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      Gut microbiota composition is associated with SARS-CoV-2 vaccine immunogenicity and adverse events

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          Abstract

          Objective

          The gut microbiota plays a key role in modulating host immune response. We conducted a prospective, observational study to examine gut microbiota composition in association with immune responses and adverse events in adults who have received the inactivated vaccine (CoronaVac; Sinovac) or the mRNA vaccine (BNT162b2; BioNTech; Comirnaty).

          Design

          We performed shotgun metagenomic sequencing in stool samples of 138 COVID-19 vaccinees (37 CoronaVac and 101 BNT162b2 vaccinees) collected at baseline and 1 month after second dose of vaccination. Immune markers were measured by SARS-CoV-2 surrogate virus neutralisation test and spike receptor-binding domain IgG ELISA.

          Results

          We found a significantly lower immune response in recipients of CoronaVac than BNT162b2 vaccines (p<0.05). Bifidobacterium adolescentis was persistently higher in subjects with high neutralising antibodies to CoronaVac vaccine (p=0.023) and their baseline gut microbiome was enriched in pathways related to carbohydrate metabolism (linear discriminant analysis (LDA) scores >2 and p<0.05). Neutralising antibodies in BNT162b2 vaccinees showed a positive correlation with the total abundance of bacteria with flagella and fimbriae including Roseburia faecis (p=0.028). The abundance of Prevotella copri and two Megamonas species were enriched in individuals with fewer adverse events following either of the vaccines indicating that these bacteria may play an anti-inflammatory role in host immune response (LDA scores>3 and p<0.05).

          Conclusion

          Our study has identified specific gut microbiota markers in association with improved immune response and reduced adverse events following COVID-19 vaccines. Microbiota-targeted interventions have the potential to complement effectiveness of COVID-19 vaccines.

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          Most cited references51

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          Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

          Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; p interaction =0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. Funding UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D’Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca.
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            Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection

            Predictive models of immune protection from COVID-19 are urgently needed to identify correlates of protection to assist in the future deployment of vaccines. To address this, we analyzed the relationship between in vitro neutralization levels and the observed protection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using data from seven current vaccines and from convalescent cohorts. We estimated the neutralization level for 50% protection against detectable SARS-CoV-2 infection to be 20.2% of the mean convalescent level (95% confidence interval (CI) = 14.4-28.4%). The estimated neutralization level required for 50% protection from severe infection was significantly lower (3% of the mean convalescent level; 95% CI = 0.7-13%, P = 0.0004). Modeling of the decay of the neutralization titer over the first 250 d after immunization predicts that a significant loss in protection from SARS-CoV-2 infection will occur, although protection from severe disease should be largely retained. Neutralization titers against some SARS-CoV-2 variants of concern are reduced compared with the vaccine strain, and our model predicts the relationship between neutralization and efficacy against viral variants. Here, we show that neutralization level is highly predictive of immune protection, and provide an evidence-based model of SARS-CoV-2 immune protection that will assist in developing vaccine strategies to control the future trajectory of the pandemic.
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              mRNA vaccines — a new era in vaccinology

              mRNA vaccines represent a promising alternative to conventional vaccine approaches because of their high potency, capacity for rapid development and potential for low-cost manufacture and safe administration. However, their application has until recently been restricted by the instability and inefficient in vivo delivery of mRNA. Recent technological advances have now largely overcome these issues, and multiple mRNA vaccine platforms against infectious diseases and several types of cancer have demonstrated encouraging results in both animal models and humans. This Review provides a detailed overview of mRNA vaccines and considers future directions and challenges in advancing this promising vaccine platform to widespread therapeutic use.
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                Author and article information

                Journal
                Gut
                Gut
                gutjnl
                gut
                Gut
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0017-5749
                1468-3288
                February 2022
                8 February 2022
                8 February 2022
                : gutjnl-2021-326563
                Affiliations
                [1 ]departmentDepartment of Medicine and Therapeutics, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong SAR, China
                [2 ]departmentState Key Laboratory of Digestive Disease, Institute of Digestive Disease, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong SAR, China
                [3 ]departmentLi Ka Shing Institute of Health Sciences, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong SAR, China
                [4 ]departmentMicrobiota I-Center (MagIC) , The Chinese University of Hong Kong , Hong Kong SAR, China
                [5 ]departmentHKU-Pasteur Research Pole, LKS Faculty of Medicine , The University of Hong Kong , Hong Kong SAR, China
                [6 ]departmentSchool of Public Health, LKS Faculty of Medicine , The University of Hong Kong , Hong Kong SAR, China
                [7 ]departmentDepartment of Anaesthesia and Intensive Care, Faculty of Medicine , The Chinese University Hong Kong , Hong Kong SAR, China
                [8 ]departmentJockey Club School of Public Health and Primary Care, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong SAR, China
                [9 ]departmentDepartment of Surgery, LKS Faculty of Medicine , The University of Hong Kong , Hong Kong SAR, China
                [10 ]departmentStanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong SAR, China
                Author notes
                [Correspondence to ] Dr Hein M Tun, HKU-Pasteur Research Pole, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; heinmtun@ 123456hku.hk ; Professor Francis KL Chan, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; fklchan@ 123456cuhk.edu.hk
                Author information
                http://orcid.org/0000-0002-6850-4454
                http://orcid.org/0000-0003-3791-2305
                http://orcid.org/0000-0003-1634-3780
                http://orcid.org/0000-0001-8257-2843
                http://orcid.org/0000-0001-7371-503X
                http://orcid.org/0000-0001-7388-2436
                http://orcid.org/0000-0001-7597-5062
                Article
                gutjnl-2021-326563
                10.1136/gutjnl-2021-326563
                8844967
                35140064
                1be89272-fef4-4344-acd6-bb8817182627
                © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 13 November 2021
                : 16 January 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100005847, Health and Medical Research Fund;
                Award ID: Commissioned Research Grant
                Funded by: the National Research Foundation of Korea (NRF) grant funded through the Korea government;
                Award ID: (NRF-2018M3A9H4055203)
                Funded by: Enhanced start-up research grant of HKU;
                Award ID: Enhanced start-up research grant of HKU
                Funded by: RGC Research Impact Fund;
                Award ID: R7033-18
                Categories
                Gut Microbiota
                1506
                2474
                2312
                Original research
                Custom metadata
                unlocked

                Gastroenterology & Hepatology
                immune response,covid-19,enteric bacterial microflora
                Gastroenterology & Hepatology
                immune response, covid-19, enteric bacterial microflora

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