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Longitudinal Study of SARS-CoV-2 Vaccinations and Infections in Patients with Gastrointestinal Cancer: Stabilizing
Maria A Gonzalez-Carmona1,2, Alina M Schmitz1, Moritz Berger3
1Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
Abstract:
This longitudinal study examined how active gastrointestinal (GI) cancer types affect immune responses to SARS-CoV-2, focusing on the ability to neutralize the Omicron variants. Patients with GI cancer (n = 168) were categorized into those with hepatocellular carcinoma, hepatic metastatic GI cancer, non-hepatic metastatic GI cancer, and two control groups of patients with and without underlying liver diseases. Humoral and cellular immune responses were evaluated before and after Omicron antigen exposures. In the pre-Omicron era, humoral SARS-CoV-2 immunity decreased after three antigen contacts without further antigen exposure. While Omicron neutralization was significantly lower than wildtype neutralization (p < 0.01), Omicron infections were yet mild to moderate. Additional Omicron exposures improved IgG levels (p < 0.01) and Omicron neutralization (p < 0.01). However, this effect was significantly less intense in patients with active GI cancer, particularly in patients with pancreaticobiliary neoplasms (PBN; p = 0.04), with underlying immunodeficiency (p = 0.05), and/or under conventional chemotherapy (p = 0.05). Pre-Omicron SARS-CoV-2 immunity prevented severe clinical courses of infections with Omicron variants in patients with GI cancer. However, in patients with PBN, with underlying immunodeficiency, and/or under conventional chemotherapy initial contacts with Omicron antigens triggered only reduced immune responses. Thus, subgroups could be identified for whom booster vaccinations are of special clinical significance.
Insights
Active gastrointestinal (GI) cancers can weaken immune responses to SARS-CoV-2 Omicron variants. Booster vaccinations are crucial for GI cancer patients, especially those with pancreaticobiliary neoplasms or undergoing chemotherapy, to enhance protection.
Area of Science:
- Immunology
- Oncology
- Virology
Background:
- Gastrointestinal (GI) cancers and their treatments can impact immune function.
- SARS-CoV-2 Omicron variants present unique challenges for existing immunity.
- Understanding immune responses in cancer patients is critical for public health.
Purpose of the Study:
- To investigate the effect of active GI cancers on immune responses to SARS-CoV-2, specifically Omicron variants.
- To evaluate humoral and cellular immunity in GI cancer patients before and after Omicron antigen exposure.
- To identify subgroups of GI cancer patients who may benefit most from booster vaccinations.
Main Methods:
- Longitudinal study of 168 GI cancer patients and controls.
- Categorization of patients by cancer type (hepatocellular carcinoma, metastatic GI cancer) and controls (liver disease).
- Assessment of humoral and cellular immune responses, including Omicron neutralization, pre- and post-antigen exposure.
Main Results:
- Pre-Omicron immunity offered protection against severe Omicron infections in GI cancer patients.
- Omicron neutralization was lower than wildtype, but infections were mild to moderate.
- GI cancer patients, particularly those with pancreaticobiliary neoplasms (PBN), immunodeficiency, or chemotherapy, showed reduced immune responses to Omicron antigens.
- Booster exposures improved IgG levels and neutralization, but less effectively in vulnerable GI cancer subgroups.
Conclusions:
- Pre-existing SARS-CoV-2 immunity mitigates severe Omicron infections in GI cancer patients.
- Active GI cancers, PBN, immunodeficiency, and chemotherapy impair immune responses to Omicron.
- Specific GI cancer patient subgroups require booster vaccinations for enhanced protection against SARS-CoV-2 variants.
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