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Association between SARS-CoV-2 infection and anti-apolipoprotein A-1 antibody in children
Nicolas Vuilleumier1,2, Sabrina Pagano1,2, Elsa Lorthe3,4,5
1Division of Laboratory Medicine, Diagnostics Department, Geneva University Hospitals, Geneva, Switzerland.
Insights
Autoantibodies against apolipoprotein A-1 (AAA1) are elicited by SARS-CoV-2 infection in children. AAA1 seropositivity is linked to a two-fold increased risk of persistent COVID-19 symptoms lasting at least four weeks.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Autoantibodies against apolipoprotein A-1 (AAA1) are known to be triggered by SARS-CoV-2 infection in adults, correlating with persistent COVID-19 symptoms.
- The prevalence and clinical significance of AAA1 in pediatric populations following SARS-CoV-2 infection remain largely unexplored.
Purpose of the Study:
- To investigate the prevalence of AAA1 in children exposed to SARS-CoV-2.
- To determine the association between AAA1 seropositivity and the persistence of COVID-19 symptoms in pediatric patients.
Main Methods:
- A prospective cohort study (SEROCOV-KIDS) involving 1031 children (6 months to 17 years) was conducted.
- Participants' serologies for anti-SARS-CoV-2 antibodies and AAA1 were analyzed.
- Data on symptom persistence were collected via online questionnaires, and logistic regression was used for statistical analysis.
Main Results:
- Overall AAA1 seropositivity was 5.8%, with higher rates observed in infected-unvaccinated children.
- AAA1 seroconversion risk was doubled in infected-unvaccinated children compared to other groups (OR: 2.11).
- AAA1 seropositivity was independently associated with a two-fold increased odds of symptom persistence for at least 4 weeks (p ≤ 0.03).
Conclusions:
- SARS-CoV-2 infection can induce an AAA1 response in children.
- AAA1 seropositivity in children is linked to a higher likelihood of short-term symptom persistence post-infection.
- Further research is needed to understand the long-term implications of AAA1 in pediatric Long COVID.
Background And Aims:
Autoantibodies against apolipoprotein A-1 (AAA1) are elicited by SARS-CoV-2 infection and predict COVID-19 symptoms persistence at one year in adults, but whether this applies to children is unknown. We studied the association of SARS-CoV-2 exposure with AAA1 prevalence in children and the association of AAA1 seropositivity with symptom persistence.
Methods:
Anti-SARS-CoV-2 and AAA1 serologies were examined in 1031 participants aged 6 months to 17 years old from the prospective SEROCOV-KIDS cohort and recruited between 12.2021 and 02.2022. Four SARS-CoV-2 serology-based groups were defined: "Infected-unvaccinated (I+/V-)", "Uninfected-vaccinated (I-/V+)", "Infected-Vaccinated (I+/V+)", and "Naïve (I-/V-)". Reported outcomes were collected using online questionnaires. Associations with study endpoints were assessed using logistic regression.
Results:
Overall, seropositivity rates for anti-RBD, anti-N, and AAA1 were 71% (736/1031), 55% (568/1031), and 5.8% (60/1031), respectively. AAA1 showed an inverse association with age but not with any other characteristics. The I+/V- group displayed higher median AAA1 levels and seropositivity (7.9%) compared to the other groups (p ≤ 0.011), translating into a 2-fold increased AAA1 seroconversion risk (Odds ratio [OR]: 2.11, [95% Confidence Interval (CI)]: 1.22-3.65; p=0.008), unchanged after adjustment for age and sex. AAA1 seropositivity was independently associated with a 2-fold odds of symptoms persistence at ≥ 4 weeks (p ≤ 0.03) in the entire dataset and infected individuals, but not ≥ 12 weeks.
Conclusions:
Despite the limitations of the study (cross-sectional design, patient-related outcomes using validated questionnaires), the results indicate that SARS-CoV-2 infection could elicit an AAA1 response in children, which could be independently associated with short-time symptoms persistence.
