Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;43(2):393-400.
doi: 10.1111/liv.15368. Epub 2022 Aug 8.

Analysis of the humoral and cellular response after the third COVID-19 vaccination in patients with autoimmune hepatitis

Johannes Hartl  1   2 , Darius Ferenc Rüther  1   2 , Paul Maria Duengelhoef  1   3 , Thomas Theo Brehm  1   4 , Silja Steinmann  1   2 , Jan Philipp Weltzsch  1   2 , Fabian Glaser  1   2 , Martina Sterneck  1 , Marcial Sebode  1   2 , Christina Weiler-Normann  1   2 , Marc Lütgehetmann  4   5   6 , Golda Melina Schaub  1   4 , Friedrich Haag  3 , Christoph Schramm  1   2   7   8 , Julian Schulze Zur Wiesch  1   4 , Ansgar Wilhelm Lohse  1   2   4   8
Affiliations

Analysis of the humoral and cellular response after the third COVID-19 vaccination in patients with autoimmune hepatitis

Johannes Hartl et al. Liver Int. 2023 Feb.

Abstract

Background & aims: To explore the humoral and T-cell response to the third COVID-19 vaccination in autoimmune hepatitis (AIH).

Methods: Anti-SARS-CoV-2 antibody titers were prospectively determined in 81 AIH patients and 53 healthy age- and sex-matched controls >7 days (median 35) after the first COVID-19 booster vaccination. The spike-specific T-cell response was assessed using an activation-induced marker assay (AIM) in a subset of patients.

Results: Median antibody levels were significantly lower in AIH compared to controls (10 908 vs. 25 000 AU/ml, p < .001), especially in AIH patients treated with MMF (N = 14, 4542 AU/ml, p = .004) or steroids (N = 27, 7326 AU/ml, p = .020). Also, 48% of AIH patients had antibody titers below the 10% percentile of the healthy controls (9194 AU/ml, p < .001). AIH patients had a high risk of failing to develop a spike-specific T-cell response (15/34 (44%) vs. 2/16 (12%), p = .05) and showed overall lower frequencies of spike-specific CD4 + T cells (median: 0.074% vs 0.283; p = .01) after the booster vaccination compared to healthy individuals. In 34/81 patients, antibody titers before and after booster vaccination were available. In this subgroup, all patients but especially those without detectable/low antibodies titers (<100 AU/ml) after the second vaccination (N = 11/34) showed a strong, 148-fold increase.

Conclusion: A third COVID-19 vaccination efficiently boosts antibody levels and T-cell responses in AIH patients and even seroconversion in patients with the absent immune response after two vaccinations, but to a lower level compared to controls. Therefore, we suggest routinely assessing antibody levels in AIH patients and offering additional booster vaccinations to those with suboptimal responses.

Keywords: COVID-19 vaccination; autoimmune hepatitis; immunosuppression.

PubMed Disclaimer

References

REFERENCES

    1. Lee A, Wong SY, Chai LYA, et al. Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis. BMJ (Clinical research ed). 2022;376:e068632.
    1. Ruether DF, Schaub GM, Duengelhoef PM, et al. SARS-CoV2-specific humoral and T-cell immune response after second vaccination in liver cirrhosis and transplant patients. Clin Gastroenterol Hepatol. 2022;20(1):162-172.e9.
    1. Duengelhoef P, Hartl J, Ruther D, et al. SARS-CoV-2 vaccination response in patients with autoimmune hepatitis and autoimmune cholestatic liver disease. United Eur Gastroenterol J. 2022;10:319-329.
    1. Terziroli Beretta-Piccoli B, Lleo A. Is immunosuppression truly associated with worse outcomes in autoimmune hepatitis patients with COVID-19? Liver Int. 2022;42(2):274-276.
    1. Efe C, Lammert C, Tascilar K, et al. Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis. Liver Int. 2022;42(3):607-614.