Prozone masks elevated SARS-CoV-2 antibody level measurements

We report a prozone effect in measurement of SARS-CoV-2 spike protein antibody levels from an antibody surveillance program. Briefly, the prozone effect occurs in immunoassays when excessively high antibody concentration disrupts the immune complex formation, resulting in a spuriously low reported r...

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Bibliographic Details
Published inPloS one Vol. 19; no. 3; p. e0301232
Main Authors Sandoval, Micaela N, McClellan, Samuel P, Pont, Stephen J, Ross, Jessica A, Swartz, Michael D, Silberman, Mark A, Boerwinkle, Eric
Format Journal Article
LanguageEnglish
Published United States Public Library of Science 28.03.2024
Public Library of Science (PLoS)
Subjects
Analysis
Antibodies
Antibodies, Viral
Biology and Life Sciences
Coronaviruses
COVID-19
Electronic components industry
Health aspects
Humans
Immune response
Immunoassay - methods
Masks
Measurement
Medicine and Health Sciences
People and places
Prospective Studies
Research and Analysis Methods
SARS-CoV-2
Spike Glycoprotein, Coronavirus
Viral antibodies
United States
Texas
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Summary:We report a prozone effect in measurement of SARS-CoV-2 spike protein antibody levels from an antibody surveillance program. Briefly, the prozone effect occurs in immunoassays when excessively high antibody concentration disrupts the immune complex formation, resulting in a spuriously low reported result. Following participant inquiries, we observed anomalously low measurement of SARS-CoV-2 spike protein antibody levels using the Roche Elecsys® Anti-SARS-CoV-2 S immunoassay from participants in the Texas Coronavirus Antibody Research survey (Texas CARES), an ongoing prospective, longitudinal antibody surveillance program. In July, 2022, samples were collected from ten participants with anomalously low results for serial dilution studies, and a prozone effect was confirmed. From October, 2022 to March, 2023, serial dilution of samples detected 74 additional cases of prozone out of 1,720 participants' samples. Prozone effect may affect clinical management of at-risk populations repeatedly exposed to SARS-CoV-2 spike protein through multiple immunizations or serial infections, making awareness and mitigation of this issue paramount.
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Competing Interests: The authors have declared no competing interest.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0301232