The spike glycoprotein of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) continues to accumulate substitutions, leading to breakthrough infections of vaccinated individuals. It remains ...unclear if exposures to antigenically distant SARS-CoV-2 variants can overcome memory B cell biases established by initial SARS-CoV-2 encounters. We determined the specificity and functionality of antibody and B cell responses following exposure to BA.5 and XBB variants in individuals who received ancestral SARS-CoV-2 mRNA vaccines. BA.5 exposures elicited antibody responses that targeted epitopes conserved between the BA.5 and ancestral spike. XBB exposures also elicited antibody responses that primarily targeted epitopes conserved between the XBB.1.5 and ancestral spike. However, unlike BA.5, a single XBB exposure elicited low frequencies of XBB.1.5-specific antibodies and B cells in some individuals. Pre-existing cross-reactive B cells and antibodies were correlated with stronger overall responses to XBB but weaker XBB-specific responses, suggesting that baseline immunity influences the activation of variant-specific SARS-CoV-2 responses.
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•Variant breakthrough infections boost ancestral cross-reactive antibodies and B cells•First and second BA.5 exposures fail to elicit variant-specific antibodies and B cells•XBB infections and vaccinations elicit XBB-specific responses in some individuals•XBB-specific responses correlate with low levels of pre-existing humoral immunity
It is unknown if antigenically distant SARS-CoV-2 variants can overcome memory B cell biases established by initial SARS-CoV-2 encounters. Johnston, Painter, Li et al. show that BA.5 and XBB exposures recall B cells targeting conserved epitopes in the ancestral SARS-CoV-2 spike protein. They found instances of XBB-specific responses after XBB exposures, which correlated with low baseline levels of humoral immunity.
Aim
To develop a structured education programme for individuals with Type 1 diabetes who are engaging in regular exercise.
Method
A multidisciplinary team of experts in supporting exercise and ...physical activity for people with Type 1 diabetes, alongside researchers with experience of developing self‐management education, developed an exercise programme using the Medical Research Council framework. The programme was informed by a review of the evidence relating to Type 1 diabetes and exercise, the behaviour change literature (including the behaviour change taxonomy), and qualitative interviews with stakeholders. The programme and supporting resources were refined using an iterative process of testing, delivery and collecting feedback from participants and the wider development team.
Results
The outcome of the intervention development was the design of a feasible and acceptable intervention for people with Type 1 diabetes to support safe exercise. The pilot allowed refinement of the intervention prior to testing in a two‐site feasibility randomized controlled trial. Key findings from the pilot informed minor restructuring of the timetable (timings and order) and adaptation of supporting educational materials (participant handbook and teaching materials).
Conclusion
The ‘EXercise in people with Type One Diabetes’ (EXTOD) education programme has been developed using robust methodology for the generation of educational interventions. It now needs testing in a randomized controlled trial.
What's new?
Currently there is no dedicated structured education programme that supports the management of Type 1 diabetes for exercise.
A self‐management education programme to support safe and effective exercise for people with Type 1 diabetes has been developed using the Medical Research Council framework.
In the exercise programme we developed, participants were able to adjust their regimens and plan their exercise in a more structured way.
The programme was delivered by trained healthcare professionals, meaning it can be embedded into the specialist care setting.
If demonstrated to be effective, this programme could potentially expand currently available support for adults with Type 1 diabetes who wish to exercise.
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