Sex Differences in B Cell Dynamics after Seasonal Influenza Vaccination are Dependent on the Age and Hormonal Profile of Vaccinees

Sex differences in the humoral immune responses to the seasonal quadrivalent influenza vaccine (QIV) in young adults (YA; 18-49yo) or high dose QIV in old adults (OA; 75+yo) were analyzed to evaluate how age-related changes in steroids impact sex differences in B cell responses. Prior to vaccination, CD19+ B cells from OAs, regardless of sex, showed greater enrichment of hallmark pathways associated with inflammatory responses than YAs. Among YAs, females had greater H3N2, but not H1N1, neutralizing antibody titers and greater proportions of hemagglutinin (HA)+CD19+ B cells and HA+ memory B cells than males through 28 days post-vaccination (DPV), which was not observed among OAs. CD19+ B cells from YA females had greater transcriptional activity at 7 DPV than YA males, with upregulation of estrogen-responsive genes and NF-κB-mediated inflammatory pathways in B cell subsets. HA stimulation and treatment of antibody secreting cells (ASCs) from YAs and OAs with estradiol increased the number and size of HA+IgG+ ASCs from YA females and to a lesser extent OA females, but not males, which was inhibited by estrogen receptor antagonism. Machine learning algorithms illustrated that baseline (0 DPV) steroids, including 17-hydroxyprogesterone, estrogens, and testosterone, as well as HA+CD19+ B cells and HA+ ASCs were major predictors of subsequent seroconversion at 28 DPV, particularly in YA. This study provides mechanistic insights into steroid mediation of greater influenza vaccine-induced immunity among reproductive-aged females as compared with age-matched males and explains how sex differences in vaccine-induced immunity are reduced with old age.