MS patients on anti-CD20 therapy have robust T cell responses to SARS-CoV-2 vaccination

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Scientists at Johns Hopkins University School of Medicine, United States, studied the pattern of immune responses induced by 2019 coronavirus disease (COVID-19) vaccines in multiple sclerosis (MS) patients receiving anti-CD20 treatment. As detailed in the study currently available on the site medRxiv* preprint server, they observed that these patients present a robust T cell response despite a reduced humoral response to vaccines.

Study: Discordant humoral and T cell immune responses to SARS-CoV-2 vaccination in people with multiple sclerosis on anti-CD20 therapy. Image Credit: Kateryna Kon / Shutterstock

Background

Therapeutic interventions for MS are known to induce immune suppression and thus indirectly increase the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and severe COVID-19. According to the available literature, patients with MS receiving certain disease-modifying therapies, including anti-CD20 therapies and sphingosine-1-phosphate (S1P) receptor modulators, may have reduced antibody responses to various vaccines. existing, including COVID-19. In contrast, evidence suggests that T cell responses to most common vaccines can be maintained in patients receiving anti-CD20 therapies.

In the current study, scientists investigated humoral and T-cell immune responses to COVID-19 vaccines in MS patients receiving anti-CD20 therapies or other disease-modifying treatments.

Study design

One hundred and one multiple sclerosis patients who received Pfizer, Moderna, or Johnson & Johnson vaccines were enrolled in the study. Of these, 39 were on anti-CD20 therapy, three were on S1P-modulating therapy, and 60 were on other types of disease-modifying therapy (injections, natalizumab, and non-S1P-modulating oral therapy) or no therapy.

Blood samples were taken from the participants four to eight weeks after the final dose of the vaccine and tested for IgG-specific S1 spike antibodies. Similarly, peripheral blood mononuclear cells isolated from blood were analyzed for spike-specific interferon-gamma (IFN-γ) secreting T lymphocyte responses.

Humoral immune response

About 56% and 33% of participants on anti-CD20 therapy and S1P receptor modulator therapy, respectively, exhibited antibody responses to COVID-19 vaccines. In contrast, about 94% of participants on other disease-modifying therapies or without therapy exhibited vaccine-induced antibody responses.

Specifically, vaccine-induced antibody responses were seen in 100% of participants taking injectables or natalizumab, and in 86% of participants taking other types of disease-modifying therapies. Likewise, all of the participants who were not receiving any treatment showed strong antibody responses to the COVID-19 vaccines.

Cell-mediated immune response

Overall, a robust T cell immune response to COVID-19 vaccines was seen in most participants (86%) receiving any of the therapies mentioned. Interestingly, about 97% of participants on anti-CD20 treatment exhibited a spike-specific T-cell response, with a significantly higher number of cells secreting IFN-γ than seen in participants receiving other treatments. disease modifiers or no treatment.

Importance of the study

The study reveals an important finding that MS patients receiving immunosuppressive treatments, including anti-CD20 therapy, exhibit a strong T cell response to COVID-19 vaccines, despite a reduced antibody response.

Compared to other disease-modifying therapies, anti-CD20 therapy is associated with a more robust T cell response in patients with MS. In contrast, non-anti-CD20 therapies are associated with humoral and cellular immune responses to COVID-19 vaccines.

Since B cells are needed to produce antibodies and activate CD4 + and CD8 + T cells, B cell depletion therapies such as anti-CD20 therapies should suppress both humoral and T cell responses. However, a robust T cell response observed in patients on anti-CD20 treatment could be due to depletion of regulatory B cells involved in inhibiting T cell activation. Another reason could be the attenuation of B cell-mediated activation of regulatory T cells.

Other studies show that a robust T cell response induced by natural infection is associated with a lower severity of COVID-19. In view of this observation, scientists suggest that MS patients receiving anti-CD20 treatment may still obtain some level of protection against vaccination, even in the absence of a sufficient antibody response.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.


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