AUTHOR=Favalli Andrea , Favalli Ennio Giulio , Gobbini Andrea , Zagato Elena , Bombaci Mauro , Maioli Gabriella , Pesce Elisa , Donnici Lorena , Gruarin Paola , Biggioggero Martina , Curti Serena , Manganaro Lara , Marchisio Edoardo , Bevilacqua Valeria , Martinovic Martina , Fabbris Tanya , Sarnicola Maria Lucia , Crosti Mariacristina , Marongiu Laura , Granucci Francesca , Notarbartolo Samuele , Bandera Alessandra , Gori Andrea , De Francesco Raffaele , Abrignani Sergio , Caporali Roberto , Grifantini Renata TITLE=Immunosuppressant Treatment in Rheumatic Musculoskeletal Diseases Does Not Inhibit Elicitation of Humoral Response to SARS-CoV-2 Infection and Preserves Effector Immune Cell Populations JOURNAL=Frontiers in Immunology VOLUME=13 YEAR=2022 URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.873195 DOI=10.3389/fimmu.2022.873195 ISSN=1664-3224 ABSTRACT=

COVID-19 has proven to be particularly serious and life-threatening for patients presenting with pre-existing pathologies. Patients affected by rheumatic musculoskeletal disease (RMD) are likely to have impaired immune responses against SARS-CoV-2 infection due to their compromised immune system and the prolonged use of disease-modifying anti-rheumatic drugs (DMARDs), which include conventional synthetic (cs) DMARDs or biologic and targeted synthetic (b/ts) DMARDs. To provide an integrated analysis of the immune response following SARS-CoV-2 infection in RMD patients treated with different classes of DMARDs we carried out an immunological analysis of the antibody responses toward SARS-CoV-2 nucleocapsid and RBD proteins and an extensive immunophenotypic analysis of the major immune cell populations. We showed that RMD individuals under most DMARD treatments mount a sustained antibody response to the virus, with neutralizing activity. In addition, they displayed a sizable percentage of effector T and B lymphocytes. Among b-DMARDs, we found that anti-TNFα treatments are more favorable drugs to elicit humoral and cellular immune responses as compared to CTLA4-Ig and anti-IL6R inhibitors. This study provides a whole picture of the humoral and cellular immune responses in RMD patients by reassuring the use of DMARD treatments during COVID-19. The study points to TNF-α inhibitors as those DMARDs permitting elicitation of functional antibodies to SARS-CoV-2 and adaptive effector populations available to counteract possible re-infections.