A compromised specific humoral immune response against the SARS-CoV-2 receptor-binding domain is related to viral persistence and periodic shedding in the gastrointestinal tract
Date
2020Author
Hu, Fengyu
Chen, Fengjuan
Ou, Zhihua
Fan, Qinghong
Tan, Xinghua
Wang, Yaping
Pan, Yuejun
Ke, Bixia
Li, Linghua
Guan, Yujuan
Mo, Xiaoneng
Wang, Jian
Wang, Jinlin
Luo, Chun
Wen, Xueliang
Li, Min
Ren, Peidi
Ke, Changwen
Li, Junhua
Lei, Chunliang
Tang, Xiaoping
Li, Feng
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been redetected after discharge in some coronavirus disease
2019 (COVID-19) patients. The reason for the recurrent positivity of the test and the potential public health concern due to this
occurrence are still unknown. Here, we analyzed the viral data and clinical manifestations of 289 domestic Chinese COVID-19
patients and found that 21 individuals (7.3%) were readmitted for hospitalization after detection of SARS-CoV-2 after discharge.
First, we experimentally confirmed that the virus was involved in the initial infection and was not a secondary infection. In positive
retests, the virus was usually found in anal samples (15 of 21, 71.4%). Through analysis of the intracellular viral subgenomic
messenger RNA (sgmRNA), we verified that positive retest patients had active viral replication in their gastrointestinal tracts (3 of 16
patients, 18.7%) but not in their respiratory tracts. Then, we found that viral persistence was not associated with high viral titers,
delayed viral clearance, old age, or more severe clinical symptoms during the first hospitalization. In contrast, viral rebound was
associated with significantly lower levels of and slower generation of viral receptor-binding domain (RBD)-specific IgA and IgG
antibodies. Our study demonstrated that the positive retest patients failed to create a robust protective humoral immune response,
which might result in SARS-CoV-2 persistence in the gastrointestinal tract and possibly in active viral shedding. Further exploration
of the mechanism underlying the rebound in SARS-CoV-2 in this population will be crucial for preventing virus spread and
developing effective vaccines.
Link to resource
https://doi.org/10.1038/s41423-020-00550-2Collections
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