Impaired CD4(+) T cell response in older adults is associated with reduced immunogenicity and reactogenicity of mRNA COVID-19 vaccination

Whether age-associated defects in T cells impact the immunogenicity and reactogenicity of mRNA vaccines remains unclear. Using a vaccinated cohort (n = 216), we demonstrated that older adults (aged ≥65 years) had fewer vaccine-induced spike-specific CD4(+) T cells including CXCR3(+) circulating follicular helper T cells and the T(H)1 subset of helper T cells after the first dose, which correlated with their lower peak IgG levels and fewer systemic adverse effects after the second dose, compared with younger adults. Moreover, spike-specific T(H)1 cells in older adults expressed higher levels of programmed cell death protein 1, a negative regulator of T cell activation, which was associated with low spike-specific CD8(+) T cell responses. Thus, an inefficient CD4(+) T cell response after the first dose may reduce the production of helper T cytokines, even after the second dose, thereby lowering humoral and cellular immunity and reducing systemic reactogenicity. Therefore, enhancing CD4(+) T cell response following the first dose is key to improving vaccine efficacy in older adults.