Concentrations of Pneumococcal IgA and IgM are compromised in some individuals with antibody deficiencies

Abstract

The response to pneumococcal vaccination is assessed by measurement of antigen specific IgG only and is compromised in a number of antibody deficiencies. We measured the concentrations of Pneumococcal IgA and IgM in individuals with both normal and abnormal pneumococcal capsular polysaccharide (PCP) IgG concentrations. A higher number of individuals had abnormal pre-vaccination IgA and IgM concentrations below the lower limit of the normal range compared to the control group. Post vaccination a lower number of individuals had IgA and IgM concentrations below the upper limit of the normal range compared to the control group. Non responders had a higher percentage of individuals with a prior history of infection. In addition, individuals with a history of prior infection had lower pre- and post-vaccination concentrations of PCP IgG, IgA, and IgM. Post-vaccination IgA and IgM concentrations identified four groups of responses which correlated with prior history of infection. A higher percentage of individuals with abnormal PCP IgA and IgM concentrations had a history of prior infection compared to the percentage of individuals with normal concentrations. In individuals with an antibody deficiency, measurement of Pneumococcal IgA and IgM correlates with the number of individuals with prior history of infection.

The clinical relevance of IgM and IgA anti-pneumococcal polysaccharide ELISA assays in patients with suspected antibody deficiency

“…Previous studies have reported conflicting results concerning the correlation between PnPS responses for all three immunoglobulin isotypes with their respective serum levels. Similar to our results, poor correlations were found in a healthy population by Parker et al [13] and a PAD cohort by De Carlos et al [16]. In contrast, Cavaliere et al found a significant correlation in a CVID cohort [11].…”

“…Isolated decreased anti‐PnPS IgM, and in particular the anti‐PnPS IgA response, might have clinical relevance. Decreased anti‐PnPS IgA and IgM responses have been reported in healthy adult blood donors [ 12 , 13 ], but have also been associated with a greater rate of respiratory infections in patients with CVID [ 11 , 15 ] and PAD [ 16 ]. In patients with recurrent ENT, or airway infections in whom no PAD could be diagnosed according to the current standards, the clinical relevance of isolated decreased anti‐PnPS IgA and/or IgM responses has not yet been investigated.…”

“…The cumulative PnPS antibody response can also be measured for IgM‐ and IgA‐type antibodies, but this is not routinely performed for the assessment of immunocompetence or risk of pneumococcal infection [ 11 , 12 , 13 , 14 ]. Anti‐PnPS IgA and IgM antibody responses have been investigated in healthy donors [ 12 , 13 , 14 ], patients with common variable immunodeficiency disorders (CVID) [ 11 , 15 ], patients with primary antibody deficiency (PAD) [ 16 ] and children with transient hypogammaglobulinaemia of infancy (THI) [ 17 ]. The anti‐PnPS IgA and IgM assays identify CVID patients with greater risk of infectious and non‐infectious (autoimmunity, enteropathy) complications [ 11 , 15 , 16 , 18 ] and predict the disease course in young children diagnosed with antibody deficiency [ 19 ].…”

“…Anti‐PnPS IgA and IgM antibody responses have been investigated in healthy donors [ 12 , 13 , 14 ], patients with common variable immunodeficiency disorders (CVID) [ 11 , 15 ], patients with primary antibody deficiency (PAD) [ 16 ] and children with transient hypogammaglobulinaemia of infancy (THI) [ 17 ]. The anti‐PnPS IgA and IgM assays identify CVID patients with greater risk of infectious and non‐infectious (autoimmunity, enteropathy) complications [ 11 , 15 , 16 , 18 ] and predict the disease course in young children diagnosed with antibody deficiency [ 19 ]. However, it is unknown whether an isolated inability to mount a normal IgM or IgA PnPS response should be considered a clinically relevant PAD.…”

Antibody responses after sequential vaccination with PCV13 and PPSV23 in kidney transplant recipients

“…Decreased anti-pneumococcal IgA and IgM levels have been observed in healthy adult blood donors [18], but have also been associated with a pronounced rate of respiratory infections in patients with CVID [34] and primary antibody deficiency (PAD) [35]. It is also known that individuals characterized as having an intact humoral response based on measurement of serotype-specific IgG concentration can still display impaired anti-pneumococcal IgM and IgA levels [36].…”