Immunosenescence and cytomegalovirus-associated immune signatures on severe acute respiratory syndrome coronavirus 2 booster responses Irene Reina-Alfonso, Pablo Álvarez-Heredia, Isabel M Vallejo-Bermúdez, Ana Navas-Romo, Mónica Espinar-García, Fakhri Hassouneh, Ana Belén Pérez, Raquel Tarazona, Rafael Solana, Alexander Batista-Duharte, Juan Molina, Alejandra Pera Journals of Gerontology Series A Biological Sciences and Medical Sciences, 2026 Aging remodels antiviral immunity, yet its influence on responses to repeated mRNA vaccination is not fully defined. We evaluated humoral and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike–specific T-cell responses in 41 adults—stratified by age (<50 vs. ≥60 years), sex, prior SARS-CoV-2 infection, and cytomegalovirus (CMV) serostatus—before and after a fourth dose of the bivalent BNT162b2 vaccine. Anti-RBD IgG titers increased in nearly all participants, with no measurable impact of age, sex, infection history, or CMV status, and baseline titers predicted post-booster antibody levels. In contrast, cellular immunity showed clear heterogeneity across aging-related variables. Although the booster enhanced IFN-γ production and reduced TNF-α-associated inflammatory activity at the cohort level, older adults and males exhibited significantly lower post-boost frequencies of IFN-γ–producing CD4+ T cells. Prior SARS-CoV-2 infection was associated with attenuated CD4+ recall responses, whereas infection-naïve and female participants showed the strongest functional gains. Immunosenescence markers were associated with reduced cellular responsiveness. CMV-related immune remodeling—including higher anti-CMV IgG levels and expansions of differentiated CD8+ subsets—correlated with diminished IFN-γ responses in CD4+ and CD8+ T cells after boosting, suggesting that chronic CMV imprinting constrains heterologous antiviral immunity even in mid-adult life. Humoral and cellular changes were largely uncoupled, supporting the need to evaluate both arms of adaptive immunity. These findings indicate that while a fourth bivalent BNT162b2 dose reliably reinforces humoral immunity across ages, the magnitude and quality of cellular responses are shaped by age, sex, infection history, and CMV-associated immunosenescence. Incorporating immune-aging markers into vaccination strategies may improve booster efficacy in older populations.
Algorithms for appropriate patient stratification in the face of a new SARS-CoV-2 pandemic Paula Álvarez, Ana Navas, Manuel Martí-Antonio, Raquel Bernardo, Antonio Trujillo-Aguilera, Antonio Costa, Laura Carrero-Chiquillo, José Manuel Vaquero, Carmen de la Fuente, Juan Molina, Aurora Jurado Immunity and Ageing, 2025 Although the SARS-Cov-2 pandemic has passed, the virus continues to cause infection and death. Immunological response is crucial to overcome the disease. Elucidating the prognostic value of measurable immunological variables at the time of admission and throughout the disease progression could provide stratification tools, improving the management of patients. A total of 1,096 samples belonging to 979 hospitalised patients molecularly diagnosed with SARS-CoV-2 infection, together with their medical records were retrospectively analysed. Demographic data, including age, sex, date of symptom onset and admission and T, B and NK cells and serum cytokine levels, were collected as predictor variables. Stratification of patients was performed according to their severity (grade 1: uncomplicated disease; grade 2: mild pneumonia; grade 3: severe pneumonia), their admission to Intensive Care Unit and their final outcome (death vs. alive). On admission, more severe patients were older, had lower lymphocyte subpopulation counts and higher levels of IL-6, IL-8, IL-10 and IP-10. The trend of lymphocyte counts throughout the disease progression since the symptom onset was to increase both in less and severe patients (even though in these last the levels remained significantly lower), except for NK cells, which decreased. Regarding cytokine levels, IL-6 and IL-8 tended to increase, whereas IL-10 and IP-10 tended to decrease in more severe patients, although particularly IL-10 remained significantly higher in them as compared with less severe patients, and, interestingly, its tendency was to increase in those who died. When considering the clinical evolution, an increase of IL-8 serum levels and a decrease of NK cells were significantly associated with a worsening, while an increase of CD19+ B and CD8+ T cells and a decrease of IL-6, IL-10, MCP-1 and IP-10 cytokine circulating levels were significantly related to an improvement. By integrating all the results, 13 optimal classification trees were constructed using evolutionary algorithms to predict COVID-19 outcome. The age and the study of lymphocyte populations in a county hospital, together with cytokine serum level quantitation in a third-level hospital, are enough variables to predict the outcome of patients hospitalised due to SARS-CoV-2 infection.
Association Between Peach and Olive Pollen Non-Specific Lipid Transfer Protein Allergy and HLA Class II Phenotype Paula Álvarez, Juan Molina, Raquel Bernardo, Rafael González, Bárbara Manzanares, Rocío Aguado, Laura Carrero, Aurora Jurado, Berta Ruiz-León, Ana Navas International Journal of Molecular Sciences, 2025 Concomitant sensitisation to non-specific lipid transfer proteins (nsLTPs) from olive pollen (Ole e 7) and peach (Pru p 3) has been observed in the south of Spain. In the search for reasons to explain this observation, we studied a potential causal relationship between Human Leukocyte Antigen (HLA) molecules and nsLTP sensitisation. For this purpose, eighteen Ole e 7-monosensitised (MONOLE) patients, 22 Pru p 3-monosensitised (MONPRU) patients, and 22 bisensitised (BI) patients were genotyped for HLA class II alleles. Complementarily, T-cell epitopes were predicted with the Immune Epitope Database analysis tool to test HLA epitope presentation. Our results showed a significant increase in DRB1*11 and DQB1*03 frequencies in MONPRU patients and DRB1*04 frequency in MONOLE patients. Additionally, T-cell epitope analysis revealed high binding affinity between the predicted Pru p 3 epitopes and DRB1*11 and between the predicted Ole e 7 epitopes and DRB1*04, suggesting that presentation of these epitopes may be favoured and predisposing individuals to sensitisation. Conversely, low DQB1*05 frequency and poor binding ability of predicted epitopes from both nsLTPs postulated this allele as a possible protective factor to sensitisation. Variations in the binding affinity between nsLTP epitopes and HLA molecules may underlie individual susceptibility to nsLTP allergy.
Vitamin D and nutritional support in patients with heart failure: effect on circulating cytokines Aura D. Herrera-Martinez, Concepción Muñoz-Jiménez, Ana Navas Romo, José López Aguilera, María Ángeles Gálvez Moreno, María José Molina Puerta, Aurora Jurado Roger Revista De Osteoporosis Y Metabolismo Mineral, 2025 La Revista de Osteoporosis y Metabolismo Mineral (ROMM) es el medio de difusión de la Sociedad Española de Osteoporosis y Metabolismo Mineral (SEIOMM) y la Sociedad Iberoamericana de Osteoporosis y Metabolismo Mineral (SIBOMM).
Pollen-Food Allergy Syndrome: From Food Avoidance to Deciphering the Potential Cross-Reactivity between Pru p 3 and Ole e 7 Paula Álvarez, Rocío Aguado, Juan Molina, Antonio Trujillo-Aguilera, Mayte Villalba, Araceli Díaz-Perales, Carmen Oeo-Santos, Eduardo Chicano, Nadine Blanco, Ana Navas, Berta Ruiz-León, Aurora Jurado Nutrients, 2024 Background: Cross-reactivity between nonspecific lipid transfer proteins could cause anaphylaxis, further influencing food avoidance and nutrient deficiencies. The one affecting olive pollen (Ole e 7) and peach (Pru p 3) may underlie a variety of pollen-food syndromes, though a deep molecular analysis is necessary. Methods: Three Ole e 7-monosensitised patients (MON_OLE), three Pru p 3-monosensitised patients (MON_PRU) and three bisensitised patients (BI) were selected. For epitope mapping, both digested proteins were incubated with patient sera, and the captured IgE-bound peptides were characterised by LC-MS. Results: The analysis revealed two Ole e 7 epitopes and the three Pru p 3 epitopes previously described. Interestingly, the “KSALALVGNKV” Ole e 7 peptide was recognised by MON_OLE, BI and MON_PRU patients. Conversely, all patients recognised the “ISASTNCATVK” Pru p 3 peptide. Although complete sequence alignment between both proteins revealed 32.6% identity, local alignment considering seven residue fragments showed 50 and 57% identity when comparing “ISASTNCATVK” with Ole e 7 and “KSALALVGNKV” with Pru p 3. Conclusions: This study mapped sIgE-Ole e 7-binding epitopes, paving the way for more precise diagnostic tools. Assuming non-significant sequence similarity, structural homology and shared key residues may underlie the potential cross-reactivity between Ole e 7 and Pru p 3 nsLTPs.
Systemic Inflammation in Oncologic Patients Undergoing Systemic Treatment and Receiving Whey Protein-Based Nutritional Support Aura D. Herrera-Martínez, Ana Navas Romo, Soraya León-Idougourram, Concepción Muñoz-Jiménez, Rosa Rodríguez-Alonso, Gregorio Manzano García, Marta Camacho-Cardenosa, Antonio Casado-Diaz, María Ángeles Gálvez-Moreno, María José Molina Puertas, Aurora Jurado Roger International Journal of Molecular Sciences, 2024 There is increasing evidence about the role of inflammation in sarcopenia and tumor progression; thus, its modulation would represent a valuable strategy for improving clinical outcomes in patients with cancer. Several studies have reported that whey protein has significant anti-inflammatory and antioxidant characteristics in humans. We aimed to evaluate the effects of whey protein-based oral nutritional support on circulating cytokines in patients with solid tumors undergoing systemic treatment. Forty-six patients with solid tumors of different origin and undergoing systemic treatment were evaluated. Nutritional support with two daily whey protein-based oral supplements was administered. Circulating levels of IL-6, IL-8, IL-10, MCP-1 and IP-10 were determined. Nutritional evaluation included anthropometric, instrumental and biochemical parameters. Over 63% of the evaluated patients underwent surgery, 56.5% required chemotherapy and almost 50% received combined treatment. Patients with resected primary tumor presented with lower baseline IL-6 (p < 0.05) and IP-10 (p < 0.001); after three months of nutritional support, they presented with lower IL-8 (p < 0.05) and tended to present lower IL-6 and IP-10 (p = 0.053 and 0.067, respectively). Significant positive correlations between circulating cytokines, C-reactive protein and ferritin were observed; similarly, negative correlations with anthropometric and biochemical nutritional parameters were noticed (p < 0.05). We did not observe significant changes in circulating cytokine levels (IL-6, IL-8, IL-10, MCP-1 and IP-10) in patients with cancer undergoing systemic treatment after three months of nutritional support with whey protein-based oral supplements. According to a univariate analysis in our cohort, circulating IL-8 was associated with mortality in these patients, additionally, MCP-1 and IP-10 tended to correlate; but an age- and sex-adjusted multivariate analysis revealed that only baseline MCP-1 was significantly associated with mortality (OR 1.03 (95% CI: 1.00–1.05)). In conclusion, surgery of the primary solid tumor and combination treatment allow significant reduction in circulating cytokine levels, which remained stable while patients received nutritional support with whey protein-based oral supplements over three months. The role of MCP-1 as an independent factor for mortality in these patients should be further evaluated.
Nutritional Support Reduces Circulating Cytokines in Patients with Heart Failure Aura D. Herrera-Martínez, Concepción Muñoz Jiménez, Ana Navas Romo, José López Aguilera, Manuel Crespin Crespin, Bárbara Torrecillas Baena, Antonio Casado-Díaz, María Ángeles Gálvez Moreno, María José Molina Puerta, Aurora Jurado Roger Nutrients, 2024 Increased inflammation is associated with the pathogenesis of heart failure (HF). Increased circulating levels of cytokines have been previously reported and generally associated with worse clinical outcomes. In this context, the modulation of inflammation-related parameters seems to be a reasonable therapeutic option for improving the clinical course of the disease. Based on this, we aimed to compare changes in circulating cytokines when Mediterranean diet alone or in combination with hypercaloric, hyperproteic oral nutritional supplements (ONS), enriched with omega−3 (n−3) polyunsaturated fatty acids were administered to patients with HF. Briefly, patients were randomly assigned to receive Mediterranean Diet (control group) vs. Mediterranean Diet plus ONS (intervention group). We observed increased circulating levels of IL-6, IL-8, MCP-1 and IP-10. MCP-1 and IL-6 were associated with overweight and obesity (p = 0.01–0.01–0.04, respectively); IL-6 and IL-8 were positively correlated with fat mass and CRP serum levels (p = 0.02–0.04, respectively). Circulating levels of IL-8 significantly decreased in all patients treated with the Mediterranean diet, while IL-6 and IP-10 only significantly decreased in patients that received plus ONS. In the univariate analysis, MCP-1 and its combination with IL-6 were associated with increased mortality (p = 0.02), while the multivariate analysis confirmed that MCP-1 was an independent factor for mortality (OR 1.01, 95%ci 1.01–1.02). In conclusion, nutritional support using hypercaloric, hyperproteic, n-3 enriched ONS in combination with Mediterranean Diet was associated with decreased circulating levels of some cytokines and could represent an interesting step for improving heart functionality of patients with HF.
Longitudinal study of patients with discrepant results in CLIFT and a solid-phase dsDNA antibody assay: Does a gold standard dsDNA assay exist? Antonio Trujillo Aguilera, Raquel Bernardo Serrano, Ana Navas, Juan Alcaide Molina, Paula Alvarez Romero, Aurora Jurado Roger Lupus Science and Medicine, 2023 ObjectiveAntidouble-stranded DNA (dsDNA) antibodies are essential for diagnosis and follow-up of systemic lupus erythematous (SLE). To ensure the best diagnostic approach, most healthcare laboratories opt for a combination of highly sensitive methods, such as solid-phase immunoassays, and highly specific methods, such as theCrithidia luciliaeindirect immunofluorescence test (CLIFT). Even so, discordant results are common, thus hindering the diagnostic process. Therefore, this study aimed to characterise a cohort of patients with discrepant results for a dsDNA fluorescence enzyme immunoassay (FEIA) and CLIFT during 2016–2018 and to follow patients up until December 2021.MethodsWe performed an observational, longitudinal and retrospective study on 417 samples from 257 patients who had been referred for suspected connective tissue diseases or followed up after diagnosis. All of them were positive for antinuclear antibodies (ANAs) using an indirect immunofluorescence assay (IFA) on Hep-2 cells, the entry criterion in our laboratory, and positive for FEIA dsDNA. Samples were then tested with CLIFT according to our routine protocol, which includes CLIFT testing after FEIA dsDNA results ≥10 UI/ml. After the assessment of data quality, the final analysis was based on 222 patients.ResultsEighty-three patients (37.4%) had positive results in both tests and met the diagnostic criteria for SLE. However, 139 patients (62.6%) had discrepant results (FEIA+, CLIFT–). Of these, 58 patients (41.7%) had a diagnosis of SLE, with 47 (33.8%) having been previously diagnosed and under treatment. The remaining 11 patients (7.9%) had a new diagnosis of SLE, which was made up within 4 years of the initial screening. A total of 81 of the 139 patients (57.5%) with discrepant results did not meet lupus criteria during the follow-up period.ConclusionsThe study showed that CLIFT could be negative in both treated and newly diagnosed SLE, thus underlining the importance of follow-up of dsDNA-positive results using solid-phase tests. Therefore, quantitative tests such as FEIA could add value to the diagnosis and management of patients with suspected SLE.
Role of IP-10 to Predict Clinical Progression and Response to IL-6 Blockade With Sarilumab in Early COVID-19 Pneumonia. A Subanalysis of the SARICOR Clinical Trial Marta Trigo-Rodríguez, Sheila Cárcel, Ana Navas, Reinaldo Espíndola-Gómez, José Carlos Garrido-Gracia, María Ángeles Esteban Moreno, Rafael León-López, Pedro María Martínez Pérez-Crespo, Eduardo Aguilar Alonso, David Vinuesa, Alberto Romero-Palacios, Inés Pérez-Camacho, Belén Gutiérrez-Gutiérrez, Francisco Javier Martínez-Marcos, Concepción Fernández-Roldán, Eva León, Alexandra Aceituno Caño, Juan E Corzo-Delgado, Elena Perez-Nadales, Cristina Riazzo, Carmen de la Fuente, Aurora Jurado, Julián Torre-Cisneros, Nicolás Merchante Open Forum Infectious Diseases, 2023 BackgroundThe Clinical Trial of Sarilumab in Adults With COVID-19 (SARICOR) showed that patients with coronavirus disease 2019 (COVID-19) pneumonia and increased levels of interleukin (IL)-6 might benefit from blockade of the IL-6 pathway. However, the benefit from this intervention might not be uniform. In this subanalysis, we sought to determine if other immunoactivation markers, besides IL-6, could identify which subgroup of patients benefit most from this intervention.MethodsThe SARICOR trial was a phase II, open-label, multicenter, controlled trial (July 2020–March 2021) in which patients were randomized to receive usual care (UC; control group), UC plus a single dose of sarilumab 200 mg (sarilumab-200 group), or UC plus a single dose of sarilumab 400 mg (sarilumab-400 group). Patients who had baseline serum samples for cytokine determination (IL-8, IL-10, monocyte chemoattractant protein–1, interferon-inducible protein [IP]-10) were included in this secondary analysis. Progression to acute respiratory distress syndrome (ARDS) according to cytokine levels and treatment received was evaluated.ResultsOne hundred one (88%) of 115 patients enrolled in the SARICOR trial had serum samples (control group: n = 33; sarilumab-200: n = 33; sarilumab-400: n = 35). Among all evaluated biomarkers, IP-10 showed the strongest association with treatment outcome. Patients with IP-10 ≥2500 pg/mL treated with sarilumab-400 had a lower probability of progression (13%) compared with the control group (58%; hazard ratio, 0.19; 95% CI, 0.04–0.90; P = .04). Conversely, patients with IP-10 <2500 pg/mL did not show these differences.ConclusionsIP-10 may predict progression to ARDS in patients with COVID-19 pneumonia and IL-6 levels >40 pg/mL. Importantly, IP-10 value <2500 pg/mL might discriminate those individuals who might not benefit from sarilumab therapy among those with high IL-6 levels.
Back to basics: likelihood ratios for olive and grass pollen specific IgE in seasonal allergic rhinitis Bárbara Manzanares, Rafael González, Pilar Serrano, Ana Navas, Corona Alonso, Lourdes Fernandez, Aurora Jurado, Carmen Moreno-Aguilar Frontiers in Allergy, 2023 IntroductionSpecific IgE (sIgE) is merely a sensitization marker that cannot be used for allergy diagnosis if there are no associated clinical symptoms. As of 2023, there is still no evidence regarding the quantity of sIgE necessary to confirm or exclude clinical disease. Therefore, this study aimed to calculate cut-offs for sIgE, allowing us to effectively diagnose olive or grass pollen allergy and select allergenic immunotherapy (AIT) candidate patients in a region under high olive and grass allergenic pressure.MethodsAn observational retrospective study consisting of the review of electronic medical records from 1,172 patients diagnosed with seasonal rhino-conjunctivitis and suspected allergy to olive or grass pollen. Symptoms correlated with sIgE to Poaceae and Oleaceae whole extracts and sIgE to genuine allergenic components were evaluated. Optimal cut-off values were calculated using receiver operating characteristic curves. Relevant clinical symptoms and AIT indications were taken into consideration when determining the clinical allergy diagnosis.ResultssIgE to Lolium showed the best area under the curve (AUC) for both diagnosis (0.957) and an indication of AIT (0.872). The optimal cut-off values for grass diagnosis and AIT indication were 1.79 kUA/L and 8.83 kUA/L, respectively. A value of 5.62 kUA/L was associated with a positive likelihood ratio (LR) of 10.08 set for grass allergy. Olea sIgE showed the best AUC for the diagnosis (0.950). The optimal cut-off for diagnosis was 2.41 kUA/L. A value of 6.49 kUA/L was associated with a positive LR of 9.98 to confirm olive pollen allergy. In regard to immunotherapy, Ole e 1 sIgE showed the best AUC (0.860). The optimal cut-off was 14.05 kUA/L. Ole e 1 sIgE value of 4.8 kUA/L was associated with a 0.09 negative LR to exclude olive AIT indication.ConclusionsThe sIgE cut-offs found in this population under high olive and grass allergenic pressure reduce the gap between sensitization and clinical allergy, providing a new tool for the diagnosis of seasonal allergic rhinitis/asthma and helping to discriminate patients who will benefit from AIT.
The age again in the eye of the COVID-19 storm: evidence-based decision making María C. Martín, Aurora Jurado, Cristina Abad-Molina, Antonio Orduña, Oscar Yarce, Ana M. Navas, Vanesa Cunill, Danilo Escobar, Francisco Boix, Sergio Burillo-Sanz, María C. Vegas-Sánchez, Yesenia Jiménez-de las Pozas, Josefa Melero, Marta Aguilar, Oana Irina Sobieschi, Marcos López-Hoyos, Gonzalo Ocejo-Vinyals, David San Segundo, Delia Almeida, Silvia Medina, Luis Fernández, Esther Vergara, Bibiana Quirant, Eva Martínez-Cáceres, Marc Boiges, Marta Alonso, Laura Esparcia-Pinedo, Celia López-Sanz, Javier Muñoz-Vico, Serafín López-Palmero, Antonio Trujillo, Paula Álvarez, Álvaro Prada, David Monzón, Jesús Ontañón, Francisco M. Marco, Sergio Mora, Ricardo Rojo, Gema González-Martínez, María T. Martínez-Saavedra, Juana Gil-Herrera, Sergi Cantenys-Molina, Manuel Hernández, Janire Perurena-Prieto, Beatriz Rodríguez-Bayona, Alba Martínez, Esther Ocaña, Juan Molina Immunity and Ageing, 2021
COVID-19: Age, Interleukin-6, C-reactive protein, and lymphocytes as key clues from a multicentre retrospective study Aurora Jurado, María C. Martín, Cristina Abad-Molina, Antonio Orduña, Alba Martínez, Esther Ocaña, Oscar Yarce, Ana M. Navas, Antonio Trujillo, Luis Fernández, Esther Vergara, Beatriz Rodríguez, Bibiana Quirant, Eva Martínez-Cáceres, Manuel Hernández, Janire Perurena-Prieto, Juana Gil, Sergi Cantenys, Gema González-Martínez, María T. Martínez-Saavedra, Ricardo Rojo, Francisco M. Marco, Sergio Mora, Jesús Ontañón, Marcos López-Hoyos, Gonzalo Ocejo-Vinyals, Josefa Melero, Marta Aguilar, Delia Almeida, Silvia Medina, María C. Vegas, Yesenia Jiménez, Álvaro Prada, David Monzón, Francisco Boix, Vanesa Cunill, Juan Molina Immunity and Ageing, 2020