Airway antibodies emerge according to COVID-19 severity and wane rapidly but reappear after SARS-CoV-2 vaccination

• DOI: 10.1172/jci.insight.151463
• Publication Date: 2021-10-19T16:31:25Z
• Authors: Alberto Cagigi; Meng Yu; Björn Österberg; Julia Svensson; Sara Falck-Jones; Sindhu Vangeti; Eric Åhlberg; Lida Azizmohammadi; Anna Warnqvist; Ryan Falck-Jones; Pia C. Gubisch; Mert Ödemis; Farangies Ghafoor; Mona Eisele; Klara Lenart; Max Bell; Niclas Johansson; Jan Albert; Jörgen Sälde; Deleah D. Pettie; Michael P. Murphy; Lauren Carter; Neil P. King; Sebastian Ols; Johan Normark; Clas Ahlm; Mattias N. Forsell; Anna Färnert; Karin Loré; Anna Smed-Sörensen
• Keywords: Adult; Male; 0301 basic medicine; Infectious Medicine; COVID-19 Vaccines; Immunology; Immunization, Secondary; Infektionsmedicin; Antibodies, Viral; 03 medical and health sciences; Humans; Longitudinal Studies; Lung; Aged; 0303 health sciences; SARS-CoV-2; R; Immunology in the medical area; COVID-19; Middle Aged; Antibodies, Neutralizing; Immunity, Humoral; Immunoglobulin A; 3. Good health; Immunologi inom det medicinska området; Immunoglobulin G; Medicine; Female; Research Article; Follow-Up Studies

AbstractUnderstanding the presence and durability of antibodies against SARS-CoV-2 in the airways is required to provide insights on the ability of individuals to neutralize the virus locally and prevent viral spread. Here, we longitudinally assessed both systemic and airway immune responses upon SARS-CoV-2 infection in a clinically well-characterized cohort of 147 infected individuals representing the full spectrum of COVID-19 severity; from asymptomatic infection to fatal disease. In addition, we evaluated how SARS-CoV-2 vaccination influenced the antibody responses in a subset of these individuals during convalescence as compared to naïve individuals. Not only systemic but also airway antibody responses correlated with the degree of COVID-19 disease severity. However, while systemic IgG levels were durable for up to 8 months, airway IgG and IgA had declined significantly within 3 months. After vaccination, there was an increase in both systemic and airway antibodies, in particular IgG, often exceeding the levels found during acute disease. In contrast, naïve individuals showed low airway antibodies after vaccination. In the former COVID-19 patients, airway antibody levels were significantly elevated after the boost vaccination, highlighting the importance of prime and boost vaccination also for previously infected individuals to obtain optimal mucosal protection.