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      Respiratory mucosal immunity against SARS-CoV-2 following mRNA vaccination

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          Abstract

          SARS-CoV-2 mRNA vaccination induces robust humoral and cellular immunity in the circulation; however, it is currently unknown whether it elicits effective immune responses in the respiratory tract, particularly against variants of concern (VOCs), including Omicron. We compared the SARS-CoV-2 S-specific total and neutralizing antibody responses, and B and T cell immunity, in the bronchoalveolar lavage fluid (BAL) and blood of COVID-19 vaccinated individuals and hospitalized patients. Vaccinated individuals had significantly lower levels of neutralizing antibody against D614G, Delta (B.1.617.2) and Omicron BA.1.1 in the BAL compared to COVID-19 convalescents, despite robust S-specific antibody responses in the blood. Furthermore, mRNA vaccination induced circulating S-specific B and T cell immunity, but in contrast to COVID-19 convalescents, these responses were absent in the BAL of vaccinated individuals. Using a mouse immunization model, we demonstrated that systemic mRNA vaccination alone induced weak respiratory mucosal neutralizing antibody responses, especially against SARS-CoV-2 Omicron BA.1.1 in mice; however, a combination of systemic mRNA vaccination plus mucosal adenovirus-S immunization induced strong neutralizing antibody responses, not only against the ancestral virus but also the Omicron BA.1.1 variant. Together, our study supports the contention that the current COVID-19 vaccines are highly effective against severe disease development, likely through recruiting circulating B and T cell responses during re-infection, but offer limited protection against breakthrough infection, especially by Omicron sublineage. Hence, mucosal booster vaccination is needed to establish robust sterilizing immunity in the respiratory tract against SARS-CoV-2, including infection by Omicron sublineage and future VOCs.

          Abstract

          COVID-19 mRNA vaccines induce poor anti-Omicron mucosal immunity, but this immunity can boosted with an intranasal immunization.

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          Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection

          Predictive models of immune protection from COVID-19 are urgently needed to identify correlates of protection to assist in the future deployment of vaccines. To address this, we analyzed the relationship between in vitro neutralization levels and the observed protection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using data from seven current vaccines and from convalescent cohorts. We estimated the neutralization level for 50% protection against detectable SARS-CoV-2 infection to be 20.2% of the mean convalescent level (95% confidence interval (CI) = 14.4-28.4%). The estimated neutralization level required for 50% protection from severe infection was significantly lower (3% of the mean convalescent level; 95% CI = 0.7-13%, P = 0.0004). Modeling of the decay of the neutralization titer over the first 250 d after immunization predicts that a significant loss in protection from SARS-CoV-2 infection will occur, although protection from severe disease should be largely retained. Neutralization titers against some SARS-CoV-2 variants of concern are reduced compared with the vaccine strain, and our model predicts the relationship between neutralization and efficacy against viral variants. Here, we show that neutralization level is highly predictive of immune protection, and provide an evidence-based model of SARS-CoV-2 immune protection that will assist in developing vaccine strategies to control the future trajectory of the pandemic.
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            Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization

            The SARS-CoV-2 B.1.617 lineage was identified in October 2020 in India1-5. Since then, it has become dominant in some regions of India and in the UK, and has spread to many other countries6. The lineage includes three main subtypes (B1.617.1, B.1.617.2 and B.1.617.3), which contain diverse mutations in the N-terminal domain (NTD) and the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein that may increase the immune evasion potential of these variants. B.1.617.2-also termed the Delta variant-is believed to spread faster than other variants. Here we isolated an infectious strain of the Delta variant from an individual with COVID-19 who had returned to France from India. We examined the sensitivity of this strain to monoclonal antibodies and to antibodies present in sera from individuals who had recovered from COVID-19 (hereafter referred to as convalescent individuals) or who had received a COVID-19 vaccine, and then compared this strain with other strains of SARS-CoV-2. The Delta variant was resistant to neutralization by some anti-NTD and anti-RBD monoclonal antibodies, including bamlanivimab, and these antibodies showed impaired binding to the spike protein. Sera collected from convalescent individuals up to 12 months after the onset of symptoms were fourfold less potent against the Delta variant relative to the Alpha variant (B.1.1.7). Sera from individuals who had received one dose of the Pfizer or the AstraZeneca vaccine had a barely discernible inhibitory effect on the Delta variant. Administration of two doses of the vaccine generated a neutralizing response in 95% of individuals, with titres three- to fivefold lower against the Delta variant than against the Alpha variant. Thus, the spread of the Delta variant is associated with an escape from antibodies that target non-RBD and RBD epitopes of the spike protein.
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              SARS-CoV-2 vaccines in development

              Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in late 2019 in China and is the causative agent of the coronavirus disease 2019 (COVID-19) pandemic. To mitigate the effects of the virus on public health, the economy and society, a vaccine is urgently needed. Here I review the development of vaccines against SARS-CoV-2. Development was initiated when the genetic sequence of the virus became available in early January 2020, and has moved at an unprecedented speed: a phase I trial started in March 2020 and there are currently more than 180 vaccines at various stages of development. Data from phase I and phase II trials are already available for several vaccine candidates, and many have moved into phase III trials. The data available so far suggest that effective and safe vaccines might become available within months, rather than years.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: VisualizationRole: Writing - original draftRole: Writing - review & editing
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: VisualizationRole: Writing - review & editing
                Role: Project administrationRole: Resources
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: Methodology
                Role: InvestigationRole: ResourcesRole: Validation
                Role: InvestigationRole: ResourcesRole: Writing - review & editing
                Role: Project administrationRole: Validation
                Role: InvestigationRole: Resources
                Role: Resources
                Role: ConceptualizationRole: SupervisionRole: Writing - original draft
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: Validation
                Role: ConceptualizationRole: InvestigationRole: ResourcesRole: ValidationRole: Writing - review & editing
                Role: ConceptualizationRole: Writing - review & editing
                Role: ConceptualizationRole: InvestigationRole: ResourcesRole: Writing - review & editing
                Role: InvestigationRole: ResourcesRole: VisualizationRole: Writing - original draftRole: Writing - review & editing
                Role: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Validation
                Role: InvestigationRole: Resources
                Role: MethodologyRole: ResourcesRole: ValidationRole: Writing - review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: VisualizationRole: Writing - original draftRole: Writing - review & editing
                Role: Writing - review & editing
                Role: Funding acquisitionRole: Writing - review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: Supervision
                Role: ConceptualizationRole: InvestigationRole: Methodology
                Role: MethodologyRole: ResourcesRole: Writing - review & editing
                Role: ConceptualizationRole: InvestigationRole: Writing - review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing - original draftRole: Writing - review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing - original draftRole: Writing - review & editing
                Journal
                Sci Immunol
                Sci Immunol
                sciimmunol
                immunology
                Science Immunology
                American Association for the Advancement of Science
                2470-9468
                19 July 2022
                19 July 2022
                : eadd4853
                Affiliations
                [ 1 ]Carter Immunology Center, University of Virginia, Charlottesville, VA, USA 22908
                [ 2 ]Division of Infectious Disease and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA 22908
                [ 3 ]Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA 55905
                [ 4 ]Center for Retrovirus Research, The Ohio State University, Columbus, OH, USA 43210
                [ 5 ]Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA 43210
                [ 6 ]Department of Systems Biotechnology, Chung-Ang University, Anseong, Gyeonggi-do, Republic of Korea 17546
                [ 7 ]Department of Immunology, Mayo Clinic, Rochester, MN, USA 55905
                [ 8 ]Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA 55905
                [ 9 ]Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA 98109
                [ 10 ]Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104
                [ 11 ]Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia, Charlottesville, VA, USA 22908
                [ 12 ]Child Health Research Center, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA 22908
                [ 13 ]Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA 46074
                [ 14 ]Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA 77555
                Author notes
                [*]

                These authors contribute equally

                [#]

                These authors contribute equally

                []Corresponding author. Email: liu.6244@ 123456osu.edu , js6re@ 123456virginia.edu
                Author information
                https://orcid.org/0000-0003-3593-4324
                https://orcid.org/0000-0003-4423-3634
                https://orcid.org/0000-0002-5426-1498
                https://orcid.org/0000-0003-2978-8703
                https://orcid.org/0000-0001-5160-7783
                https://orcid.org/0000-0003-3667-2960
                https://orcid.org/0000-0001-9718-2901
                https://orcid.org/0000-0002-6585-0087
                https://orcid.org/0000-0002-7921-484X
                https://orcid.org/0000-0002-5332-977X
                https://orcid.org/0000-0002-8824-6691
                https://orcid.org/0000-0002-4876-059X
                https://orcid.org/0000-0002-2923-8245
                https://orcid.org/0000-0002-1501-6510
                https://orcid.org/0000-0002-6311-2881
                https://orcid.org/0000-0002-6964-2314
                https://orcid.org/0000-0003-2328-0255
                https://orcid.org/0000-0002-2347-4511
                Article
                add4853
                10.1126/sciimmunol.add4853
                9348751
                35857583
                c3dc8ddd-2fd2-443a-bf8b-3fe6aea8e9d2
                Copyright © 2022 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works

                This is an open-access article distributed under the terms of the Creative Commons Attribution license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 June 2022
                : 11 July 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: NIH R01 AI150473
                Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: AI057459
                Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: AI147903
                Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: AI157852
                Funded by: FundRef http://dx.doi.org/10.13039/100000049, National Institute on Aging;
                Award ID: NS122174
                Funded by: FundRef http://dx.doi.org/10.13039/100000065, National Institute of Neurological Disorders and Stroke;
                Award ID: NS103212
                Funded by: FundRef http://dx.doi.org/10.13039/501100016206, Université de Sfax;
                Award ID: AI147394
                Funded by: FundRef http://dx.doi.org/10.13039/501100016206, Université de Sfax;
                Award ID: AG047156
                Funded by: FundRef http://dx.doi.org/10.13039/501100016206, Université de Sfax;
                Award ID: AG069264
                Funded by: FundRef http://dx.doi.org/10.13039/501100016206, Université de Sfax;
                Award ID: AI147394S1
                Funded by: FundRef , The Ohio State University;
                Award ID: NCI U54CA260582
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