New studies are offering more accurate insights into the seriousness of COVID-19, which can be assessed by examining autoantibodies in the nasal cavity. This advancement could lead to tailored treatment strategies.
COVID-19 presents a wide spectrum of symptoms, from mild to severe. While new virus variants tend to cause milder effects, individuals with pre-existing conditions remain at a significantly higher risk for severe illness. Recent research from Emory University is shedding light on how the presence of autoantibodies in the nasal cavity can help accurately predict COVID-19 severity, thereby paving the way for personalized treatment. For those at high risk, this information could be pivotal in guiding swift treatment approaches, including the prompt use of medications like Paxlovid within a week of initial symptoms to reduce the chances of severe illness.
A study published in Science Translational Medicine observed 125 patients across a two-year period, covering a range of COVID-19 cases from mild to severe. The research monitored antibodies in both the bloodstream and nasal passages. Surprisingly, over 70% of those with mild or moderate COVID-19 developed specific autoantibodies in their nasal cavities, which were linked to fewer symptoms, improved antiviral responses, and quicker recoveries.
The results indicate that these nasal autoantibodies may serve a protective function, helping to manage the immune system, reducing excessive inflammation, and enhancing the body’s ability to combat the virus.
“Typically, autoantibodies are associated with negative health outcomes and increased inflammation, indicating a worse prognosis,” explains Eliver Ghosn, the study’s senior author and a member of the Lowance Center for Human Immunology and Emory Vaccine Center. “However, our findings reveal that, in the context of COVID-19, it’s quite the opposite. The autoantibodies found in the nose appeared shortly after infection, targeting a crucial inflammatory molecule created by the patient’s cells. These autoantibodies bind to the molecule, likely to prevent excessive inflammation, and their levels decreased as patients recovered, suggesting the body utilizes them to maintain balance.”
Previously conducted studies indicated that the presence of autoantibodies in the bloodstream correlated with severe, life-threatening COVID-19 cases. However, these studies often overlooked the nasal cavity – the primary site of infection. The recent findings suggest that the immune responses activated in the nose differ from those in the bloodstream. In essence, autoantibodies in the nasal passage signal protection, while those in the blood are linked to increased severity.
“The breakthrough insight was focusing on the nasal cavity, the true infection site, rather than the blood,” Ghosn states. “While blood autoantibodies are associated with poor outcomes, those produced in the nose soon after infection correlate with effective recovery.”
FlowBEAT: An Enhanced Diagnostic Tool
To enable more accurate assessments of antibodies formed at the infection site in the nasal cavity, Ghosn’s lab developed an innovative technology named FlowBEAT, which allows for the measurement of various antibody types in nasal swabs and other biological samples. This tool may have future implications for diagnosing other respiratory viruses, such as flu or RSV.
“Traditionally, antibody measurement technologies have low sensitivity and efficiency, often limited to examining one or a few antibodies at a time,” Ghosn elaborates. “FlowBEAT changes that by enabling us to analyze any standard nasal swab to measure multiple types of antibodies against numerous viral and host antigens simultaneously in a single test—providing a much more sensitive, efficient, and scalable method to identify nasal autoantibodies that can predict symptom severity.”
Moving forward, the researchers aim to determine whether this intriguing method of managing COVID-19 in the nasal cavity applies to other respiratory infections, like flu and RSV.
“If it turns out that this nasal autoantibody response is a widespread mechanism for protecting against various viral infections, it could revolutionize how we understand protective immunity,” Ghosn predicts. “We will be able to view autoantibodies through a new lens, potentially motivating fresh research avenues and improved treatment options for common respiratory infections.”
Based on their findings, the Ghosn Lab is collaborating with Emory’s patent office to create a predictive diagnostic test utilizing “leftover” samples from standard nasal swabs used for COVID-19 testing.
“Currently, we focus either on assessing the risk of infection before it occurs or studying the infection after recovery,” notes Ben Babcock, a PhD candidate who led the study in Ghosn’s Lab. “Imagine if we could track the immune response in real-time, right in the clinic. Having a real-time test could empower physicians and patients with the immediate information needed to make quicker and more informed treatment choices.”
This research was part of a significant collaboration between the Ghosn Lab at Emory and Drs. Sulggi Lee from UCSF and Nadia Roan from Gladstone Institutes, in partnership with Emory laboratories led by Drs. F. Eun-Hyung Lee, Iñaki Sanz, and Rabin Tirouvanziam.
CITATION: Babcock et al. Transient anti-interferon autoantibodies in the airways are associated with recovery from COVID-19. Science Translational Medicine, DOI.
FUNDING: This research was supported by the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) awards R21AI167032, R01AI123126-05S1 and National Cancer Institute (NCI) award U54 CA260563 Emory SeroNet; the COVID Fast Grant from Emergent Ventures at the Mercatus Center; and the Program for Breakthrough Biomedical Research Award. Ben Babcock received partial support from the American Society of Hematology (ASH).
