Patients with asthma, COPD, ILD have reduced COVID vaccine protection
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Key takeaways:
- Protection against COVID-19 from vaccination appeared reduced in patients with asthma, COPD and interstitial lung disease.
- Personalized vaccination schemes could help protect these patients.
Patients with asthma, COPD and interstitial lung disease have reduced SARS-CoV-2 vaccine-specific antibody, B-cell and T-cell responses, which signals poorer protection against COVID-19, according to results published in ERJ Open Research.
“The findings suggest that what we understand about how the vaccine protects healthy individuals may not be broadly applicable to patients with underlying lung conditions,” R. Lee Reinhardt, PhD, associate professor in the department of immunology and genomic medicine at National Jewish Health, told Healio. “This highlights a need for clinicians to consider varied vaccination schemes to ensure their patients with asthma, COPD or ILD maintain sufficient anti-SARS-CoV-2 antibody and/or memory B cells and T cells to protect against severe COVID-19.”
Using blood samples and deep immune phenotyping, Reinhardt and colleagues assessed humoral and cell-mediated responses to a SARS-CoV-2 vaccine in nine patients (mean age, 58 years; 56% women) with asthma, eight patients (mean age, 64 years; 62% women) with COPD and 15 patients (mean age, 62 years; 60% women) with ILD against 31 healthy patients (mean age, 50 years; 45% women).
Researchers found lower antibody titers to the vaccine antigen in about half (48.3%) of all those with a lung condition 3 to 4 months after the last vaccine administration compared with those observed in the healthy controls. Specifically, those with asthma (P < .035) and those with COPD (P < .022) showed significantly lower antibody titers, as did 40% of the patients with ILD.
“We did not expect that a majority of patients with underlying lung conditions (asthma, COPD, ILD) would exhibit an impaired vaccine response,” Reinhardt told Healio.
Three to 5 months after vaccination, fewer patients with a chronic lung disease achieved “good blocking” of ACE2-mFc compared with healthy patients (22% vs. 94%), demonstrating the possibility of poor humoral protection in these patients, according to the researchers.
Notably, a reduced vaccine-specific antibody response corresponded to fewer vaccine-specific memory B cells in patients with asthma, COPD or ILD. Those with ILD (P < .012) and asthma (P < .032) showed significantly fewer receptor-binding domain B cells than healthy controls, whereas patients with COPD on average showed fewer of these B cells than healthy controls.
When evaluating memory T cells, patients with a lung disease vs. patients classified as healthy had decreased responsiveness (asthma: CD8+, P < .004; CD4+, P < .023; COPD: CD8+, P < .008). Among those with ILD, researchers found limited CD8+ T-cell responses in 21.4% of the cohort and weak CD4+ responses in 42.9% of patients.
Researchers additionally observed heterogeneity between the groups in terms of their cytokine profiles, such that bulk CD8+ T cells that were interferon gamma-competent were only significantly elevated among patients with COPD compared with controls (P < .012) and the percentage of IL-2-producing bulk CD8+ T cells were significantly lower among patients with asthma compared with controls (P < .014). Researchers noted even greater heterogeneity in vaccine-specific follicular T-helper cells.
Lastly, vaccine-elicited antibody responses did not correlate with T-cell responses, and this was an unexpected finding, Reinhardt told Healio.
“Specifically, some individuals mount a productive antibody response to the vaccine but do not mount a similarly protective T-cell response,” Reinhardt said. “In contrast, some patients appear to mount a productive T-cell response but lack protective serum antibodies. This suggests that the immune response to the vaccine may vary in individuals with underlying lung conditions that are distinct from what has been observed in healthy individuals.
“I think this work highlights that more heterogeneity exists in the vaccine response to SARS-CoV-2 than was previously appreciated,” Reinhardt added. “Clinical trials and research efforts must take into account how patients with underlying medical conditions may respond differently after vaccination. With more deep immune phenotyping of both B-cell and T-cell responses after vaccination, the research can better inform clinicians on how best to care for unique patient populations.”
In terms of future studies, Reinhardt said two ideas need to be investigated to help those with respiratory conditions.
“First, we need to understand why individuals with underlying lung conditions are not responding to the SAR-CoV-2 vaccine in the same manner as healthy controls,” he said. “This will help in the development of better clinical care. Second, we need to understand if the impaired vaccine response to SARS-CoV-2 extends to other vaccines critical to the welfare of these patients such as the seasonal flu vaccine and the respiratory syncytial virus vaccine. This could provide long-term insight into how best to approach vaccination of more vulnerable patient populations.”
Reference:
- National Jewish Health study examines COVID vaccine protection for patients with lung conditions. https://www.nationaljewish.org/about/news/press-releases/2023-news/national-jewish-health-study-examines-covid-vaccine-protection-for-patients. Published Oct. 10, 2023. Accessed Oct. 18, 2023.