Emergency response for evaluating SARS-CoV-2 immune status, seroprevalence and convalescent plasma in Argentina

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Abstract

We report the emergency development and application of a robust serologic test to evaluate acute and convalescent antibody responses to SARS-CoV-2 in Argentina. The assays, COVIDAR IgG and IgM, which were produced and provided for free to health authorities, private and public health institutions and nursing homes, use a combination of a trimer stabilized spike protein and the receptor binding domain (RBD) in a single enzyme-linked immunosorbent assay (ELISA) plate. Over half million tests have already been distributed to detect and quantify antibodies for multiple purposes, including assessment of immune responses in hospitalized patients and large seroprevalence studies in neighborhoods, slums and health care workers, which resulted in a powerful tool for asymptomatic detection and policy making in the country. Analysis of antibody levels and longitudinal studies of symptomatic and asymptomatic SARS-CoV-2 infections in over one thousand patient samples provided insightful information about IgM and IgG seroconversion time and kinetics, and IgM waning profiles. At least 35% of patients showed seroconversion within 7 days, and 95% within 45 days of symptoms onset, with simultaneous or close sequential IgM and IgG detection. Longitudinal studies of asymptomatic cases showed a wide range of antibody responses with median levels below those observed in symptomatic patients. Regarding convalescent plasma applications, a protocol was standardized for the assessment of end point IgG antibody titers with COVIDAR with more than 500 plasma donors. The protocol showed a positive correlation with neutralizing antibody titers, and was used for clinical trials and therapies across the country. Using this protocol, about 80% of convalescent donor plasmas were potentially suitable for therapies. Here, we demonstrate the importance of providing a robust and specific serologic assay for generating new information about antibody kinetics in infected individuals and mitigation policies to cope with pandemic needs.

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  1. SciScore for 10.1101/2020.10.21.20216960: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was conducted in accordance with the Declaration of Helsinki, and was reviewed and approved by the Bioethics Committee of Fundación Instituto Leloir (HHS IRB # 00007572) (CBFIL Protocol #35).
    Consent: All participants provided written informed consent prior to the study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Following a washing step with PBS-T, 100 μl of diluted horseradish peroxidase (HRP)-conjugated with goat anti-human IgM (Sigma), or with mouse anti-human IgG antibodies (BD pharmingen), was added to the wells and incubated for 30 min.
    goat anti-human IgM
    suggested: None
    anti-human IgM
    suggested: None
    anti-human IgG
    suggested: None
    Experimental Models: Cell Lines
    SentencesResources
    For protein expression, FreeStyle293-F (293-F) cells or adherent HEK293-T (293-T) cells were maintained at 37°C with 8% CO2 and 5% CO2, respectively. 293-F cells were grown and transfected in Expi293™ expression medium and 293-T cells were grown in D-MEM high glucose supplemented with 10% Fetal Bovine Serum and Penicillin/Streptomycin 1% and transfected in Opti-MEM reduced serum media.
    293-F
    suggested: RRID:CVCL_6642)
    Transfected 293-F suspension cultures were maintained at 32° and transfected 293-T cells were maintained at 37°C.
    293-T
    suggested: None
    ACE2 and TMPRSS2 expressing 293T cells (293T-ACE2+TMPRSS2 clone F8-2), were used for these assays [31].
    293T
    suggested: RRID:CVCL_YZ65)
    Software and Algorithms
    SentencesResources
    Enzyme-linked immunosorbent assays development: The ELISA protocol was adapted from previously established protocols used for Chagas disease by Laboratorio Lemos S.R.L. [42], and for SARS-CoV2 by the Krammer Laboratory [41].
    Krammer Laboratory
    suggested: None
    Absolute inhibitory concentrations (absIC) values were calculated for all patient sera samples by modeling a 4-parameter logistic (4PL) regression with GraphPad Prism 8.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    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:
    In this regard, an important limitation has been to obtain harmonized antibody titers information used in different clinical trials and therapeutic applications. By tittering more than 500 convalescent plasma samples, we showed a diversity of titers, which correlated with donor disease severity (Figure 5A). We provided a standardized protocol, widely distributed and used in Argentina for quantitative IgG measurements. A positive correlation between IgG quantitation, using COVIDAR, with neutralizing activity measured by a pseudotyped virus was shown (Figure 5C). This protocol has been useful to normalize quantifications at hospitals and heath institutions using plasma for compassionate therapies and for different clinical trials [22,23]. Although IgG titers correlated with neutralizing activities, the relevant open question is how they correlate with protection [38,39]. While the pandemic still progresses, scientists, public health workers, and policy makers are being challenged to create new strategies based on evidence and experiences in different parts of the world. A consensus has emerged that serological testing provides an essential tool in the pandemic response, nevertheless, serology testing strategies should be dynamic and adaptable to specific needs and resources available in different regions. Our work provides widely and freely available robust serology reagents, protocols, and data on humoral responses of SARS-CoV-2 infected individuals that hopefully helps findin...

    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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