Throughout the pandemic, Cate Speake, PhD, and the Center for Interventional Immunology have conducted countless COVID-19 studies — from understanding how the immune system responds to the virus to testing the Pfizer vaccine. Lab staff worked in shifts to ensure safe social distancing. Dr. Speake would even drop off snacks and drinks for her team early in the morning before anyone else arrived.

After over a year of intense hours and innovative research, her team is turning their attention to one key COVID-19 question: Can people who take certain medications to slow down their immune system for autoimmune disease mount a proper response to COVID-19 vaccines?

“We think it's really important to understand how COVID and COVID immunization impact the populations we study the most — people with autoimmunity,” Dr. Speake says.

That’s not the only study BRI researchers are conducting to understand how COVID-19 vaccines work in various populations. Bernard Khor, MD, PhD, is also studying the effectiveness of COVID-19 vaccines among people with Down Syndrome (DS). People with Down syndrome are at increased risk for complications of COVID-19 and have higher instances of autoimmunity than people without DS.

“Respiratory infections are a leading cause of death in people with Down syndrome, which is why it's so important to understand how effective COVID vaccines are in this population,” Dr. Khor says. “Not only is the goal to help people with Down syndrome mount a more effective immune response, but also to try and understand what this can teach us about vaccine response in people without Down syndrome too.”

What does it mean to “mount a vaccine response?”

In general, vaccines help train your immune system to fight off diseases. They do this by teaching the immune system to recognize an invader (say SARS-CoV-2, which causes COVID-19) and attack if they see it.

Two types of immune cells help your body recognize and attack invaders: B cells and T cells. B cells help your body recognize harmful invaders by making antibodies. T cells help destroy those invaders. “Mounting a vaccine response” or “responding to a vaccine” means that when you get a vaccine, these immune cells can recognize germs and fight them off. 

Learn more about MRNA vaccines for COVID-19.  

Do medicines for autoimmune disease impact your ability to respond to the vaccine?

Having an autoimmune disease, which happens when your immune system starts mistakenly attacking healthy cells, does not typically impact your body’s ability to respond to vaccines. But some of the medications people take for these conditions slow down the immune system, which could affect vaccine response.

Dr. Speake’s team is working with researchers at the University of Washington (UW) to learn if and how certain medications impact how your body responds to the Pfizer and Moderna COVID-19 vaccines.

So far, researchers have taken blood samples before and after both vaccine doses from people with conditions like rheumatoid arthritis, inflammatory bowel disease and multiple sclerosis who take certain medications.

UW’s team has led the first part of data analysis, examining whether B cells are responding properly to vaccination by making an antibody response. So far, their research has shown that most of the therapies they’re studying do not affect the amount of antibodies someone makes to the vaccine.

“This is really good news, because it means that, in general, people with autoimmunity who are taking these therapies still have a very good response to their COVID vaccination,” Dr. Speake says.

The one group they found that did not have a strong antibody response to these therapies were people who take therapies like rituximab or ocrelizumab, which deplete B cells.

“This is what we expected to see — if you don’t have any B cells, it's really hard for your body to make a new response,” she says.

Next, BRI will lead an analysis looking at T cell response.

“The T cell piece is really important — we need to know more about both responses to put the full puzzle together,” Dr. Speake says. “Once we have that information, we can start to inform clinicians and they can inform their patients of which therapies might have an impact on vaccine response.”

Read more about vaccine response and immune system diseases 

Does having Down syndrome impact your ability to respond to COVID-19 vaccines?

Understanding how vaccines work in people with Down syndrome is vital, because people with this condition are more likely to have complications from respiratory infections.

“We start to see bad outcomes from COVID-19 among people with Down syndrome around age 40, as compared to around 60 in people without Down syndrome,” Dr. Khor says. 

Research on past vaccines in people with DS shows that they do respond to vaccines, but their response might not be as effective as people without DS.

“Those past studies are asking if people with Down syndrome make a response, which they do,” Dr. Khor says. “But there is some data that suggests that those responses might not be as high quality as someone without Down syndrome. When you look closer at the data, they are typically at the lower end of the spectrum — they might have fewer antibodies that don’t work as well. And we still don’t know how factors like age and gender may play into their vaccine response.”

Dr. Khor’s team is studying blood samples from volunteers with DS before and after each vaccine dose. His team hopes to learn more about how exactly having DS impacts your response and if there’s a way to change vaccines so people with DS create a stronger immune response.  

“This will open the door to answering questions like ‘how can we help them make a more effective response?’” Dr. Khor says. “‘Is it one dose fits all or do we need to do something different to get more effective coverage based on age or other characteristics? And answering these questions among the Down syndrome community can teach us about immune response among other people too.”

Read more: Why Down Syndrome Holds Key Clues About Autoimmunity

Learn more about groundbreaking research at BRI: See how volunteers fuel immune system research and learn about an unprecedented way to study RA.