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Abstract
ABO blood groups appear to be associated with the risk of SARS-CoV-2 infection, but the underlying mechanisms and their real importance remain unclear. Two hypotheses have been proposed: ABO compatibility-dependence (neutralization by anti-ABO antibodies) and ABO-dependent intrinsic susceptibility (spike protein attachment to histo-blood group glycans). We tested the first hypothesis through an anonymous questionnaire addressed to hospital staff members. We estimated symptomatic secondary attack rates (SAR) for 333 index cases according to spouse ABO blood group compatibility. Incompatibility was associated with a lower SAR (28% vs. 47%; OR 0.43, 95% CI 0.27–0.69), but no ABO dependence was detected in compatible situations. For the second hypothesis, we detected no binding of recombinant SARS-CoV-2 RBD to blood group-containing glycans. Thus, although no intrinsic differences in susceptibility according to ABO blood type were detected, ABO incompatibility strongly decreased the risk of COVID-19 transmission, suggesting that anti-ABO antibodies contribute to virus neutralization.
Highlights
Following an initial study in Wuhan and Shenzhen in China, early in the coronavirus disease 2019 (COVID-19) pandemic (Zhao et al, 2020), a large number of studies reported associations between ABO blood group and COVID-19
As PCR-confirmed COVID-19 for primary and secondary cases was the only inclusion criterion met, these couples were excluded from the study
We found that the risk of COVID-19 transmission to blood group A individuals was no higher than that to members of other blood groups in situations of ABO compatibility, calling into question the ability of the SARS-CoV-2 receptor-binding domain (RBD) to attach to a blood group A structure
Summary
Following an initial study in Wuhan and Shenzhen in China, early in the coronavirus disease 2019 (COVID-19) pandemic (Zhao et al, 2020), a large number of studies reported associations between ABO blood group and COVID-19. The receptor-binding domain (RBD) of the viral spike protein may act as a lectin, facilitating attachment to a blood group A epitope present on the respiratory and digestive epithelial cells of blood group A individuals, favoring infection and accounting for the higher susceptibility of blood group A individuals than of individuals of the other ABO types (Wu et al, 2021). Such a mechanism has already been reported for some strains of noroviruses and rotaviruses (Le Pendu and Ruvöen-Clouet, 2019), contributing to so-called “ABO-dependent intrinsic susceptibility” (Figure 1). We reassessed SARS-CoV-2 RBD binding to blood group A epitopes
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