COVID-19 continues to cause a pandemic, having infected more than 20 million people globally. Successful elimination of the SARS-CoV-2 virus will require an effective vaccine. However, the immune correlates of infection are currently poorly understood. While neutralizing antibodies are believed to be essential for protection against infection, the contribution of the neutralizing antibody response to resolution of SARS-CoV-2 infection has not yet been defined. In this study the antibody responses to the SARS-CoV-2 spike protein and nucleocapsid proteins were investigated in a UK patient cohort, using optimised immunoassays and a retrovirus-based pseudotype entry assay. It was discovered that in severe COVID-19 infections an early antibody response to both antigens was associated with improved prognosis of infection. While not all SARS-CoV-2-reactive sera were found to possess neutralizing antibodies, neutralizing potency of sera was found to be greater in patients who went on to resolve infection, compared with those that died from COVID-19. Furthermore, viral genetic variation in spike protein was found to influence the production of neutralizing antibodies. Infection with the recently described spike protein variant 614G produced higher levels of neutralizing antibodies when compared to viruses possessing the 614D variant. These findings support the assertion that vaccines targeting generation of neutralizing antibodies may be useful at limiting SARS-CoV-2 infection. Assessment of the antibody responses to SARS-CoV-2 at time of diagnosis will be a useful addition to the diagnostic toolkit, enabling stratification of clinical intervention for severe COVID-19 disease.
Hypertriglyceridaemia is an established cause of acute pancreatitis and responds to insulin therapy in addition to lipid lowering medication. We report a case of severe hypertriglycaeridemia of 149 mmol/L in a 36-year-old man with type 2 diabetes who presented to the surgical ward with abdominal pain due to pancreatitis and developed acute cholestasis, jaundice and eruptive xanthomata. His triglycerides improved to 3.8 mmol/L with sliding scale insulin within two weeks of in-hospital stay. However, his total cholesterol remained raised at 23.7 mmol/L. The lipoprotein electrophoresis confirmed the presence of lipoprotein X associated with bile obstruction, which contributed to an increase in total cholesterol. The total cholesterol normalized on improvement of his cholestasis. 2013; 50: 173-175. DOI: 10.1258 50: 173-175. DOI: 10. /acb.2012 Case A 36-year-old Caucasian man was admitted to the surgical ward in this hospital with the third episode of acute on chronic pancreatitis in the previous six years. Two earlier such events were followed by recurrent complex pancreatic surgery. He also had a cholecystectomy performed for gallstones. The patient had an eight-year history of type 2 diabetes, poorly controlled by treatment with metformin and insulin (glycosylated haemoglobin [HbA1c] 12.5%, 113 mmol/mol) and a history of non-alcoholic steatohepatitis. Prior to the admission in order to control his lipid profile he had been on atorvastatin tablets for months but had run out of his medications and was off them for approximately eight weeks. He has never smoked and ceased drinking alcohol after the first episode of pancreatitis in 2005. His past history included self-administration of steroid and testosterone injections in the year 2000 for building muscle strength before participating in heavy-lifting competitions.
Ann Clin Biochem
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