Frontiers in Immunology (Jun 2022)

Immunosuppressant Treatment in Rheumatic Musculoskeletal Diseases Does Not Inhibit Elicitation of Humoral Response to SARS-CoV-2 Infection and Preserves Effector Immune Cell Populations

  • Andrea Favalli,
  • Andrea Favalli,
  • Ennio Giulio Favalli,
  • Andrea Gobbini,
  • Andrea Gobbini,
  • Elena Zagato,
  • Elena Zagato,
  • Mauro Bombaci,
  • Gabriella Maioli,
  • Elisa Pesce,
  • Lorena Donnici,
  • Paola Gruarin,
  • Martina Biggioggero,
  • Serena Curti,
  • Lara Manganaro,
  • Lara Manganaro,
  • Edoardo Marchisio,
  • Valeria Bevilacqua,
  • Martina Martinovic,
  • Tanya Fabbris,
  • Maria Lucia Sarnicola,
  • Mariacristina Crosti,
  • Laura Marongiu,
  • Laura Marongiu,
  • Francesca Granucci,
  • Francesca Granucci,
  • Samuele Notarbartolo,
  • Alessandra Bandera,
  • Alessandra Bandera,
  • Alessandra Bandera,
  • Andrea Gori,
  • Andrea Gori,
  • Andrea Gori,
  • Raffaele De Francesco,
  • Raffaele De Francesco,
  • Sergio Abrignani,
  • Sergio Abrignani,
  • Roberto Caporali,
  • Roberto Caporali,
  • Renata Grifantini

DOI
https://doi.org/10.3389/fimmu.2022.873195
Journal volume & issue
Vol. 13

Abstract

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COVID-19 has proven to be particularly serious and life-threatening for patients presenting with pre-existing pathologies. Patients affected by rheumatic musculoskeletal disease (RMD) are likely to have impaired immune responses against SARS-CoV-2 infection due to their compromised immune system and the prolonged use of disease-modifying anti-rheumatic drugs (DMARDs), which include conventional synthetic (cs) DMARDs or biologic and targeted synthetic (b/ts) DMARDs. To provide an integrated analysis of the immune response following SARS-CoV-2 infection in RMD patients treated with different classes of DMARDs we carried out an immunological analysis of the antibody responses toward SARS-CoV-2 nucleocapsid and RBD proteins and an extensive immunophenotypic analysis of the major immune cell populations. We showed that RMD individuals under most DMARD treatments mount a sustained antibody response to the virus, with neutralizing activity. In addition, they displayed a sizable percentage of effector T and B lymphocytes. Among b-DMARDs, we found that anti-TNFα treatments are more favorable drugs to elicit humoral and cellular immune responses as compared to CTLA4-Ig and anti-IL6R inhibitors. This study provides a whole picture of the humoral and cellular immune responses in RMD patients by reassuring the use of DMARD treatments during COVID-19. The study points to TNF-α inhibitors as those DMARDs permitting elicitation of functional antibodies to SARS-CoV-2 and adaptive effector populations available to counteract possible re-infections.

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