Longitudinal characterization of humoral and cellular immunity in hospitalized COVID-19 patients reveal immune persistence up to 9 months after infection

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Abstract

Background

Insights into early, specific humoral and cellular responses to infection with SARS-CoV-2, as well as the persistence and magnitude of resulting immune memory is important amidst the ongoing pandemic. The combination of humoral and cellular immunity will most likely contribute to protection from reinfection or severe disease.

Methods

Here, we conducted a longitudinal study on hospitalized moderate and severe COVID-19 patients from the acute phase of disease into convalescence at five- and nine-months post symptom onset. Utilizing flow cytometry, serological assays as well as B cell and T cell FluoroSpot assays, we assessed the magnitude and specificity of humoral and cellular immune memory during and after human SARS-CoV-2 infection.

Findings

During acute COVID-19, we observed an increase in germinal center activity, a substantial expansion of antibodysecreting cells, and the generation of SARS-CoV-2-neutralizing antibodies. Despite gradually decreasing antibody levels, we show persistent, neutralizing antibody titers as well as robust specific memory B cell responses and polyfunctional T cell responses at five- and nine-months after symptom onset in both moderate and severe COVID-19 patients. Long-term SARS-CoV-2 specific responses were marked by preferential targeting of spike over nucleocapsid protein.

Conclusions

Our findings describe the initiation and, importantly, persistence of cellular and humoral SARS-CoV-2 specific immunological memory in hospitalized COVID-19 patients long after recovery, likely contributing towards protection against reinfection.

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  1. SciScore for 10.1101/2021.03.17.435581: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: All patients or next of kin and control donors provided informed consent in line with the ethical approval.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablePatients were primarily male, with median age of 57 (range 18-76) for moderate and median age of 58 (range 40-74) for severe patients (Figure 1A-C).
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Antibodies against Ki67, IgG, IgA and IgM in permeabilization buffer were added to the cells and incubated in the dark for 30 minutes at 4°C.
    Ki67, IgG
    suggested: None
    SARS-CoV-2-specific antibody ELISAs: RBD-specific IgG/IgM antibodies was assessed using WANTAI SARS-CoV-2 Ab ELISA (Beijing Wantai Biological Pharmacy Ent.), while S1- and N-specific IgG antibody levels were assessed using semi-quantitative IgG ELISAs (Euroimmun) according to the manufacturer’s instructions.
    RBD-specific IgG/IgM
    suggested: None
    N-specific IgG
    suggested: None
    Ethanol-activated low autofluorescent polyvinylidene difluoride membrane plates were coated overnight with either 1) anti-IgA and anti-IgG capture antibodies (15 mg/mL) or 2) SARS-CoV-2 S1 (20 μg/ mL) or N protein (10 mg/mL).
    anti-IgA
    suggested: None
    anti-IgG
    suggested: None
    Cells were then discarded from plates and the captured antibodies were developed with anti-human IgG-550 and anti-human IgA-490 detection antibodies (1:500 dilution).
    anti-human IgG-550
    suggested: None
    anti-human IgA-490
    suggested: None
    All wells with SARS-CoV-2 peptide pool stimulations contained the final concentration of 2 μg/mL of peptides and anti-CD28 antibody diluted at 1:100.
    anti-CD28
    suggested: None
    Experimental Models: Cell Lines
    SentencesResources
    Final serum dilutions were incubated for 1 hour at 37°C and 5% CO2 in duplicate and then moved to 96-well plates seeded with confluent Vero E6 cells, followed by a 4-day incubation at 37°C 5% CO2.
    Vero E6
    suggested: None
    Software and Algorithms
    SentencesResources
    Samples were acquired with a BD LSRFortessa (BD Biosciences) followed by analysis with FlowJo software version 10 (FlowJo Inc).
    FlowJo
    suggested: (FlowJo, RRID:SCR_008520)
    Statistics: Statistical analyses were performed using GraphPad Prism (GraphPad Software).
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)
    Correlation and hierarchical clustering analysis were performed with GraphPad Prism (v9.0.1) or R (v4.0.2) and RStudio (v1.3.1056) using packages corrplot (v0.84) and heatmaply (v1.1.1).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    RStudio
    suggested: (RStudio, RRID:SCR_000432)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of Study: The current study, although extensive in regard to immunological analyses performed, is limited by a relatively small COVID-19 patient cohort size (acute phase n = 26, 5-months n = 17, and 9-months n = 13). Here, we assessed SARS-CoV-2-specific immune responses in moderately and severely sick COVID-19 patients who required hospitalization, however, we were not able to include asymptomatic or mild cases. Therefore, the longitudinal characteristics and magnitude of the immune responses observed in the current COVID-19 patient cohort may only be applicable to hospitalized patients.

    Results from TrialIdentifier: No clinical trial numbers were referenced.


    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.