Antibody response to COVID-19 vaccine in immune-mediated diseases
In this cross-sectional study, authors studied hospital workers and a control group to assess antibody response to inactivated COVID-19 vaccine in patients with immune-mediated disease. In the study, 82 hospital workers with immune-mediated disease and 300 control members were evaluated, all subjects had a negative history of COVID-19. Sera were obtained after at least 21 days following the second vaccination. Anti-spike IgG antibody titers were measured quantitively using an immunoassay method. Results indicate that patients with immune-mediated disease were less likely to have detectable antibodies than healthy controls among hospital workers and among the elderly population included in this study. Those using immunosuppressive or immune-modulating drugs were significantly less likely to have detectable antibodies when compared to those off treatment. Additionally, a negative association between age and the antibody titer categories among patients and controls were demonstrated. In conclusion, a large majority of patients with immune modulated disease and immunocompetent controls developed a significant humoral response when the second vaccine was received. Those on rituximab and other immunosuppressants had significantly reduced antibody titers as did those over 60 years of age. The authors urge further studies to determine if these individuals should receive a booster dose of the COVID-19 vaccine.
Methotrexate influence on COVID-19 infection
In this case series, authors investigate methotrexate treatment and the effectiveness against infection in COVID-19. Clinical assessment of symptoms, SARS-CoV-2 RNA, and anti-SARS-CoV-2 IgG in an initial case series of four families and confirmed cases of seven families in which one family member developed COVID-19 and exposed other family members who received methotrexate treatment. In the initial case study, three of four women on a trip developed COVID-19, while the fourth women who was on methotrexate remained virus free. Two of the three women went on to infect their husbands, while the third husband treated with methotrexate remained virus free. Seven other families were identified in a follow-up case series, in which one member developed COVID-19, and the other while receiving methotrexate, remained free of virus. In further experiments when mice were treated with methotrexate, ACE2 expression significantly decreased in the lung, intestinal epithelium, and in intestinal organoids. The authors conclude that methotrexate may have protective effects on SARS-CoV-2 infection by downregulating ACE2 (angiotensin-converting enzyme-2). Authors suggest further data sets and studies to determine success.
Antibody response to mRNA vaccine in women vs. men
In this article from the The Journal of Infectious Disease, authors measure the antibody response in men and women after two doses of the COVID-19 mRNA vaccine. It appears from their research that the first dose produced a higher IgG level and higher percentage inhibition of spike-ACE2 receptor binding in women when compared to men. After two doses, IgG levels remained significantly higher in women compared to men, while percent inhibition was similar among both genders. The importance of this community cohort study aims to inform future efforts to understand vaccine protection and side effects related to the mRNA vaccine.
SARS-CoV-2 induction of hyperthyroidism of Graves’ disease
In this article, authors investigate the effects of the SARS-CoV-2 virus on organ systems including the thyroid gland and the expression of angiotensin-converting enzyme -2 (ACE2) protein which functions as a receptor, allowing the virus into cells. We know that older adults and those with comorbidities are at higher risk for developing complications, however, recent reports indicate that infection with COVID-19 may cause Graves’ disease (autoimmune hyperthyroidism) in post-COVID patients. The article goes on to discuss the symptoms, risk factors, associated disorders, and therapeutics associated with this autoimmune condition as it relates to COVID-19. Various autoimmune factors may mediate complex pathogenic signaling in autoimmune hyperthyroidism and authors suggest further studies to determine if patients with hyperthyroidism are at an enhanced risk for complications related to COVID-19. The functional relationship between the thyroid gland and COVID-19 is evolving and physicians should be aware of this phenomenon in the clinical setting.