Doctor of Philosophy, Case Western Reserve University, 0, Molecular Virology
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease characterized by joint destruction and systemic inflammation. Specifically, RA patients exhibit dysregulation of both innate and adaptive immunity, with key roles played by autoreactive T cells, B cells, and proinflammatory cytokines. Additionally, the immunosuppressive treatments used for RA can further impair immune function, increasing risks of infection.
The COVID-19 pandemic was especially severe for RA patients, who showed higher rates of SARS-CoV-2 infection, hospitalization, and mortality compared to people without immune diseases. The immune response to SARS-CoV-2 involves both innate and adaptive components, with antibodies, memory B cells, and T cells all contributing to viral clearance and durable protection. However, RA patients demonstrated impaired vaccine responses, with lower antibody levels and higher breakthrough infection rates following COVID-19 vaccination.
Aging further compounds these immune deficits through immunosenescence - the age-related decline in immune function. This involves reductions in naive T cells, impaired B cell responses, and chronic low-grade inflammation. The intersection of RA, COVID-19, and aging thus creates a multi-faceted issue of immune dysfunction.
Vaccination strategies for this vulnerable population must account for these multiple layers of immune impairment. Approaches like higher vaccine doses, additional booster shots, or use of adjuvants may be needed to overcome diminished immune responses seen in elderly RA patients. Overall, a nuanced understanding of how RA, viral infections, vaccines, and aging interact is critical for optimizing protection of this group against COVID-19 and other infections.
Committee: Donald Anthony (Advisor); Alan Levine (Committee Chair); Nora Singer (Committee Member); David Canaday (Committee Member); Carey Shive (Committee Member)
Subjects: Immunology; Virology