TY - JOUR T1 - Antibody Response to a Nucleocapsid Epitope as a Marker for COVID-19 Disease Severity JF - bioRxiv DO - 10.1101/2020.10.15.341743 SP - 2020.10.15.341743 AU - Sanjana Sen AU - Emily C. Sanders AU - Kristin N. Gabriel AU - Brian M. Miller AU - Hariny M. Isoda AU - Gabriela S. Salcedo AU - Jason E. Garrido AU - Rebekah P. Dyer AU - Rie Nakajima AU - Aarti Jain AU - Alicia M. Santos AU - Keertna Bhuvan AU - Delia F. Tifrea AU - Joni L. Ricks-Oddie AU - Philip L. Felgner AU - Robert A. Edwards AU - Sudipta Majumdar AU - Gregory A. Weiss Y1 - 2020/01/01 UR - http://biorxiv.org/content/early/2020/10/16/2020.10.15.341743.abstract N2 - Characterization of antibody response to SARS-CoV-2 is urgently needed to predict COVID-19 disease trajectories. Ineffective antibodies or antibody-dependent enhancement (ADE) could derail patients’ immune responses, for example. ELISA and coronavirus antigen microarray (COVAM) analysis epitope-mapped plasma from 86 COVID-19 patients. The experiments identified antibodies to a 21-residue epitope from nucleocapsid (termed Ep9) associated with severe disease, including ICU stay, requirement for ventilators, and death. Furthermore, anti-Ep9 antibodies correlate both with various comorbidities and ADE hallmarks, including increased IL-6 levels and early IgG response. Importantly, anti-Ep9 antibodies can be detected within five days post-symptom onset and sometimes within one day. The results lay the groundwork for a new type of COVID-19 diagnostic for the early prediction of disease severity to guide more effective therapeutic interventions.One Sentence Summary Antibodies targeting a specific location within a SARS-CoV-2 structural protein are linked to poor COVID-19 disease outcomes.Competing Interest StatementThe authors declare the following competing financial interest(s): P.L.F., R.N., and A.J. have a financial interest in a company, Nanommune Inc., that is commercializing the COVAM technology. Nanommune partners with Sino Biological Inc. (Beijing, China) for expression and purification of COVAM antigens used in this study. The terms of this arrangement have been reviewed and approved by the University of California, Irvine in accordance with its conflict of interest policies. ER -