Robust Neutralizing Antibodies to SARS-CoV-2 Develop and Persist in Subjects with Diabetes and COVID-19 Pneumonia

• Published in: The journal of clinical endocrinology and metabolism Vol. 106; no. 5; pp. 1472 - 1481
• Main Authors: Dispinseri, Stefania, Lampasona, Vito, Secchi, Massimiliano, Cara, Andrea, Bazzigaluppi, Elena, Negri, Donatella, Brigatti, Cristina, Pirillo, Maria Franca, Marzinotto, Ilaria, Borghi, Martina, Rovere-Querini, Patrizia, Tresoldi, Cristina, Ciceri, Fabio, Scavini, Marina, Scarlatti, Gabriella, Piemonti, Lorenzo
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.05.2021
• Subjects: Analysis; Antibodies; Antibodies, Neutralizing - immunology; Antibody response; Bacterial pneumonia; Clinical; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - immunology; Dextrose; Diabetes; Diabetes Complications - immunology; Diabetes Complications - virology; Diabetes mellitus; Diabetics; Female; Glucose; Health aspects; Humans; Hyperglycemia; Immune response (humoral); Male; Medical research; Medicine, Experimental; Mortality; Pneumonia; Pneumonia - complications; Pneumonia - immunology; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Spike protein; Vaccination; Vaccine development; Vaccines; Viral antibodies; China; COVID-19; survival rate; neutralizing antibodies; SARS-CoV-2; diabetes; humoral response
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/clinem/dgab055

Abstract Context Demonstrating the ability to mount a neutralizing antibody response to SARS-CoV-2 in the presence of diabetes is crucial to understand COVID-19 pathogenesis, reinfection potential, and vaccine development. Objective The aim of this study was to characterize the kinetics and durability of neutralizing antibody (Nab) response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the presence of hyperglycemia. Methods Using a lentiviral vector–based SARS-CoV-2 neutralization assay to measure Nabs, we characterized 150 patients randomly selected from a cohort of 509 patients with confirmed COVID-19 pneumonia. We analyzed Nab response according to the presence of diabetes or hyperglycemia, at the time of hospitalization and during the postdischarge follow-up: 1-, 3-, and 6-month outpatient visits. Results Among 150 randomly selected patients 40 (26.6%) had diabetes. Diabetes (hazard ratio [HR] 8.9, P < .001), glucose levels (HR 1.25 × 1.1 mmol/L, P < .001), and glucose variability (HR 1.17 × 0.6 mmol/L, P < .001) were independently associated with an increased risk of mortality. The neutralizing activity of SARS-CoV-2 antibodies in patients with diabetes was superimposable, as for kinetics and extent, to that of patients without diabetes. It was similar across glucose levels and correlated with the humoral response against the SARS-CoV-2 spike protein. Positivity for Nabs at the time of hospital admission conferred protection on mortality, both in the presence (HR 0.28, P = .046) or absence of diabetes (HR 0.26, P = .030). The longevity of the Nab response was not affected by diabetes. Conclusion Diabetes and hyperglycemia do not affect the kinetics and durability of the neutralizing antibody response to SARS-CoV-2. These findings provide the rational to include patients with diabetes in the early phase of the vaccination campaign against SARS-CoV-2.