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The effect of pneumococcal immunization on total and antigen-specific B cells in patients with severe chronic kidney disease.
BMC Immunology ( IF 3 ) Pub Date : 2019-11-12 , DOI: 10.1186/s12865-019-0325-9
Gabrielle Nicole Gaultier 1 , William McCready 2 , Marina Ulanova 1, 2
Affiliation  

BACKGROUND While the 23-valent pneumococcal polysaccharide vaccine (PPV23) is routinely used in Canada and some other countries to prevent pneumococcal infection in adults with chronic kidney disease (CKD), patients develop a suboptimal antibody response to PPV23 due to their immune dysfunction. The 13-valent pneumococcal conjugate vaccine (PCV13) has superior immunogenicity in some categories of immunocompromised adults; however, its effect on the immune response in CKD patients has only been addressed by two recent studies with conflicting results. The effect of PPV23 or PCV13 on B cells in these patients has not been previously studied. We studied the absolute numbers and proportions of B cells and subpopulations in two groups of adult patients with severe CKD pre- and 7 days post-immunization with PCV13: pneumococcal vaccine naïve and previously immunized with PPV23 (over one year ago). RESULTS PPV23 immunized patients had significantly lower proportions and absolute numbers of class switched memory (CD19 + CD27 + IgM-), as well as lower absolute numbers of IgM memory (CD19 + CD27 + IgM+) and class switched B cells (CD19 + CD27-IgM-) compared to PPV23 naïve patients. Following PCV13 immunization, the differences in absolute numbers of B-cell subpopulations between groups remained significant. The PPV23 immunized group had higher proportions of CD5- B cells along with lower proportions and absolute numbers of CD5+ B cells compared to PPV23 naïve patients both pre- and post-immunization with PCV13. However, previous PPV23 immunization did not have a noticeable effect on the numbers of total IgG or serotype 6B and 14 specific antibody-secreting cells detected 7 days post-immunization with PCV13. Nevertheless, fold increase in anti-serotype 14 IgG concentrations 28 days post-PCV13 was greater in PPV23 naïve than in previously immunized patients. CONCLUSIONS The results suggest that immunization with PPV23 may result in long-term changes in B-cell subpopulations such as increased prevalence of CD5- B cells and decreased prevalence of class switched memory B cells in the peripheral blood. Because previous immunization with PPV23 in patients with CKD is associated with a significant decrease in the total class switched memory B cells in response to subsequent immunization with PCV13, this may reduce PCV13 immunogenicity in the setting of PPV23 followed by PCV13. TRIAL REGISTRATION Registered February 24, 2015 at ClinicalTrials.gov (NCT02370069).

中文翻译:

肺炎球菌免疫对严重慢性肾脏病患者总B细胞和抗原特异性B细胞的影响。

背景技术虽然在加拿大和其他一些国家常规使用23价肺炎球菌多糖疫苗(PPV23)来预防患有慢性肾脏病(CKD)的成年人中的肺炎球菌感染,但由于其免疫功能障碍,患者对PPV23的抗体反应欠佳。13价肺炎球菌结合疫苗(PCV13)在某些免疫功能低下的成年人中具有优越的免疫原性;然而,它对CKD患者免疫应答的作用仅由两项最近的研究解决,其结果相互矛盾。以前尚未研究过PPV23或PCV13对这些患者B细胞的作用。我们研究了在PCV13免疫前和免疫后7天的两组患有严重CKD的成年患者中B细胞和亚群的B细胞和亚群的绝对数量和比例:尚未接种过肺炎球菌疫苗,并且以前已经使用PPV23进行了免疫(一年多以前)。结果经PPV23免疫的患者的类别转换记忆(CD19 + CD27 + IgM-)的比例和绝对数量显着较低,并且IgM记忆类别(CD19 + CD27 + IgM +)和类别转换B细胞(CD19 + CD27- IgM-)与单纯PPV23的患者相比。进行PCV13免疫后,各组之间B细胞亚群绝对数量的差异仍然很明显。与未接种PCV13的PPV23初治患者相比,PPV23免疫组的CD5-B细胞比例更高,而CD5 + B细胞的比例和绝对数量更低。然而,先前的PPV23免疫对总IgG或血清型6B的数量没有显着影响,在用PCV13免疫7天后检测到14种特异性抗体分泌细胞。但是,PPV23初次接种PCV13后28天抗血清14型IgG浓度的增加倍数高于先前免疫的患者。结论结果表明,PPV23免疫可能会导致B细胞亚群的长期变化,例如外周血CD5-B细胞的患病率增加以及类开关记忆B细胞的患病率降低。由于先前在CKD患者中使用PPV23进行的免疫反应与随后对PCV13进行免疫反应后的总类别转换记忆B细胞的显着减少有关,这可能会降低PPV23在PCV13之后的环境中的PCV13免疫原性。试验注册2015年2月24日在ClinicalTrials.gov上注册(NCT02370069)。
更新日期:2020-04-22
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