Why lupus patients are less protected from COVID-19 vaccines? A new study provides new insights 

Since the outbreak of the COVID-19 pandemic, vaccination has become an important means of fighting the virus. However, a new study has found that for some patients with autoimmune diseases, such as systemic lupus erythematosus (lupus), the protection produced by the COVID-19 vaccine may be relatively weak. What is going on? This study, published in the journal Nature Immunology, reveals some of the reasons.

Lupus is a chronic autoimmune disease in which the patient’s immune system mistakenly attacks its own tissues and organs, leading to a variety of symptoms. Because of the abnormalities in the immune system itself, the body of a lupus patient may react differently to the COVID-19 vaccine.

Researchers at Emory University found through a study of 79 lupus patients and 64 healthy people that the mRNA COVID-19 vaccine can effectively induce neutralizing antibodies and establish immune memory in healthy people, allowing the body to respond more quickly and effectively to the virus’s reinvasion. However, in lupus patients, the antibody levels and immune effects produced by the vaccine are relatively weak.

More importantly, the researchers also found that a special B cell subset called “DN2 B cells” is more active in lupus patients. This type of cell has previously been thought to be associated with autoimmune responses. Studies have shown that the increase in DN2 B cells in lupus patients is closely related to poor neutralizing antibody response. In other words, the overactivity of this cell may interfere with the normal effect of the vaccine and lead to insufficient antibody production.

The study helps us understand how immune responses to vaccines are generated and sustained in people with autoimmune diseases such as lupus, said Katia Faliti, Ph.D., of the Emory University Department of Medicine, the study’s lead author. By examining lupus patients who had never been infected with the coronavirus, the researchers explored both antibody-based and cell-based immunity and identified key factors that contribute to strong vaccine responses, as well as factors that may limit protection.

“We have previously found that DN2 B cells are associated with lupus disease and severity, particularly in women of black ancestry,” added Iñaki Sanz, MD, PhD, professor of immunology in the School of Medicine and senior author of the study. “Now we have found evidence that vaccine-mediated activation of DN2 B cells persists over time, even six months after vaccination, when immune memory is formed, and that this activation is present and accounts for a greater proportion of persistent anti-COVID-19 memory in lupus patients.”

The significance of this study is:

A deeper understanding of why lupus patients have a weaker response to the COVID-19 vaccine: The study revealed the particularity of the immune response of lupus patients after receiving the COVID-19 vaccine at the cellular and molecular levels, providing an important scientific basis for us to better understand this phenomenon. Provides clues for the development of more effective vaccination strategies: Studies suggest that different vaccination strategies may be needed for patients with autoimmune diseases such as lupus, such as adjusting vaccine doses, number of vaccinations, or using other types of vaccines to enhance their immune protection. Provides potential targets for the development of new treatments: Intervention targeting DN2 B cells may become a new direction for the treatment of lupus or other autoimmune diseases in the future. Although this study has brought us new insights, we also need to realize that this is only a preliminary study and more research is needed to confirm and improve it. For lupus patients, when it comes to vaccination, they should still follow the doctor’s advice and develop a personalized vaccination plan based on their own circumstances.