Type 2 diabetes compromises SARS-CoV-2-specific immunological memory following ChAdOx1 nCoV-19 vaccination

Despite the success of vaccination, isolated cases of COVID-19 infection are being reported in the vulnerable subjects worldwide. Given that individuals with type-2 diabetes (T2D) often exhibit immune dysregulation, this study aimed to characterize SARS-CoV-2-specific immunity following ChAdOx1 nCoV-19 vaccination in subjects with T2D.

We recruited 55 T2D and 60 healthy control (HC) subjects and monitored their immunological parameters at baseline, 3rd, 6th, and 12th month post-ChAdOx1 nCoV-19 vaccination. The frequency of SARS-CoV-2 epitope-specific CD8+ T cells were determined using MHC-I dextramers. The SARS-CoV-2 specific recall responses were assessed by lymphocyte proliferation, intracellular (TNF-α, IFN-γ) and extracellular (IL-2, IL-4, IL-6, IL-10, IFN-γ, TGF-β) cytokine estimation following in-vitro stimulation with SARS-CoV-2 S-protein peptide pool (SP). The anti-S antibody titers and the frequency of memory B cells (CD19+ CD27+), plasmablasts (CD19+ CD27hiCD38hi), and plasma cells (CD38hi CD138+) were also determined.

Following vaccination, the incidence of COVID-19 disease was significantly higher in T2D individuals, suggesting an increased rate of breakthrough infections. The T2D cohort also exhibited lower frequency of SARS-CoV-2-specific peripheral CD8+ T cells and demonstrated diminished recall responses, as evidenced by reduced in-vitro lymphocyte proliferation. During breakthrough COVID-19 disease, systemic levels of IFN-γ were elevated in T2D subjects, whereas higher IL-10 levels were observed only in HC. Upon SP stimulation, a greater proportion of CD8+ and CD4+ T cells from HC expressed IFN-γ and TNF-α, indicating a more robust antiviral cell-mediated immune response. Additionally, B cell immunophenotyping revealed a reduced frequency of memory B cells in T2D.

The data indicate that individuals with T2D exhibit impaired vaccine-induced SARS-CoV-2-specific immunological memory, in contrast to HC, who demonstrate a well-regulated balance between pro- and anti-inflammatory responses.