|
1
|
Staats LAN, Pfeiffer H, Knopf J, Lindemann A, Fürst J, Kremer AE, Hackstein H, Neurath MF, Muñoz LE, Achenbach S, Leppkes M, Herrmann M, Schett G, Steffen U. IgA2 Antibodies against SARS-CoV-2 Correlate with NET Formation and Fatal Outcome in Severely Diseased COVID-19 Patients. Cells 2020; 9:E2676. [PMID: 33322797 PMCID: PMC7764693 DOI: 10.3390/cells9122676] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to an adaptive immune response in the host and the formation of anti-SARS-CoV-2 specific antibodies. While IgG responses against SARS-CoV-2 have been characterized quite well, less is known about IgA. IgA2 activates immune cells and induces inflammation and neutrophil extracellular trap (NET) formation which may contribute to organ injury and fatal outcome in SARS-CoV-2-infected patients. SARS-CoV-2 spike protein specific antibody levels were measured in plasma samples of 15 noninfected controls and 82 SARS-CoV-2-infected patients with no or mild symptoms, moderate symptoms (hospitalization) or severe disease (intensive care unit, ICU). Antibody levels were compared to levels of C-reactive protein (CRP) and circulating extracellular DNA (ecDNA) as markers for general inflammation and NET formation, respectively. While levels of SARS-CoV-2-specific IgG were similar in all patient groups, IgA2 antibodies were restricted to severe disease and showed the strongest discrimination between nonfatal and fatal outcome in patients with severe SARS-CoV-2 infection. While anti-SARS-CoV-2 IgG and IgA2 levels correlated with CRP levels in severely diseased patients, only anti-SARS-CoV-2 IgA2 correlated with ecDNA. These data suggest that the formation of anti-SARS-CoV-2 IgA2 during SARS-CoV-2 infection is a marker for more severe disease related to NET formation and poor outcome.
Collapse
Affiliation(s)
- Léonie A. N. Staats
- Department of Internal Medicine 1, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.A.N.S.); (A.L.); (J.F.); (A.E.K.); (M.F.N.); (M.L.)
- Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (J.K.); (L.E.M.); (M.H.); (G.S.)
| | - Hella Pfeiffer
- Department of Transfusion Medicine and Haemostaseology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (H.P.); (H.H.); (S.A.)
| | - Jasmin Knopf
- Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (J.K.); (L.E.M.); (M.H.); (G.S.)
- Department of Internal Medicine 3, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Aylin Lindemann
- Department of Internal Medicine 1, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.A.N.S.); (A.L.); (J.F.); (A.E.K.); (M.F.N.); (M.L.)
- Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (J.K.); (L.E.M.); (M.H.); (G.S.)
| | - Julia Fürst
- Department of Internal Medicine 1, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.A.N.S.); (A.L.); (J.F.); (A.E.K.); (M.F.N.); (M.L.)
- Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (J.K.); (L.E.M.); (M.H.); (G.S.)
| | - Andreas E. Kremer
- Department of Internal Medicine 1, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.A.N.S.); (A.L.); (J.F.); (A.E.K.); (M.F.N.); (M.L.)
- Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (J.K.); (L.E.M.); (M.H.); (G.S.)
| | - Holger Hackstein
- Department of Transfusion Medicine and Haemostaseology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (H.P.); (H.H.); (S.A.)
| | - Markus F. Neurath
- Department of Internal Medicine 1, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.A.N.S.); (A.L.); (J.F.); (A.E.K.); (M.F.N.); (M.L.)
- Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (J.K.); (L.E.M.); (M.H.); (G.S.)
| | - Luis E. Muñoz
- Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (J.K.); (L.E.M.); (M.H.); (G.S.)
- Department of Internal Medicine 3, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Susanne Achenbach
- Department of Transfusion Medicine and Haemostaseology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (H.P.); (H.H.); (S.A.)
| | - Moritz Leppkes
- Department of Internal Medicine 1, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (L.A.N.S.); (A.L.); (J.F.); (A.E.K.); (M.F.N.); (M.L.)
- Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (J.K.); (L.E.M.); (M.H.); (G.S.)
| | - Martin Herrmann
- Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (J.K.); (L.E.M.); (M.H.); (G.S.)
- Department of Internal Medicine 3, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Georg Schett
- Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (J.K.); (L.E.M.); (M.H.); (G.S.)
- Department of Internal Medicine 3, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Ulrike Steffen
- Deutsches Zentrum Immuntherapie (DZI), 91054 Erlangen, Germany; (J.K.); (L.E.M.); (M.H.); (G.S.)
- Department of Internal Medicine 3, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| |
Collapse
|