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Front Immunol . Immune responses in COVID-19 patients during breakthrough infection with SARS-CoV-2 variants Delta, Omicron-BA.1 and Omicron-BA.5

tetano

Editor, Senior Moderator
Front Immunol


. 2023 Jul 13;14:1150667.
doi: 10.3389/fimmu.2023.1150667. eCollection 2023. Immune responses in COVID-19 patients during breakthrough infection with SARS-CoV-2 variants Delta, Omicron-BA.1 and Omicron-BA.5

Maren Bormann[SUP] 1 [/SUP], Leonie Brochhagen[SUP] 1 [/SUP], Mira Alt[SUP] 1 [/SUP], Mona Otte[SUP] 1 [/SUP], Laura Thümmler[SUP] 1 2 [/SUP], Lukas van de Sand[SUP] 1 [/SUP], Ivana Kraiselburd[SUP] 3 [/SUP], Alexander Thomas[SUP] 3 [/SUP], Jule Gosch[SUP] 3 [/SUP], Peer Braß[SUP] 1 [/SUP], Sandra Ciesek[SUP] 4 5 6 [/SUP], Marek Widera[SUP] 4 [/SUP], Sebastian Dolff[SUP] 1 [/SUP], Ulf Dittmer[SUP] 7 [/SUP], Oliver Witzke[SUP] 1 [/SUP], Folker Meyer[SUP] 3 [/SUP], Monika Lindemann[SUP] 2 [/SUP], Andreas Schönfeld[SUP] 1 [/SUP], Hana Rohn[SUP] 1 [/SUP], Adalbert Krawczyk[SUP] 1 7 [/SUP]



Affiliations
Abstract

Background: Breakthrough infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are increasingly observed in vaccinated individuals. Immune responses towards SARS-CoV-2 variants, particularly Omicron-BA.5, are poorly understood. We investigated the humoral and cellular immune responses of hospitalized COVID-19 patients during Delta and Omicron infection waves.
Methods: The corresponding SARS-CoV-2 variant of the respective patients were identified by whole genome sequencing. Humoral immune responses were analyzed by ELISA and a cell culture-based neutralization assay against SARS-CoV-2 D614G isolate (wildtype), Alpha, Delta (AY.43) and Omicron (BA.1 and BA.5). Cellular immunity was evaluated with an IFN-γ ELISpot assay.
Results: On a cellular level, patients showed a minor IFN-γ response after stimulating PBMCs with mutated regions of SARS-CoV-2 variants. Neutralizing antibody titers against Omicron-BA.1 and especially BA.5 were strongly reduced. Double-vaccinated patients with Delta breakthrough infection showed a significantly increased neutralizing antibody response against Delta compared to double-vaccinated uninfected controls (median complete neutralization titer (NT[SUB]100[/SUB]) 640 versus 80, p<0.05). Omicron-BA.1 infection increased neutralization titers against BA.1 in double-vaccinated patients (median NT[SUB]100[/SUB] of 160 in patients versus 20 in controls, p=0.07) and patients that received booster vaccination (median NT[SUB]100[/SUB] of 50 in patients versus 20 in controls, p=0.68). For boosted patients with BA.5 breakthrough infection, we found no enhancing effect on humoral immunity against SARS-CoV-2 variants.
Conclusion: Neutralizing antibody titers against Omicron-BA.1 and especially BA.5 were strongly reduced in SARS-CoV-2 breakthrough infections. Delta and Omicron-BA.1 but not Omicron-BA.5 infections boosted the humoral immunity in double-vaccinated patients and patients with booster vaccination. Despite BA.5 breakthrough infection, those patients may still be vulnerable for reinfections with BA.5 or other newly emerging variants of concern.

Keywords: COVID-19; Delta; Omicron; SARS-CoV-2; breakthrough infections.

 
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