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Miyara M, Saichi M, Sterlin D, Anna F, Marot S, Mathian A, Atif M, Quentric P, Mohr A, Claër L, Parizot C, Dorgham K, Yssel H, Fadlallah J, Chazal T, Haroche J, Luyt CE, Mayaux J, Beurton A, Benameur N, Boutolleau D, Burrel S, de Alba S, Mudumba S, Hockett R, Gunn C, Charneau P, Calvez V, Marcelin AG, Combes A, Demoule A, Amoura Z, Gorochov G. Pre-COVID-19 Immunity to Common Cold Human Coronaviruses Induces a Recall-Type IgG Response to SARS-CoV-2 Antigens Without Cross-Neutralisation. Front Immunol 2022; 13:790334. [PMID: 35222375 PMCID: PMC8873934 DOI: 10.3389/fimmu.2022.790334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/11/2022] [Indexed: 12/26/2022] Open
Abstract
The capacity of pre-existing immunity to human common coronaviruses (HCoV) to cross-protect against de novo COVID-19is yet unknown. In this work, we studied the sera of 175 COVID-19 patients, 76 healthy donors and 3 intravenous immunoglobulins (IVIG) batches. We found that most COVID-19 patients developed anti-SARS-CoV-2 IgG antibodies before IgM. Moreover, the capacity of their IgGs to react to beta-HCoV, was present in the early sera of most patients before the appearance of anti-SARS-CoV-2 IgG. This implied that a recall-type antibody response was generated. In comparison, the patients that mounted an anti-SARS-COV2 IgM response, prior to IgG responses had lower titres of anti-beta-HCoV IgG antibodies. This indicated that pre-existing immunity to beta-HCoV was conducive to the generation of memory type responses to SARS-COV-2. Finally, we also found that pre-COVID-19-era sera and IVIG cross-reacted with SARS-CoV-2 antigens without neutralising SARS-CoV-2 infectivity in vitro. Put together, these results indicate that whilst pre-existing immunity to HCoV is responsible for recall-type IgG responses to SARS-CoV-2, it does not lead to cross-protection against COVID-19.
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Affiliation(s)
- Makoto Miyara
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Melissa Saichi
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Delphine Sterlin
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, Paris, France
| | - François Anna
- Unité de Virologie Moléculaire et Vaccinologie, Institut Pasteur, Paris, France
- Theravectys, Paris, France
| | - Stéphane Marot
- Sorbonne Université, Inserm, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de Virologie, Paris, France
| | - Alexis Mathian
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
- Service de Médecine Interne 2, Institut E3M, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Mo Atif
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Paul Quentric
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Audrey Mohr
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Laetitia Claër
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Christophe Parizot
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Karim Dorgham
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Hans Yssel
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Jehane Fadlallah
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
- Service de Médecine Interne 2, Institut E3M, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Thibaut Chazal
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
- Service de Médecine Interne 2, Institut E3M, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Julien Haroche
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
- Service de Médecine Interne 2, Institut E3M, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, APHP, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Université, INSERM, UMRS 1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Julien Mayaux
- Service de Médecine Intensive-Réanimation, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alexandra Beurton
- Service de Médecine Intensive-Réanimation, APHP, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Inserm UMRS Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Neila Benameur
- Service de la pharmacie, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - David Boutolleau
- Sorbonne Université, Inserm, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de Virologie, Paris, France
| | - Sonia Burrel
- Sorbonne Université, Inserm, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de Virologie, Paris, France
| | | | | | | | - Cary Gunn
- Genalyte Inc., San Diego, CA, United States
| | - Pierre Charneau
- Unité de Virologie Moléculaire et Vaccinologie, Institut Pasteur, Paris, France
- Theravectys, Paris, France
| | - Vincent Calvez
- Sorbonne Université, Inserm, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de Virologie, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, Inserm, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de Virologie, Paris, France
| | - Alain Combes
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, APHP, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Université, INSERM, UMRS 1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Alexandre Demoule
- Service de Médecine Intensive-Réanimation, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Zahir Amoura
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
- Service de Médecine Interne 2, Institut E3M, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Guy Gorochov
- Sorbonne Université, Inserm, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
- *Correspondence: Guy Gorochov,
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Ikegami S, Benirschke RC, Fakhrai-Rad H, Motamedi MH, Hockett R, David S, Lee HK, Kang J, Gniadek TJ. Target specific serologic analysis of COVID-19 convalescent plasma. PLoS One 2021; 16:e0249938. [PMID: 33909632 PMCID: PMC8081213 DOI: 10.1371/journal.pone.0249938] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/27/2021] [Indexed: 11/18/2022] Open
Abstract
This study compared the performance of four serology assays for Coronavirus Disease 2019 (COVID-19) and investigated whether COVID-19 disease history correlates with assay performance. Samples were tested at Northshore using the Elecsys Anti-SARS-CoV-2 (Roche Diagnostics), Access SARS-CoV-2 IgG anti-RBD (Beckman Coulter), and LIAISON SARS-CoV-2 S1/S2 IgG (DiaSorin) as well as at Genalyte using Maverick Multi-Antigen Serology Panel. The study included one hundred clinical samples collected before December 2019 and ninety-seven samples collected from convalescent plasma donors originally diagnosed with COVID-19 by PCR. COVID-19 disease history was self-reported by the plasma donors. There was no difference in specificity between the assays tested. Clinical sensitivity of these four tests was 98% (Genalyte), 96% (Roche), 92% (DiaSorin), and 87% (Beckman). The only statistically significant differences in clinical sensitivity was between the Beckman assay and both Genalyte and Roche assays. Convalescent plasma donor characteristics and disease symptoms did not correlate with false negative results from the Beckman and DiaSorin assays. All four tests showed high specificity (100%) and varying sensitivities (89-98%). No correlations between disease history and serology results were observed. The Genalyte Multiplex assay showed as good or better sensitivity to three other previously validated assays with FDA Emergency Use Authorizations.
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Affiliation(s)
- Sachie Ikegami
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Robert C. Benirschke
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | | | | | - Rick Hockett
- Genalyte Inc., San Diego, California, United States of America
| | - Sean David
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States of America
- Department of Family Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Hong Kee Lee
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Jason Kang
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Thomas J. Gniadek
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States of America
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Sterlin D, Mathian A, Miyara M, Mohr A, Anna F, Claër L, Quentric P, Fadlallah J, Devilliers H, Ghillani P, Gunn C, Hockett R, Mudumba S, Guihot A, Luyt CE, Mayaux J, Beurton A, Fourati S, Bruel T, Schwartz O, Lacorte JM, Yssel H, Parizot C, Dorgham K, Charneau P, Amoura Z, Gorochov G. IgA dominates the early neutralizing antibody response to SARS-CoV-2. Sci Transl Med 2021; 13:eabd2223. [PMID: 33288662 PMCID: PMC7857408 DOI: 10.1126/scitranslmed.abd2223] [Citation(s) in RCA: 665] [Impact Index Per Article: 221.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/26/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
Humoral immune responses are typically characterized by primary IgM antibody responses followed by secondary antibody responses associated with immune memory and composed of IgG, IgA, and IgE. Here, we measured acute humoral responses to SARS-CoV-2, including the frequency of antibody-secreting cells and the presence of SARS-CoV-2-specific neutralizing antibodies in the serum, saliva, and bronchoalveolar fluid of 159 patients with COVID-19. Early SARS-CoV-2-specific humoral responses were dominated by IgA antibodies. Peripheral expansion of IgA plasmablasts with mucosal homing potential was detected shortly after the onset of symptoms and peaked during the third week of the disease. The virus-specific antibody responses included IgG, IgM, and IgA, but IgA contributed to virus neutralization to a greater extent compared with IgG. Specific IgA serum concentrations decreased notably 1 month after the onset of symptoms, but neutralizing IgA remained detectable in saliva for a longer time (days 49 to 73 post-symptoms). These results represent a critical observation given the emerging information as to the types of antibodies associated with optimal protection against reinfection and whether vaccine regimens should consider targeting a potent but potentially short-lived IgA response.
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Affiliation(s)
- Delphine Sterlin
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
- Département d'Immunologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
- Unit of Antibodies in Therapy and Pathology, Institut Pasteur, UMR1222, Inserm, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Alexis Mathian
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
- Service de Médecine Interne 2, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
| | - Makoto Miyara
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
- Département d'Immunologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
| | - Audrey Mohr
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
| | - François Anna
- Unité de Virologie Moléculaire et Vaccinologie, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- Theravectys, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Laetitia Claër
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
| | - Paul Quentric
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
| | - Jehane Fadlallah
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
- Service de Médecine Interne 2, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
| | - Hervé Devilliers
- Centre Hospitalier Universitaire de Dijon, Hôpital François Mitterrand, service de médecine interne et maladies systémiques (médecine interne 2) et Centre d'Investigation Clinique, Inserm CIC-EC 1432, 3 rue du FBG Raines, 21000 Dijon, France
| | - Pascale Ghillani
- Département d'Immunologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
| | - Cary Gunn
- Genalyte Inc., 10520 Wateridge Circle, San Diego, CA 92121, USA
| | - Rick Hockett
- Genalyte Inc., 10520 Wateridge Circle, San Diego, CA 92121, USA
| | - Sasi Mudumba
- Genalyte Inc., 10520 Wateridge Circle, San Diego, CA 92121, USA
| | - Amélie Guihot
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
- Département d'Immunologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, APHP, Sorbonne-Université, Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
- Sorbonne Université, INSERM, UMRS 1166-ICAN Institute of Cardiometabolism and Nutrition, 91 boulevard de l'Hôpital, 75013 Paris, France
| | - Julien Mayaux
- Service de Médecine Intensive-Réanimation et Pneumologie, APHP, Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
| | - Alexandra Beurton
- Service de Médecine Intensive-Réanimation et Pneumologie, APHP, Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
- Sorbonne Université, Inserm UMRS Neurophysiologie respiratoire expérimentale et clinique, AP-HP, 91 boulevard de l'Hôpital, 75013 Paris, France
| | - Salma Fourati
- Service de Biochimie Endocrinienne et Oncologique, AP-HP, Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
- Inserm UMR1149, Centre de Recherche sur l'Inflammation Paris Montmartre (CRI), 16 rue Henri Huchard, 75890 Paris, France
| | - Timothée Bruel
- Virus and Immunity Unit, Department of Virology, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- CNRS-UMR3569, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- Vaccine Research Institute, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Olivier Schwartz
- Virus and Immunity Unit, Department of Virology, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- CNRS-UMR3569, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- Vaccine Research Institute, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Jean-Marc Lacorte
- Sorbonne Université, INSERM, UMRS 1166-ICAN Institute of Cardiometabolism and Nutrition, 91 boulevard de l'Hôpital, 75013 Paris, France
- Service de Biochimie Endocrinienne et Oncologique, AP-HP, Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
| | - Hans Yssel
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
| | - Christophe Parizot
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
- Département d'Immunologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
| | - Karim Dorgham
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
| | - Pierre Charneau
- Unité de Virologie Moléculaire et Vaccinologie, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- Theravectys, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
| | - Zahir Amoura
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France
- Service de Médecine Interne 2, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
| | - Guy Gorochov
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 boulevard de l'Hôpital, 75013 Paris, France.
- Département d'Immunologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France
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Bognar K, Shafrin J, Brauer M, Zhao L, Hockett R, O'Neil M, Jena A. The potential value of rapid, cloud-enabled onsite testing for the diagnosis of rheumatoid arthritis in the United States. J Med Econ 2018; 21:1057-1066. [PMID: 30019600 DOI: 10.1080/13696998.2018.1502191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIMS Improvements in information technology have granted the recent development of rapid, cloud-enabled, onsite laboratory testing for rheumatoid arthritis (RA). This study aims to quantify the value to payers of such technologies. MATERIALS AND METHODS To calculate the value of rapid, cloud-enabled, onsite laboratory testing to diagnose RA relative to traditional, centralized laboratory testing, an Excel-based decision tree model was created that simulated potential cost-savings to payers who cover routine evaluations of RA patients in the US. First, a conceptual framework was created to identify the value components of rapid, cloud-enabled onsite testing. Second, value associated with patient time savings, savings on visit fees, change in treatment costs, and QALY improvements was measured, leveraging existing literature and information from an observational study. Lastly, these value components were combined to estimate the total incremental value accruing to payers per patient-year relative to centralized laboratory testing. RESULTS Rapid, cloud-enabled, onsite testing is estimated to save one office and 1.81 laboratory visits during the evaluation period for the average patient. Results from an observational study found that rapid, cloud-enabled testing increased the likelihood of completing diagnostic orders from 84.5% to 97%, resulting in an increased probability of early treatment (3.5 percentage points) with disease-modifying anti-rheumatic drugs among patients eligible for treatment. The combined total value was $5,648 per evaluated patient-year. This value is primarily attributed to health benefits of early treatment ($5,048), fewer visit payments ($459), and patient time savings due to fewer office ($216) and laboratory visits ($255). LIMITATIONS AND CONCLUSIONS Data on the impact of rapid, cloud-enabled, onsite testing on patient health, care delivery, and clinical decision-making is scarce. More robust real-world data would confirm the validity of our model. Rapid, cloud-enabled, onsite testing has the potential to generate significant value to payers.
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Affiliation(s)
| | - Jason Shafrin
- a Precision Health Economics , Los Angeles , CA , USA
| | | | - Lauren Zhao
- a Precision Health Economics , Los Angeles , CA , USA
| | | | | | - Anupam Jena
- c Harvard Medical School Department of Health Care Policy , Boston , MA , USA
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de Villartay JP, Lewis D, Hockett R, Waldmann TA, Korsmeyer SJ, Cohen DI. Deletional rearrangement in the human T-cell receptor alpha-chain locus. Proc Natl Acad Sci U S A 1987; 84:8608-12. [PMID: 3500476 PMCID: PMC299594 DOI: 10.1073/pnas.84.23.8608] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The antigen-specific receptor on the surface of mature T lymphocytes is a heterodimer consisting of polypeptides termed alpha and beta. In the course of characterizing human T-cell tumors with an immature (CD4-, CD8-) surface phenotype, we detected a 2-kilobase alpha-related transcript. Analysis of cDNA clones corresponding to this transcript established that a genetic element (which we call TEA, for "T early alpha") located between the alpha-chain variable- and joining-region genes had been spliced to the alpha constant region. The TEA transcript is present early in thymocyte ontogeny, and its expression declines during T-cell maturation. More important, the TEA area functions as an active site for rearrangement within the alpha gene locus. Blot hybridization of restriction enzyme-digested DNA with a TEA probe revealed a narrowly limited pattern of rearrangement in polyclonal thymic DNA, surprisingly different from the pattern expected for the mature alpha gene with its complex diversity. These DNA blots also showed that TEA is generally present in the germ-line configuration in cells expressing the gamma delta heterodimeric receptor and is deleted from mature (alpha beta-expressing) T-lymphocyte tumors and lines. Moreover, the TEA transcript lacked a long open reading frame for protein but instead possessed multiple copies of a repetitive element resembling those utilized in the heavy-chain class switch of the immunoglobulin genes. The temporal nature of the rearrangements and expression detected by TEA suggests that this recombination could mediate a transition between immature (gamma delta-expressing) T cells and mature (alpha beta-expressing) T cells.
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Affiliation(s)
- J P de Villartay
- Laboratory of Chemical Biology, National Institute of Diabetes, Digestive, and Kidney Diseases, Bethesda, MD 20892
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