Characterization of SARS-CoV-2 RNA, Antibodies, and Neutralizing Capacity in Milk Produced by Women with COVID-19

  1. Ryan M. Pace
  2. Janet E. Williams
  3. Kirsi M. Järvinen
  4. Mandy B. Belfort
  5. Christina D. W. Pace
  6. Kimberly A. Lackey
  7. Alexandra C. Gogel
  8. Phuong Nguyen-Contant
  9. Preshetha Kanagaiah
  10. Theresa Fitzgerald
  11. Rita Ferri
  12. Bridget Young
  13. Casey Rosen-Carole
  14. Nichole Diaz
  15. Courtney L. Meehan
  16. Beatrice Caffé
  17. Mark Y. Sangster
  18. David Topham
  19. Mark A. McGuire
  20. Antti Seppo
  21. Michelle K. McGuire

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Abstract

Results from prior studies assaying human milk for the presence of SARS-CoV-2, the causative virus of COVID-19, have suggested milk may act as a potential vehicle for mother-to-child transmission. Most previous studies are limited because they followed only a few participants, were cross-sectional, and/or failed to report how milk was collected and/or analyzed.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.16.20196071: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: All participants gave informed consent, and procedures were approved by the Institutional Review Boards at the University of Idaho (20-056, 20-060), the University of Rochester Medical Center (1507), and Brigham and Women’s Hospital (2020P000804).
    IRB: All participants gave informed consent, and procedures were approved by the Institutional Review Boards at the University of Idaho (20-056, 20-060), the University of Rochester Medical Center (1507), and Brigham and Women’s Hospital (2020P000804).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableTo be eligible, women needed to be ≥18 years of age, lactating, and have received a positive test result for COVID-19 in the previous 8 days.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    A weight-based concentration method was used to assign antigen-specific antibody titers in test samples.
    antigen-specific
    suggested: None
    Experimental Models: Cell Lines
    SentencesResources
    After incubation, Vero E6/TMPRSS2 cells (kindly provided by Yoshihiro Kawaoka, National Institute of Infectious Diseases,
    Vero E6/TMPRSS2
    suggested: None
    Software and Algorithms
    SentencesResources
    As needed, samples were shipped on dry ice between UI and URMC.
    URMC
    suggested: None

    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:
    We also acknowledge that this study has limitations. For instance, most samples were collected from women after onset of symptoms, limiting generalizability to pre-symptomatic women. Additionally, none of our participants was hospitalized due to COVID-19. As disease severity may be related to viral titer38, it is possible that milk produced by individuals with more severe COVID-19 could contain SARS-CoV-2. The short duration of the follow-up period also does not allow characterization of the durability of the milk IgA and IgG responses. Initial reports on serum IgG response may suggest a relatively short-lived response36,37, and no data exist on the presence of long-lived memory B-cells in context of SARS-CoV-2. Milk IgA, representing a mucosal response, may have its own pattern of durability. In summary, we did not detect SARS-CoV-2 RNA in milk collected from women with mild-to-moderate COVID-19. However, we demonstrated that milk contains anti-SARS-CoV-2 antibodies and that their concentrations are correlated with milk’s ability to effectively neutralize SARS-CoV-2 infectivity. We found evidence of SARS-CoV-2 on the breasts of several women, but it is unclear whether this RNA reflects viable virus. Taken together with the well-documented benefits of breastfeeding to maternal and infant health, our data support recommendations to encourage breastfeeding in women with mild-to-moderate COVID-19 illness.

    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

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  2. Version published to 10.1128/mbio.03192-20
  3. Version published to 10.1101/2020.09.16.20196071v1 on medRxiv