Humoral responses in coronavirus disease 2019 (COVID-19) are often of limited durability, as seen with other human coronavirus epidemics. To address the underlying etiology, we examined post mortem thoracic lymph nodes and spleens in acute SARS-CoV-2 infection and observed the absence of germinal centers and a striking reduction in Bcl-6 + germinal center B cells but preservation of AID + B cells. Absence of germinal centers correlated with an early specific block in Bcl-6 + T FH cell differentiation together with an increase in T-bet + T H1 cells and aberrant extra-follicular TNF-α accumulation. Parallel peripheral blood studies revealed loss of transitional and follicular B cells in severe disease and accumulation of SARS-CoV-2-specific “disease-related” B cell populations. These data identify defective Bcl-6 + T FH cell generation and dysregulated humoral immune induction early in COVID-19 disease, providing a mechanistic explanation for the limited durability of antibody responses in coronavirus infections, and suggest that achieving herd immunity through natural infection may be difficult.

Key Points Question In patients receiving rituximab, what are the current rates of screening and recognition of hypogammaglobulinemia, and what are the infectious risks and predictors for increased mortality? Findings In a cohort study of 4479 patients receiving rituximab, many patients were found as not being screened or not being properly identified as having hypogammaglobulinemia. Following rituximab therapy, there was a significant increase in severe infections in the overall study cohort, increased mortality was associated with severe infections in the 6 months before and after rituximab therapy, and higher cumulative doses of immunoglobulin replacement therapy were associated with a reduced risk of severe infections. Meaning Many patients are not being screened or properly identified as having hypogammaglobulinemia before or after rituximab therapy, which may contribute to inferior outcomes with excess morbidity and mortality; monitoring routine serum immunoglobulin levels before and after rituximab therapy may help identify patients at high risk for developing infections and who may benefit from immunoglobulin replacement therapy.

Nuclear factor-κB (NF-κB) is a transcription factor with important roles in regulating innate immune and inflammatory responses. NF-κB is activated through the phosphorylation of its inhibitor, IκB, by the IκB kinase (IKK) complex. Physical exercise elicits changes in skeletal muscle gene expression, yet signaling cascades and transcription factors involved remain largely unknown. To determine whether NF-κB signaling is regulated by exercise in vivo, rats were run on a motorized treadmill for 5–60 min. Exercise resulted in up to twofold increases in IKKα/β phosphorylation in the soleus and red gastrocnemius muscles throughout the time course studied. In red gastrocnemius muscles, NF-κB activity increased 50% 1–3 h after 60 min of treadmill exercise, returning to baseline by 5 h. Contraction of isolated extensor digitorum longus muscles in vitro increased IKKα/β phosphorylation sevenfold and this was accompanied by a parallel increase in IκBα phosphorylation. Additional kinases that are activated by exercise include p38, extracellular-signal regulated protein kinase (ERK), and AMP-activated protein kinase (AMPK). Inhibitors of p38 (SB-203580) and ERK (U-0126) blunted contraction-mediated IKK phosphorylation by 39 ± 4% ( P = 0.06) and 35 ± 10% ( P = 0.09), respectively, and in combination by 76 ± 5% ( P < 0.05), suggesting that these kinases might influence the activation of IKK and NF-κB during exercise. In contrast, 5-aminoimidazole-4-carboxamide-1-β-d-ribofuranoside, an activator of AMPK, had no effect on either IKK or NF-κB activity. In conclusion, acute submaximal exercise transiently stimulates NF-κB signaling in skeletal muscle. This activation is a local event because it can occur in the absence of exercise-derived systemic factors.

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