IgG Production In Patients Research Articles

Bendamustine impairs humoral but not cellular immunity to SARS-CoV-2 vaccination in rituximab-treated B-cell lymphoma-affected patients.

Patients with B-cell lymphoma are a fragile category of subjects, particularly exposed to infections and characterized by an impaired vaccination response due to the disease itself and, even more, to the chemotherapy regimen. For this reason, extensive knowledge of the immune response status of these subjects is of fundamental importance to obtain possible indications for a tailored immunization strategy. We enrolled two cohorts of patients with B-cell lymphoma under rituximab treatment or 3-24 months after treatment. In all patients, we evaluated both humoral and cellular immunological memory toward SARS-CoV-2, after standard vaccination and upon one booster dose. We observed no Spike-specific IgG production in patients (n = 25) under anti-CD20 treatment, whereas patients (n = 16) vaccinated after the completion of chemotherapy showed a higher humoral response. Evaluating SARS-CoV-2-specific T-cell response, we found that patients in both cohorts had developed robust cellular immunity after vaccination. Of the 21 patients (51%) that experienced a breakthrough SARS-CoV-2 infection, only six patients developed severe disease. Interestingly, these six patients had all been treated with rituximab plus bendamustine. Notably, we observed that Spike-specific IgG levels in patients treated with rituximab plus bendamustine were absent or lower compared with those in patients treated with rituximab plus other chemotherapy, whereas Spike-specific T-cell response was not different based on chemotherapy regiment. Our results show that, in patients with B-cell lymphoma under rituximab therapy, anti-SARS-CoV-2 mRNA vaccination induces a weak or absent humoral response but a consistent T-cell response. In addition, chemotherapy regimens with bendamustine further reduce patients' ability to mount a Spike-specific humoral response even after a long time period from chemotherapy discontinuation. These results provide evidence that different chemotherapeutics display different immunosuppressive properties that could be taken in to account in the choice of the right drug regimen for the right patient. Moreover, they question whether immunocompromised patients, particularly those treated with bendamustine, need interventions to improve vaccine-induced immune response.

Passive transfer of autoimmune autonomic neuropathy to mice.

Autoimmune autonomic neuropathy (AAN) is an acquired, often severe, form of dysautonomia. Many patients with AAN have serum antibodies specific for the neuronal ganglionic nicotinic acetylcholine receptor (AChR). Rabbits immunized with a fusion protein corresponding to the N-terminal extracellular domain of the ganglionic AChR alpha3 subunit produce ganglionic AChR antibodies and develop signs of experimental AAN (EAAN) that recapitulate the cardinal autonomic features of AAN in man. We now demonstrate that EAAN is an antibody-mediated disorder by documenting sympathetic, parasympathetic, and enteric autonomic dysfunction in mice injected with rabbit IgG containing ganglionic AChR antibodies. Recipient mice develop transient gastrointestinal dysmotility, urinary retention, dilated pupils, reduced heart rate variability, and impaired catecholamine response to stress. The autonomic signs are associated with a reversible failure of nicotinic cholinergic synaptic transmission in superior mesenteric ganglia. Mice injected with IgG from two patients with AAN (of three tested) demonstrated a milder phenotype with evidence of urinary retention and gastrointestinal dysmotility. The demonstration that ganglionic AChR-specific IgG causes impaired autonomic synaptic transmission and autonomic failure in mice implicates an antibody-mediated pathogenesis for AAN. The antibody effect is potentially reversible, justifying early use of immunomodulatory therapy directed at lowering IgG levels and abrogating IgG production in patients with AAN.

Immunologic significance of a collagen-derived culture filtrate containing proteolytic activity in Aspergillus-related diseases

Background: Despite increasing evidence implicating fungal proteases in the virulence of pulmonary fungal diseases, routine fungal culture media do not favor protease production. Hence, filtrates that serve as the source of antigen for serologic determinations are poor in proteases, and consequently, the immunologic significance of these enzymes is unknown. Methods: A clinical isolate of Aspergillus fumigatus was cultured on collagen medium, resulting in excretion of high levels of fungal proteases in the culture filtrate. This was compared with standard culture filtrates by diverse analytic techniques including immunoblotting with sera of patients with pulmonary aspergilloma (PA) and allergic bronchopulmonary aspergillosis (ABPA). Results: Protein profiles of collagen medium filtrate showed several (glyco)proteins not found in conventional culture filtrates, including a prominent 32 kd glycoprotein, which coisolated in gel filtration and ion-exchange chromatography with elastase activity, as well as 67 kd and 94 kd (glyco)proteins. Intense IgG binding was seen with the 32 kd glycoprotein when ABPA and PA sera were used. The 94 kd protein showed intense binding with PA sera but not with ABPA sera, whereas for the 67 kd glycoprotein the reverse tended to be the case. Conclusion: Fungal culture on collagen media results in the production of filtrates with high protease activity, containing unique (glyco)proteins of which at least one (32 kd) is closely associated with fungal elastase activity. These constituents are immunologically relevant, eliciting IgG production in patients with PA and ABPA, suggesting production of these (glyco)proteins during disease in vivo. The use of collagen media filtrates may enhance our serodiagnostic capacity in patients with fungal pulmonary diseases.

Dynamics of Immunoglobulin Synthesis After Major Trauma

Major mechanical trauma causes a severe suppression of B-cell differentiation and IgM synthesis in mononuclear leukocyte cultures. In this study the effect of recombinant lymphokines and physiologic T-cell supernatants on B-cell differentiation was investigated. The influence of potentially suppressing monocytes and positive regulatory T-lymphocytes was eliminated using purified B-cell cultures. Antigen-induced IgM synthesis was reduced on all days following trauma. Addition of recombinant interleukin 2 or T-cell supernatant enhanced but did not restore IgM synthesis. Although recombinant interleukin 4 and recombinant interferon gamma had a suppressive effect on IgM synthesis in controls, both lymphokines were ineffective in the patients' IgM synthesis. Spontaneous IgG production in patients was dramatically elevated, and the addition of lymphokines did not show any enhancing effect in patients. These results demonstrate that the IgM/IgG shift observed in peripheral blood mononuclear cell cultures also exists in purified B-cell cultures. Interleukin 2 partially restored suppressed IgM synthesis, while interleukin 4 and interferon gamma were ineffective in patients' B-cell differentiation. Interleukin 2 was the most effective lymphokine for the induction of Ig synthesis. These results lead us to conclude that the altered B-cell metabolism might also be responsible for the suppression of humoral immunity following trauma.