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Non-Neutralizing Antibody Functions Predict Susceptibility to SARS-CoV-2 Infection after mRNA Booster Vaccination

Levy, Shlomia; Trifkovic, Sanja; Mielke, Dieter; Oppenheimer, Hannah; Goodman, Derrick; Ostrovsky, Daniel; Sanfield-Oakley, Sherry A.; Brackett, Caroline; Friedman, Lilach M; Kerkau, Melissa; Webby, Richard; Tomaras, Georgia; Guido, Ferrari; Nesher, Lior; Hertz, Tomer
Jan 2026
10.2139/ssrn.6019238
Previous studies have shown that neutralizing and binding antibody titers are correlates of protection for symptomatic SARS-CoV-2 infection. We previously reported that individuals with low IgG and IgA baseline immune history (BIH) to SARS-CoV-2 variants were at increased risk of symptomatic infection in study of healthcare workers that received 3 or 4 doses of the Pfizer BNT-1262b2 vaccine. We also found that 1-month post-vaccination with the 4th booster dose, individuals with low-BIH mounted significant rises in binding and neutralizing antibody titers, to levels comparable to those of individuals with high-BIH, demonstrating that their increased risk was not due to inability to respond to vaccination. To further study the underlying factors that are associated with increased risk, we conducted a systems serology study of 40 low-BIH and 40 high-BIH individuals across 7 months of follow-up. We found that individuals with low BIH exhibited a significantly higher risk of symptomatic infection (HR=2.691, p=0.0065) and mounted weaker IgA and antibody-dependent cellular cytotoxicity (ADCC) responses compared to high-BIH individuals, particularly against Omicron and Delta variants. Baseline levels of the chemokine CXCL-11 were elevated in the low-BIH group. We then showed that baseline immune profiles can be used to train a prediction model of infection risk across 7 months of follow-up with 76% accuracy. IgA, ADCC and ADCP baseline features were dominant predictors of susceptibility. Our findings suggest that non-neutralizing antibody functions, especially IgA and ADCC, contribute to protection against symptomatic SARS-CoV-2 infection and that serology-guided stratification can enhance discovery of immune correlates of risk informing future vaccine design and deployment strategies.

Distinct early IgA profile may determine severity of COVID-19 symptoms: an immunological case series

Dahlke, Christine; Heidepriem, Jasmin; Kobbe, Robin; Santer, Rene; Koch, Till; Fathi, Anahita; Ly, My L.; Schmiedel, Stefan; Seeberger, Peter H.; ID-UKE COVID-19 study group; Addo, Marylyn M.; Loeffler, Felix F.
Apr 2020
10.1101/2020.04.14.20059733
SARS-CoV-2 is the causative agent of COVID-19 and is a severe threat to global health. Patients infected with SARS-CoV-2 show a wide range of symptoms and disease severity, while limited data is available on its immunogenicity. Here, the kinetics of the development of SARS-CoV-2-specific antibody responses in relation to clinical features and dynamics of specific B-cell populations are reported. Immunophenotyping of B cells was performed by flow cytometry with longitudinally collected PBMCs. In parallel, serum samples were analyzed for the presence of SARS-CoV-2-specific IgA, IgG, and IgM antibodies using whole proteome peptide microarrays. Soon after disease onset in a mild case, we observed an increased frequency of plasmablasts concomitantly with a strong SARS-CoV-2-specific IgA response. In contrast, a case with more severe progression showed a delayed, but eventually very strong and broad SARS-CoV-2-specific IgA response. This case study shows that determining SARS-CoV-2-specific antibody epitopes can be valuable to monitor the specificity and magnitude of the early B-cell response, which could guide the development of vaccine candidates. Follow-up studies are required to evaluate whether the kinetics and strength of the SARS-CoV-2-specific IgA response could be potential prognostic markers of viral control.

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