Impaired Humoral Response to Third Dose of BNT162b2 mRNA COVID-19 Vaccine Despite Detectable Spike Protein-specific T cells in Lung Transplant Recipients
Abstract
The immunogenicity of the mRNA coronavirus disease 2019 vaccine in thoracic organ transplant recipients is poor. Early reports provided evidence of increased immunogenicity after the third mRNA vaccine dose in solid organ transplant recipients.
However, the antibody and cellular responses after the third dose of the BNT162b2 vaccine (Pfizer-BioNTech) and its safety in lung transplant recipients (LTRs) are unknown to date. We included 15 LTRs without a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who received 2 doses of the BNT162b2 vaccine 21 d apart with no antibody response.
In this cohort, we assessed the antibody and cellular responses immediately before and 3 wk after the third dose administered 3 mo after the second dose. Anti-SARS-CoV-2 immunoglobulin (Ig) G levels were tested by Microblot-Array coronavirus disease 2019 IgG against a mix of recombinant antigens (TestLine Clinical Diagnostics, Brno, Czech Republic).
SARS-CoV-2-specific T cells were assessed by detecting intracellular cytokines after a 4-h stimulation of patients' peripheral blood mononuclear cells with 51 overlapping 11mer peptides of the spike receptor-binding domain protein (JPT Peptide Technologies, Berlin, Germany) as we described previously. Závěrem lze říci, že při absenci humorální odpovědi jsme detekovali vznik buněčné odpovědi u 47 % LTR po třetí dávce vakcíny, což by mohlo mít klinický přínos; měřitelná odpověď je však nízká, převážně buněčná a detekovatelná pouze u poloviny pacientů.
Spolu s žádnými známkami epizod rejekce by měla být u LTR doporučena třetí dávka, ale s opatrností, že ochrana vakcínou nesmí být větší než částečná.