Cellular and humoral immunity assessment in recovered COVID-19 Iraqi dentists
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Abstract
Background: Dentists, safeguarding against contagious diseases, face infection risks. The study aimed to assess post-COVID immunity, quantification of salivary biomarkers for prognostication, and immune surveillance. Materials and methods: A cross-sectional study was done on 91 working Iraqi dentists from June to August 2022. The dual IgG s1 &n, and IgA s1 &n specific to COVID-19 were measured by ELISA-specific kits from serum and saliva. From randomly selected 36 out of 91 participants CD4 and subtypes TH1 and TH2 were counted by flow cytometry from fresh whole peripheral blood. Results: All CD4, Th1, and Th2 percentage levels were reduced as a whole if compared to known normal value, and Th2 elevated and inhibited the level of Th1 in all study individuals. All cells were significantly associated with a positive history of COVID-19 infection whereas the CD4 was significantly related to the Pfizer type of vaccine, loss of both sense and recovery time within 15 days. A positive correlation was found between CD4 and Th2 and CD4 with IgG n in serum; this antibody was highly significant with positive COVID-19 infection higher than that of serum IgG s1. Noticeably, the IgA (s+n) in serum was associated with a positive history of infection and could be detected in individuals with a duration of the last infection >1-2 years and last vaccine duration > 6- 12 months. Conclusion: A low percentage level of CD4 and an imbalance Th1/Th2 ratio made the recovered individual more susceptible to re-infection but the significantly high percentage of specific COVID antibodies followed one time of infection or booster vaccine dose gave their protection.
Received date: 10-09-2023
Accepted date:28-10-2023
Published date:15-03-2025
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References
Centers for Disease Control and Prevention. COVID-19 Testing: What You Need to Know 2022.
Long QX, Liu BZ, Deng HJ, Wu GC, Deng K, Chen YK, et al. Antibody responses to SARS-CoV-2 in patients with COVID-19. Nat Med. 2020;26(6):845-8 10.1038/s41591-020-0897-1.
Choe PG, Perera R, Park WB, Song KH, Bang JH, Kim ES, et al. MERS-CoV Antibody Responses 1 Year after Symptom Onset, South Korea, 2015. Emerg Infect Dis. 2017;23(7):1079-84.
Resham AK, Qassem WJ, Mohammad WJ. Evaluation of Nurses' Knowledge and Attitudes about the Prevention of the Coronavirus Disease 2019 at Emergency Units in Government Hospitals in Baghdad City/Iraq. KJNS. 2021;11(2):17-29.
Zeng W, Liu G, Ma H, Zhao D, Yang Y, Liu M, et al. Biochemical characterization of SARS-CoV-2 nucleocapsid protein. Biochem Biophys Res Commun. 2020;527(3):618-23.
Iyer AS, Jones FK, Nodoushani A, Kelly M, Becker M, Slater D, et al. Dynamics and significance of the antibody response to SARS-CoV-2 infect.. medRxiv. 2020.
Jalkanen P, Pasternack A, Maljanen S, Melén K, Kolehmainen P, Huttunen M, et al. A Combination of N and S Antigens With IgA and IgG Measurement Strengthens the Accuracy of SARS-CoV-2 Serodiagnostics. J Infect Dis. 2021;224(2):218-28.
Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genome structure, replication, and pathogenesis. J MED VIROL. 2020;92(4):418-23.
Dutta NK, Mazumdar K, Gordy JT. The Nucleocapsid Protein of SARS–CoV–2: a Target for Vaccine Development. JVI..2020;94(13).
McAndrews KM, Dowlatshahi DP, Dai J, Becker LM, Hensel J, Snowden LM, et al. Heterogeneous antibodies against SARS-CoV-2 spike receptor binding domain and nucleocapsid with implications for COVID-19 immunity. JCI Insight. 2020;5(18).
Muslim Dawood S, Khudhur Al Joofy I. Evaluation of IgM and IgG in COVID-19 Recovered Patients in Iraq. Arch Razi Inst. 2022;77(3):1191-7.
Ali MA, Hu C, Jahan S, Yuan B, Saleh MS, Ju E, et al. Sensing of COVID‐19 Antibodies in Seconds via Aerosol Jet Nanoprinted Reduced‐Graphene‐Oxide‐Coated 3D Electrodes. Adv Mater. 2021;33(7):2006647.
Wajnberg A, Amanat F, Firpo A, Altman DR, Bailey MJ, Mansour M, et al. Robust neutralizing antibodies to SARS-CoV-2 infection persist for months. Science..2020;370(6521):1227-30.
Interim Guidelines for COVID-19 Antibody Testing in Clinical and Public Health Settings. , CDC, 16 Dec. 2022.
Morales-Narváez E, Dincer C. The impact of biosensing in a pandemic outbreak: COVID-19. Biosens. Bioelectron. 2020;163:112274.
Phelan AL. COVID-19 immunity passports and vaccination certificates: scientific, equitable, and legal challenges. Lancet.2020;395(10237):1595-8.
Al Hajji Y, Taylor H, Starkey T, Lee LYW, Tilby M. Antibody response to a third booster dose of SARS-CoV-2 vaccination in adults with hematological and solid cancer: a systematic review. BJC. 2022;127(10):1827-36.
Fendler A, Shepherd STC, Au L, Wilkinson KA, Wu M, Schmitt AM, et al. Immune responses following the third COVID-19 vaccination are reduced in patients with hematological malignancies compared to patients with solid cancer. Cancer Cell. 2022;40(2):114-6.
Marlet J, Gatault P, Maakaroun Z, Longuet H, Stefic K, Handala L, et al. Antibody Responses after a Third Dose of COVID-19 Vaccine in Kidney Transplant Recipients and Patients Treated for Chronic Lymphocytic Leukemia. Vaccines. 2021;9(10):1055.
Ali MA, Hu C, Zhang F, Jahan S, Yuan B, Saleh MS, et al. N protein‐based ultrasensitive SARS‐CoV‐2 antibody detection in seconds via 3D nanoprinted, microarchitected array electrodes. J Med Viro. 2022;94(5):2067-78.
Shapiro LC, Thakkar A, Campbell ST, Forest SK, Pradhan K, Gonzalez-Lugo JD, et al. Efficacy of booster doses in augmenting waning immune responses to COVID-19 vaccine in patients with cancer. Cancer Cell. 2022;40(1):3-5. https://doi.org/10.1016/j.ccell.2021.11.006
Zeng C, Evans JP, Chakravarthy K, Qu P, Reisinger S, Song N-J, et al. COVID-19 mRNA booster vaccines elicit strong protection against the SARS-CoV-2 Omicron variant in patients with cancer. Cancer Cell. 2022;40(2):117-9. (Crossref)
Reimann P, Ulmer H, Mutschlechner B, Benda M, Severgnini L, Volgger A, et al. Efficacy and safety of heterologous booster vaccination with Ad26.COV2.S after BNT162b2 mRNA COVID‐19 vaccine in haemato‐oncological patients with no antibody response. Br J Haematol. 2022;196(3):577-84.
Fendler A, Shepherd STC, Au L, Wu M, Harvey R, Wilkinson KA, et al. Functional immune responses against SARS-CoV-2 variants of concern after fourth COVID-19 vaccine dose or infection in patients with blood cancer. Cell Rep Med. 2022;3(10):100781.
Aleebrahim-Dehkordi E, Molavi B, Mokhtari M, Deravi N, Fathi M, Fazel T, et al. T helper type (Th1/Th2) responses to SARS-CoV-2 and influenza A (H1N1) virus: From cytokines produced to immune responses. Transpl Immunol. 2022;70:101495.
Raphael I, Joern RR, Forsthuber TG. Memory CD4(+) T Cells in Immunity and Autoimmune Diseases. Cells. 2020;9(3).
Le Bert N, Tan AT, Kunasegaran K, Tham CYL, Hafezi M, Chia A, et al. SARS-CoV-2-specific T cell immunity in cases of COVID-19 and SARS, and uninfected controls. Nature. 2020;584(7821):457-62.
Adamo S, Chevrier S, Cervia C, Zurbuchen Y, Raeber ME, Yang L, et al. Lymphopenia-induced T-cell proliferation is a hallmark of severe COVID-19. 2020.
Kuri-Cervantes L, Pampena M, Meng W, Rosenfeld A, Ittner C, Weisman A, et al. Comprehensive mapping of immune perturbations associated with severe COVID-19. Sci. Immunol. 2020;5:eabd7114.
Koch T, Mellinghoff SC, Shamsrizi P, Addo MM, Dahlke C. Correlates of Vaccine-Induced Protection against SARS-CoV-2. Vaccines. 2021;9(3):238.
Neidleman J, Luo X, Frouard J, Xie G, Gill G, Stein ES, et al. SARS-CoV-2-Specific T Cells Exhibit Phenotypic Features of Helper Function, Lack of Terminal Differentiation, and High Proliferation Potential. Cell Rep Med. 2020;1(6):100081.
Gil-Etayo FJ, Suàrez-Fernández P, Cabrera-Marante O, Arroyo D, Garcinuño S, Naranjo L, et al. T-Helper Cell Subset Response Is a Determining Factor in COVID-19 Progression. Front Cell Infect Microbiol. 2021;11:624483.
Rahimzadeh M, Naderi N. Toward an understanding of regulatory T cells in COVID-19: A systematic review. J Med Virol. 2021;93(7):4167-81.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. JCE. 2008;61(4):344-9.
Li; R, Duffee; D, Gbadamosi-Akindele. MF. CD4 Count. National library of health: StatPearls Publishing; 2023 Last Update: May 1, 2023.
Salomé B, Horowitz A. Impaired CD4 T-cell response to SARS-CoV-2: rationale for PD-1 blockade in patients with cancer and COVID-19? Cancer Discov.2021;11(8):1877-8.
Oja AE, Saris A, Ghandour CA, Kragten NA, Hogema BM, Nossent EJ, et al. Divergent SARS‐CoV‐2‐specific T‐and B‐cell responses in severe but not mild COVID‐19 patients. Eur. J. Immunol. 2020;50(12):1998-2012.
Supriya R, Gao Y, Gu Y, Baker JS. Role of Exercise Intensity on Th1/Th2 Immune Modulations During the COVID-19 Pandemic. Frontiers in Immunology. 2021;12.
Adnan Mezher M, Bahjat Alrifai S, Mahmood Raoof W. Analysis of Proinflammatory Cytokines in COVID-19 Patients in Baghdad, Iraq. Archives of Razi Institute. 2023;78(1):305-13.
McGeachy MJ, Cua DJ. T cells doing it for themselves: TGF-β regulation of Th1 and Th17 cells. Immunity. 2007;26(5):547-9.
Fathi F, Sami R, Mozafarpoor S, Hafezi H, Motedayyen H, Arefnezhad R, et al. Immune system changes during COVID-19 recovery play a key role in determining disease severity. Int J Immunopathol Pharmacol. 2020;34:2058738420966497.
Cassaniti I, Percivalle E, Bergami F, Piralla A, Comolli G, Bruno R, et al. SARS-CoV-2 specific T-cell immunity in COVID-19 convalescent patients and unexposed controls measured by ex vivo ELISpot assay. Avicenna J Clin Microbiol Infect. 2021;27(7):1029-34.
Juan Francisco Gutiérrez-Bautista, Antonio Rodriguez-Nicolas, Antonio Rosales-Castillo, Pilar Jiménez, Federico Garrido, Per Anderson, et al. Negative Clinical Evolution in COVID-19 Patients Is Frequently Accompanied With an Increased Proportion of Undifferentiated Th Cells and a Strong Underrepresentation of the Th1 Subset 2020;11.
Li H, Liu L, Zhang D, Xu J, Dai H, Tang N, et al. SARS-CoV-2 and viral sepsis: observations and hypotheses. The Lancet. 2020;395(10235):1517-20.
Ye Q, Wang B, Mao J. The pathogenesis and treatment of the Cytokine Storm in COVID-19. J Infect.. 2020;80(6):607-13.
Finlay JB, Brann DH, Abi Hachem R, Jang DW, Oliva AD, Ko T, et al. Persistent post-COVID-19 smell loss is associated with immune cell infiltration and altered gene expression in olfactory epithelium. Sci Transl Med. 2022;14(676):eadd0484.
Mantovani A, Netea MG. Trained innate immunity, epigenetics, and Covid-19. N Engl J Med Overseas Ed. 2020;383(11):1078-80.
Painter MM, Mathew D, Goel RR, Apostolidis SA, Pattekar A, Kuthuru O, et al. Rapid induction of antigen-specific CD4(+) T cells is associated with coordinated humoral and cellular immunity to SARS-CoV-2 mRNA vaccination. Immunity. 2021;54(9):2133-42.e3.
Amit S, Regev-Yochay G, Afek A, Kreiss Y, Leshem E. Early rate reductions of SARS-CoV-2 infection and COVID-19 in BNT162b2 vaccine recipients. The Lancet. 2021;397(10277):875-7.
Supriya R, Gao Y, Gu Y, Baker JS. Role of exercise intensity on Th1/Th2 immune modulations during the COVID-19 pandemic. Front Immunol. 2021;12:761382.
Grifoni A, Weiskopf D, Ramirez SI, Mateus J, Dan JM, Moderbacher CR, et al. Targets of T cell responses to SARS-CoV-2 coronavirus in humans with COVID-19 disease and unexposed individuals. Cell. 2020;181(7):1489-501. e15.
Ali D, Taha G. Effect of Covid-19 vaccine on some immunological salivary biomarkers (sIgA and Interleukine-17). J Fac Med Baghdad. 2023;65(2).
Sheikh-Mohamed S, Isho B, Chao GYC, Zuo M, Cohen C, Lustig Y, et al. Systemic and mucosal IgA responses are variably induced in response to SARS-CoV-2 mRNA vaccination and are associated with protection against subsequent infection. Mucosal Immunol. 2022;15(5):799-808.
Barzegar-Amini M, Mahmoudi M, Dadgarmoghaddam M, Farzad F, Najafabadi AQ, Jabbari-Azad F. Comparison of Serum Total IgA Levels in Severe and Mild COVID-19 Patients and Control Group. J Clin Immunol. 2022;42(1):10-8.
Rangel-Ramírez VV, Macías-Piña KA, Servin-Garrido RR, de Alba-Aguayo DR, Moreno-Fierros L, Rubio-Infante N. A systematic review and meta-analysis of the IgA seroprevalence in COVID-19 patients: Is there a role for IgA in COVID-19 diagnosis or severity? Microbiol Res. 2022;263:127105.
Watanabe S, Naito Y, Yamamoto T. Host factors that aggravate COVID-19 pneumonia. Int J Fam Med Prim Care. 2020; 1 (3). 2020;1011.
Carvalho Á, Henriques AR, Queirós P, Rodrigues J, Mendonça N, Rodrigues AM, et al. Persistence of IgG COVID-19 antibodies: A longitudinal analysis. Front Public Health. 2022;10:1069898.
Boyton RJ, Altmann DM. The immunology of asymptomatic SARS-CoV-2 infection: what are the key questions? Nat Rev Immunol. 2021;21(12):762-8.