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Poor neutralization and rapid decay of antibodies to SARS-CoV-2 variants in vaccinated dialysis patients.

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Bassi, Jessica 
Giannini, Olivier 
Silacci-Fregni, Chiara 
Pertusini, Laura 
Hitz, Paolo 


Patients on dialysis are at risk of severe course of SARS-CoV-2 infection. Understanding the neutralizing activity and coverage of SARS-CoV-2 variants of vaccine-elicited antibodies is required to guide prophylactic and therapeutic COVID-19 interventions in this frail population. By analyzing plasma samples from 130 hemodialysis and 13 peritoneal dialysis patients after two doses of BNT162b2 or mRNA-1273 vaccines, we found that 35% of the patients had low-level or undetectable IgG antibodies to SARS-CoV-2 Spike (S). Neutralizing antibodies against the vaccine-matched SARS-CoV-2 and Delta variant were low or undetectable in 49% and 77% of patients, respectively, and were further reduced against other emerging variants. The fraction of non-responding patients was higher in SARS-CoV-2-naïve hemodialysis patients immunized with BNT162b2 (66%) than those immunized with mRNA-1273 (23%). The reduced neutralizing activity correlated with low antibody avidity. Patients followed up to 7 months after vaccination showed a rapid decay of the antibody response with an average 21- and 10-fold reduction of neutralizing antibodies to vaccine-matched SARS-CoV-2 and Delta variant, which increased the fraction of non-responders to 84% and 90%, respectively. These data indicate that dialysis patients should be prioritized for additional vaccination boosts. Nevertheless, their antibody response to SARS-CoV-2 must be continuously monitored to adopt the best prophylactic and therapeutic strategy.


Funder: Swiss Kidney Foundation


Animals, Antibodies, Neutralizing, Antibody Affinity, CHO Cells, COVID-19 Vaccines, Case-Control Studies, Cricetulus, Dose-Response Relationship, Immunologic, Follow-Up Studies, HEK293 Cells, Humans, Immunoglobulin G, Neutralization Tests, Renal Dialysis, Risk Factors, SARS-CoV-2, Vaccination, mRNA Vaccines

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PLoS One

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Public Library of Science (PLoS)
MRC (via Imperial College London) (MR/W005611/1)