T cell receptor sequencing identifies prior SARS-CoV-2 infection and correlates with neutralizing antibodies and disease severity
Rebecca Elyanow, … , Harlan S. Robins, David M. Koelle
Rebecca Elyanow, … , Harlan S. Robins, David M. Koelle
Published April 19, 2022
Citation Information: JCI Insight. 2022;7(10):e150070. https://doi.org/10.1172/jci.insight.150070.
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Clinical Research and Public Health COVID-19 Infectious disease

T cell receptor sequencing identifies prior SARS-CoV-2 infection and correlates with neutralizing antibodies and disease severity

Abstract

BACKGROUND Measuring the immune response to SARS-CoV-2 enables assessment of past infection and protective immunity. SARS-CoV-2 infection induces humoral and T cell responses, but these responses vary with disease severity and individual characteristics.METHODS A T cell receptor (TCR) immunosequencing assay was conducted using small-volume blood samples from 302 individuals recovered from COVID-19. Correlations between the magnitude of the T cell response and neutralizing antibody (nAb) titers or indicators of disease severity were evaluated. Sensitivity of T cell testing was assessed and compared with serologic testing.RESULTS SARS-CoV-2–specific T cell responses were significantly correlated with nAb titers and clinical indicators of disease severity, including hospitalization, fever, and difficulty breathing. Despite modest declines in depth and breadth of T cell responses during convalescence, high sensitivity was observed until at least 6 months after infection, with overall sensitivity ~5% greater than serology tests for identifying prior SARS-CoV-2 infection. Improved performance of T cell testing was most apparent in recovered, nonhospitalized individuals sampled > 150 days after initial illness, suggesting greater sensitivity than serology at later time points and in individuals with less severe disease. T cell testing identified SARS-CoV-2 infection in 68% (55 of 81) of samples with undetectable nAb titers (<1:40) and in 37% (13 of 35) of samples classified as negative by 3 antibody assays.CONCLUSION These results support TCR-based testing as a scalable, reliable measure of past SARS-CoV-2 infection with clinical value beyond serology.TRIAL REGISTRATION Specimens were accrued under trial NCT04338360 accessible at clinicaltrials.gov.FUNDING This work was funded by Adaptive Biotechnologies, Frederick National Laboratory for Cancer Research, NIAID, Fred Hutchinson Joel Meyers Endowment, Fast Grants, and American Society for Transplantation and Cell Therapy.

Authors

Rebecca Elyanow, Thomas M. Snyder, Sudeb C. Dalai, Rachel M. Gittelman, Jim Boonyaratanakornkit, Anna Wald, Stacy Selke, Mark H. Wener, Chihiro Morishima, Alexander L. Greninger, Michael Gale Jr., Tien-Ying Hsiang, Lichen Jing, Michael R. Holbrook, Ian M. Kaplan, H. Jabran Zahid, Damon H. May, Jonathan M. Carlson, Lance Baldo, Thomas Manley, Harlan S. Robins, David M. Koelle

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Figure 4

Association of T cell clonal breadth with clinical variables.

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Association of T cell clonal breadth with clinical variables. (A–E) Corr...
(A–E) Correlation of clonal breadth with hospitalization (A), fever (B), difficulty breathing (C), sex (D), and age (E) was evaluated by univariate Mann-Whitney U test (P) and multivariate linear regression with age, sex, hospitalization, fever, difficulty breathing, and TCR rearrangements as variables. Data are expressed as median ± IQR (n = 302 convalescent individuals). Population means and 95% CI values for (A–D) were as follows: (A) nonhospitalized, 3.4 × 10–4 (3.1 × 10–4 to 3.7 × 10–4); hospitalized, 6.3 × 10–4 (5.1 × 10–4 to 7.5 × 10–4); (B) no fever, 2.8 × 10–4 (2.3 × 10–4 to 3.2 × 10–4); fever, 4.0 × 10–4 (3.7 × 10–4 to 4.4 × 10–4); (C) no difficulty breathing, 3.3 × 10–4 (3.0 × 10–4 to 3.6 × 10–4); difficulty breathing, 4.0 × 10–4 (3.6 × 10–4 to 4.4 × 10–4); (D) female, 3.1 × 10–4 (3.0 × 10–4 to 3.4 × 10–4); male, 4.4 × 10–4 (3.9 × 10–4 to 4.8 × 10–4).