Maternal Antibody Response, Neutralizing Potency, and Placental Antibody Transfer After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection.
Maternal Antibody Response, Neutralizing Potency, and Placental Antibody Transfer After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection.
复制标题
DOI：
10.1097/aog.0000000000004440
复制
发表时间：
2021-08-01
影响因子：
7.2
通讯作者：
Badell ML
中科院分区：
文献类型：
--
作者：
Joseph NT;Dude CM;Verkerke HP;Irby LS;Dunlop AL;Patel RM;Easley KA;Smith AK;Stowell SR;Jamieson DJ;Velu V;Badell ML
探讨妊娠期严重急性呼吸综合征冠状病毒（SARS-CoV-2）感染后母体的免疫反应，并量化经胎盘抗体转移的效率。我们对在怀孕期间任何时候检测出SARS CoV-2阳性的孕妇进行了一项前瞻性队列研究，并在分娩时收集了配对的母亲和脐带血样本。进行ELISA和中和试验以测量母体血浆和脐带血浓度以及针对SARS-CoV-2刺突蛋白的IgG、伊加和IgM抗体的中和效力。使用非参数显著性检验分析了有症状与无症状感染的浓度差异以及从PCR阳性到分娩的时间。分析脐带与母体抗受体结合结构域（抗RBD）IgG滴度的比值，以评估经胎盘转移效率。分析了32个配对样本。在100%（n=32）的母体和91%（n=29）的脐带血样本中检测到可检测的抗RBD IgG。94%（n=30）的母体和25%（n = 8）的脐带血样本中存在功能性中和抗体。与无症状感染相比，有症状感染与中位[IQR]母体抗RBD IgG滴度的显著差异相关（log 3.2 [3.5，2.4] vs. log 2.7 [2.9，1.4]，p = 0.03）。与PCR阳性后14天内分娩的患者相比，分娩> 14天的患者的母体抗RBD IgG滴度中位数并不显著更高（log 3.3 [3.5，2.4] vs log 2.67 [2.8，1.6]，p = 0.05）。脐带与母体抗体比值的中位数[范围]为0.81 [0.67，0.88]。这些结果表明，SARS-CoV-2感染后，母体产生了强有力的中和和抗RBD IgG反应，但经胎盘抗体转移的效率低于预期，母体血液和脐带血之间的中和作用显著降低。母体感染确实赋予新生儿一定程度的抗体保护，但保护的稳健性和持久性需要进一步研究。妊娠期严重急性呼吸综合征冠状病毒（SARS-CoV-2）感染与强大的母体免疫应答和中和效力相关;然而，抗体通过胎盘的转移低于预期。
To characterize maternal immune response after severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection during pregnancy and quantify the efficiency of transplacental antibody transfer. We conducted a prospective cohort study of pregnant patients who tested positive for SARS CoV-2 at any point in pregnancy and collected paired maternal and cord blood samples at the time of delivery. ELISA and neutralization assays were performed to measure maternal plasma and cord blood concentrations and neutralizing potency of IgG, IgA, and IgM antibodies directed against the SARS-CoV-2 spike protein. Differences in concentrations according to symptomatic vs asymptomatic infection and time from positive PCR to delivery were analyzed using nonparametric tests of significance. The ratio of cord to maternal anti-receptor binding domain (anti-RBD) IgG titers was analyzed to assess transplacental transfer efficiency. 32 paired samples were analyzed. Detectable anti-RBD IgG was detected in 100% (n=32) of maternal and 91% (n=29) of cord blood samples. Functional neutralizing antibody was present in 94% (n=30) of the maternal and 25% (n = 8) of cord blood samples. Symptomatic infection was associated with a significant difference in median [IQR] maternal anti-RBD IgG titers compared to asymptomatic infection (log 3.2 [3.5, 2.4] vs. log 2.7 [2.9, 1.4], p = 0.03). Median maternal anti-RBD IgG titers were not significantly higher in patients who delivered > 14 days compared to those who delivered within 14 days from positive PCR (log 3.3 [3.5, 2.4] vs log 2.67 [2.8, 1.6], p = 0.05). Median [range] cord to maternal antibody ratio was 0.81 [0.67, 0.88]. These results demonstrate robust maternal neutralizing and anti-RBD IgG response after SARS-CoV-2 infection, yet a lower-than-expected efficiency of transplacental antibody transfer and a significant reduction in neutralization between maternal blood and cord blood. Maternal infection does confer some degree of neonatal antibody protection, but the robustness and durability of protection require further study. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection in pregnancy is associated with robust maternal immune response and neutralizing potency; however, antibody transfer across the placenta is less than expected.