A role for Nucleocapsid-specific antibody function in Covid-19 Convalescent plasma therapy

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Abstract

COVID-19 convalescent plasma (CCP), a passive polyclonal antibody therapeutic, has exhibited mixed results in the treatment of COVID-19. Given that the therapeutic effect of CCP may extend beyond the ability of SARS-CoV-2-specific antibody binding and neutralization to influence the evolution of the endogenous antibody response, we took a systematic and comprehensive approach to analyze SARS-CoV-2 functional antibody profiles of participants in a randomized controlled trial of CCP treatment of individuals hospitalized with COVID-19 pneumonia where CCP was associated with both decreased mortality and improved clinical severity. Using systems serology, we found that the clinical benefit of CCP is related to a shift towards reduced inflammatory Spike (S) responses and enhanced Nucleocapsid (N) humoral responses. We found CCP had the greatest clinical benefit in participants with low pre-existing anti-SARS-CoV-2 antibody function, rather than S or N antibody levels or participant demographic features. Further, CCP induced immunomodulatory changes to recipient humoral profiles persisted for at least two months, marked by the selective evolution of anti-inflammatory Fc-glycan profiles and persistently expanded nucleocapsid-specific humoral immunity following CCP therapy. Together, our findings identify a novel mechanism of action of CCP, suggest optimal patient characteristics for CCP treatment, identify long-last immunomodulatory effects of CCP, and provide guidance for development of novel N-focused antibody therapeutics for severe COVID-19 hyperinflammation.

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  1. SciScore for 10.1101/2022.02.19.22271230: (What is this?)

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

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Antibodies
    SentencesResources
    Antibody Titer and Fc-Receptor Binding Assays: Antigen-specific antibody subclass, isotype, and Fc-receptor (FcR) binding levels were assayed with a customized multiplexed Luminex bead array, as previously described.
    Antigen-specific antibody subclass, isotype,
    suggested: None
    Antigen-specific antibody titers were detected with Phycoerythrin (PE)-coupled antibodies against IgG1, IgG2, IgG3, IgG4, IgA1, and IgM (SouthernBiotech, Birmingham, AL).
    Phycoerythrin ( PE)-coupled antibodies against IgG1
    suggested: None
    IgG1
    suggested: None
    IgG2
    suggested: None
    IgG3
    suggested: None
    IgG4
    suggested: None
    IgA1
    suggested: None
    IgM ( SouthernBiotech , Birmingham , AL)
    suggested: None
    IgM
    suggested: None
    PE median fluorescence intensity (MFI) was measured as the readout of each antigen-specific antibody measurements.
    antigen-specific
    suggested: None
    Ab-Directed Functional Assays: Bead-based assays were used to quantify antibody-dependent cellular phagocytosis (ADCP), antibody-dependent neutrophil phagocytosis (ADNP) and antibody-dependent complement deposition (ADCD), as previously described(Ackerman et al., 2018; Ackerman et al., 2011; Fischinger et al., 2019; Karsten et al., 2019; Lu et al., 2016).
    antibody-dependent neutrophil phagocytosis ( ADNP
    suggested: None
    antibody-dependent complement deposition ( ADCD)
    suggested: None
    Neutrophils were stained with an anti-CD66b PacBlue detection antibody (Biolegend) and fixed with 4% paraformaldehyde (Alfa Aesar).
    anti-CD66b
    suggested: None
    To measure antibody-dependent deposition of C3, lyophilized guinea pig complement (Cedarlane) was reconstituted according to manufacturer’s instructions and diluted in gelatin veronal buffer with calcium and magnesium (GBV++) (Boston BioProducts) and mixed with immune complexes.
    C3
    suggested: None
    After a 20-minute incubation at 37°C, C3 was detected with an anti-C3 fluorescein-conjugated goat IgG fraction detection antibody (Mpbio).
    anti-C3 fluorescein-conjugated goat IgG
    suggested: None
    Antibody-dependent NK (ADNK) cell activity was measured via an ELISA-based assay, as described previously (Chung et al., 2015).
    Antibody-dependent NK
    suggested: None
    NK cells were mixed with a staining cocktail containing anti-CD107a BV605 antibody (Biolegand), Golgi stop (BD Biosciences) and Brefeldin A (BFA, Sigma Aldrich).
    anti-CD107a
    suggested: (BioLegend Cat# 328634, RRID:AB_2563851)
    Subsequently, cells were permeabilized using Perm B (Invitrogen) and intracellularly stained with an anti-MIP-1ß-BV421 (BD Biosciences) and IFNγ-PE (BioLegend) antibodies.
    anti-MIP-1ß-BV421
    suggested: None
    IFNγ-PE
    suggested: None
    For the purpose of visualization, the correlation networks were visualized using ‘ggraph’ (v.2.0.4) and ‘igraph’ (v.1.2.6) packages. 4. Mixed Linear Model: We used two nested mixed linear models (null and full model) without/with treatment group information to assess the significance of the association between measured antibody levels and treatment groups while controlling for potential confounding clinical characteristics.
    v.2.0.4
    suggested: None
    Software and Algorithms
    SentencesResources
    The UMAP visualization was performed on principal components whose cumulative explained variance is larger than 90% by umap function in R package ‘umap’ (version 0.2.7.0) with fine-tuning parameters (neighbor = 8, min.dist = 0.1), and visualized by ggplot function in R package ggplot2 (version 3.3.5) Polar Plots: Polar plots were used to visualize the mean percentile of groups in Figure 2C, 3C, 5A.
    ggplot2
    suggested: (ggplot2, RRID:SCR_014601)

    Results from OddPub: Thank you for sharing your data.


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Despite these limitations, we were able to use deep humoral immune profiling to understand how CCP modulates host immunodominance and provides clinical benefit. Expanding this approach in larger clinical trials will be essential to validate these findings. The emergence of the omicron variant has rendered most of our monoclonal antibody therapeutics no longer active.(Aggarwal et al., 2021; Cameroni et al., 2021; Cao et al., 2021; Planas et al., 2021) Now there is a renewed interest in use of polyclonal antibody therapies like CCP, which are less likely to loose efficacy to new variants because they target multiple sites in the virus and plasma from survivors of recently circulating variants can be procured relatively quickly. By using a systemic approach to study correlates of therapeutic benefit of CCP, we have found novel targets for future severe COVID-19 disease modifying treatments. Our findings contribute to a burgeoning literature showing the promise of anti-N monoclonal antibodies as disease modifying treatment for severe COVID-19 induced hyperinflammation. Further, our findings show that by choosing CCP based on high S titers alone and selecting patients based on low pre-existing S titers, we are likely incorrectly matching patients with therapies. Finally, our research confirms the importance of the functional S and N antibody response in treatment of COVID-19 disease and should guide development of COVID-19 monoclonal and polyclonal antibody therapeutics that focus...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04397757CompletedCOVID-19 Convalescent Plasma for the Treatment of Hospitaliz…


    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.

    Results from scite Reference Check: We found no unreliable references.


    About SciScore

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