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Letters to the Editor
in vascular and inflammatory cells. While this is a prom- ising hypothesis, further studies will be needed to better decipher the underlying pathway of IFN-I activation in SCD as well as its specific contribution in the protection of SCD patients from serious COVID-19 complications.
Finally, we monitored the serological titers in a sub- group of 17 seropositive patients to explore the persist- ence of humoral immunity. We observed a rapid and con- stant decrease in IgG levels of 63.4% after 3 months (Figure 1C), a decrease which may be greater than in the general population.12 In line, we observed one case of a 17-year-old homozygous patient considered as a having a severe phenotype of SCD (past history of ACS and fre- quent VOE). He had at the beginning of the study period a positive SARS-CoV-2 serology (titer of 2.3 UI/L) with no history of COVID-19 symptoms. He presented 90 days later with mild fever and a positive SARS-CoV-2 RT-PCR. His concomitant serology was negative and sub- sequent controls showed no secondary increase in IgG titers.
To our knowledge, there is no data on the duration of humoral immunity in SCD patients against SARS-CoV-2. These patients may also present an alteration of their immunity against other respiratory viruses such as influenza.13 Transient humoral immunity regarding the anti-nucleocapsid IgG response has been demonstrated in other populations, especially those with mild symp- toms.14 A recent study in a pediatric population showed an anti-nucleocapsid IgG decline 60 days after the first positive RT-PCR test but a positive titer still present at 90 days.15 More data on SCD patients are needed to confirm these findings.
In conclusion, SCD children were exposed to SARS- CoV-2 at least as much as their healthy peers during the first wave of the pandemic in France but despite theoret- ical susceptibility, they presented no severe complica- tions. Nonetheless, humoral immunity appears to be transient in these patients and a second COVID-19 infec- tion may occur. The basal activation of the IFN-I path- way in a majority of homozygous patients may represent a potential protective state to better control viral load. These findings raise important questions regarding the management of the ongoing pandemic in SCD patients. The negative outcome of COVID-19 in SCD patients in some reports may pertain to other factors including access to care and comorbidities, rather than SCD itself.6 Addressing these additional aspects may prove an effec- tive strategy.
Valentine Brousse,1,2 Laurent Holvoet,1 Rémi Pescarmona,3,4 Sebastien Viel,3,4 Magali Perret,3,4 Benoit Visseaux,5
Valentine Marie Ferre,5 Ghislaine Ithier,1 Caroline Le Van Kim,2 Malika Benkerrou,1,6 Florence Missud1 and Berengere Koehl1,2
1Sickle Cell Disease Center, Hematology Unit, Hôpital Robert Debré, Assistance Publique – Hôpitaux de Paris, Paris; 2Université de Paris, UMR_S1134, BIGR, INSERM, Institut National de la Transfusion Sanguine, Laboratoire d’Excellence GR-Ex, Paris; 3Centre International de Recherche en Infectiologie (CIRI), Université Lyon 1, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, ENS, Lyon; 4Laboratoire d’Immunologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite; 5Université de Paris, Assistance Publique - Hôpitaux de Paris, Service de Virologie, Hôpital Bichat; INSERM UMR 1137-IAME, Decision SCiences in Infectious Diseases control and care (DeSCID), Paris and 6Université de Paris, INSERM UMR 1123, ECEVE, Paris, France
Correspondence:
BERENGERE KOEHL - berengere.koehl@aphp.fr/ berengere.koehl@inserm.fr
doi:10.3324/haematol.2021.278573 Received: February 14, 2021.
Accepted: May 4, 2021.
Pre-published: May 13, 2021.
Disclosures: VB is consultant for bluebirdbio.
Contributions: VB, BK designed the study; VB, BK, FM, LH,
GI and MB enrolled patients; VB and BK wrote the manuscript; BK performed the statistical analysis; VMF and BV were responsible for SARS-Cov-2 serologies and SV, RP and MG performed IFN-I profile analysis. All authors discussed the data, revised and approved the manuscript.
Acknowledgments: we are indebted to Labex GR-EX and URGEB Hôpital Universitaire Robert Debré.
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