Dynamic changes in anti-SARS-CoV-2 antibodies during SARS-CoV-2 infection and recovery from COVID-19

Kening Li ,Jian Wu ,Wanlin Li ,Aihua Zhong ,Ziyu Wang ,Li Lü ,Yun Cai ,Zhihua Wang ,Min Wu ,Wei Wu ,Gan Zhen-Hua ,Bin Huang ,Jie Li ,Mengyan Zhu ,Qianghu Wang ,Shukui Wang ,Bakwatanisa Bosco ,Lingxiang Wu ,Qinghua Qiao ,Xinyi Xia

doi:10.1038/s41467-020-19943-y

Abstract

Deciphering the dynamic changes in antibodies against SARS-CoV-2 is essential for understanding the immune response in COVID-19 patients. Here we analyze the laboratory findings of 1,850 patients to describe the dynamic changes of the total antibody, spike protein (S)-, receptor-binding domain (RBD)-, and nucleoprotein (N)-specific immunoglobulin M (IgM) and G (IgG) levels during SARS-CoV-2 infection and recovery. The generation of S-, RBD-, and N-specific IgG occurs one week later in patients with severe/critical COVID-19 compared to patients with mild/moderate disease, while S- and RBD-specific IgG levels are 1.5-fold higher in severe/critical patients during hospitalization. The RBD-specific IgG levels are 4-fold higher in older patients than in younger patients during hospitalization. In addition, the S- and RBD-specific IgG levels are 2-fold higher in the recovered patients who are SARS-CoV-2 RNA negative than those who are RNA positive. Lower S-, RBD-, and N-specific IgG levels are associated with a lower lymphocyte percentage, higher neutrophil percentage, and a longer duration of viral shedding. Patients with low antibody levels on discharge might thereby have a high chance of being tested positive for SARS-CoV-2 RNA after recovery. Our study provides important information for COVID-19 diagnosis, treatment, and vaccine development.

Highlights

Deciphering the dynamic changes in antibodies against SARS-CoV-2 is essential for understanding the immune response in COVID-19 patients
We found that compared with patients with mild/moderate disease, those with severe/critical disease experienced a delay in S, receptor-binding domain (RBD), and N-specific IgG development of ~1 week
We found that the S- and RBD-specific IgG level was much higher in recovered COVID-19 patients who were SARSCoV-2 negative, indicating that antibodies play an important role in viral clearance

Summary

Introduction

Deciphering the dynamic changes in antibodies against SARS-CoV-2 is essential for understanding the immune response in COVID-19 patients. We analyze the laboratory findings of 1,850 patients to describe the dynamic changes of the total antibody, spike protein (S)-, receptor-binding domain (RBD)-, and nucleoprotein (N)-specific immunoglobulin M (IgM) and G (IgG) levels during SARS-CoV-2 infection and recovery. In consideration of the high false-negative rate of viral RNA detection, on March 3, 2020, SARS-CoV-2-specific IgM and IgG antibody levels were added to the “Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia of China” as alternative methods to diagnose the suspected cases. We describe the dynamic changes of the SARS-CoV-2-specific antibody levels, including the total, S-, RBD-, and N-specific IgM and IgG levels on admission, during hospitalization, and on discharge, and the relationship between viral shedding and the antibody response

Methods

Results

Conclusion