Low Innate Immunity and Lagged Adaptive Immune Response in the Re-Tested Viral RNA Positivity of a COVID-19 Patient

Recent studies have highlighted observations regarding re-tested positivity (RP) of SARS-CoV-2 RNA in discharged COVID-19 patients, however, the immune mechanisms underlying SARS-CoV-2 RNA RP in immunocompetent patients remain elusive. Herein, we describe the case of an immunocompetent COVID-19 pati...

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Published in:Frontiers in immunology Vol. 12; p. 664619
Main Authors: Lai, Changchun, Liu, Xinglong, Yan, Qihong, Lv, Hualiang, Zhou, Lei, Hu, Longbo, Cai, Yong, Wang, Guoqiang, Chen, Yufeng, Chai, Renjie, Liu, Zhenwei, Xu, Yuhua, Huang, Wendong, Xiao, Fei, Hu, Linhui, Li, Yaocai, Huang, Jianhong, Zhou, Qiang, Li, Luqian, Peng, Tao, Zhang, Haiye, Zhang, Zhenhui, Chen, Ling, Chen, Chunbo, Ji, Tianxing
Format: Journal Article
Language:English
Published: Frontiers Media S.A 01-07-2021
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Summary:Recent studies have highlighted observations regarding re-tested positivity (RP) of SARS-CoV-2 RNA in discharged COVID-19 patients, however, the immune mechanisms underlying SARS-CoV-2 RNA RP in immunocompetent patients remain elusive. Herein, we describe the case of an immunocompetent COVID-19 patient with moderate symptoms who was twice re-tested as positive for SARS-CoV-2 RNA, and the period between first and third viral RNA positivity was 95 days, longer than previously reported (18–25 days). The chest computed tomography findings, plasma anti-SARS-CoV-2 antibody, neutralizing antibodies (NAbs) titer, and whole blood transcriptic characteristics in the viral RNA RP patient and other COVID-19 patients were analyzed. During the SARS-CoV-2 RNA RP period, new lung lesions were observed. The COVID-19 patient with viral RNA RP had delayed seroconversion of anti-spike/receptor-binding domain (RBD) IgA antibody and NAbs and were accompanied with disappearance of the lung lesions. Further experimental data validated that NAbs titer was significantly associated with anti-RBD IgA and IgG, and anti-spike IgG. The RP patient had lower interferon-, T cells- and B cell-related genes expression than non-RP patients with mild-to-moderate symptoms, and displayed lower cytokines and chemokines gene expression than severe patients. Interestingly, the RP patient had low expression of antigen presentation-related genes and low B cell counts which might have contributed to the delayed anti-RBD specific antibody and low CD8+ cell response. Collectively, delayed antigen presentation-related gene expression was found related to delayed adaptive immune response and contributed to the SARS-CoV-2 RNA RP in this described immunocompetent patient.
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These authors have contributed equally to this work
This article was submitted to Viral Immunology, a section of the journal Frontiers in Immunology
Reviewed by: Michael Chattergoon, Johns Hopkins University, United States; Anthony Tanoto Tan, Duke-NUS Medical School, Singapore
Edited by: Xin-Xin Zhang, Shanghai Public Health Clinical Center, China
ISSN:1664-3224
1664-3224
DOI:10.3389/fimmu.2021.664619