ABSTRACT
Understanding how older people respond to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical if we are to confront the coronavirus disease 2019 (COVID-19) pandemic and establish effective vaccination strategies. Immunosenescence reduces the ability to respond to neoantigens and may compromise the life of infected individuals. Here, we analyzed the immunological memory to SARS-CoV-2 in 102 recovered patients aged over 60 years several months after the infection had been resolved. Specific memory T lymphocytes against the virus were measured by interferon-γ (IFN-γ) and granzyme B release by ELISpot; memory B-lymphocyte responses were quantified by detection of anti-S IgG1 producer cells by ELISpot and anti-S and anti-N antibodies were determined by enzyme-linked immunosorbent assay (ELISA). Memory T lymphocytes were found in peripheral blood of most of the studied donors, more than 7 months after the infection in some of them. Fewer patients maintained memory B lymphocytes, but antibodies, mainly anti-S, were highly durable and positively correlated with T responses. More robust humoral responses were found in patients who had more severe symptoms and had been admitted to hospital. We concluded that specific immunity against SARS-CoV-2 is effectively preserved regardless of age, despite the great heterogeneity of their immune responses, and that memory T lymphocytes and anti-S IgG might be more durable than memory B cells and anti-N IgG.
Subject(s)
Antibodies, Viral/immunology , COVID-19 , Immunity, Cellular/physiology , Immunity, Humoral , Immunologic Memory , SARS-CoV-2 , Aged , Aged, 80 and over , Enzyme-Linked Immunospot Assay , Female , Humans , Immunoglobulin G , Male , Memory B Cells , Memory T Cells , Middle AgedABSTRACT
Wegener's granulomatosis (WG) is a systemic, necrotizing and granulomatous vasculitis that affects the upper and lower respiratory tract and the kidney. It is the most common antineutrophil cytoplasmic antibodies (ANCA) vasculitis. The diagnosis of WG is based on clinical manifestations, histological findings and the presence of ANCA in serum. The American College of Rheumatology criteria includes: oral and nasal inflammation, abnormal chest radiography (nodules, fixed infiltrates, or cavities, urinary sediment (hematuria), and granulomatous inflammation on biopsy. Treatment of WG is divided into 2 phases, induction of remission (IR), followed by a maintenance phase (MP). In the IR it is necessary to use immunosuppressive intensive therapy (cyclophosphamide plus steroids) and the MP is a less intensive therapy in which immunosuppressors (IS) such as azathioprine, methotrexate, mycophenolate of mofetil, among others, may be employed. Their purpose is to keep remission and lower the adverse effects associated with IS. Etanercept has not been proven successfully for the MP. Rituximab and 15-dexopergualin constitute promising the rapies for refractory WG.
Subject(s)
Granulomatosis with Polyangiitis/diagnosis , Granulomatosis with Polyangiitis/drug therapy , Granulomatosis with Polyangiitis/classification , HumansABSTRACT
La granulomatosis de Wegener es una vasculitis sistémica, necrosante y granulomatosa que afecta el tracto respiratorio superior e inferior y el riñón; es la vasculitis anticuerpos anticitoplasma del neutrófilo (ANCA) positiva más frecuente. El diagnóstico se basa en las manifestaciones clínicas, la biopsia de los órganos afectados y la presencia de ANCA en el suero. Los criterios de clasificación según el Colegio Americano de Reumatología son inflamación oral o nasal, alteraciones en la radiografía de tórax (nódulos, infiltrado pulmonar fijo, cavitaciones), anormalidades urinarias (hematuria), biopsia con infiltrado granulomatoso. El tratamiento se divide en dos fases: de inducción a la remisión y de mantenimiento. En la primera es necesario el uso de terapia inmunosupresora intensiva: ciclofosfamida más esteroides para controlar la actividad de la enfermedad (tres a seis meses). En la fase de mantenimiento, menos intensa, se emplean inmunosupresores como azatioprina, metotrexate, micofenolato de mofetilo, entre otros; su objetivo es mantener la remisión y disminuir los efectos adversos asociados a la ciclofosfamida. El etanercept no ha sido útil para la fase de mantenimiento. El rituximab y la 15-desoxipergualina son terapias alternativas en casos refractarios.
Wegener's granulomatosis (WG) is a systemic, necrotizing and granulomatous vasculitis that affects the upper and lower respiratory tract and the kidney. It is the most common antineutrophil cytoplasmic antibodies (ANCA) vasculitis. The diagnosis of WG is based on clinical manifestations, histological findings and the presence of ANCA in serum. The American College of Rheumatology criteria includes: oral and nasal inflammation, abnormal chest radiography (nodules, fixed infiltrates, or cavities, urinary sediment (hematuria), and granulomatous inflammation on biopsy. Treatment of WG is divided into 2 phases, induction of remission (IR), followed by a maintenance phase (MP). In the IR it is necessary to use immunosuppressive intensive therapy (cyclophosphamide plus steroids) and the MP is a less intensive therapy in which immunosuppressors (IS) such as azathioprine, methotrexate, mycophenolate of mofetil, among others, may be employed. Their purpose is to keep remission and lower the adverse effects associated with IS. Etanercept has not been proven successfully for the MP. Rituximab and 15-dexopergualin constitute promising the rapies for refractory WG.
