Are the immune-compromised worse off?

4 minute read

Australian researchers will study the effects of COVID-19 on people with weakened immune systems

Australian researchers will study the effects of COVID-19 on people with weakened immune systems to see whether they are especially vulnerable to the virus, or whether they might actually be protected from some of its effects.

The collaboration – led by UNSW’s Kirby Institute with the Garvan Institute, St Vincent’s Hospital and the Institute of Clinical Pathology & Medical Research at Westmead Hospital, and partly funded by Gilead Sciences – will recruit COVID-19 patients who are also either undergoing cancer treatment, have had an organ or stem cell transplant, have HIV, have an inherited immunodeficiency, or are taking immunomodulatory therapies.

The lead author is Professor Mark Polizzotto from the Kirby Institute, a haematologist at St Vincent’s Hospital who leads the two bodies’ clinical research program in cancer and immunodeficiency.

Professor Polizzotto said while people with cancer did appear to be more vulnerable to the virus, there was not yet enough data on the other populations to know.

He said this study would explore several facets of the effects of COVID-19 on these patients.

“One of our interests is increased vulnerability,” he said.

“Another, which is more speculative, is whether some immune therapies, either for cancer or autoimmune diseases or HIV, may on some level be protective. That’s a hard question to get at and we wouldn’t definitively answer a question like that with a study like this.

“But this is a virus where see a lot of replication early on, and later in the people who do badly, you see a real immune activation. So there has been a question in our minds whether some of those treatments might be protective.”

Immune-suppressing drugs such as IL-6 blocker tocilizumab are being tested on COVID-19 patients and appear effective at mitigating the hyperimmune response known as cytokine storm.

“We’re going to get a tonne of information about where they’re at with their [condition] and what drugs they’re on,” Professor Polizzotto said. “Where they agree, we’re also going to take some blood that lets us profile their immune system and the genetics of the virus and understand that a little bit better. Then we’ll follow each person to see how they do over time.

“If something was really protective, it might jump out at us. That’s not going to be tremendously solid data but it might just be enough to provoke more [work].”

Professor Polizzotto said since the immune system was not a simple dial to turn up and down, the groups might show different effects in terms of vulnerability and protection.

“It might well be that people who have problems making antibodies – for example, if they’ve had a cancer therapy that that prevents them from doing that – might have more problems with the virus, while people who are on a drug that inhibits some of that immune activation, maybe they’ll do a little bit better.”

The final aspect would be to see where care had been disrupted by COVID-19, as changes had been made to keep people out of hospital.

“That might inform planning for pandemics in the future,” he said.

“These are super-complex, super-high-touch groups in terms of their need for medical care. So they’re probably not just vulnerable in the biological sense of vulnerable to infection, but they’re probably particularly vulnerable to the disruption that we’re seeing in the healthcare system.”

The patients will be enrolled either from NSW only, nationally or from overseas cohorts depending on how rare their condition is, in order to have large enough numbers to generate good data.

“The concern was that by now we would have the sort of situation we’ve seen in parts of Europe,” he said. “I’m really delighted that’s not the case.

“It’s easier to do research when clinics are not so overwhelmed, and if we don’t get large numbers I’ll be super happy, even though we won’t answer the questions!”

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