Biodistribution and serologic response in SARS-CoV-2 induced ARDS: A cohort study

• Published in: PloS one 2020-11, Vol.15 (11), p.e0242917
• Main Authors: Schlesinger, Tobias, Weißbrich, Benedikt, Wedekink, Florian, Notz, Quirin, Herrmann, Johannes, Krone, Manuel, Sitter, Magdalena, Schmid, Benedikt, Kredel, Markus, Stumpner, Jan, Dölken, Lars, Wischhusen, Jörg, Kranke, Peter, Meybohm, Patrick, Lotz, Christopher
• Format: Article
• Language: English
• Subjects: Adult respiratory distress syndrome; Aged; Analysis; Anesthesiology; Antibodies; Antibodies, Neutralizing - blood; Antibodies, Neutralizing - immunology; Antibodies, Viral - blood; Antibodies, Viral - immunology; Antiviral drugs; Biodistribution; Biology and life sciences; Blood; Cohort analysis; Complications and side effects; Corona; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - immunology; COVID-19 - virology; COVID-19 Serological Testing - methods; Critical care; Demographic aspects; Diagnosis; Dialysate; Disease transmission; Enzyme-Linked Immunosorbent Assay; Female; Germany - epidemiology; Gynecology; Health services; Humans; Immunoglobulin A; Immunoglobulin A - blood; Immunoglobulin A - immunology; Immunoglobulin G - blood; Immunoglobulin G - immunology; Immunoglobulin M; Immunoglobulin M - blood; Immunoglobulin M - immunology; Infections; Intensive care; Load distribution; Male; Medicine and health sciences; Middle Aged; Neutralizing; Obstetrics; Pandemics; Patients; Polymerase chain reaction; Protein Domains - immunology; Research and Analysis Methods; Respiratory diseases; Respiratory distress syndrome; Respiratory Distress Syndrome - etiology; Respiratory Distress Syndrome - immunology; Respiratory Distress Syndrome - virology; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; Reverse transcription; Ribonucleic acid; Risk factors; RNA; RNA, Viral - genetics; SARS-CoV-2 - genetics; SARS-CoV-2 - immunology; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Spike Glycoprotein, Coronavirus - immunology; Stress concentration; Survival; Urine; Viral diseases; Viral load; Viral Load - genetics; Virology; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0242917

The viral load and tissue distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain important questions. The current study investigated SARS-CoV-2 viral load, biodistribution and anti-SARS-CoV-2 antibody formation in patients suffering from severe corona virus disease 2019 (COVID-19) induced acute respiratory distress syndrome (ARDS). This is a retrospective single-center study in 23 patients with COVID-19-induced ARDS. Data were collected within routine intensive care. SARS-CoV-2 viral load was assessed via reverse transcription quantitative polymerase chain reaction (RT-qPCR). Overall, 478 virology samples were taken. Anti-SARS-CoV-2-Spike-receptor binding domain (RBD) antibody detection of blood samples was performed with an enzyme-linked immunosorbent assay. Most patients (91%) suffered from severe ARDS during ICU treatment with a 30-day mortality of 30%. None of the patients received antiviral treatment. Tracheal aspirates tested positive for SARS-CoV-2 in 100% of the cases, oropharyngeal swabs only in 77%. Blood samples were positive in 26% of the patients. No difference of viral load was found in tracheal or blood samples with regard to 30-day survival or disease severity. SARS-CoV-2 was never found in dialysate. Serologic testing revealed significantly lower concentrations of SARS-CoV-2 neutralizing IgM and IgA antibodies in survivors compared to non-survivors (p = 0.009). COVID-19 induced ARDS is accompanied by a high viral load of SARS-CoV-2 in tracheal aspirates, which remained detectable in the majority throughout intensive care treatment. Remarkably, SARS-CoV-2 RNA was never detected in dialysate even in patients with RNAemia. Viral load or the buildup of neutralizing antibodies was not associated with 30-day survival or disease severity.