Coronavirus vaccines are believed to be the only effective means to contain the pandemic rapidly. Scientists have worked at an unprecedented speed to develop vaccines and therapeutics to reduce the mortality rate due to COVID-19 infection. Several vaccines have received emergency use authorization (EUA) and are being used to vaccinate millions of people worldwide. However, vaccinating the world’s population is a time-consuming task. The emergence of SARS-CoV2 variants in the time between vaccine development and approval has threatened the efficacy of the available vaccines. The currently available vaccines are based on the spike protein of the original SARS-CoV2 strain. Neutralizing antibodies (nAbs) are produced after natural COVID-19 infection or post-vaccination. Understanding how long these antibodies will protect individuals from SARS-CoV2 infection and its newly emerged variants is extremely important. Although several studies have estimated the persistence of post-infection nAb titers, very few performed long-term follow-up studies (one year after infection), especially against the variants.
A new study reported the persistence of immune responses over twelve months after natural infection. In this study, researchers collected blood samples from 358 confirmed SARS-CoV2 positive patients in Japan at the 6th and 12th months after the onset of the disease. These samples were analyzed for comprehensive humoral immunity using the CLEIA method. Scientists investigated the levels of immunoreactive antibodies targeting the receptor-binding domain (RBD) of the spike protein (SP), nucleocapsid protein (NP), and nAbs against multiple VOCs and VOIs. The authors of this study also aimed to determine the host factors that contribute to the persistence of antibody response. In the current study, researchers observed that 61% of individuals who participated showed persistence of nAbs at functionally effective titers for one year despite a decreasing tendency of nAbs over time. This result is in line with another recent study that reported immunity induced after natural COVID-19 infection was maintained for at least a year.
Contrary to these reports, an earlier study comprising 164 patients reported that over 65% of the participants showed no antibodies or rapid decline in the levels of nAbs after six months. Many studies indicated that the amount of antibodies produced, including the nAb titer, is linked with the severity of infection. These studies also suggested that individuals who experienced severe COVID-19 disease with a high viral load may induce robust humoral immune response compared to individuals who experienced mild or asymptomatic infection. Similar to these reports, the current study also observed individuals who recovered from severe infection possessed higher levels of all types of antibodies analyzed in this study. Most importantly, these patients showed higher neutralizing capacity against VOCs, including the Beta and Delta strain of SARS-CoV2. This is an interesting finding as several studies have indicated that the Delta strain can escape immune responses induced after natural infection or vaccine-induced immunity.
However, unlike patients who recovered from severe infection, those that experienced mild or asymptomatic illness showed reduced protection against VOCs and decreased levels of nAbs. Previous studies indicated that certain host factors, such as obesity, sex, and smoking, may influence disease severity. However, these studies did not indicate the role of these host factors on the persistence of nAbs at 12 months post-infection. The present study addressed the gap in research and reported that severe COVID-19 infection and age of the patients significantly correlated with the extent of neutralization activity after 12 months. Interestingly, this study also revealed that older adults who suffered from severe COVID-19 infections possessed more nAbs than vaccinated older age groups. The authors of this study did not observe a robust increase in the neutralizing potency between six and 12 months. This result indicates that B-lymphocyte clones express potent nAbs immediately after the acute phase of the infection.
Overall, the researchers revealed that those recovered from COVID-19 showed robust humoral immunity even at 12 months after infection. However, a decreasing tendency in the level of antibodies was observed. Interestingly, in patients who suffered from severe illness, neutralizing antibodies were found to be effective against SARS-CoV-2 VOCs.
Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
Miyakawa K. et al. medRxiv 2021 Sept 27:21264013.
Lijeskić O et al. Vaccines (Basel) 2021 Sep 17; 9(9):1031.
Gallais F et al. EBioMedicine. 2021 Sep; 71:103561.
Dott. Gianfrancesco Cormaci
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