#AZ疫苗 有個 #非常奇怪 的現象，之前讓我不太理解： 明明 #中和抗體的數值不高（疫苗/康復者血清的比值只有0.54，遠低於其他BNT/Moderna/Novavax），然而在真實世界，#AZ的保護力卻超乎預期地好；尤其是 #預防重症 方面，對原株病毒幾乎可達100%。之前也提到過，上個月Nature Medicine「英國同期同地同族群」研究，也證實AZ和BNT的保護力，可說是不相上下。 咦，為什麼會這樣？ 這暗示一件事情：疫苗的保護力，除了中和抗體，肯定還有 #別的東西。而最有可能的候選人，就是細胞免疫的主角： CD8 Cytotoxic lymphocyte，又稱 killer cell：#殺手T細胞。 有一點醫學知識的人應該都知道，免疫系統就是「細胞免疫」和「體液免疫」這兩大主角分庭抗禮。體液免疫容易評估，只要測測抗體就可以。但細胞免疫，尤其是殺手細胞的活性和能力評估，相較之下就困難得多。 就這麼剛好，這個月Nature News，有一篇關於 #疫苗混打 的文章，也提到這個概念。讀完挺興奮，有些段落很值得節錄出來： 1. #AZ疫苗強項在激發T細胞反應，而 #mRNA疫苗強項在激發抗體。 （個人解讀：所以有可能，光是用「#中和抗體效價」，#無法評估AZ 這種病毒載體疫苗的真正效力） （The Oxford–AstraZeneca vaccine uses a harmless virus called an adenovirus to carry genetic material from SARS-CoV-2 into cells. Vaccines using this technology have a good track record of inducing strong T-cell responses, says Sander, whereas vaccines using messenger RNA, such as Pfizer’s, have proved “exceptionally good” at inducing high levels of antibodies.） 2. #抗體 的強項在於「#預防感染」，而 #T細胞 的強項在於「#感染後預防重症」 （個人解讀：這可能可以解釋，為什麼打AZ最多的英國，最近delta病例激增數萬，但是重症和 #死亡人數依然一片靜悄悄。AZ引發的殺手細胞，可能讓新冠就變成個小感冒了。在未來「變種病毒」甚囂塵上的年代，當中和抗體對這些變種越趨弱勢（這在AZ BNT Moderna都已經被證實），不曉得殺手T細胞的反應會一樣減弱、或仍然寶刀未老？就英國最近的資料來看，我個人傾向後者） （“Neutralizing antibodies are probably a good surrogate for predicting efficacy,” she says, because they help to prevent viral infection. But T cells, especially ‘killer’ T cells that carry a protein called CD8, protect against severe disease by killing cells that have already been infected.） 3. 在「#免疫功能抑制」的病患，例如器官移植者，促進「#T細胞免疫」的疫苗組合，會是比較優勢的選擇 （個人解讀：這可能不只適用於器官移植者。許多在施打Rituximab這類藥物的病患，當B細胞和抗體反應被藥物抑制得零零落落，可能對他們而言，增強殺手Ｔ細胞的疫苗，會更有實質幫助。） Combinations that provoke good T-cell responses might be better for people who have had organ transplants and are taking medication to suppress their immune systems, for instance, because their bodies will struggle to produce antibodies. “There are many ways of exploiting this knowledge in a strategic way,” she says. 4. 這篇的主旨，其實是在講混打疫苗的趨勢。看起來有可能，#混打AZ和mRNA疫苗，可以同時 #雙收強化Ｔ細胞和Ｂ細胞的功效。但一來目前混打的病例還太少，二來真實世界的efficacy還缺乏數據，三來T細胞免疫的測定困難，所以這篇的結論仍然是老調重彈：有希望、可看好，但還要研究證實。

Welcome to the Reuters.com BETA. Read our Editor's note on how we're helping professionals make smart decisions. June 30, 202110:11 AM CSTLast Updated 2 months ago Healthcare & Pharmaceuticals U.S. Commerce chief says Taiwan's TSMC asked for help getting COVID vaccines Reuters 3 minute read U.S. Secretary of Commerce Gina Raimondo takes a question during a press briefing at the White House in Washington, U.S., April 7, 2021. REUTERS/Kevin Lamarque/File Photo The logo of Taiwan Semiconductor Manufacturing Co (TSMC) is pictured at its headquarters, in Hsinchu, Taiwan, Jan. 19, 2021. REUTERS/Ann Wang/File Photo U.S. Secretary of Commerce Gina Raimondo takes a question during a press briefing at the White House in Washington, U.S., April 7, 2021. REUTERS/Kevin Lamarque/File Photo 1/2 The logo of Taiwan Semiconductor Manufacturing Co (TSMC) is pictured at its headquarters, in Hsinchu, Taiwan, Jan. 19, 2021. REUTERS/Ann Wang/File Photo WASHINGTON, June 29 (Reuters) - U.S. Commerce Secretary Gina Raimondo on Monday said she had spoken with the chief executive of Taiwan Semiconductor Manufacturing Co Ltd (2330.TW) (TSMC) and that he had asked for help getting access to COVID-19 vaccines. Raimondo told Reuters in an interview "he asked for help in that regard, he has spoken to high level officials in the White House. We have responded and we definitely want to be a good partner and I do think it's helping." Taiwan said two weeks ago it will allow officials from Taiwan's Foxconn and TSMC to negotiate on its behalf for COVID-19 vaccines. read more Mid-June the United States shipped 2.5 million COVID-19 vaccine doses to Taiwan, more than tripling Washington's previous allocation of shots for the island. read more TSMC said in a statement to Reuters that they believed "getting vaccines for Taiwan would help to protect the communities and ensure normal operations." Taiwan has been trying to speed up the arrival of the millions of vaccines it has on order as it deals with a rise in domestic cases, although infections remain comparatively low. The request from TSMC, the world's biggest manufacturer of semiconductors on contract, coincides with a global chip shortage that has slowed production of manufacturers around the world, including in the U.S. auto industry where it is forecast the crisis will hit the production of 3.9 million vehicles. Raimondo has a key role in resolving the crisis for U.S. companies. Although there has been no major impact so far on chip production in Taiwan since domestic cases began rising in the middle of May, some U.S. auto executives have told Reuters privately earlier this month they were concerned COVID-19 in Taiwan could impact the flow of semiconductors to U.S. factories. Reporting by David Shepardson in Washington; Additional reporting by Ben Blanchard in Taipei; Editing by Simon Cameron-Moore Our Standards: The Thomson Reuters Trust Principles. 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