Impaired IgM antibody responses to an influenza virus vaccine in adults with sickle cell anemia

Ballester, Oscar F.; Abdallah, Jorge M.; Prasad, Ananda S.

doi:10.1002/ajh.2830200413

Cited by 29 publications

(31 citation statements)

References 10 publications

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“…Splenectomy can provoke modifications in the immunologic state, such as increase in the total number of lymphocytes, including B-and T-cells [8,9], and can induce alterations of the humoral immunity [27-291. Morever, in the absence of functional splenic tissue, as in sickle cell anemia, impairment of antigen-specific IgM and IgG antibody responses has been reported [30]. However, in our study, half of the patients were splenectomized, and the same altered B-cell differentiation was observed in splenectomized and nonsplenectomized cases, discarding an important effect of splenectomy .…”

Section: Discussioncontrasting

confidence: 42%

Effect of alpha interferon on the altered t‐b‐cell immunoregulation in patients with thalassemia major

et al. 1987

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We studied the ability of B-lymphocytes to differentiate to immunoglobulin-producing cells in 14 patients with thalassemia major, 11 parents of the patients, and 86 normal subjects. In comparison with the parents of the patients and with the normal individuals, the patients were found to have 1) an increased number of cells spontaneously secreting immunoglobulin; 2) a decreased number of plaque-forming cells (PFC) when induced with pokeweed mitogen (PWM) and a deficient helper T-cell function for the induction of B-cell differentiation; 3) an increase in the number of PFC after the addition of alpha interferon (100 IU/ml) to the cell cultures with PWM. Previous incubation of non-T-cells with alpha interferon for 1 hr and subsequent coculture with T-cells from the same patients or from normal subjects in the presence of PWM increased the number of PFC. On the contrary, previous incubation of T-cells with alpha interferon followed by coculture with normal non-T-cells or cells from the same patient did not modify the number of PFC. These results suggest that patients with thalassemia major possess hyperreactive spontaneous B-cell responses and that these B-cells are unable to differentiate to immunoglobulin-secreting cells in the presence of PWM. This would be due to a T-helper-cell deficiency with an inability to produce lymphokines (interferon being one of them), while the B-cell function seems to remain intrinsically intact.

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Section: Discussioncontrasting

confidence: 42%

Effect of alpha interferon on the altered t‐b‐cell immunoregulation in patients with thalassemia major

et al. 1987

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“…Five studies found that influenza vaccine was immunogenic among children and adults with seroconversion rates of 60–87% and seroprotection rates of 70–100% [55–59]; however, the immune response may be blunted in children who receive chronic transfusions (90% immune response among subjects not on chronic transfusions compared with 61% among those subjects receiving chronic transfusions) [59]. One study in adults with sickle cell disease found impaired immune responses to trivalent inactivated vaccine, suggesting that the long-term effects of sickle cell disease, such as splenic atrophy, may affect immune response to vaccination [60]. Influenza vaccines are generally considered safe among individuals with sickle cell disease; however, one study suggested a 7- to 9-fold increased risk of hospitalization for sickle cell anemia after administration of trivalent inactivated vaccine [61].…”

Section: Resultsmentioning

confidence: 99%

Potential Impact of Co-Infections and Co-Morbidities Prevalent in Africa on Influenza Severity and Frequency: A Systematic Review

et al. 2015

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Infectious diseases and underlying medical conditions common to Africa may affect influenza frequency and severity. We conducted a systematic review of published studies on influenza and the following co-infections or co-morbidities that are prevalent in Africa: dengue, malaria, measles, meningococcus, Pneumocystis jirovecii pneumonia (PCP), hemoglobinopathies, and malnutrition. Articles were identified except for influenza and PCP. Very few studies were from Africa. Sickle cell disease, dengue, and measles co-infection were found to increase the severity of influenza disease, though this is based on few studies of dengue and measles and the measles study was of low quality. The frequency of influenza was increased among patients with sickle cell disease. Influenza infection increased the frequency of meningococcal disease. Studies on malaria and malnutrition found mixed results. Age-adjusted morbidity and mortality from influenza may be more common in Africa because infections and diseases common in the region lead to more severe outcomes and increase the influenza burden. However, gaps exist in our knowledge about these interactions.

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“…High rates of alloimmunization, connective tissue diseases and transplant rejections , as well as incidences of aberrant vaccine reactivity , have bought to surface adaptive immune abnormalities in SCA. Currently, however, little has been done to characterize T and B lymphocyte phenotype, function and contribution to chronic inflammatory diseases in SCA.…”

Section: Adaptive Immune Dysfunction In Scamentioning

confidence: 99%

“…These abnormalities, including reduction in the proportion of circulating CD4+ and CD8+ T cells, dysfunction of regulatory T cells and impaired B cell IgM secretion , occur concurrent with increased immune activation and may affect vaccine reactivity in individuals with SCA. Thus, immune abnormalities in SCA may potentially explain incidences of impaired magnitude or duration of response to vaccines reported in individuals with SCA . Of note, critical studies reporting adaptive immune changes in SCA were done among SCA populations in the United States and Europe .…”

Section: Introductionmentioning

confidence: 99%

Alteration of lymphocyte phenotype and function in sickle cell anemia: Implications for vaccine responses

et al. 2016

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Individuals with sickle cell anemia (SCA) have increased susceptibility to infections, secondary to impairment of immune function. Besides the described dysfunction in innate immunity, including impaired opsonization and phagocytosis of bacteria, evidence of dysfunction of T and B lymphocytes in SCA has also been reported. This includes reduction in the proportion of circulating CD4+ and CD8+ T cells, reduction of CD4+ helper : CD8+ suppressor T cell ratio, aberrant activation and dysfunction of regulatory T cells (Treg), skewing of CD4+ T cells towards Th2 response and loss of IgM-secreting CD27+IgMhighIgDlow memory B cells. These changes occur on the background of immune activation characterized by predominance of memory CD4+ T cell phenotypes, increased Th17 signaling and elevated levels of C-reactive protein and pro-inflammatory cytokines IL-6 and TNF-α, which may affect the immunogenicity and protective efficacy of vaccines available to prevent infections in SCA. Thus, in order to optimize the use of vaccines in SCA, a thorough understanding of T and B lymphocyte functions and vaccine reactivity among individuals with SCA is needed. Studies should be encouraged of different SCA populations, including sub-Saharan Africa where the burden of SCA is highest. This article summarizes our current understanding of lymphocyte biology in SCA, and highlights areas that warrant future research.

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Impaired IgM antibody responses to an influenza virus vaccine in adults with sickle cell anemia

Cited by 29 publications

References 10 publications

Effect of alpha interferon on the altered t‐b‐cell immunoregulation in patients with thalassemia major

Effect of alpha interferon on the altered t‐b‐cell immunoregulation in patients with thalassemia major

Potential Impact of Co-Infections and Co-Morbidities Prevalent in Africa on Influenza Severity and Frequency: A Systematic Review

Alteration of lymphocyte phenotype and function in sickle cell anemia: Implications for vaccine responses

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