Recovery from the Middle East respiratory syndrome is associated with antibody and T cell responses

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Science Immunology  04 Aug 2017:
Vol. 2, Issue 14, eaan5393
DOI: 10.1126/sciimmunol.aan5393

Breaking the camel virus’s back

Middle East respiratory syndrome coronavirus (MERS-CoV) causes a potentially lethal zoonotic pneumonia that can transfer between individuals after initial exposure to an infected camel. Now, Zhao et al. dig deeper into the immune response in MERS-CoV survivors. They found that neutralizing antibody titers could predict protection in an animal model but that antibody levels were often transient. Moreover, both CD4+ and CD8+ T cells were induced after MERS-CoV infection, and these cells could be detected even in the absence of virus-specific antibody. These data suggest that T cells may be useful in detecting mild or subclinical infection and that epitopes recognized by these T cells may form the basis for future vaccine design and immunotherapy.


The Middle East respiratory syndrome coronavirus (MERS-CoV) causes a highly lethal pneumonia. MERS was recently identified as a candidate for vaccine development, but most efforts focus on antibody responses, which are often transient after CoV infections. CoV-specific T cells are generally long-lived, but the virus-specific T cell response has not been addressed in MERS patients. We obtained peripheral blood mononuclear cells and/or sera from 21 MERS survivors. We detected MERS-CoV–specific CD4+ and CD8+ T cell responses in all MERS survivors and demonstrated functionality by measuring cytokine expression after peptide stimulation. Neutralizing (PRNT50) antibody titers measured in vitro predicted serum protective ability in infected mice and correlated with CD4+ but not CD8+ T cell responses; patients with higher PRNT50 and CD4+ T cell responses had longer intensive care unit stays and prolonged virus shedding and required ventilation. Survivors with undetectable MERS-CoV–specific antibody responses mounted CD8+ T cell responses comparable with those of the whole cohort. There were no correlations between age, disease severity, comorbidities, and virus-specific CD8+ T cell responses. In conclusion, measurements of MERS-CoV–specific T cell responses may be useful for predicting prognosis, monitoring vaccine efficacy, and identifying MERS patients with mild disease in epidemiological studies and will complement virus-specific antibody measurements.

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