Department of Woman, Pediatric Infectious Diseases Unit, Child and Adolescent Medicine, Geneva University Hospitals and Geneva University, Geneva, Switzerland.
Division of Laboratory Medicine, Department of Diagnostics and of Medical Specialties, Geneva University Hospitals and Geneva University, Geneva, Switzerland.
Eur J Clin Invest. 2022 Oct;52(10):e13818. doi: 10.1111/eci.13818. Epub 2022 Jun 2.
SARS-CoV-2 infection triggers different auto-antibodies, including anti-apolipoprotein A-1 IgGs (AAA1), which could be of concern as mediators of persistent symptoms. We determined the kinetics of AAA1 response over after COVID-19 and the impact of AAA1 on the inflammatory response and symptoms persistence.
All serologies were assessed at one, three, six and twelve months in 193 hospital employees with COVID-19. ROC curve analyses and logistic regression models (LRM) were used to determine the prognostic accuracy of AAA1 and their association with patient-reported COVID-19 symptoms persistence at 12 months. Interferon (IFN)-α and-γ production by AAA1-stimulated human monocyte-derived macrophages (HMDM) was assessed in vitro.
AAA1 seropositivity was 93% at one month and declined to 15% at 12 months after COVID-19. Persistent symptoms at 12 months were observed in 45.1% of participants, with a predominance of neurological (28.5%), followed by general (15%) and respiratory symptoms (9.3%). Over time, strength of correlations between AAA1 and anti-SARS-COV2 serologies decreased, but remained significant. From the 3 month on, AAA1 levels predicted persistent respiratory symptoms (area under the curves 0.72-0.74; p < 0.001), independently of disease severity, age and gender (adjusted odds ratios 4.81-4.94; p = 0.02), while anti-SARS-CoV-2 serologies did not. AAA1 increased IFN-α production by HMDMs (p = 0.03), without affecting the IFN-γ response.
COVID-19 induces a marked though transient AAA1 response, independently predicting one-year persistence of respiratory symptoms. By increasing IFN-α response, AAA1 may contribute to persistent symptoms. If and how AAA1 levels assessment could be of use for COVID-19 risk stratification remains to be determined.
SARS-CoV-2 感染会引发不同的自身抗体，包括抗载脂蛋白 A-1 IgG（AAA1），其可能作为持续性症状的介质而受到关注。我们确定了 COVID-19 后 AAA1 反应的动力学以及 AAA1 对炎症反应和症状持续性的影响。
对 193 名 COVID-19 住院员工的血清学在一个月、三个月、六个月和十二个月进行评估。使用 ROC 曲线分析和逻辑回归模型（LRM）来确定 AAA1 的预后准确性及其与 12 个月时患者报告的 COVID-19 症状持续性的相关性。通过 AAA1 刺激的人单核细胞衍生的巨噬细胞（HMDM）评估 IFN-α和-γ的产生。
一个月时 AAA1 阳性率为 93%，COVID-19 后 12 个月降至 15%。12 个月时有持续性症状的参与者占 45.1%，以神经症状为主（28.5%），其次是全身症状（15%）和呼吸道症状（9.3%）。随着时间的推移，AAA1 与抗 SARS-COV2 血清学之间的相关性强度降低，但仍然显著。从第三个月开始，AAA1 水平预测持续性呼吸道症状（曲线下面积 0.72-0.74；p<0.001），独立于疾病严重程度、年龄和性别（调整后的优势比 4.81-4.94；p=0.02），而抗 SARS-CoV-2 血清学则不然。AAA1 增加了 HMDM 中 IFN-α的产生（p=0.03），而不影响 IFN-γ反应。
COVID-19 诱导明显但短暂的 AAA1 反应，独立预测一年的呼吸道症状持续存在。通过增加 IFN-α反应，AAA1 可能有助于持续性症状。AAA1 水平评估是否以及如何用于 COVID-19 风险分层仍有待确定。
