COVID-19 survival associates with the immunoglobulin response to the SARS-CoV-2 spike receptor binding domain
Massimiliano Secchi, Elena Bazzigaluppi, Cristina Brigatti, Ilaria Marzinotto, Cristina Tresoldi, Patrizia Rovere-Querini, Andrea Poli, Antonella Castagna, Gabriella Scarlatti, Alberto Zangrillo, Fabio Ciceri, Lorenzo Piemonti, Vito Lampasona
Massimiliano Secchi, Elena Bazzigaluppi, Cristina Brigatti, Ilaria Marzinotto, Cristina Tresoldi, Patrizia Rovere-Querini, Andrea Poli, Antonella Castagna, Gabriella Scarlatti, Alberto Zangrillo, Fabio Ciceri, Lorenzo Piemonti, Vito Lampasona
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Clinical Research and Public Health Immunology

COVID-19 survival associates with the immunoglobulin response to the SARS-CoV-2 spike receptor binding domain

Abstract

BACKGROUND Serological assays are of critical importance to investigate correlates of response and protection in coronavirus disease 2019 (COVID-19), to define previous exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in populations, and to verify the development of an adaptive immune response in infected individuals.METHODS We studied 509 patients confirmed to have COVID-19 from the San Raffaele Hospital of Milan and 480 samples of prepandemic organ donor sera collected in 2010–2012. Using fluid-phase luciferase immune precipitation (LIPS) assays, we characterized IgG, IgM, and IgA antibodies to the spike receptor binding domain (RBD), S1+S2, nucleocapsid, and ORF6 to ORF10 of SARS-CoV-2, to the HCoV-OC43 and HCoV-HKU1 betacoronaviruses spike S2, and the H1N1Ca2009 flu virus hemagglutinin. Sequential samples at 1 and 3 months after hospital discharge were also tested for SARS-CoV-2 RBD antibodies in 95 patients.RESULTS Antibodies developed rapidly against multiple SARS-CoV-2 antigens in 95% of patients by 4 weeks after symptom onset and IgG to the RBD increased until the third month of follow-up. We observed a major synchronous expansion of antibodies to the HCoV-OC43 and HCoV-HKU1 spike S2. A likely coinfection with influenza was neither linked to a more severe presentation of the disease nor to a worse outcome. Of the measured antibody responses, positivity for IgG against the SARS-CoV-2 spike RBD was predictive of survival.CONCLUSION The measurement of antibodies to selected epitopes of SARS-CoV-2 antigens can offer a more accurate assessment of the humoral response in patients and its impact on survival. The presence of partially cross-reactive antibodies with other betacoronaviruses is likely to impact on serological assay specificity and interpretation.TRIAL REGISTRATION COVID-19 Patients Characterization, Biobank, Treatment Response and Outcome Predictor (COVID-BioB). ClinicalTrials.gov identifier: NCT04318366.FUNDING IRCCS Ospedale San Raffaele and Università Vita Salute San Raffaele.

Authors

Massimiliano Secchi, Elena Bazzigaluppi, Cristina Brigatti, Ilaria Marzinotto, Cristina Tresoldi, Patrizia Rovere-Querini, Andrea Poli, Antonella Castagna, Gabriella Scarlatti, Alberto Zangrillo, Fabio Ciceri, Lorenzo Piemonti, Vito Lampasona

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Figure 3

Assay performance of the SARS-CoV-2 spike RBD LIPS in COVID-19.

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Assay performance of the SARS-CoV-2 spike RBD LIPS in COVID-19. Antibody...
Antibody levels in COVID-19 patient (n = 575) and control (n = 480) sera were stratified by symptom duration (weeks 1, 2, 3, ≥4) at serum sampling and IgM, IgA, IgG immunoglobulin class. Left panels: ROC curve analysis of LIPS assays measuring either IgM, IgA, or IgG at 1 week to 4 weeks or later after symptom onset. Shown are the total ROC-AUC and the pAUC95. Middle panels: Venn diagrams of spike RBD antibody-positive or -negative score combinations (shown as count and percentages) for different immunoglobulin classes at the same time points. Right panels: ROC-AUC, pAUC95, sensitivity, specificity, positive, and negative predictive values of an algorithm combining results from IgG and IgM immunoglobulin class–specific LIPS assays at the same time points.