Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA.
Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA 02115, USA.
Sci Transl Med. 2023 Sep 6;15(712):eadf6598. doi: 10.1126/scitranslmed.adf6598.
Beyond the acute illness caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) infection, about one-fifth of infections result in long-term persistence of symptoms despite the apparent clearance of infection. Insights into the mechanisms that underlie postacute sequelae of COVID-19 (PASC) will be critical for the prevention and clinical management of long-term complications of COVID-19. Several hypotheses have been proposed that may account for the development of PASC, including persistence of virus and dysregulation of immune responses. Among the immunological changes noted in PASC, alterations in humoral immunity have been observed in some patient subsets. To begin to determine whether SARS-CoV-2- or other pathogen-specific humoral immune responses evolve uniquely in PASC, we performed comprehensive antibody profiling against SARS-CoV-2, a panel of endemic pathogens, and a panel of routine vaccine antigens using systems serology in two cohorts of patients with preexisting systemic autoimmune rheumatic disease (SARD) who either developed or did not develop PASC. A distinct qualitative shift observed in Fcγ receptor (FcγR) binding was observed in individuals with PASC. Specifically, individuals with PASC harbored weaker FcγR-binding anti-SARS-CoV-2 antibodies and stronger FcγR-binding antibody responses against the endemic coronavirus OC43. Individuals with PASC developed an OC43 S2-specific antibody response with stronger FcγR binding, linked to cross-reactivity across SARS-CoV-2 and common coronaviruses. These findings identify previous coronavirus imprinting as a potential marker for the development of PASC in individuals with SARDs.
除了由严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染引起的急性疾病外,约五分之一的感染尽管感染明显清除,但仍会导致症状长期持续存在。了解导致 COVID-19 后后遗症 (PASC) 的机制对于预防和临床管理 COVID-19 的长期并发症至关重要。已经提出了几种可能导致 PASC 发展的假说,包括病毒持续存在和免疫反应失调。在 PASC 中观察到的免疫变化中,一些患者亚群的体液免疫发生改变。为了开始确定 SARS-CoV-2 或其他病原体特异性体液免疫反应是否在 PASC 中独特进化,我们使用系统血清学在两个队列的预先存在的系统性自身免疫性风湿病 (SARD) 患者中针对 SARS-CoV-2、一组地方性病原体和一组常规疫苗抗原进行了全面的抗体分析,这些患者要么发展为 PASC,要么未发展为 PASC。在 PASC 个体中观察到 Fcγ 受体 (FcγR) 结合的明显定性转变。具体来说,PASC 个体具有较弱的 FcγR 结合抗 SARS-CoV-2 抗体和更强的 FcγR 结合针对地方性冠状病毒 OC43 的抗体反应。PASC 个体产生了具有更强 FcγR 结合的 OC43 S2 特异性抗体反应,与 SARS-CoV-2 和常见冠状病毒之间的交叉反应有关。这些发现确定了先前的冠状病毒印记作为 SARD 个体中 PASC 发展的潜在标志物。