AIPMED

ANNALS OF IBADAN POSTGRADUATE MEDICINE

HUMORAL IMMUNITY IN PATIENTS WITH SARS-COV-2 INFECTION: A REVIEW

H.D. Ogundipe

Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria


ABSTRACT

The COVID-19 pandemic caused by SARS-CoV-2 started in China in December, 2019 and has spread across several continents. As at 5th December, 2020, there have been 65,257,767 confirmed cases of COVID-19 worldwide with 1,513,179 deaths (2.31% mortality) Humoral immune responses are highly specific and they provide long-lasting protection against reinfection and the titre of antibodies that persist is directly related to the extent of protection afforded. As research towards generating effective vaccines against SARS-CoV-2 are in advanced stages, there is need for continued robust review of the available data from various studies on the antibody response from natural SARS-COV-2 infection as regards the potential for immunity against re-infection following exposure to the antigens of this virus. Antibodies against RBD of the spike protein of SARS-CoV-2 were detected in majority of patients, appearing within the first week, peaking by 3rd week. IgG antibodies was observed to last beyond 120days and it is predicted seroreversion would happen at about 42.72 months. Antibody response to SARS-CoV-2 correlates with the severity of COVID-19. It was also higher amongst males, hospitalized patients, older people and patients with higher BMI and was lower among smokers, immunosuppressed individuals and patients using anti-inflammatory medications. Persistence of high levels of antiSARS-CoV-2 neutralizing antibodies (IgG) following natural infection is thus likely to be associated with conferment of long term protection against re-infection or attenuate disease severity if reinfection occurs. There is a good potential for development of immunity against SARS-CoV-2 infection in vaccinated individuals.

Keywords: : SARS-CoV-2, Antibody response, AntiSARS-CoV-2 antibody

Correspondence

Dr. H. Ogundipe

Department of Surgery,

University College Hospital,

Ibadan, Oyo State,

Nigeria.

Email: habeebogundipe@gmail.com


INTRODUCTION

The COVID-19 pandemic caused by SARS-CoV-2 started in Hubei province, China in December, 2019 and has spread across all continents except the Antarctica. Globally, as of 5 December 2020, there have been 65,257,767 confirmed cases of COVID19, including 1,513,179 deaths. (2.31 %).1

Adaptive immune response involves T cells, which seek out and destroy cells that have been infected by the invading pathogen (cell mediated immunity) and B cells the produce antibodies targeted against particular disease causing organisms (humoral).

IgM antibodies are produced first and disappear after a few weeks and their presence as such suggest recent infection. IgG antibodies are produced at the same time or 2-3 days later, and titres (levels) usually remain for months or years, their co-existence with IgM antibody suggest recent infection and when they occur alone, it denotes prior infection2 and their persistence suggests development of immunity.3

Humoral immune responses are highly specific and they provide long-lasting protection against reinfection. The quantity of antibodies that persist is directly related to the extent of protection afforded against the virus that induced them.4

Antibodies act by either prevention infection of cells by binding to the virus and preventing its interaction with its receptor (neutralizing antibodies) or by causing destruction of infected cells and virus bound to them and marking them for demolition through cell mediated immune response (binding antibodies)

Neutralizing antibodies play a major role in viral clearance and prevention of re-infection and their continued presence in the apparent absence of the inducing pathogen backed up by memory cells provides a first line of defense against re-infection.3,5 Consequently, they are central to reducing transmission of infection as well as limiting morbidity and mortality from infections. Thus in epidemics and pandemics, like COVID-19, ability to generate adequate and lasting neutralizing antibodies against viral infection is essential for its limiting viral spread.6

Researches towards generating effective vaccines that protect against SARS-CoV-2 infection are in advanced stages, however, there is limited understanding of the antibody response from natural SARS-COV-2 infection. There are concerns that SARS-CoV-2 infection may induce transient antibody response4 raising apprehension about risk of re-infection and the uncertainty about the duration of vaccine protection.7 A proper understanding of antibody response to SARS-CoV-2 will help guide development of modalities and strategies for vaccination.7,8