
developed a specific T-cell response. These results indicate that BCDTs do not abrogate SARSCoV-2 cellular memory and provide a possible explanation as to why the majority of patients on BCDTs recover from COVID-19.

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.

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