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. 2023 Feb 8;76(3):e155-e162.
doi: 10.1093/cid/ciac590.

Development of an Effective Immune Response in Adults With Down Syndrome After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccination

Laura Esparcia-Pinedo  1 , Ayla Yarci-Carrión  2 , Gloria Mateo-Jiménez  3 , Noelia Ropero  1 , Laura Gómez-Cabañas  4 , Ángel Lancho-Sánchez  4 , Patricia Almendro-Vázquez  5 , Enrique Martín-Gayo  1   6 , Estela Paz-Artal  5 , Francisco Sanchez-Madrid  1   6 , Fernando Moldenhauer  7 , Ainhoa Gutiérrez-Cobos  2 , Diego Real de Asúa  6   7 , Arantzazu Alfranca  1   6
Affiliations

Development of an Effective Immune Response in Adults With Down Syndrome After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccination

Laura Esparcia-Pinedo et al. Clin Infect Dis. .

Erratum in

Abstract

Background: Immune dysregulation in individuals with Down syndrome (DS) leads to an increased risk for hospitalization and death due to coronavirus disease 2019 (COVID-19) and may impair the generation of protective immunity after vaccine administration.

Methods: The cellular and humoral responses of 55 individuals with DS who received a complete SARS-CoV-2 vaccination regime at 1 to 3 (visit [V 1]) and 6 (V2) months were characterized.

Results: SARS-CoV-2-reactive CD4+ and CD8+ T lymphocytes with a predominant Th1 phenotype were observed at V1 and increased at V2. Likewise, an increase in SARS-CoV-2-specific circulating Tfh (cTfh) cells and CD8+ CXCR5+ PD-1hi lymphocytes was already observed at V1 after vaccine administration. Specific immunoglobulin G (IgG) antibodies against SARS-CoV-2 S protein were detected in 96% and 98% of subjects at V1 and V2, respectively, although IgG titers decreased significantly between both time points.

Conclusions: Our findings show that DS individuals develop an effective immune response to usual regimes of SARS-CoV-2 vaccination.

Keywords: COVID-19; Down syndrome; SARS-CoV-2; immune system; vaccination.

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Conflict of interest statement

Potential conflicts of interest. E. P.-A. reports fees for Advisory Board participation from Pharmamar and AstraZeneca. D. R. d. A. reports grant number 19/00634 from Instituto Carlos III and grant number 2021A/2069 from Fondation Jerome Lejeune; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Universidad Complutense de Madrid (Título propio de experto en bioética clínica), Weill Cornell Medicine-Qatar (Division of Medical Ethics—several courses), Instituto Universitario de Investigación Ortega Y Gasset (Máster oficial en bioética clínica), Escuela Andaluza de Salud Pública (Curso Consultoría Ética Clínica [2022] y Máster en bioética [2021]), and Consejería de Salud, Comunidad De Madrid (Curso Consultoría Ética Clínica [November 2021]). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
T-cell response in patients with DS after SARS-CoV-2 vaccination. SARS-CoV-2–specific CD4+ (A) and CD8+ (B) lymphocytes in patients with DS at visit 0, visit 1, and visit 2. Upper panels: pie charts indicate the percentage of patients with or without T-cell immunity against SARS-CoV-2 at each visit. Lower panels: number of patients with T-cell response against specific peptide pools at each visit. Abbreviations: DS, Down syndrome; RBD, receptor binding domain; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 2.
Figure 2.
T-helper subsets in patients with DS after SARS-CoV-2 vaccination. A (Left), percentage of SARS-CoV-2–specific Th1 and Th2 CD4+ lymphocytes at visits 1 (V1) and 2 (V2); (right) percentage of SEB-activated Th1 and Th2 CD4+ cells at V1 and V2. B, Graphics show the percentage of Th1 (left) and Th2 (right) CD4+ subsets in non-DS and DS donors at visits 1 and 2. Mean + SD values are shown. **P < .01; ****P < .0001. Abbreviations: DS, Down syndrome; ns, nonsignificant; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SEB, Staphylococcal enterotoxin B; SD, standard deviation; Th/TH, T-helper.
Figure 3.
Figure 3.
Circulating Tfh in patients with DS after SARS-CoV-2 vaccination. A, Graphics show the percentage of circulating CD4+ CXCR5+ (left) and CD4+ CXCR5+ PD-1hi (right) cells at visits 1 (V1) and 2 (V2). Mean + SD values are shown. B, Graphics show the percentage of CD4+ CXCR5+ (left) and CD4+ CXCR5+ PD-1high (PD-1hi) (right) cells at V1 and V2 in non-DS and DS donors. C, Graphics show the percentage of SARS-CoV-2–specific CD8+ CXCR5+ (left) and PD-1hi expression within the CD8+ CXCR5+ population (right) at V1 and V2 (n = 11). **P < .01. Abbreviations: DS, Down syndrome; ns, nonsignificant; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SD, standard deviation; Tfh T-follicular helper cells.
Figure 4.
Figure 4.
Humoral response in patients after SARS-CoV-2 vaccination. A, Specific anti–SARS-CoV-2 S IgG titers in patients with DS at visits 0 (PRE), 1 (V1), and 2 (V2), in DS and non-DS donors. Dots show median time for V1 and V2 in each cohort. B, Specific anti–SARS-CoV-2 S IgG titers at visits 0 (V0), 1 (V1), and 2 (V2) in patients with DS ≤40 years (left) or >40 years (right). ****P < .0001; ***P < .001. Abbreviations: BAU, binding antibody units; DS, Down syndrome; IgG, immunoglobulin G; ns, nonsignificant; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
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