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Clever S, Volz A. Mouse models in COVID-19 research: analyzing the adaptive immune response. Med Microbiol Immunol 2023; 212:165-183. [PMID: 35661253 PMCID: PMC9166226 DOI: 10.1007/s00430-022-00735-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
The emergence of SARS-CoV-2, the severe acute respiratory syndrome coronavirus type 2 causing the COVID-19 pandemic, resulted in a major necessity for scientific countermeasures. Investigations revealing the exact mechanisms of the SARS-CoV-2 pathogenesis provide the basis for the development of therapeutic measures and protective vaccines against COVID-19. Animal models are inevitable for infection and pre-clinical vaccination studies as well as therapeutic testing. A well-suited animal model, mimicking the pathology seen in human COVID-19 patients, is an important basis for these investigations. Several animal models were already used during SARS-CoV-2 studies with different clinical outcomes after SARS-CoV-2 infection. Here, we give an overview of different animal models used in SARS-CoV-2 infection studies with a focus on the mouse model. Mice provide a well-established animal model for laboratory use and several different mouse models have been generated and are being used in SARS-CoV-2 studies. Furthermore, the analysis of SARS-CoV-2-specific T cells during infection and in vaccination studies in mice is highlighted.
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Affiliation(s)
- Sabrina Clever
- Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Asisa Volz
- Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
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2
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Epitope Coverage of Anti-SARS-CoV-2 Nucleocapsid IgA and IgG Antibodies Correlates with Protection against Re-Infection by New Variants in Subsequent Waves of the COVID-19 Pandemic. Viruses 2023; 15:v15020584. [PMID: 36851798 PMCID: PMC9967965 DOI: 10.3390/v15020584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
The COVID-19 pandemic continues to affect individuals across the globe, with some individuals experiencing more severe disease than others. The relatively high frequency of re-infections and breakthrough infections observed with SARS-CoV-2 highlights the importance of extending our understanding of immunity to COVID-19. Here, we aim to shed light on the importance of antibody titres and epitope utilization in protection from re-infection. Health care workers are highly exposed to SARS-CoV-2 and are therefore also more likely to become re-infected. We utilized quantitative, multi-antigen, multi-epitope SARS-CoV-2 protein microarrays to measure IgG and IgA titres against various domains of the nucleocapsid and spike proteins. Potential re-infections in a large, diverse health care worker cohort (N = 300) during the second wave of the pandemic were identified by assessing the IgG anti-N titres before and after the second wave. We assessed epitope coverage and antibody titres between the 'single infection' and 're-infection' groups. Clear differences were observed in the breadth of the anti-N response before the second wave, with the epitope coverage for both IgG (p = 0.019) and IgA (p = 0.015) being significantly increased in those who did not become re-infected compared to those who did. Additionally, the IgG anti-N (p = 0.004) and anti-S titres (p = 0.018) were significantly higher in those not re-infected. These results highlight the importance of the breadth of elicited antibody epitope coverage following natural infection in protection from re-infection and disease in the COVID-19 pandemic.
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3
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Goldman JD, Wang K, Röltgen K, Nielsen SCA, Roach JC, Naccache SN, Yang F, Wirz OF, Yost KE, Lee JY, Chun K, Wrin T, Petropoulos CJ, Lee I, Fallen S, Manner PM, Wallick JA, Algren HA, Murray KM, Hadlock J, Chen D, Dai CL, Yuan D, Su Y, Jeharajah J, Berrington WR, Pappas GP, Nyatsatsang ST, Greninger AL, Satpathy AT, Pauk JS, Boyd SD, Heath JR. Reinfection with SARS-CoV-2 and Waning Humoral Immunity: A Case Report. Vaccines (Basel) 2022; 11:5. [PMID: 36679852 PMCID: PMC9861578 DOI: 10.3390/vaccines11010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Recovery from COVID-19 is associated with production of anti-SARS-CoV-2 antibodies, but it is uncertain whether these confer immunity. We describe viral RNA shedding duration in hospitalized patients and identify patients with recurrent shedding. We sequenced viruses from two distinct episodes of symptomatic COVID-19 separated by 144 days in a single patient, to conclusively describe reinfection with a different strain harboring the spike variant D614G. This case of reinfection was one of the first cases of reinfection reported in 2020. With antibody, B cell and T cell analytics, we show correlates of adaptive immunity at reinfection, including a differential response in neutralizing antibodies to a D614G pseudovirus. Finally, we discuss implications for vaccine programs and begin to define benchmarks for protection against reinfection from SARS-CoV-2.
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Affiliation(s)
- Jason D. Goldman
- Division of Infectious Diseases, Swedish Medical Center, Seattle, WA 98122, USA
- Providence St. Joseph Health, Renton, WA 98057, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98195, USA
| | - Kai Wang
- Institute for Systems Biology, Seattle, WA 98103, USA
| | - Katharina Röltgen
- Department of Pathology, Stanford University, Stanford, CA 94305, USA
| | | | | | | | - Fan Yang
- Department of Pathology, Stanford University, Stanford, CA 94305, USA
| | - Oliver F. Wirz
- Department of Pathology, Stanford University, Stanford, CA 94305, USA
| | - Kathryn E. Yost
- Department of Pathology, Stanford University, Stanford, CA 94305, USA
| | - Ji-Yeun Lee
- Department of Pathology, Stanford University, Stanford, CA 94305, USA
| | - Kelly Chun
- LabCorp Esoterix, Calabasas, CA 91301, USA
| | - Terri Wrin
- Monogram Biosciences, South San Francisco, CA 94080, USA
| | | | - Inyoul Lee
- Institute for Systems Biology, Seattle, WA 98103, USA
| | | | - Paula M. Manner
- Providence St. Joseph Health, Renton, WA 98057, USA
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA 98104, USA
| | - Julie A. Wallick
- Providence St. Joseph Health, Renton, WA 98057, USA
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA 98104, USA
| | - Heather A. Algren
- Providence St. Joseph Health, Renton, WA 98057, USA
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA 98104, USA
| | - Kim M. Murray
- Institute for Systems Biology, Seattle, WA 98103, USA
| | - Jennifer Hadlock
- Providence St. Joseph Health, Renton, WA 98057, USA
- Institute for Systems Biology, Seattle, WA 98103, USA
| | - Daniel Chen
- Institute for Systems Biology, Seattle, WA 98103, USA
| | | | - Dan Yuan
- Institute for Systems Biology, Seattle, WA 98103, USA
| | - Yapeng Su
- Institute for Systems Biology, Seattle, WA 98103, USA
| | - Joshua Jeharajah
- Division of Infectious Diseases, Polyclinic, Seattle, WA 98104, USA
| | - William R. Berrington
- Division of Infectious Diseases, Swedish Medical Center, Seattle, WA 98122, USA
- Providence St. Joseph Health, Renton, WA 98057, USA
| | - George P. Pappas
- Division of Pulmonology and Critical Care Medicine, Swedish Medical Center, Seattle, WA 98104, USA
| | - Sonam T. Nyatsatsang
- Division of Infectious Diseases, Swedish Medical Center, Seattle, WA 98122, USA
- Providence St. Joseph Health, Renton, WA 98057, USA
| | - Alexander L. Greninger
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA 98109, USA
- Vaccine and Infectious Disease Division, Fred Hutch, Seattle, DC 98109, USA
| | | | - John S. Pauk
- Division of Infectious Diseases, Swedish Medical Center, Seattle, WA 98122, USA
- Providence St. Joseph Health, Renton, WA 98057, USA
| | - Scott D. Boyd
- Department of Pathology, Stanford University, Stanford, CA 94305, USA
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94304, USA
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4
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Upreti S, Samant M. A Review on Immunological Responses to SARS-CoV-2 and Various COVID-19 Vaccine Regimens. Pharm Res 2022; 39:2119-2134. [PMID: 35773445 PMCID: PMC9247891 DOI: 10.1007/s11095-022-03323-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/24/2022] [Indexed: 12/19/2022]
Abstract
The transmission of SARS-CoV-2 has caused serious health crises globally. So far, 7 vaccines that are already being assessed in Phase IV clinical trials are, Comirnaty/ Pfizer; Spikevax/Moderna (m RNA vaccine); Vaxzevria or Covishield; Ad26.COV2.S; Ad5-nCoV (adenoviral vector-based vaccine); CoronaVac and BBIBP-CorV (inactivated virus vaccine). Besides, there are about 280 vaccines that are undergoing preclinical and clinical trials including Sputnik-V, Covaxin or BBV152, and NVX-CoV2373. These vaccines are being studied for their immunological responses and efficiency against COVID-19, and have been reported to demonstrate effective T and B cell responses. However, the long-lasting immunity of these vaccine regimens still needs to be investigated. An in-depth understanding of the vaccine efficacy and immune control mechanism is imperative for the rational purposing and implementation of the vaccines. Hence, in this review, we have comprehensively discussed the immune response induced in COVID-19 patients, as well as in the convalescent individuals to avoid reinfection. Moreover, we have also summarized the immunological responses and prophylactic efficacy of various COVID-19 vaccine regimens. In this context, this review can give insights into the development of effective vaccines against SARS-CoV-2 and its variants in the future.
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Affiliation(s)
- Shobha Upreti
- Cell and Molecular Biology Laboratory, Department Of Zoology, Soban Singh Jeena University Campus, Almora, Uttarakhand, India.,Department Of Zoology, Kumaun University, Nainital, Uttarakhand, India
| | - Mukesh Samant
- Cell and Molecular Biology Laboratory, Department Of Zoology, Soban Singh Jeena University Campus, Almora, Uttarakhand, India.
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Costa R, Alberola J, Olea B, Gozalbo-Rovira R, Giménez E, Cuevas-Ferrando E, Torres I, Albert E, Carbonell N, Ferreres J, Sánchez G, Rodríguez-Díaz J, Blasco ML, Navarro D. Combined kinetic analysis of SARS-CoV-2 RNAemia, N-antigenemia and virus-specific antibodies in critically ill adult COVID-19 patients. Sci Rep 2022; 12:8273. [PMID: 35585163 PMCID: PMC9114819 DOI: 10.1038/s41598-022-12461-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/11/2022] [Indexed: 01/28/2023] Open
Abstract
Combined kinetic analysis of plasma SARS-CoV-2 RNAemia, Nucleocapsid (N)-antigenemia and virus-specific antibodies may help ascertain the role of antibodies in preventing virus dissemination in COVID-19 patients. We performed this analysis in a cohort of 71 consecutive critically ill COVID-19 patients (49 male; median age, 65 years) using RT-PCR assay, lateral flow immunochromatography method and receptor binding domain (RBD) and N-based immunoassays. A total of 338 plasma specimens collected at a median of 12 days after symptoms onset were available for analyses. SARS-CoV-2 RNAemia and N-antigenemia were detected in 37 and 43 specimens from 26 (36.5%) and 30 (42.2%) patients, respectively. Free RNA was the main biological form of SARS-CoV-2 found in plasma. The detection rate for both viral components was associated with viral load at the upper respiratory tract. Median time to SARS-CoV-2-RBD antibody detection was 14 days (range, 4–38) from onset of symptoms. Decreasing antibody levels were observed in parallel to increasing levels of both RNAemia and N-antigenemia, yet overall a fairly modest inverse correlation (Rho = −0.35; P < 0.001) was seen between virus RNAemia and SARS-CoV-2-RBD antibody levels. The data cast doubts on a major involvement of antibodies in virus clearance from the bloodstream within the timeframe examined.
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Affiliation(s)
- Rosa Costa
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Juan Alberola
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Beatriz Olea
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | | | - Estela Giménez
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Enric Cuevas-Ferrando
- Department of Preservation and Food Safety Technologies, Institute of Agrochemistry and Food Technology, IATA-CSIC, Valencia, Spain
| | - Ignacio Torres
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Eliseo Albert
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Av. Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Nieves Carbonell
- Medical Intensive Care Unit, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - José Ferreres
- Medical Intensive Care Unit, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Gloria Sánchez
- Department of Preservation and Food Safety Technologies, Institute of Agrochemistry and Food Technology, IATA-CSIC, Valencia, Spain
| | - Jesús Rodríguez-Díaz
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - María Luisa Blasco
- Medical Intensive Care Unit, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - David Navarro
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Av. Blasco Ibáñez 17, 46010, Valencia, Spain. .,Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain.
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Detection of SARS-CoV-2 Derived Small RNAs and Changes in Circulating Small RNAs Associated with COVID-19. Viruses 2021; 13:v13081593. [PMID: 34452458 PMCID: PMC8402885 DOI: 10.3390/v13081593] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/17/2022] Open
Abstract
Cleavage of double-stranded RNA is described as an evolutionary conserved host defense mechanism against viral infection. Small RNAs are the product and triggers of post transcriptional gene silencing events. Up until now, the relevance of this mechanism for SARS-CoV-2-directed immune responses remains elusive. Herein, we used high throughput sequencing to profile the plasma of active and convalescent COVID-19 patients for the presence of small circulating RNAs. The existence of SARS-CoV-2 derived small RNAs in plasma samples of mild and severe COVID-19 cases is described. Clusters of high siRNA abundance were discovered, homologous to the nsp2 3′-end and nsp4 virus sequence. Four virus-derived small RNA sequences have the size of human miRNAs, and a target search revealed candidate genes associated with ageusia and long COVID symptoms. These virus-derived small RNAs were detectable also after recovery from the disease. The additional analysis of circulating human miRNAs revealed differentially abundant miRNAs, discriminating mild from severe cases. A total of 29 miRNAs were reduced or absent in severe cases. Several of these are associated with JAK-STAT response and cytokine storm.
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7
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The fall in antibody response to SARS-CoV-2: a longitudinal study of asymptomatic to critically ill patients up to 10 months after recovery. J Clin Microbiol 2021; 59:e0113821. [PMID: 34379530 PMCID: PMC8525561 DOI: 10.1128/jcm.01138-21] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The aim of this study was to assess the long-term dynamics and factors associated with the serological response against the severe acute respiratory syndrome coronavirus 2 after primary infection. A prospective longitudinal study was conducted with monthly serological follow-up during the first 4 months, and then at 6, 8, and 10 months after the disease onset of all recovered adult in- and outpatients with coronavirus disease 2019 (COVID-19) attending Udine Hospital (Italy) during the first wave (from March to May 2020). A total of 546 individuals were included (289 female, mean age 53.1 years), mostly with mild COVID-19 (370, 68.3%). Patients were followed for a median of 302 days (interquartile range, 186 to 311). The overall seroconversion rate within 2 months was 32% for IgM and 90% for IgG. Seroreversion was observed in 90% of patients for IgM at 4 months and in 47% for IgG at 10 months. Older age, number of symptoms at acute onset, and severity of acute COVID-19 were all independent predictors of long-term immunity both for IgM (β, linear regression coefficient, 1.10, P = 0.001; β 5.15 P = 0.014; β 43.84 P = 0.021, respectively) and for IgG (β 1.43 P < 0.001; β 10.46 P < 0.001; β 46.79 P < 0.001, respectively), whereas the initial IgG peak was associated only with IgG duration (β 1.12, P < 0.001). IgM antibodies disappeared at 4 months, and IgG antibodies declined in about half of patients 10 months after acute COVID-19. These effects varied depending on the intensity of the initial antibody response, age, and burden of acute COVID-19.
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Evidence of Long-Lasting Humoral and Cellular Immunity against SARS-CoV-2 Even in Elderly COVID-19 Convalescents Showing a Mild to Moderate Disease Progression. Life (Basel) 2021; 11:life11080805. [PMID: 34440549 PMCID: PMC8401673 DOI: 10.3390/life11080805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 12/13/2022] Open
Abstract
We here evaluate the humoral and cellular immune response against SARS-CoV-2 in 41 COVID-19 convalescents. As previous studies mostly included younger individuals, one advantage of our study is the comparatively high mean age of the convalescents included in the cohort considered (54 ± 8.4 years). While anti-SARS-CoV-2 antibodies were still detectable in 95% of convalescents up to 8 months post infection, an antibody-decay over time was generally observed in most donors. Using a multiplex assay, our data additionally reveal that most convalescents exhibit a broad humoral immunity against different viral epitopes. We demonstrate by flow cytometry that convalescent donors show a significantly elevated number of natural killer cells when compared to healthy controls, while no differences were found concerning other leucocyte subpopulations. We detected a specific long-lasting cellular immune response in convalescents by stimulating immune cells with SARS-CoV-2-specific peptides, covering domains of the viral spike, membrane and nucleocapsid protein, and measuring interferon-γ (IFN-γ) release thereafter. We modified a commercially available ELISA assay for IFN-γ determination in whole-blood specimens of COVID-19 convalescents. One advantage of this assay is that it does not require special equipment and can, thus, be performed in any standard laboratory. In conclusion, our study adds knowledge regarding the persistence of immunity of convalescents suffering from mild to moderate COVID-19. Moreover, our study provides a set of simple methods to characterize and confirm experienced COVID-19.
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Lee E, Oh JE. Humoral Immunity against SARS-CoV-2 and the Impact on COVID-19 Pathogenesis. Mol Cells 2021; 44:392-400. [PMID: 34059562 PMCID: PMC8245316 DOI: 10.14348/molcells.2021.0075] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023] Open
Abstract
It has been more than a year since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged. Many studies have provided insights into the various aspects of the immune response in coronavirus disease 2019 (COVID-19). Especially for antibody treatment and vaccine development, humoral immunity to SARS-CoV-2 has been studied extensively, though there is still much that is unknown and controversial. Here, we introduce key discoveries on the humoral immune responses in COVID-19, including the immune dynamics of antibody responses and correlations with disease severity, neutralizing antibodies and their cross-reactivity, how long the antibody and memory B-cell responses last, aberrant autoreactive antibodies generated in COVID-19 patients, and the efficacy of currently available therapeutic antibodies and vaccines against circulating SARS-CoV-2 variants, and highlight gaps in the current knowledge.
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Affiliation(s)
- Eunjin Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea
| | - Ji Eun Oh
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea
- BioMedical Research Center, KAIST, Daejeon 34141, Korea
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10
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Izak M, Gendelman V, Bransburg-Zabary S, Stoyanov E, Gat R, Cohen D, Chen J, Maor Y, Benov A, Lev B, Zimhony O, Shinar E. Qualifying coronavirus disease 2019 convalescent plasma donors in Israel. Vox Sang 2021; 117:185-192. [PMID: 34125976 PMCID: PMC8447161 DOI: 10.1111/vox.13162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 12/19/2022]
Abstract
Background and Objectives Passive immunization using investigational COVID‐19 convalescent plasma (CCP) is a promising therapeutic strategy and could improve outcome if transfused early and contain high levels of anti‐SARS‐CoV‐2 antibodies. We report the management of a national CCP collection and distribution program in Israel. Materials and Methods From 1 April 2020 to 15 January 2021, 4020 volunteer donors donated 5221 CCP units and 837 (20.8%) donors donated more than once. Anti‐nucleocapsid IgG antibodies were determined using chemiluminescent immunoassay method (Abbott). A statistical model based on repeated IgG tests in sequential donations was created to predict the time of antibody decline below sample/cut‐off (S/CO) level of 4.0. Results Ninety‐six percent of CCP donors suffered a mild disease or were asymptomatic. Older donors had higher antibody levels. Higher antibody levels (S/CO ≥4) were detected in 35.2% of the donors. Low positive (S/CO ≥1.4–3.99) were found in 37%, and 27.8% had undetectable antibodies (S/CO ≤1.4). The model predicted decrease antibody thresholds of 0.55%/day since the first CCP donation, providing guidance for the effective timing of future collections from donors with high antibody levels. Conclusions An efficient CCP collection and distribution program was achieved, based on performing initial and repeated plasma collections, preferably from donors with higher antibody levels, and only antibody‐rich units were supplied for therapeutic use. The inventory met the quantity and quality standards of the authorities, enabled to respond to the growing demand of the medical system and provide a product that may contribute to improve prognosis in patients with COVID‐19.
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Affiliation(s)
- Marina Izak
- National Blood Services, Magen David Adom, Ramat Gan, Israel
| | | | | | | | - Roni Gat
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Daniel Cohen
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Chen
- Trauma and Combat Medicine Branch, Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Hospital Management, Meir Medical Center, KfarSaba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Maor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Disease Unit, Wolfson Medical Center, Holon, Israel
| | - Avi Benov
- Trauma and Combat Medicine Branch, Israel Defense Forces Medical Corps, Ramat Gan, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Boaz Lev
- Epidemic Unit, Ministry of Health, Jerusalem, Israel
| | - Oren Zimhony
- Infectious Disease Unit, Kaplan Medical Center, Rehovot, Israel
| | - Eilat Shinar
- National Blood Services, Magen David Adom, Ramat Gan, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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11
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Nguyen KD, Wirz OF, Röltgen K, Pandey S, Tolentino L, Boyd SD, Pham TD. Efficient Identification of High-Titer Anti-Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibody Plasma Samples by Pooling Method. Arch Pathol Lab Med 2021; 145:1221-1227. [PMID: 34101801 DOI: 10.5858/arpa.2021-0215-sa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT.– The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has elicited a surge in demand for serological testing to identify previously infected individuals. In particular, antibody testing is crucial in identifying COVID-19 convalescent plasma (CCP), which has been approved by the Food and Drug Administration (FDA) under the Emergency Use Authorization (EUA) for use as passive immune therapy for hospitalized patients infected with COVID-19. Currently, high-titer CCP can be qualified by Ortho's Vitros COVID-19 IgG antibody test (VG). OBJECTIVE.– To explore the use of an efficient testing method to identify high-titer CCP for use in treating COVID-19 infected patients and track COVID-19 positivity over time. DESIGN.– We evaluated an ELISA-based method that detects antibodies specific to the SARSCoV-2 receptor binding domain (RBD) with individual and pooled plasma samples and compared its performance against VG. Using the pooled RBD-ELISA (P-RE) method, we also screened over 10,000 longitudinal healthy blood donor samples to assess seroprevalence. RESULTS.– P-RE demonstrates 100% sensitivity in detecting FDA-defined high-titer samples when compared to VG. Overall sensitivity of P-RE when compared to VG and our individual sample RBD-ELISA (I-RE) were 83% and 56%, respectively. When screening 10,218 healthy blood donor samples by P-RE, we found the seroprevalence correlated with the local infection rates with a correlation coefficient of 0.21 (P< .001). CONCLUSIONS.– Pooling plasma samples can be used to efficiently screen large populations for individuals with high-titer anti-RBD antibodies, important for CCP identification.
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Affiliation(s)
- Khoa D Nguyen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA (Nguyen, Wirz, Röltgen, Pandey, Boyd, Pham)
| | - Oliver F Wirz
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA (Nguyen, Wirz, Röltgen, Pandey, Boyd, Pham)
| | - Katharina Röltgen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA (Nguyen, Wirz, Röltgen, Pandey, Boyd, Pham)
| | - Suchitra Pandey
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA (Nguyen, Wirz, Röltgen, Pandey, Boyd, Pham).,Stanford Blood Center, Palo Alto, CA, USA (Pandey, Tolentino, Pham)
| | - Lorna Tolentino
- Stanford Blood Center, Palo Alto, CA, USA (Pandey, Tolentino, Pham)
| | - Scott D Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA (Nguyen, Wirz, Röltgen, Pandey, Boyd, Pham).,Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA, USA (Boyd)
| | - Tho D Pham
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA (Nguyen, Wirz, Röltgen, Pandey, Boyd, Pham).,Stanford Blood Center, Palo Alto, CA, USA (Pandey, Tolentino, Pham)
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12
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Newberry JA, Gautreau M, Staats K, Carrillo E, Mulkerin W, Yang S, Kohn MA, Matheson L, Boyd SD, Pinsky BA, Blomkalns AL, Strehlow MC, D'Souza PA. SARS-CoV-2 IgG Seropositivity and Acute Asymptomatic Infection Rate among Firefighter First Responders in an Early Outbreak County in California. PREHOSP EMERG CARE 2021:1-10. [PMID: 33819128 DOI: 10.1080/10903127.2021.1912227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
Objective: Firefighter first responders and other emergency medical services (EMS) personnel have been among the highest risk healthcare workers for illness during the SARS-CoV-2 pandemic. We sought to determine the rate of seropositivity for SARS-CoV-2 IgG antibodies and of acute asymptomatic infection among firefighter first responders in a single county with early exposure in the pandemic. Methods: We conducted a cross-sectional study of clinically active firefighters cross-trained as paramedics or EMTs in the fire departments of Santa Clara County, California. Firefighters without current symptoms were tested between June and August 2020. Our primary outcomes were rates of SARS-CoV-2 IgG antibody seropositivity and SARS-CoV-2 RT-PCR swab positivity for acute infection. We report cumulative incidence, participant characteristics with frequencies and proportions, and proportion positive and associated relative risk (with 95% confidence intervals). Results: We enrolled 983 out of 1339 eligible participants (response rate: 73.4%). Twenty-five participants (2.54%, 95% CI 1.65-3.73) tested positive for IgG antibodies and 9 (0.92%, 95% CI 0.42-1.73) tested positive for SARS-CoV-2 by RT-PCR. Our cumulative incidence, inclusive of self-reported prior positive PCR tests, was 34 (3.46%, 95% CI 2.41-4.80). Conclusion: In a county with one of the earliest outbreaks in the United States, the seroprevalence among firefighter first responders was lower than that reported by other studies of frontline health care workers, while the cumulative incidence remained higher than that seen in the surrounding community.
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13
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Triggle CR, Bansal D, Ding H, Islam MM, Farag EABA, Hadi HA, Sultan AA. A Comprehensive Review of Viral Characteristics, Transmission, Pathophysiology, Immune Response, and Management of SARS-CoV-2 and COVID-19 as a Basis for Controlling the Pandemic. Front Immunol 2021; 12:631139. [PMID: 33717166 PMCID: PMC7952616 DOI: 10.3389/fimmu.2021.631139] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 emerged from China in December 2019 and during 2020 spread to every continent including Antarctica. The coronavirus, SARS-CoV-2, has been identified as the causative pathogen, and its spread has stretched the capacities of healthcare systems and negatively affected the global economy. This review provides an update on the virus, including the genome, the risks associated with the emergence of variants, mode of transmission, immune response, COVID-19 in children and the elderly, and advances made to contain, prevent and manage the disease. Although our knowledge of the mechanics of virus transmission and the immune response has been substantially demystified, concerns over reinfection, susceptibility of the elderly and whether asymptomatic children promote transmission remain unanswered. There are also uncertainties about the pathophysiology of COVID-19 and why there are variations in clinical presentations and why some patients suffer from long lasting symptoms-"the long haulers." To date, there are no significantly effective curative drugs for COVID-19, especially after failure of hydroxychloroquine trials to produce positive results. The RNA polymerase inhibitor, remdesivir, facilitates recovery of severely infected cases but, unlike the anti-inflammatory drug, dexamethasone, does not reduce mortality. However, vaccine development witnessed substantial progress with several being approved in countries around the globe.
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Affiliation(s)
- Chris R. Triggle
- Department of Pharmacology, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Devendra Bansal
- Department of Health Protection & Communicable Diseases Control, Ministry of Public Health, Doha, Qatar
| | - Hong Ding
- Department of Pharmacology, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Md Mazharul Islam
- Department of Animal Resources, Ministry of Municipality and Environment, Doha, Qatar
| | | | - Hamad Abdel Hadi
- Communicable Diseases Centre, Hamad Medical Corporations, Doha, Qatar
| | - Ali A. Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine, Cornell University, Doha, Qatar
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14
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Amjadi MF, O'Connell SE, Armbrust T, Mergaert AM, Narpala SR, Halfmann PJ, Bashar SJ, Glover CR, Heffron AS, Taylor A, Flach B, O'Connor DH, Kawaoka Y, McDermott AB, Sethi AK, Shelef MA. Fever, Diarrhea, and Severe Disease Correlate with High Persistent Antibody Levels against SARS-CoV-2. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.01.05.21249240. [PMID: 33442707 PMCID: PMC7805469 DOI: 10.1101/2021.01.05.21249240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Lasting immunity will be critical for overcoming the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, factors that drive the development of high titers of anti-SARS-CoV-2 antibodies and how long those antibodies persist remain unclear. Our objective was to comprehensively evaluate anti-SARS-CoV-2 antibodies in a clinically diverse COVID-19 convalescent cohort at defined time points to determine if anti-SARS-CoV-2 antibodies persist and to identify clinical and demographic factors that correlate with high titers. Using a novel multiplex assay to quantify IgG against four SARS-CoV-2 antigens, a receptor binding domain-angiotensin converting enzyme 2 inhibition assay, and a SARS-CoV-2 neutralization assay, we found that 98% of COVID-19 convalescent subjects had anti-SARS-CoV-2 antibodies five weeks after symptom resolution (n=113). Further, antibody levels did not decline three months after symptom resolution (n=79). As expected, greater disease severity, older age, male sex, obesity, and higher Charlson Comorbidity Index score correlated with increased anti-SARS-CoV-2 antibody levels. We demonstrated for the first time that COVID-19 symptoms, namely fever, abdominal pain, diarrhea and low appetite, correlated consistently with higher anti-SARS-CoV-2 antibody levels. Our results provide new insights into the development and persistence of anti-SARS-CoV-2 antibodies.
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15
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Frush K, Lee G, Wald SH, Hawn M, Krna C, Holubar M, Beatty D, Chawla A, Pinsky BA, Schilling L, Maldonado Y. Navigating the Covid-19 Pandemic by Caring for Our Health Care Workforce as They Care for Our Patients. NEJM CATALYST 2021. [PMCID: PMC7743894 DOI: 10.1056/cat.20.0378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Leaders at Stanford Medicine, located in one of the first U.S. communities to be affected by Covid-19, quickly realized that they were not prepared to meet the escalating needs of their clinical and operational workforce. The pandemic would require existing care-delivery structures across the academic medical system to be expanded and aligned to prioritize workforce protection. Leaders identified an approach driven by connection, collaboration, and caring. They created specialized teams to develop a systemwide Occupational Health service with practices and procedures to assess health care workers and begin robust Covid-19 polymerase chain reaction testing; to centralize operations to maximize utilization of essential clinical and nonclinical staffing resources; to make visible and address psychological safety concerns and basic needs for faculty and staff; to aggressively address personal protective equipment supply chain issues and effectively assess infection risk; and to plan for a safe return of elective procedures and visits.
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Affiliation(s)
- Karen Frush
- Chief Quality Officer, Stanford Health Care, Stanford, California, USA
- Clinical Professor of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Grace Lee
- Associate Chief Medical Officer for Practice Innovation, Stanford Children’s Health, Stanford, California, USA
- Professor of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Samuel H. Wald
- Associate Chief Medical Officer and Vice President, Perioperative Services, Stanford Health Care, Stanford, California, USA
- Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mary Hawn
- Emile Holman Professor and Chair, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Catherine Krna
- President and CEO, University HealthCare Alliance, Newark, California, USA
- Associate Dean, Ambulatory Care, Stanford University School of Medicine, Stanford, California, USA
| | - Marisa Holubar
- Associate Medical Director, Infection Prevention, Stanford Hospital and Clinics, Stanford, California, USA
- Clinical Associate Professor of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Dale Beatty
- Chief Nursing Officer, Stanford Health Care, Stanford, California, USA
| | - Amanda Chawla
- Vice President, Supply Chain, Stanford Health Care, Stanford, California, USA
| | - Benjamin A. Pinsky
- Associate Medical Director of Clinical Pathology for Covid-19 Testing, Stanford Health Care, Stanford, California, USA
- Medical Director, Clinical Virology Laboratory, Stanford Health Care, Stanford, California, USA
- Associate Professor of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Lisa Schilling
- Vice President, Quality, Safety, and Clinical Effectiveness, Stanford Health Care, Stanford, California, USA
| | - Yvonne Maldonado
- Medical Director, Infection Control, Lucile Packard Children’s Hospital, Palo Alto, California, USA
- Professor, Pediatrics – Infectious Diseases, and Professor, Epidemiology and Population Health, Stanford University, Stanford, California, USA
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16
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Wolf J, Kaiser T, Pehnke S, Nickel O, Lübbert C, Kalbitz S, Arnold B, Ermisch J, Berger L, Schroth S, Isermann B, Borte S, Biemann R. Differences of SARS-CoV-2 serological test performance between hospitalized and outpatient COVID-19 cases. Clin Chim Acta 2020; 511:352-359. [PMID: 33159952 PMCID: PMC7642750 DOI: 10.1016/j.cca.2020.10.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Serological severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody assays differ in the target antigen specificity, e.g. of antibodies directed against the viral spike or the nucleocapsid protein, and in the spectrum of detected immunoglobulins. The aim of the study was to evaluate the performance of two different routinely used immunoassays in hospitalized and outpatient COVID-19 cases. METHODS The test characteristics of commercially available spike1 protein-based serological assays (Euroimmun, EI-assays), determining IgA or IgG and nucleocapsid-based assays (Virotech, VT-assays) determining IgA, IgM or IgG were compared in 139 controls and 116 hospitalized and outpatient COVID-19 cases. RESULTS Hospitalized COVID-19 patients (n = 51; 115 samples) showed significantly higher concentrations of antibodies against SARS-CoV-2 and differed from outpatient cases (n = 65) by higher age, higher disease severity scores and earlier follow up blood sampling. Sensitivity of the two IgG assays was comparable in hospitalized patients tested ≥ 14 days (EI-assay: 88%, CI95% 67.6-99.9; VT-assay: 96%, CI95% 77.7-99.8). In outpatient COVID-19 cases sensitivity was significantly lower in the VT-assay (86.2%, CI95% 74.8-93.1) compared with the EI-assay (98.5%, CI95% 90.6-99.9). Assays for IgA and IgM demonstrated a lack of specificity or sensitivity. CONCLUSIONS Our results indicate that SARS-CoV-2 serological assays may need to be optimized to produce reliable results in outpatient COVID-19 cases who are low or even asymptomatic. Assays for IgA and IgM have limited diagnostic performance and do not prove an additional value for population-based screening approaches.
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Affiliation(s)
- Johannes Wolf
- Department of Laboratory Medicine, Hospital St. Georg, Leipzig, Germany,ImmunoDeficiencyCenter Leipzig (IDCL) at Hospital St. Georg Leipzig, Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiency Diseases, Leipzig, Germany
| | - Thorsten Kaiser
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany
| | - Sarah Pehnke
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany
| | - Olaf Nickel
- Department of Laboratory Medicine, Hospital St. Georg, Leipzig, Germany
| | - Christoph Lübbert
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany,Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany,Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany
| | - Sven Kalbitz
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Benjamin Arnold
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Jörg Ermisch
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Luisa Berger
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Stefanie Schroth
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany
| | - Stephan Borte
- Department of Laboratory Medicine, Hospital St. Georg, Leipzig, Germany,ImmunoDeficiencyCenter Leipzig (IDCL) at Hospital St. Georg Leipzig, Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiency Diseases, Leipzig, Germany,Department of Laboratory Medicine, Division of Clinical Immunology, Karolinska Institute at Karolinska University Hospital, Huddinge, Sweden
| | - Ronald Biemann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany,Corresponding author at: Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital Leipzig, Paul List Straße 16-18, 04103 Leipzig, Germany
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17
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Goldman JD, Wang K, Röltgen K, Nielsen SCA, Roach JC, Naccache SN, Yang F, Wirz OF, Yost KE, Lee JY, Chun K, Wrin T, Petropoulos CJ, Lee I, Fallen S, Manner PM, Wallick JA, Algren HA, Murray KM, Su Y, Hadlock J, Jeharajah J, Berrington WR, Pappas GP, Nyatsatsang ST, Greninger AL, Satpathy AT, Pauk JS, Boyd SD, Heath JR. Reinfection with SARS-CoV-2 and Failure of Humoral Immunity: a case report. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.09.22.20192443. [PMID: 32995830 PMCID: PMC7523175 DOI: 10.1101/2020.09.22.20192443] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Recovery from COVID-19 is associated with production of anti-SARS-CoV-2 antibodies, but it is uncertain whether these confer immunity. We describe viral RNA shedding duration in hospitalized patients and identify patients with recurrent shedding. We sequenced viruses from two distinct episodes of symptomatic COVID-19 separated by 144 days in a single patient, to conclusively describe reinfection with a new strain harboring the spike variant D614G. With antibody and B cell analytics, we show correlates of adaptive immunity, including a differential response to D614G. Finally, we discuss implications for vaccine programs and begin to define benchmarks for protection against reinfection from SARS-CoV-2.
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Affiliation(s)
- Jason D. Goldman
- Division of Infectious Diseases, Swedish Medical Center, Seattle, WA, USA
- Providence St. Joseph Health, Renton, WA, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Kai Wang
- Institute for Systems Biology, Seattle, WA, USA
| | | | | | | | | | - Fan Yang
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Oliver F. Wirz
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Kathryn E. Yost
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Ji-Yeun Lee
- Department of Pathology, Stanford University, Stanford, CA, USA
| | | | - Terri Wrin
- Monogram Biosciences, South San Francisco, CA, USA
| | | | - Inyoul Lee
- Institute for Systems Biology, Seattle, WA, USA
| | | | - Paula M. Manner
- Providence St. Joseph Health, Renton, WA, USA
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | - Julie A. Wallick
- Providence St. Joseph Health, Renton, WA, USA
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | - Heather A. Algren
- Providence St. Joseph Health, Renton, WA, USA
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA, USA
| | | | - Yapeng Su
- Institute for Systems Biology, Seattle, WA, USA
| | - Jennifer Hadlock
- Providence St. Joseph Health, Renton, WA, USA
- Institute for Systems Biology, Seattle, WA, USA
| | | | - William R. Berrington
- Division of Infectious Diseases, Swedish Medical Center, Seattle, WA, USA
- Providence St. Joseph Health, Renton, WA, USA
| | - George P. Pappas
- Division of Pulmonology and Critical Care Medicine, Swedish Medical Center, Seattle, WA, USA
| | - Sonam T. Nyatsatsang
- Division of Infectious Diseases, Swedish Medical Center, Seattle, WA, USA
- Providence St. Joseph Health, Renton, WA, USA
| | - Alexander L. Greninger
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutch, Seattle, WA, USA
| | | | - John S. Pauk
- Division of Infectious Diseases, Swedish Medical Center, Seattle, WA, USA
- Providence St. Joseph Health, Renton, WA, USA
| | - Scott D. Boyd
- Department of Pathology, Stanford University, Stanford, CA, USA
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA, USA
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