A bead-based multiplex assay covering all coronaviruses pathogenic for humans for sensitive and specific surveillance of SARS-CoV-2 humoral immunity

Serological assays measuring antibodies against SARS-CoV-2 are key to describe the epidemiology, pathobiology or induction of immunity after infection or vaccination. Of those, multiplex assays targeting multiple antigens are especially helpful as closely related coronaviruses or other antigens can be analysed simultaneously from small sample volumes, hereby shedding light on patterns in the immune response that would otherwise remain undetected. We established a bead-based 17-plex assay detecting antibodies targeting antigens from all coronaviruses pathogenic for humans: SARS-CoV-2, SARS-CoV, MERS-CoV, HCoV strains 229E, OC43, HKU1, and NL63. The assay was validated against five commercial serological immunoassays, a commercial surrogate virus neutralisation test, and a virus neutralisation assay, all targeting SARS-CoV-2. It was found to be highly versatile as shown by antibody detection from both serum and dried blot spots and as shown in three case studies. First, we followed seroconversion for all four endemic HCoV strains and SARS-CoV-2 in an outbreak study in day-care centres for children. Second, we were able to link a more severe clinical course to a stronger IgG response with this 17-plex-assay, which was IgG1 and IgG3 dominated. Finally, our assay was able to discriminate recent from previous SARS-CoV-2 infections by calculating the IgG/IgM ratio on the N antigen targeting antibodies. In conclusion, due to the comprehensive method comparison, thorough validation, and the proven versatility, our multiplex assay is a valuable tool for studies on coronavirus serology.

Direct comparison of clinical diagnostic sensitivity of saliva from buccal swabs versus combined oro-/nasopharyngeal swabs in the detection of SARS-CoV-2 B.1.1.529 Omicron

BACKGROUND/PURPOSE

While current guidelines recommend the use of respiratory tract specimens for the direct detection of SARS-CoV-2 infection, saliva has recently been suggested as preferred sample type for the sensitive detection of SARS-CoV-2 B.1.1.529 (Omicron). By comparing saliva collected using buccal swabs and oro-/nasopharyngeal swabs from patients hospitalized due to COVID-19, we aimed at identifying potential differences in virus detection sensitivity between these sample types.

METHODS

We compare the clinical diagnostic sensitivity of paired buccal swabs and combined oro-/nasopharyngeal swabs from hospitalized, symptomatic COVID-19 patients collected at median six days after symptom onset by real-time polymerase chain reaction (PCR) and antigen test.

RESULTS

Of the tested SARS-CoV-2 positive sample pairs, 55.8% were identified as SARS-CoV-2 Omicron BA.1 and 44.2% as Omicron BA.2. Real-time PCR from buccal swabs generated significantly higher quantification cycle (Cq) values compared to those from matched combined oro-/nasopharyngeal swabs and resulted in an increased number of false-negative PCR results. Reduced diagnostic sensitivity of buccal swabs by real-time PCR was observed already at day one after symptom onset. Similarly, antigen test detection rates were reduced in buccal swabs compared to combined oro-/nasopharyngeal swabs.

CONCLUSION

Our results suggest reduced clinical diagnostic sensitivity of saliva collected using buccal swabs when compared to combined oro-/nasopharyngeal swabs in the detection of SARS-CoV-2 Omicron in symptomatic individuals.

Effectiveness of vaccines in preventing hospitalization due to COVID-19: A multicenter hospital-based case-control study, Germany, June 2021 to January 2022

We included 852 patients in a prospectively recruiting multicenter matched case-control study in Germany to assess vaccine effectiveness (VE) in preventing COVID-19-associated hospitalization during the Delta-variant dominance. The two-dose VE was 89 % (95 % CI 84-93 %) overall, 79 % in patients with more than two comorbidities and 77 % in adults aged 60-75 years. A third dose increased the VE to more than 93 % in all patient-subgroups.

Dissecting the dynamic transcriptional landscape of early T helper cell differentiation into Th1, Th2, and Th1/2 hybrid cells

Selective differentiation of CD4+ T helper (Th) cells into specialized subsets such as Th1 and Th2 cells is a key element of the adaptive immune system driving appropriate immune responses. Besides those canonical Th-cell lineages, hybrid phenotypes such as Th1/2 cells arise in vivo, and their generation could be reproduced in vitro. While master-regulator transcription factors like T-bet for Th1 and GATA-3 for Th2 cells drive and maintain differentiation into the canonical lineages, the transcriptional architecture of hybrid phenotypes is less well understood. In particular, it has remained unclear whether a hybrid phenotype implies a mixture of the effects of several canonical lineages for each gene, or rather a bimodal behavior across genes. Th-cell differentiation is a dynamic process in which the regulatory factors are modulated over time, but longitudinal studies of Th-cell differentiation are sparse. Here, we present a dynamic transcriptome analysis following Th-cell differentiation into Th1, Th2, and Th1/2 hybrid cells at 3-h time intervals in the first hours after stimulation. We identified an early bifurcation point in gene expression programs, and we found that only a minority of ~20% of Th cell-specific genes showed mixed effects from both Th1 and Th2 cells on Th1/2 hybrid cells. While most genes followed either Th1- or Th2-cell gene expression, another fraction of ~20% of genes followed a Th1 and Th2 cell-independent transcriptional program associated with the transcription factors STAT1 and STAT4. Overall, our results emphasize the key role of high-resolution longitudinal data for the characterization of cellular phenotypes.

AB1390 COMPLEMENTARY DIGITAL THERAPY SAFELY IMPROVES QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY ARTHRITIS

Background

Self-management strategies play a central role in improving clinical outcomes in patients with inflammatory arthritis. EULAR recently highlighted the essential role of digital health to increase the self-management of patients. Evidence regarding these supporting digital tools, including mobile apps, is currently however very limited [1].

Objectives

To evaluate the efficacy and safety of a mobile app (Mida Rheuma App) in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA, including psoriatic arthritis [PsA]) in a prospective study.

Methods

Patients with RA, SpA/ PsA, stable on their antirheumatic therapy for ≥4 weeks, were eligible to use the Mida Rheuma App in addition to standard care treatment. The usage of the app targeted the optimization of non-medical treatment in a 4-step process: (1) collection of the information (HRQoL, disease activity, physical impairment, diet, mental health, physical activity, etc.) using standardized questionnaires via the conversational health coach Mida; (2) development of a patient profile that focuses on the patient’s disease, well-being, and behavior; (3) creation of a personalized, evidence-based disease management program based on recommendations from medical guidelines, medical standards, and state-of-the-art clinical research; (4) implementation of personalized recommendations into the patient’s daily life by providing short daily tasks that accelerate positive behavior change. Additionally, the health coach Mida supports the patient in coping with stress, sadness, depression, fatigue, and further disease-related symptoms. This is achieved by various cognitive behavioral techniques, meditation and relaxation methods.

Additionally, we assessed demographic parameters, treatment regimen, disease activity (e.g., SDAI, ASDAS), and other patient-reported outcomes (e.g., SF-36) at baseline and after 4 weeks. The study was approved by the Ethics Committee of the Medical Faculty of Mannheim, Heidelberg University.

Results

Of 20 patients screened after obtaining informed consent, 19 were enrolled in the study, and 17 patients (12 RA, SpA: 1 axSpA, 4 PsA) completed the study (2 drop-outs due to unwillingness to finish the study). 7 (41.2%) patients were male, and ages ranged from 19 to 63 (40.5±12.2) years). Patients were treated as follows: 7 NSAIDs (41.2%), 2 GC (>5 mg) (11.8%), 3 HCQ (17.6%), 10 MTX (58.8%), 1 LEF (5.9%), 1 SSZ (5.9%), 1 APR (5.9%), 3 JAKi (17.6%), 1 TNFi (5.9%), 2 IL-6i (11.8%), 1 IL-17i (5.9%). No significant change in antirheumatic treatment was observed during the study. At baseline, 29.4% of the RA and PsA patients were in remission, 25.2% had low, 29.4% had moderate, and none had high disease activity according to SDAI, one axSpA patient had low disease activity (ASDAS: 2.2). At the end of the study, slightly more RA and PsA patients were in remission and had low disease activity (58.8% and 23.5%, respectively) and less had moderate activity (11.8%); the axSpA patient had inactive disease (ASDAS: 1.8).

Regarding patient-reported outcomes, statistically significant improvement was noted for the following parameters: SF-36 Total Score (relation of CI 90% and minimum clinically important difference of 2.5), increase of Physical Component Summary of SF-36 by 23.6% (p=0.024), ‘role limitations due to physical health’ by 76.9% (p=0.022), and ‘general health’ - by 17.1% (p=0.048); and evidence of potential clinical importance of their dynamics for Patient Health Questionnaire (PHQ)-9, ‘emotional well-being’ and RADAI-5. No negative changes were observed for assessed parameters. No adverse events were reported throughout the study.

Conclusion

This prospective study suggests that using an app-based personalized disease management program significantly quickly improves several measures of patient-reported outcomes and disease activity in patients with RA and PsA/SpA. These findings highlight the potential of complementary digital therapy in patients with inflammatory arthritis.

References

[1]Knitza J. JMIR Mhealth Uhealth. 2019 Aug 5;7(8):e14991

Disclosure of Interests

Dmytro Fedkov Shareholder of: Midaia GmbH, Speakers bureau: Phizer, MSD, Consultant of: Janssen, Novartis, Andrea Berghofen: None declared, Christel Weiss: None declared, Christine Peine Shareholder of: Midaia GmbH, Felix Lang Shareholder of: Midaia GmbH, Johannes Knitza Consultant of: ABATON, Vila Health, Medac, Grant/research support from: ABATON, Jan Leipe: None declared

High-dose vitamin E supplementation does not diminish ribavirin-associated haemolysis in hepatitis C treatment with combination standard alpha-interferon and ribavirin

BACKGROUND

Ribavirin is associated with haemolytic anaemia. Antioxidants have been reported to decrease severity of this anaemia.

AIM

To determine effect of vitamin E supplementation on ribavirin-associated haemolysis in chronic hepatitis C treated with standard alpha-interferon and ribavirin.

METHODS

Fifty-one naive chronic hepatitis C patients were randomized to receive either alpha-interferon/ribavirin therapy (control) or therapy plus vitamin E 800 IU b.d. with 24-week follow-up. Alanine aminotransferase ALT, haemoglobin and reticulocyte percentage were monitored. Symptoms and health-related quality of life were also monitored at each visit.

RESULTS

Forty-seven subjects were treated (27 vitamin E /20 controls). Thirteen withdrew because of adverse effects or non-compliance. Groups were similar in demographics, genotype and baseline lab indices. Comparison with baseline, treatment and follow-up values showed a significant haemoglobin and ALT reduction in both groups. There was no significant difference in haemoglobin and reticulocyte percentage between groups. Sustained viral response was not significantly different between vitamin E (11/18) and control (6/16) groups. Three patients required ribavirin dose-reduction in the vitamin E group compared with two controls. Health-related quality of life during and end-of-treatment was not different between groups.

CONCLUSIONS

Vitamin E supplementation alone during standard alpha-interferon and ribavirin therapy does not appear to diminish ribavirin-associated haemolysis.

Nonsystemic vasculitic mononeuropathy multiplex, cryoglobulinemia, and hepatitis C

A 39-year-old man developed sequential acute mononeuropathies involving both median, both ulnar, and the right radial and left peroneal nerves. Electrophysiology demonstrated an asymmetric sensorimotor axonal polyneuropathy; nerve biopsy confirmed a vasculitis. Laboratory evaluation revealed a mixed cryoglobulinemia and active hepatitis C infection. The patient stabilized with prednisone/cyclophosphamide/interferon-alpha. Hepatitis C should be considered in the differential diagnosis of mononeuropathy multiplex. Accurate diagnosis is important, as interferon-alpha may prevent transition to chronic hepatitis/cirrhosis.