SARS-CoV-2 Antibody Responses Are Correlated to Disease Severity in COVID-19 Convalescent Individuals

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Abstract

Globally, the COVID-19 pandemic has had extreme consequences for the healthcare system and has led to calls for diagnostic tools to monitor and understand the transmission, pathogenesis, and epidemiology, as well as to evaluate future vaccination strategies. In this study, we have developed novel, to our knowledge, flexible ELISA-based assays for specific detection of human SARS-CoV-2 Abs against the receptor-binding domain, including an Ag sandwich ELISA relevant for large population screening and three isotype-specific assays for in-depth diagnostics. Their performance was evaluated in a cohort of 350 convalescent participants with previous COVID-19 infection, ranging from asymptomatic to critical cases. We mapped the Ab responses to different areas on protein N and S and showed that the IgM, A, and G Ab responses against receptor-binding domain are significantly correlated to the disease severity. These assays and the data generated from them are highly relevant for diagnostics and prognostics and contribute to the understanding of long-term COVID-19 immunity.

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  1. SciScore for 10.1101/2020.07.27.20162321: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Study approval: All procedures involving the handling of human samples are in accordance with the principles described in the Declaration of Helsinki and ethically approved by the Regional Ethical Committee of the Capital Region of Denmark (H-20028627).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableThe RT-PCR positive participants are comprised of males and females aged from 18–86 and course of disease ranged from asymptomatic to critically ill.

    Table 2: Resources

    Antibodies
    SentencesResources
    The calibrator was prepared by spiking 100 µg/ml of recombinant human monoclonal IgG antibody against SARS-CoV-2 Spike1 (A02038, GenScript, Piscataway, NJ, USA) into normal human serum and diluting in serum into a 2-fold dilution.
    SARS-CoV-2
    suggested: None
    Spike1
    suggested: None
    A02038
    suggested: None
    Software and Algorithms
    SentencesResources
    Detection and development procedures were followed, as described in subsection 4.2. 7. Statistics: Statistical analyses were performed using GraphPad Prism version 8.0 (GraphPad Software, La Jolla, CA, USA) and Statistical Package for the Social Sciences 25.0 software (SPSS Inc., Chicago, IL, USA).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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.

  2. SciScore for 10.1101/2020.07.27.20162321: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementStudy approval All procedures involving the handling of human samples are in accordance with the principles described in the Declaration of Helsinki and ethically approved by the Regional Ethical Committee of the Capital Region of Denmark (H-20028627).Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Detection of IgM, IgA and IgG antibodies against SARS-CoV-2 protein N was evaluated by analyzing 136 positive samples and 174 negative controls and ROC curve analyses were assessed to estimate the assay performance (Supplementary Figure 2A–C).
    IgM, IgA
    suggested: None
    IgG antibodies against SARS-CoV-2 protein N was evaluated by analyzing 136 positive samples and 174 negative controls and ROC curve analyses
    suggested: None
    Antibodies anti-SARS-CoV-2 were detected using PierceTM HRP-conjugated streptavidin (21130, Thermo Fisher Scientific) diluted 1:16000 in PBS-T was mixed with 0.5 µg/ml biotin-labelled RBD and incubated for 2 h RT.
    anti-SARS-CoV-2
    suggested: (Abcam Cat# ab272854, RRID:AB_2847844)
    All 384well plates were handled by the Tecan Fluent automated workstation. 4.2. Direct ELISA: In-house produced assay measuring SARS-CoV-2 IgM, IgA and IgG antibody levels Nunc™ MaxiSorp Flat-Bottom 96-Well plates or Nunc™ MaxiSorp Flat-Bottom plates nonsterile 384-well plates were coated with 1 µg/ml RBD or protein N in PBS ON at 4°C.
    SARS-CoV-2 IgM
    suggested: None
    IgA
    suggested: None
    IgG antibody levels Nunc™ MaxiSorp Flat-Bottom 96-Well plates or Nunc™ MaxiSorp Flat-Bottom
    suggested: None
    Antibodies bound to SARS-CoV-2 antigens were detected using 0.5 µg/ml HRP-conjugated polyclonal rabbit antibodies against human, human IgM (P0215), human IgA (P0216) or IgG (P0214) (all from Agilent Technologies, Santa Clara, CA, USA) diluted in PBS-T and incubated for 1 h shaking at RT.
    P0215
    suggested: None
    human IgA
    suggested: None
    P0214
    suggested: None
    The calibrator was prepared by spiking 100 µg/ml of recombinant human monoclonal IgG antibody against SARS-CoV-2 Spike1 (A02038, GenScript, Piscataway, NJ, USA) into normal human serum and diluting in serum into a 2-fold dilution.
    Spike1
    suggested: None
    A02038
    suggested: None
    Software and Algorithms
    SentencesResources
    Statistics Statistical analyses were performed using GraphPad Prism version 8.0 (GraphPad Software, La Jolla, CA, USA) and Statistical Package for the Social Sciences 25.0 software (SPSS Inc., Chicago, IL, USA).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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 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.


    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 is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  3. SciScore for 10.1101/2020.07.27.20162321: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementStudy approval All procedures involving the handling of human samples are in accordance with the principles described in the Declaration of Helsinki and ethically approved by the Regional Ethical Committee of the Capital Region of Denmark (H-20028627).Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Detection of IgM, IgA and IgG antibodies against SARS-CoV-2 protein N was evaluated by analyzing 136 positive samples and 174 negative controls and ROC curve analyses were assessed to estimate the assay performance (Supplementary Figure 2A–C).
    IgM, IgA
    suggested: None
    IgG antibodies against SARS-CoV-2 protein N was evaluated by analyzing 136 positive samples and 174 negative controls and ROC curve analyses
    suggested: None
    Antibodies anti-SARS-CoV-2 were detected using PierceTM HRP-conjugated streptavidin (21130, Thermo Fisher Scientific) diluted 1:16000 in PBS-T was mixed with 0.5 µg/ml biotin-labelled RBD and incubated for 2 h RT.
    anti-SARS-CoV-2
    suggested: (Abcam Cat# ab272854, RRID:AB_2847844)
    All 384well plates were handled by the Tecan Fluent automated workstation. 4.2. Direct ELISA: In-house produced assay measuring SARS-CoV-2 IgM, IgA and IgG antibody levels Nunc™ MaxiSorp Flat-Bottom 96-Well plates or Nunc™ MaxiSorp Flat-Bottom plates nonsterile 384-well plates were coated with 1 µg/ml RBD or protein N in PBS ON at 4°C.
    SARS-CoV-2 IgM
    suggested: None
    IgA
    suggested: None
    IgG antibody levels Nunc™ MaxiSorp Flat-Bottom 96-Well plates or Nunc™ MaxiSorp Flat-Bottom
    suggested: None
    Antibodies bound to SARS-CoV-2 antigens were detected using 0.5 µg/ml HRP-conjugated polyclonal rabbit antibodies against human, human IgM (P0215), human IgA (P0216) or IgG (P0214) (all from Agilent Technologies, Santa Clara, CA, USA) diluted in PBS-T and incubated for 1 h shaking at RT.
    P0215
    suggested: None
    human IgA
    suggested: None
    P0214
    suggested: None
    The calibrator was prepared by spiking 100 µg/ml of recombinant human monoclonal IgG antibody against SARS-CoV-2 Spike1 (A02038, GenScript, Piscataway, NJ, USA) into normal human serum and diluting in serum into a 2-fold dilution.
    Spike1
    suggested: None
    A02038
    suggested: None
    Software and Algorithms
    SentencesResources
    Statistics Statistical analyses were performed using GraphPad Prism version 8.0 (GraphPad Software, La Jolla, CA, USA) and Statistical Package for the Social Sciences 25.0 software (SPSS Inc., Chicago, IL, USA).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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 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.


    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 is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  4. SciScore for 10.1101/2020.07.27.20162321: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementStudy approval All procedures involving the handling of human samples are in accordance with the principles described in the Declaration of Helsinki and ethically approved by the Regional Ethical Committee of the Capital Region of Denmark (H-20028627).Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Detection of IgM, IgA and IgG antibodies against SARS-CoV-2 protein N was evaluated by analyzing 136 positive samples and 174 negative controls and ROC curve analyses were assessed to estimate the assay performance (Supplementary Figure 2A–C).
    IgM, IgA
    suggested: None
    IgG antibodies against SARS-CoV-2 protein N was evaluated by analyzing 136 positive samples and 174 negative controls and ROC curve analyses
    suggested: None
    All 384well plates were handled by the Tecan Fluent automated workstation. 4.2. Direct ELISA: In-house produced assay measuring SARS-CoV-2 IgM, IgA and IgG antibody levels Nunc™ MaxiSorp Flat-Bottom 96-Well plates or Nunc™ MaxiSorp Flat-Bottom plates nonsterile 384-well plates were coated with 1 µg/ml RBD or protein N in PBS ON at 4°C.
    SARS-CoV-2 IgM
    suggested: None
    IgA
    suggested: None
    IgG antibody levels Nunc™ MaxiSorp Flat-Bottom 96-Well plates or Nunc™ MaxiSorp Flat-Bottom
    suggested: None
    Antibodies bound to SARS-CoV-2 antigens were detected using 0.5 µg/ml HRP-conjugated polyclonal rabbit antibodies against human, human IgM (P0215), human IgA (P0216) or IgG (P0214) (all from Agilent Technologies, Santa Clara, CA, USA) diluted in PBS-T and incubated for 1 h shaking at RT.
    P0215
    suggested: None
    human IgA
    suggested: None
    P0214
    suggested: None
    The calibrator was prepared by spiking 100 µg/ml of recombinant human monoclonal IgG antibody against SARS-CoV-2 Spike1 (A02038, GenScript, Piscataway, NJ, USA) into normal human serum and diluting in serum into a 2-fold dilution.
    SARS-CoV-2
    suggested: None
    Spike1
    suggested: None
    A02038
    suggested: None
    Software and Algorithms
    SentencesResources
    Statistics Statistical analyses were performed using GraphPad Prism version 8.0 (GraphPad Software, La Jolla, CA, USA) and Statistical Package for the Social Sciences 25.0 software (SPSS Inc., Chicago, IL, USA).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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 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.


    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 is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  5. SciScore for 10.1101/2020.07.27.20162321: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementStudy approval All procedures involving the handling of human samples are in accordance with the principles described in the Declaration of Helsinki and ethically approved by the Regional Ethical Committee of the Capital Region of Denmark (H-20028627).Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variableBoth age, sex (male) and disease severity were significantly positively correlated to the level of all three antibody isotypes.

    Table 2: Resources

    Antibodies
    SentencesResources
    Detection of IgM, IgA and IgG antibodies against SARS-CoV-2 protein N was evaluated by analyzing 136 positive samples and 174 negative controls and ROC curve analyses were assessed to estimate the assay performance (Supplementary Figure 2A–C).
    IgM, IgA
    suggested: None
          <div style="margin-bottom:8px">
            <div><b>IgG antibodies against SARS-CoV-2 protein N was evaluated by analyzing 136 positive samples and 174 negative controls and ROC curve analyses</b></div>
            <div>suggested: None</div>
          </div>
        </td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">Discussion We have developed an ELISA-based platform for detection SARS-CoV-2 antibodies comprising an indirect RBD S- ELISA for pan Ig detection and direct ELISAs for in-depth analyses of the IgM, IgA and IgG isotype responses towards RBD and protein N.</td><td style="min-width:100px;border-bottom:1px solid lightgray">
          <div style="margin-bottom:8px">
            <div><b>IgM , IgA and IgG</b></div>
            <div>suggested: None</div>
          </div>
        </td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">In a recent phase 1 trial, antibody responses against a vaccine candidate (S-2P antigen) and the RBD were assessed, finding similar Ig responses in pattern and magnitude between both antigens (17).</td><td style="min-width:100px;border-bottom:1px solid lightgray">
          <div style="margin-bottom:8px">
            <div><b>S-2P antigen </b></div>
            <div>suggested: None</div>
          </div>
        
          <div style="margin-bottom:8px">
            <div><b>antigens ( 17</b></div>
            <div>suggested: None</div>
          </div>
        </td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">They allow quantification of IgM, IgA and IgG antibody levels, rendering more detailed information about the immunological response to the viral infection.</td><td style="min-width:100px;border-bottom:1px solid lightgray">
          <div style="margin-bottom:8px">
            <div><b>IgG</b></div>
            <div>suggested: None</div>
          </div>
        </td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">All 384well plates were handled by the Tecan Fluent automated workstation. 4.2. Direct ELISA: In-house produced assay measuring SARS-CoV-2 IgM, IgA and IgG antibody levels Nunc™ MaxiSorp Flat-Bottom 96-Well plates or Nunc™ MaxiSorp Flat-Bottom plates nonsterile 384-well plates were coated with 1 µg/ml RBD or protein N in PBS ON at 4°C.</td><td style="min-width:100px;border-bottom:1px solid lightgray">
          <div style="margin-bottom:8px">
            <div><b>SARS-CoV-2 IgM</b></div>
            <div>suggested: None</div>
          </div>
        
          <div style="margin-bottom:8px">
            <div><b>IgA</b></div>
            <div>suggested: None</div>
          </div>
        
          <div style="margin-bottom:8px">
            <div><b>IgG antibody levels Nunc™ MaxiSorp Flat-Bottom 96-Well plates or Nunc™ MaxiSorp Flat-Bottom</b></div>
            <div>suggested: None</div>
          </div>
        </td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">Antibodies bound to SARS-CoV-2 antigens were detected using 0.5 µg/ml HRP-conjugated polyclonal rabbit antibodies against human, human IgM (P0215), human IgA (P0216) or IgG (P0214) (all from Agilent Technologies, Santa Clara, CA, USA) diluted in PBS-T and incubated for 1 h shaking at RT.</td><td style="min-width:100px;border-bottom:1px solid lightgray">
          <div style="margin-bottom:8px">
            <div><b>P0215</b></div>
            <div>suggested: None</div>
          </div>
        
          <div style="margin-bottom:8px">
            <div><b>human IgA</b></div>
            <div>suggested: None</div>
          </div>
        
          <div style="margin-bottom:8px">
            <div><b>P0214</b></div>
            <div>suggested: None</div>
          </div>
        </td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">The calibrator was prepared by spiking 100 µg/ml of recombinant human monoclonal IgG antibody against SARS-CoV-2 Spike1 (A02038, GenScript, Piscataway, NJ, USA) into normal human serum and diluting in serum into a 2-fold dilution.</td><td style="min-width:100px;border-bottom:1px solid lightgray">
          <div style="margin-bottom:8px">
            <div><b>SARS-CoV-2</b></div>
            <div>suggested: None</div>
          </div>
        
          <div style="margin-bottom:8px">
            <div><b>Spike1</b></div>
            <div>suggested: None</div>
          </div>
        
          <div style="margin-bottom:8px">
            <div><b>A02038</b></div>
            <div>suggested: None</div>
          </div>
        </td></tr><tr><td style="min-width:100px;text-align:center; padding-top:4px;" colspan="2"><b>Software and Algorithms</b></td></tr><tr><td style="min-width:100px;text=align:center"><i>Sentences</i></td><td style="min-width:100px;text-align:center"><i>Resources</i></td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">A total of 335 of the individuals previously infected with SARS-CoV-2 had mounted a detectable antibody response (Figure 3A), IgG being the most abundant isotype (present in the 330 individuals, Figure 3B).</td><td style="min-width:100px;border-bottom:1px solid lightgray">
          <div style="margin-bottom:8px">
            <div><b>SARS-CoV-2</b></div>
            <div>suggested: (Active Motif Cat# 91345, <a href="https://scicrunch.org/resources/Any/search?q=AB_2847847">AB_2847847</a>)</div>
          </div>
        </td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">Statistics Statistical analyses were performed using GraphPad Prism version 8.0 (GraphPad Software, La Jolla, CA, USA) and Statistical Package for the Social Sciences 25.0 software (SPSS Inc., Chicago, IL, USA).</td><td style="min-width:100px;border-bottom:1px solid lightgray">
          <div style="margin-bottom:8px">
            <div><b>GraphPad Prism</b></div>
            <div>suggested: (GraphPad Prism, <a href="https://scicrunch.org/resources/Any/search?q=SCR_002798">SCR_002798</a>)</div>
          </div>
        
          <div style="margin-bottom:8px">
            <div><b>GraphPad</b></div>
            <div>suggested: (GraphPad Prism, <a href="https://scicrunch.org/resources/Any/search?q=SCR_002798">SCR_002798</a>)</div>
          </div>
        
          <div style="margin-bottom:8px">
            <div><b>Statistical Package for the Social Sciences</b></div>
            <div>suggested: (SPSS, <a href="https://scicrunch.org/resources/Any/search?q=SCR_002865">SCR_002865</a>)</div>
          </div>
        
          <div style="margin-bottom:8px">
            <div><b>SPSS</b></div>
            <div>suggested: (SPSS, <a href="https://scicrunch.org/resources/Any/search?q=SCR_002865">SCR_002865</a>)</div>
          </div>
        </td></tr></table>
    

    Data from additional tools added to each annotation on a weekly basis.

    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 is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.