Early Humoral Response Correlates with Disease Severity and Outcomes in COVID-19 Patients

This article has been Reviewed by the following groups

Read the full article See related articles

Abstract

The Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, continues to spread globally with significantly high morbidity and mortality rates. Antigen-specific responses are of unquestionable value for clinical management of COVID-19 patients. Here, we investigated the kinetics of IgM, IgG against the spike (S) and nucleoproteins (N) proteins and their neutralizing capabilities in hospitalized COVID-19 patients with different disease presentations (i.e., mild, moderate or severe), need for intensive care units (ICU) admission or outcomes (i.e., survival vs death). We show that SARS-CoV-2 specific IgG, IgM and neutralizing antibodies (nAbs) were readily detectable in almost all COVID-19 patients with various clinical presentations. Interestingly, significantly higher levels of nAbs as well as anti-S1 and -N IgG and IgM antibodies were found in patients with more severe symptoms, patients requiring admission to ICU or those with fatal outcomes. More importantly, early after symptoms onset, we found that the levels of anti-N antibodies correlated strongly with disease severity. Collectively, these findings provide new insights into the kinetics of antibody responses in COVID-19 patients with different disease severity.

Article activity feed

  1. SciScore for 10.1101/2020.09.21.20198309: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Human subjects: Signed informed consent forms were obtained from all patients as per institutional ethical approvals obtained from the Unit of Biomedical Ethics in King Abdulaziz University Hospital (Reference No 245-20), the Institutional Review Board at the Ministry of Health, Saudi Arabia (IRB Numbers: H-02-K-076-0320-279 and H-02-K-076-0420-285), and the Global Center for Mass Gatherings Medicine, Saudi Arabia (GCMGM) (No. 20/03A).
    IRB: Human subjects: Signed informed consent forms were obtained from all patients as per institutional ethical approvals obtained from the Unit of Biomedical Ethics in King Abdulaziz University Hospital (Reference No 245-20), the Institutional Review Board at the Ministry of Health, Saudi Arabia (IRB Numbers: H-02-K-076-0320-279 and H-02-K-076-0420-285), and the Global Center for Mass Gatherings Medicine, Saudi Arabia (GCMGM) (No. 20/03A).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    After another washing, plates were incubated with HRP□conjugated goat anti□human IgG (H□+□L) or IgM antibodies (Jackson ImmunoResearch, West Grove, PA) for 1 h, washed again, and incubated with TMB (3,3’,5,5’-tetramethylbenzidine) substrate (KPL, Gaithersburg, MD) at room temperature for 30□min.
    anti□human IgG
    suggested: None
    IgM
    suggested: None
    To completely remove any excess amount of the rVSV-ΔG/G*-luciferase, 15 ml of DMEM containing rabbit polyclonal anti VSV-G antibody were added to the cells monolayer and incubated for 24 h at 37°C in 5% CO2 humidified incubator.
    anti VSV-G
    suggested: None
    Experimental Models: Cell Lines
    SentencesResources
    Cells: Baby Hamster kidney BHK-21/WI-2 cell line (Kerafast, EH1011) and African Green monkey kidney-derived Vero E6 cell line (ATCC, 1586) were cultured in Dulbecco’s modified essential medium (DMEM) contained 100 U/ml of penicillin, and 100 μg/ml of streptomycin and supplemented with 5 and 10% fetal bovine serum (FBS) in a 5% CO2 environment at 37°C.
    BHK-21/WI-2
    suggested: RRID:CVCL_HB78)
    Briefly, a T-175 tissue culture flask of BHK21/WI-2 cells were transfected with 46 μg of pcDNA expressing codon-optimized full-length SARS-CoV-2 S protein (GenBank accession number: MN908947) using Lipofectamine ™ 2000 transfection reagent (Invitrogen).
    BHK21/WI-2
    suggested: RRID:CVCL_HB78)
    Then, a 100 μl of the pseudovirus–serum mixtures were transferred onto Vero E6 cell monolayers and incubated at 37°C in a 5% CO2 humidified incubator for 24 h.
    Vero E6
    suggested: None
    Software and Algorithms
    SentencesResources
    Median Inhibitory Concentration (IC50) neutralization titers were determined using four-parameter logistic (4PL) curve in GraphPad Prism V8 software (GraphPad Co.).
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)
    Statistical analysis: Statistical analyses and graphical presentations were conducted with GraphPad Prism version 8.0 software (
    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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    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.