Clinical Immunology in Italy, with Special Emphasis to Primary and Acquired Immunodeficiencies: A Commemorative Issue in Honor of Prof. Fernando Aiuti

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Immunology and Immunotherapy".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 31115

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Guest Editor
Dipartimento di Medicina Molecolare, Sapienza, Università di Roma, AOU Policlinico Umberto I, Roma, Italy
Interests: primary immunodeficiencies; vaccines; anti-infectious immunity; mucosal immunity
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Guest Editor
IRCCS Ospedale San Raffaele, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Milan, Italy
Interests: dyshematopoiesis

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Retired, Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, AOU S. Andrea, Via di Grottarossa 1035-1039, 00189 Roma, Italy
Interests: vaccines in normal adults and in immune-mediated inflammatory diseases; microbiota
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
Interests: medicine; immunology and microbiology

Special Issue Information

Dear Colleagues,

We dedicate this Special Issue to the memory of Prof. Fernando Aiuti, whom we lost 3 years ago.

Prof. Fernando Aiuti (1935–2019) was an internationally renowned immunologist, an outstanding and brilliant researcher with a solid post-doc scientific and clinical background in infectious diseases, who provided a relevant contribution to the birth of clinical immunology in Italy in the last decades of twentieth century. In fact, he was called to hold one of the first three chairs of Clinical Immunology in Italy in 1980, as full Professor of Clinical Immunology and Allergy at Sapienza, University of Rome, a role he held for over a quarter of century. His scientific fields of interest ranged from basic immunology, where he provided relevant contributions with Hans Wigzell in Sweden at the start of 1970s for the identification of human T lymphocytes in normal and in immunodeficiency states, to clinical immunology, particularly in primary and acquired immunodeficiencies. Collaboration with the most renowned international groups of immunology and clinical immunology in Europe and the USA was a distinctive feature during his whole research career, in a period during which this attitude was common in Italy. He was an expert member of the Commission for Primary Immunodeficiencies of the World Health Organization, and his original contributions to the study of primary immunodeficiencies were in their diagnosis and pathogenesis, through their phenotypical characterization, and in treatment, with the then-pioneering bone-marrow and thymus transplantations. Together with Prof. Luisa Businco, who was full Professor of Pediatrics at Sapienza University of Rome, he funded the first Registry for Primary Immunodeficiencies in Italy, which now continues its relevant activity as the network for Primary Immunodeficiencies in Italy (IPINET). Together with other distinguished European Immunologists, Prof. Aiuti founded the European Group for Immunodeficiencies, which has now grown and developed into the European Society for Immunodeficiencies, which is very active in the field. Since 1981, with the first description of an acquired immunodeficiency syndrome (AIDS), the main study interest of Fernando Aiuti was addressed to this new syndrome, in which he and his group provided many interesting scientific contributions in the epidemiology, pathogenesis, prophylaxis, and therapy of this disease. In this period of his scientific career, Prof. Aiuti strongly felt the need to get out of the secrecy of the researcher to make the solidity of scientific information available to the general population and to remove false beliefs that could lead to the discrimination of categories of society, thus taking a public, social role, in addition to the academic one. Prof. Aiuti was enthusiastic, moved by a sincere curiosity and the tireless willingness to look for an answer to the several scientific and clinical questions for the scientific development and in the interest of patients, towards whom he has always maintained a very warm, human and protective attitude. His contagious enthusiasm was a powerful spring for the scientific growth of his group, and with his collaborators he was demanding but faithful in his friendship.

In this commemorative Special Issue, the scope of which is to witness the great development of Clinical Immunology in the last few decades, we welcome scientific contributions in the fields of basic adaptive immunology and clinical immunology, including autoimmune and allergic diseases and tumor immunology, but with a special emphasis on primary and acquired immunodeficiencies.

Prof. Dr. Isabella Quinti
Prof. Dr. Alessandro Aiuti
Dr. Raffaele D’Amelio
Prof. Dr. Paolo Rossi
Guest Editors

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Keywords

  • basic immunology
  • clinical immunology
  • allergic diseases
  • autoimmune diseases
  • tumor immunology
  • primary immunodeficiency diseases
  • acquired immunodeficiency syndrome
  • HIV
  • bone marrow transplantation
  • gene therapy
  • humoral immunodeficiencies
  • cellular immunodeficiencies
  • auto-inflammatory diseases
  • IVIg
  • SCIg
  • monoclonal antibodies
  • vaccines

Published Papers (14 papers)

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Editorial

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16 pages, 2382 KiB  
Editorial
Editorial to the Special Issue “Clinical Immunology in Italy, with Special Emphasis to Primary and Acquired Immunodeficiencies: A Commemorative Issue in Honor of Prof. Fernando Aiuti”
by Alessandro Aiuti, Raffaele D’Amelio, Isabella Quinti and Paolo Rossi
Biomedicines 2023, 11(12), 3191; https://doi.org/10.3390/biomedicines11123191 - 30 Nov 2023
Viewed by 728
Abstract
Fernando Aiuti (Figure 1), born in Urbino on 8 June 1935, suddenly died on 9 January 2019, leaving a great void not only among his family members and those who knew him and appreciated his great humanity and acute intelligence, but in the [...] Read more.
Fernando Aiuti (Figure 1), born in Urbino on 8 June 1935, suddenly died on 9 January 2019, leaving a great void not only among his family members and those who knew him and appreciated his great humanity and acute intelligence, but in the entire immunological scientific community [...] Full article
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3 pages, 203 KiB  
Editorial
A Tribute to Two Master Teachers of Immunology
by Roberto Paganelli
Biomedicines 2023, 11(8), 2178; https://doi.org/10.3390/biomedicines11082178 - 02 Aug 2023
Cited by 1 | Viewed by 602
Abstract
A Special Issue dedicated in memory of Prof. Fernando Aiuti is a special tribute to a clinician who led the field of Clinical Immunology in Italy and introduced the entire Italian medical and academic scene to it. [...] Full article

Research

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8 pages, 847 KiB  
Article
Outcome of BCG Vaccination in ADA-SCID Patients: A 12-Patient Series
by Daniele Canarutto, Chiara Oltolini, Federica Barzaghi, Valeria Calbi, Maddalena Migliavacca, Francesca Tucci, Vera Gallo, Giulia Consiglieri, Francesca Ferrua, Salvatore Recupero, Maria Celia Cervi, Hamoud Al-Mousa, Anna Pituch-Noworolska, Chiara Tassan Din, Paolo Scarpellini, Paolo Silvani, Claudia Fossati, Miriam Casiraghi, Daniela Maria Cirillo, Antonella Castagna, Maria Ester Bernardo, Alessandro Aiuti and Maria Pia Cicaleseadd Show full author list remove Hide full author list
Biomedicines 2023, 11(7), 1809; https://doi.org/10.3390/biomedicines11071809 - 24 Jun 2023
Cited by 2 | Viewed by 1558
Abstract
Vaccination with Bacillus Calmette–Guérin (BCG) can be harmful to patients with combined primary immunodeficiencies. We report the outcome of BCG vaccination in a series of twelve patients affected by adenosine deaminase deficiency (ADA-SCID). BCG vaccination resulted in a very high incidence of complications [...] Read more.
Vaccination with Bacillus Calmette–Guérin (BCG) can be harmful to patients with combined primary immunodeficiencies. We report the outcome of BCG vaccination in a series of twelve patients affected by adenosine deaminase deficiency (ADA-SCID). BCG vaccination resulted in a very high incidence of complications due to uncontrolled replication of the mycobacterium. All patients who developed BCG-related disease were treated successfully and remained free from recurrence of disease. We recommend the prompt initiation of enzyme replacement therapy and secondary prophylaxis to reduce the risk of BCG-related complications in ADA-SCID patients. Full article
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13 pages, 690 KiB  
Article
Humoral Immune Response after COVID-19 mRNA Vaccination in Patients with Liver Cirrhosis: A Prospective Real-Life Single Center Study
by Elisa Biliotti, Alessandro Caioli, Chiara Sorace, Raffaella Lionetti, Eugenia Milozzi, Chiara Taibi, Ubaldo Visco Comandini, Fabrizio Maggi, Vincenzo Puro and Gianpiero D’Offizi
Biomedicines 2023, 11(5), 1320; https://doi.org/10.3390/biomedicines11051320 - 28 Apr 2023
Cited by 4 | Viewed by 1044
Abstract
Coronavirus-disease-2019 (COVID-19) mRNA vaccination effectively reduces mortality and morbidity in cirrhotic patients, but the immunogenicity and safety of vaccination have been partially characterized. The study aimed to evaluate humoral response, predictive factors, and safety of mRNA-COVID-19 vaccination in cirrhotic patients compared to healthy [...] Read more.
Coronavirus-disease-2019 (COVID-19) mRNA vaccination effectively reduces mortality and morbidity in cirrhotic patients, but the immunogenicity and safety of vaccination have been partially characterized. The study aimed to evaluate humoral response, predictive factors, and safety of mRNA-COVID-19 vaccination in cirrhotic patients compared to healthy subjects. A prospective, single-center, observational study enrolled consecutive cirrhotic patients who underwent mRNA-COVID-19 vaccination from April to May 2021. Anti-spike-protein (anti-S) and nucleocapsid-protein (anti-N) antibodies were evaluated before the first (T0) and the second (T1) doses and 15 days after completing the vaccination. An age and sex-matched healthy reference group was included. The incidence of adverse events (AEs) was assessed. In total, 162 cirrhotic patients were enrolled, 13 were excluded due to previous SARS-CoV-2 infection; therefore, 149 patients and 149 Health Care Workers (HCWs) were included in the analysis. The seroconversion rate was similar in cirrhotic patients and HCWs at T1 (92.5% vs. 95.3%, p = 0.44) and T2 (100% in both groups). At T2, anti-S-titres were significantly higher in cirrhotic patients compared to HCWs (2776.6 vs. 1756 BAU/mL, p < 0.001]. Male sex (β = −0.32 [−0.64, −0.04], p = 0.027) and past-HCV-infection (β = −0.31 [−0.59, −0.04], p = 0.029) were independent predictors of lower anti-S-titres on multiple-gamma-regression-analysis. No severe AEs occurred. The COVID-19-mRNA vaccination induces a high immunization rate and anti-S-titres in cirrhotic patients. Male sex and past-HCV infection are associated with lower anti-S-titres. The COVID-19-mRNA vaccination is safe. Full article
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13 pages, 1393 KiB  
Article
SARS-CoV-2 Breakthrough Infections According to the Immune Response Elicited after mRNA Third Dose Vaccination in COVID-19-Naïve Hospital Personnel
by Annapaola Santoro, Andrea Capri, Daniele Petrone, Francesca Colavita, Silvia Meschi, Giulia Matusali, Klizia Mizzoni, Stefania Notari, Chiara Agrati, Delia Goletti, Patrizio Pezzotti and Vincenzo Puro
Biomedicines 2023, 11(5), 1247; https://doi.org/10.3390/biomedicines11051247 - 23 Apr 2023
Cited by 7 | Viewed by 1296
Abstract
Background: Vaccine-induced SARS-CoV-2-anti-spike antibody (anti-S/RBD) titers are often used as a marker of immune protection and to anticipate the risk of breakthrough infections, although no clear cut-off is available. We describe the incidence of SARS-CoV-2 vaccine breakthrough infections in COVID-19-free personnel of our [...] Read more.
Background: Vaccine-induced SARS-CoV-2-anti-spike antibody (anti-S/RBD) titers are often used as a marker of immune protection and to anticipate the risk of breakthrough infections, although no clear cut-off is available. We describe the incidence of SARS-CoV-2 vaccine breakthrough infections in COVID-19-free personnel of our hospital, according to B- and T-cell immune response elicited one month after mRNA third dose vaccination. Methods: The study included 487 individuals for whom data on anti-S/RBD were available. Neutralizing antibody titers (nAbsT) against the ancestral Whuan SARS-CoV-2, and the BA.1 Omicron variant, and SARS-CoV-2 T-cell specific response were measured in subsets of 197 (40.5%), 159 (32.6%), and 127 (26.1%) individuals, respectively. Results: On a total of 92,063 days of observation, 204 participants (42%) had SARS-CoV-2 infection. No significant differences in the probability of SARS-CoV-2 infection for different levels of anti-S/RBD, nAbsT, Omicron nAbsT, or SARS-CoV-2 T cell specific response, and no protective thresholds for infection were found. Conclusions: Routine testing for vaccine-induced humoral immune response to SARS-CoV-2 is not recommended if measured as parameters of ‘protective immunity’ from SARS-CoV-2 after vaccination. Whether these findings apply to new Omicron-specific bivalent vaccines is going to be evaluated. Full article
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16 pages, 3269 KiB  
Article
How CD4+ T Cells Transcriptional Profile Is Affected by Culture Conditions: Towards the Design of Optimal In Vitro HIV Reactivation Assays
by Giuseppe Rubens Pascucci, Elena Morrocchi, Chiara Pighi, Arianna Rotili, Alessia Neri, Chiara Medri, Giulio Olivieri, Marco Sanna, Gianmarco Rasi, Deborah Persaud, Ann Chahroudi, Mathias Lichterfeld, Eleni Nastouli, Caterina Cancrini, Donato Amodio, Paolo Rossi, Nicola Cotugno and Paolo Palma
Biomedicines 2023, 11(3), 888; https://doi.org/10.3390/biomedicines11030888 - 13 Mar 2023
Cited by 2 | Viewed by 2209
Abstract
Most of the current assays directed at the investigation of HIV reactivation are based on cultures of infected cells such as Peripheral Blood Mononuclear Cells (PBMCs) or isolated CD4+ T cells, stimulated in vitro with different activator molecules. The culture media in [...] Read more.
Most of the current assays directed at the investigation of HIV reactivation are based on cultures of infected cells such as Peripheral Blood Mononuclear Cells (PBMCs) or isolated CD4+ T cells, stimulated in vitro with different activator molecules. The culture media in these in vitro tests lack many age- and donor-specific immunomodulatory components normally found within the autologous plasma. This triggered our interest in understanding the impact that different matrices and cell types have on T cell transcriptional profiles following in vitro culture and stimulation. Methods: Unstimulated or stimulated CD4+ T cells of three young adults with perinatal HIV-infection were isolated from PBMCs before or after culture in RPMI medium or autologous plasma. Transcriptomes were sequenced using Oxford Nanopore technologies. Results: Transcriptional profiles revealed the activation of similar pathways upon stimulation in both media with a higher magnitude of TCR cascade activation in CD4+ lymphocytes cultured in RPMI. Conclusions: These results suggest that for studies aiming at quantifying the magnitude of biological mechanisms under T cell activation, the autologous plasma could better approximate the in vivo environment. Conversely, if the study aims at defining qualitative aspects, then RPMI culture could provide more evident results. Full article
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15 pages, 1302 KiB  
Article
The Third Dose of BNT162b2 COVID-19 Vaccine Does Not “Boost” Disease Flares and Adverse Events in Patients with Rheumatoid Arthritis
by Andrea Picchianti Diamanti, Assunta Navarra, Gilda Cuzzi, Alessandra Aiello, Simonetta Salemi, Roberta Di Rosa, Chiara De Lorenzo, Daniele Vio, Giandomenico Sebastiani, Mario Ferraioli, Maurizio Benucci, Francesca Li Gobbi, Fabrizio Cantini, Vittoria Polidori, Maurizio Simmaco, Esmeralda Cialdi, Palma Scolieri, Vincenzo Bruzzese, Emanuele Nicastri, Raffaele D’Amelio, Bruno Laganà and Delia Golettiadd Show full author list remove Hide full author list
Biomedicines 2023, 11(3), 687; https://doi.org/10.3390/biomedicines11030687 - 23 Feb 2023
Cited by 4 | Viewed by 1670
Abstract
Data on the risk of adverse events (AEs) and disease flares in autoimmune rheumatic diseases (ARDs) after the third dose of COVID-19 vaccine are scarce. The aim of this multicenter, prospective study is to analyze the clinical and immunological safety of BNT162b2 vaccine [...] Read more.
Data on the risk of adverse events (AEs) and disease flares in autoimmune rheumatic diseases (ARDs) after the third dose of COVID-19 vaccine are scarce. The aim of this multicenter, prospective study is to analyze the clinical and immunological safety of BNT162b2 vaccine in a cohort of rheumatoid arthritis (RA) patients followed-up from the first vaccine cycle to the third dose. The vaccine showed an overall good safety profile with no patient reporting serious AEs, and a low percentage of total AEs at both doses (40/78 (51.3%) and 13/47 (27.7%) patients after the second and third dose, respectively (p < 0.002). Flares were observed in 10.3% of patients after the end of the vaccination cycle and 12.8% after the third dose. Being vaccinated for influenza was inversely associated with the onset of AEs after the second dose, at both univariable (p = 0.013) and multivariable analysis (p = 0.027). This result could allow identification of a predictive factor of vaccine tolerance, if confirmed in larger patient populations. A higher disease activity at baseline was not associated with a higher incidence of AEs or disease flares. Effectiveness was excellent after the second dose, with only 1/78 (1.3%) mild breakthrough infection (BI) and worsened after the third dose, with 9/47 (19.2%) BI (p < 0.002), as a probable expression of the higher capacity of the Omicron variants to escape vaccine recognition. Full article
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20 pages, 3160 KiB  
Article
New Monoclonal Antibodies Specific for Different Epitopes of the Spike Protein of SARS-CoV-2 and Its Major Variants: Additional Tools for a More Specific COVID-19 Diagnosis
by Sabrina Mariotti, Maria Vincenza Chiantore, Raffaela Teloni, Angelo Iacobino, Antonio Capocefalo, Zuleika Michelini, Martina Borghi, Melissa Baggieri, Antonella Marchi, Paola Bucci, Silvia Gioacchini, Raffaele D’Amelio, Philip J. M. Brouwer, Silvia Sandini, Chiara Acchioni, Marco Sgarbanti, Antonio Di Virgilio, Felicia Grasso, Andrea Cara, Donatella Negri, Fabio Magurano, Paola Di Bonito and Roberto Nisiniadd Show full author list remove Hide full author list
Biomedicines 2023, 11(2), 610; https://doi.org/10.3390/biomedicines11020610 - 18 Feb 2023
Cited by 2 | Viewed by 1853
Abstract
The emergence of the new pathogen SARS-CoV-2 determined a rapid need for monoclonal antibodies (mAbs) to detect the virus in biological fluids as a rapid tool to identify infected individuals to be treated or quarantined. The majority of commercially available antigenic tests for [...] Read more.
The emergence of the new pathogen SARS-CoV-2 determined a rapid need for monoclonal antibodies (mAbs) to detect the virus in biological fluids as a rapid tool to identify infected individuals to be treated or quarantined. The majority of commercially available antigenic tests for SARS-CoV-2 rely on the detection of N antigen in biologic fluid using anti-N antibodies, and their capacity to specifically identify subjects infected by SARS-CoV-2 is questionable due to several structural analogies among the N proteins of different coronaviruses. In order to produce new specific antibodies, BALB/c mice were immunized three times at 20-day intervals with a recombinant spike (S) protein. The procedure used was highly efficient, and 40 different specific mAbs were isolated, purified and characterized, with 13 ultimately being selected for their specificity and lack of cross reactivity with other human coronaviruses. The specific epitopes recognized by the selected mAbs were identified through a peptide library and/or by recombinant fragments of the S protein. In particular, the selected mAbs recognized different linear epitopes along the S1, excluding the receptor binding domain, and along the S2 subunits of the S protein of SARS-CoV-2 and its major variants of concern. We identified combinations of anti-S mAbs suitable for use in ELISA or rapid diagnostic tests, with the highest sensitivity and specificity coming from proof-of-concept tests using recombinant antigens, SARS-CoV-2 or biological fluids from infected individuals, that represent important additional tools for the diagnosis of COVID-19. Full article
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10 pages, 1067 KiB  
Article
Opposite Effects of mRNA-Based and Adenovirus-Vectored SARS-CoV-2 Vaccines on Regulatory T Cells: A Pilot Study
by Francesca La Gualana, Francesca Maiorca, Ramona Marrapodi, Francesca Villani, Marzia Miglionico, Stefano Angelo Santini, Fabio Pulcinelli, Laura Gragnani, Silvia Piconese, Massimo Fiorilli, Stefania Basili, Milvia Casato, Lucia Stefanini and Marcella Visentini
Biomedicines 2023, 11(2), 511; https://doi.org/10.3390/biomedicines11020511 - 10 Feb 2023
Cited by 3 | Viewed by 4218
Abstract
New-generation mRNA and adenovirus vectored vaccines against SARS-CoV-2 spike protein are endowed with immunogenic, inflammatory and immunomodulatory properties. Recently, BioNTech developed a noninflammatory tolerogenic mRNA vaccine (MOGm1Ψ) that induces in mice robust expansion of antigen-specific regulatory T (Treg) cells. The Pfizer/BioNTech BNT162b2 mRNA [...] Read more.
New-generation mRNA and adenovirus vectored vaccines against SARS-CoV-2 spike protein are endowed with immunogenic, inflammatory and immunomodulatory properties. Recently, BioNTech developed a noninflammatory tolerogenic mRNA vaccine (MOGm1Ψ) that induces in mice robust expansion of antigen-specific regulatory T (Treg) cells. The Pfizer/BioNTech BNT162b2 mRNA vaccine against SARS-CoV-2 is identical to MOGm1Ψ except for the lipid carrier, which differs for containing lipid nanoparticles rather than lipoplex. Here we report that vaccination with BNT162b2 led to an increase in the frequency and absolute count of CD4posCD25highCD127low putative Treg cells; in sharp contrast, vaccination with the adenovirus-vectored ChAdOx1 nCoV-19 vaccine led to a significant decrease of CD4posCD25high cells. This pilot study is very preliminary, suffers from important limitations and, frustratingly, very hardly can be refined in Italy because of the >90% vaccination coverage. Thus, the provocative perspective that BNT162b2 and MOGm1Ψ may share the capacity to promote expansion of Treg cells deserves confirmatory studies in other settings. Full article
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11 pages, 847 KiB  
Article
Mortality in Severe Antibody Deficiencies Patients during the First Two Years of the COVID-19 Pandemic: Vaccination and Monoclonal Antibodies Efficacy
by Cinzia Milito, Francesco Cinetto, Andrea Palladino, Giulia Garzi, Alessandra Punziano, Gianluca Lagnese, Riccardo Scarpa, Marcello Rattazzi, Anna Maria Pesce, Federica Pulvirenti, Giulia Di Napoli, Giuseppe Spadaro, Rita Carsetti and Isabella Quinti
Biomedicines 2022, 10(5), 1026; https://doi.org/10.3390/biomedicines10051026 - 29 Apr 2022
Cited by 10 | Viewed by 1697
Abstract
Patients with severely impaired antibody responses represent a group at-risk in the SARS-CoV-2 pandemic due to the lack of Spike-specific neutralizing antibodies. The main objective of this paper was to assess, by a longitudinal prospective study, COVID-19 infection and mortality rates, and disease [...] Read more.
Patients with severely impaired antibody responses represent a group at-risk in the SARS-CoV-2 pandemic due to the lack of Spike-specific neutralizing antibodies. The main objective of this paper was to assess, by a longitudinal prospective study, COVID-19 infection and mortality rates, and disease severity in the first two years of the pandemic in a cohort of 471 Primary Antibody Defects adult patients. As secondary endpoints, we compared SARS-CoV-2 annual mortality rate to that observed over a 10-year follow-up in the same cohort, and we assessed the impact of interventions done in the second year, vaccination and anti-SARS-CoV-2 monoclonal antibodies administration on the disease outcome. Forty-one and 84 patients were infected during the first and the second year, respectively. Despite a higher infection and reinfection rate, and a higher COVID-19-related mortality rate compared to the Italian population, the pandemic did not modify the annual mortality rate for any cause in our cohort compared to that registered over the last ten years in the same cohort. PADs patients who died from COVID-19 had an underlying end-stage lung disease. We showed a beneficial effect of MoAbs administration on the likelihood of hospitalization and development of severe disease. In conclusion, COVID-19 did not cause excess mortality in Severe Antibody Deficiencies. Full article
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Review

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10 pages, 1017 KiB  
Review
The Very Low IgE Producer: Allergology, Genetics, Immunodeficiencies, and Oncology
by Paolo Maria Matricardi
Biomedicines 2023, 11(5), 1378; https://doi.org/10.3390/biomedicines11051378 - 06 May 2023
Cited by 4 | Viewed by 4979
Abstract
Opposite to other immunoglobulin (Ig) classes and subclasses, there is no consensus on the definition of normal levels of serum total IgE. However, longitudinal studies on birth cohorts produced growth charts of total IgE levels in helminth-free and never atopic children and defining [...] Read more.
Opposite to other immunoglobulin (Ig) classes and subclasses, there is no consensus on the definition of normal levels of serum total IgE. However, longitudinal studies on birth cohorts produced growth charts of total IgE levels in helminth-free and never atopic children and defining the normal ranges of total serum IgE concentration at the individual, rather than population, level. Accordingly, very ‘low IgE producers’ (i.e., children whose tIgE level belong to the lowest percentiles) became atopic while keeping their total IgE levels in a range considered ‘normal’ if compared to the general age-matched population but ‘abnormally high’ if projected on the tIgE growth chart against the trajectory of that child’s own percentile levels. In ‘low IgE producers’, the IgE-specific activity, i.e., the ratio between allergen-specific and total IgE, is more important than the absolute specific IgE levels to confirm causality between allergen exposure and allergic symptoms. Patients with allergic rhinitis or peanut anaphylaxis but low or undetectable allergen-specific IgE levels must therefore be reconsidered considering their total IgE levels. Low IgE producers have been also associated with common variable immunodeficiency, lung diseases, and malignancies. A few epidemiological studies have shown a higher risk of malignancies in very low IgE producers, leading to a debated hypothesis proposing a novel, evolutionistic-relevant function for IgE antibodies for antitumor immune surveillance. Full article
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15 pages, 955 KiB  
Review
The Many Faces of Immune Activation in HIV-1 Infection: A Multifactorial Interconnection
by Laura Mazzuti, Ombretta Turriziani and Ivano Mezzaroma
Biomedicines 2023, 11(1), 159; https://doi.org/10.3390/biomedicines11010159 - 08 Jan 2023
Cited by 8 | Viewed by 4876
Abstract
Chronic immune activation has a significant role in HIV-1 disease pathogenesis and CD4+ T-cell depletion. The causes of chronic inflammation and immune activation are incompletely understood, but they are likely multifactorial in nature, involving both direct and indirect stimuli. Possible explanations include microbial [...] Read more.
Chronic immune activation has a significant role in HIV-1 disease pathogenesis and CD4+ T-cell depletion. The causes of chronic inflammation and immune activation are incompletely understood, but they are likely multifactorial in nature, involving both direct and indirect stimuli. Possible explanations include microbial translocation, coinfection, and continued presence of competent replicating virus. In fact, long-term viral suppression treatments are unable to normalize elevated markers of systemic immune activation. Furthermore, high levels of pro-inflammatory cytokines increase susceptibility to premature aging of the immune system. The phenomenon of “inflammaging” has begun to be evident in the last decades, as a consequence of increased life expectancy due to the introduction of cART. Quality of life and survival have improved substantially; however, PLWH are predisposed to chronic inflammatory conditions leading to age-associated diseases, such as inflammatory bowel disease, neurocognitive disorders, cardiovascular diseases, metabolic syndrome, bone abnormalities, and non-HIV-associated cancers. Several approaches have been studied in numerous uncontrolled and/or randomized clinical trials with the aim of reducing immune activation/inflammatory status in PLWH, none of which have achieved consistent results. Full article
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Other

13 pages, 313 KiB  
Case Report
Insights from a Case of Good’s Syndrome (Immunodeficiency with Thymoma)
by Roberto Paganelli, Michela Di Lizia, Marika D’Urbano, Alessia Gatta, Alessia Paganelli, Paolo Amerio and Paola Parronchi
Biomedicines 2023, 11(6), 1605; https://doi.org/10.3390/biomedicines11061605 - 01 Jun 2023
Cited by 4 | Viewed by 1285
Abstract
Immunodeficiency with thymoma was described by R.A. Good in 1954 and is also named after him. The syndrome is characterized by hypogammaglobulinemia associated with thymoma and recurrent infections, bacterial but also viral, fungal and parasitic. Autoimmune diseases, mainly pure red cell aplasia, other [...] Read more.
Immunodeficiency with thymoma was described by R.A. Good in 1954 and is also named after him. The syndrome is characterized by hypogammaglobulinemia associated with thymoma and recurrent infections, bacterial but also viral, fungal and parasitic. Autoimmune diseases, mainly pure red cell aplasia, other hematological disorders and erosive lichen planus are a common finding. We describe here a typical case exhibiting all these clinical features and report a detailed immunophenotypic assessment, as well as the positivity for autoantibodies against three cytokines (IFN-alpha, IL-6 and GM-CSF), which may add to known immune abnormalities. A review of the published literature, based on case series and immunological studies, offers some hints on the still unsolved issues of this rare condition. Full article
14 pages, 4228 KiB  
Brief Report
Multiplex Proteomic Evaluation in Inborn Errors with Deregulated IgE Response
by Enrico Scala, Stefania Madonna, Daniele Castiglia, Alessandro Scala, Elisabetta Caprini and Roberto Paganelli
Biomedicines 2023, 11(1), 202; https://doi.org/10.3390/biomedicines11010202 - 13 Jan 2023
Cited by 2 | Viewed by 1915
Abstract
(1) Background: Atopic dermatitis constitutes one of the most common inflammatory skin manifestations of the pediatric population. The onset of many inborn errors occurs early in life with an AD–like picture associated with a deregulated IgE response. The availability of proteomic tests for [...] Read more.
(1) Background: Atopic dermatitis constitutes one of the most common inflammatory skin manifestations of the pediatric population. The onset of many inborn errors occurs early in life with an AD–like picture associated with a deregulated IgE response. The availability of proteomic tests for the simultaneous evaluation of hundreds of molecules allows for more precise diagnosis in these cases. (2) Methods: Comparative genomic hybridization microarray (Array–CGH) analysis and specific IgE evaluation by using allergenic microarray (ISAC) and microarray (ALEX2) systems were performed. (3) Results: Proteomic investigations that use multiplex methods have proven to be extremely useful to diagnose the sensitization profile in inborn errors with deregulated IgE synthesis. Four patients with rare diseases, such as recessive X–linked ichthyosis (RXLI, OMIM 308100), Comel–Netherton syndrome (NS, OMIM256500), monosomy 1p36 syndrome (OMIM: 607872), and a microduplication of Xp11.4 associated with extremely high levels of IgE: 7.710 kU/L, 5.300 kU/L, 1.826 kU/L, and 10.430 kU/L, respectively, were evaluated by micro– and macroarray multiplex methods. Polyreactivity to both environmental and food allergens was observed in all cases, including the first described case of association of X–chromosome microduplication and HIE. (4) Conclusions: Extensive use of proteomic diagnostics should be included among the procedures to be implemented in inborn errors with hyper–IgE. Full article
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