Abstract
BackgroundRecent studies indicate that, in addition to antibody production, lymphocyte responses to SARS-CoV-2 may play an important role in protective immunity to COVID-19 and a percentage of the general population may exhibit lymphocyte memory due to unknown/asymptomatic exposure to SARS-CoV-2 or cross-reactivity to other more common coronaviruses pre-vaccination. Total joint replacement (TJR) candidates returning to elective surgeries (median age 68 years) may exhibit similar lymphocyte and/or antibody protection to COVID-19 prior to vaccinationMethodsIn this retrospective study, we analyzed antibody titters, lymphocyte memory, and inflammatory biomarkers specific for the Spike and Nucleocapsid proteins of the SARS-CoV-2 virus in a cohort of n=73 returning TJR candidates (knees and/or hips) pre-operatively.ResultsPeripheral blood serum of TJR candidate patients exhibited a positivity rate of 18.4% and 4% for IgG antibodies specific for SARS-CoV-2 nucleocapsid and spike proteins, respectively. 13.5% of TJR candidates exhibited positive lymphocyte reactivity (SI > 2) to the SARS-CoV-2 nucleocapsid protein and 38% to the spike protein. SARS-CoV-2 reactive lymphocytes exhibited a higher production of inflammatory biomarkers (i.e., IL-1β, IL-6, TNFα, and IL-1RA) compared to non-reactive lymphocytes.ConclusionsA percentage of TJR candidates returning for elective surgeries exhibit pre-vaccination positive SARS-CoV-2 antibodies and T cell memory responses with associated pro-inflammatory biomarkers. This is an important parameter for understanding immunity, risk profiles, and may aid pre-operative planning.Trial registrationRetrospectively registered.
Highlights
Recent studies indicate that, in addition to antibody production, lymphocyte responses to SARS-CoV2 may play an important role in protective immunity to COVID-19 and a percentage of the general population may exhibit lymphocyte memory due to unknown/asymptomatic exposure to SARS-CoV-2 or cross-reactivity to other more common coronaviruses pre-vaccination
Rate of positive SARS-CoV-2 nucleocapsid and spike protein Immunoglobulin G (IgG) antibodies in Total joint replacement (TJR) candidates To measure the level of serum SARS-CoV-2 nucleocapsid and spike protein antibodies (IgG) in TJR candidates, peripheral blood serum collected pre-operatively was tested via enzyme-linked immunoassay for SARS-CoV-2 nucleocapsid (n=49) and spike protein (n=65) IgG antibodies (Fig. 1)
Eight (15%) of the 52 subjects tested for lymphocyte activation/proliferation to the SARS-CoV-2 nucleocapsid protein showed reactivity with a stimulation index higher than 2-fold (SI > 2) and 44 (85%) did not exhibit any significant lymphocyte proliferation (SI < 2) to this specific protein (Fig. 2A)
Summary
In addition to antibody production, lymphocyte responses to SARS-CoV2 may play an important role in protective immunity to COVID-19 and a percentage of the general population may exhibit lymphocyte memory due to unknown/asymptomatic exposure to SARS-CoV-2 or cross-reactivity to other more common coronaviruses pre-vaccination. Total joint replacement (TJR) candidates returning to elective surgeries (median age 68 years) may exhibit similar lymphocyte and/or antibody protection to COVID-19 prior to vaccination. Given the evidence of possible protective immunity to SARS-CoV-2 in a subset of the general population prior to vaccination, it remains unknown whether a subset of TJR candidates returning for primary or revision surgeries (median age 66 years) would exhibit similar lymphocyte and/or antibody protection to the SARS-CoV-2 virus. In a retrospective cohort of primary and revision TJR candidate patients (n=73), we analyzed specific SARS-CoV-2 nucleocapsid or spike protein lymphocyte activation/proliferation and serum IgG antibody titers specific for SARS-CoV-2 at the time of pre-operative blood work
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