TY - JOUR T1 - The COVID-19 Vaccine Landscape: What a Rheumatologist Needs to Know JF - The Journal of Rheumatology JO - J Rheumatol SP - 1201 LP - 1204 DO - 10.3899/jrheum.210106 VL - 48 IS - 8 AU - Katie Bechman AU - Mrinalini Dey AU - Mark Yates AU - Marwan Bukhari AU - Kevin Winthrop AU - James B. Galloway Y1 - 2021/08/01 UR - http://www.jrheum.org/content/48/8/1201.abstract N2 - In January 2020, a new strain of coronavirus was described. Less than 3 months later, a pandemic was declared. Within 9 months, the first vaccine received emergency authorization. Keeping up with the infodemic has been arduous, due to the unparalleled pace of scientific study. Here, we summarize the work toward a vaccine, framing the progress in a manner relevant to physicians managing patients on immune modulation.SARS-CoV-2 is a positive sense single-stranded RNA virus. Like other coronaviruses, it has 4 structural components: spike, envelope, membrane, and nucleocapsid proteins. The spike protein facilitates binding and fusion to host cells, making it an attractive vaccine antigen. There have been 3 approaches in developing a SARS-CoV-2 vaccine: (1) attaching the spike protein to a nonreplicating viral vector; (2) using messenger RNA (mRNA) technology to induce host spike protein synthesis; and (3) delivery of spike protein with an adjuvant.The AstraZeneca vaccine takes the first approach, using a replication-deficient chimpanzee adenovirus vector containing the spike gene. Once inside a cell, the vector uses the cell’s existing molecular machinery to transcribe DNA to mRNA and produce the spike protein. Replication-deficient viral vector-based vaccines have been used safely in immunosuppressed individuals. The second approach is employed by Pfizer-BioNTech and Moderna, who have produced the first vaccines to be licensed using synthetic mRNA technology. mRNA is within a lipid droplet, protecting it from enzymatic breakdown and enabling cell entry. The mRNA strand induces spike protein synthesis without entering the cell’s nucleus or affecting genetic material. Finally, Novovax have developed a protein-based vaccine, currently in submission for licensing. Manufactured from moth cells infected with baculovirus, it contains a modified spike gene, producing the spike protein. This is harvested and assembled into nanoparticles. It is combined with an immunity-priming adjuvant (matrix M1), enhancing vaccine response. The spike protein is … Address correspondence to Dr. K. Bechman, Centre for Rheumatic Disease, Weston Education Centre, King’s College London, London SE5 9RJ, UK. Email: katie.bechman{at}kcl.ac.uk. ER -