B-089 Development of a Secondary Standard for Quantitation of IgG Antibodies to SARS-CoV-2 Proteins in a Multiplex Assay

Abstract Background Serological surveillance is essential for monitoring disease burden and vaccine uptake at an individual and population level. During the pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), several serological assays were developed and obtained emergency use authorization to detect antibodies after infection. At that time, the need was to differentiate the infected from the naïve population, and these qualitative assays played a critical role in disease management. In the wake of vaccinations, there is a need for the development of quantitative assays. The world health organization (WHO) developed an international standard for quantitation. We performed this study to develop and validate an in-house secondary standard for our multiplex assay based on this WHO standard. Methods We developed a novel multiplex assay for quantifying human IgG antibodies to four different SARS-CoV-2 antigens in human serum or plasma. We have used Luminex® xMAP® technology for this assay and immobilized four recombinant proteins, namely, the receptor-binding domain of S1(RBD), nucleocapsid protein (NP), S1 protein (S1), and trimeric Spike protein (trimer) on internally coded magnetic microspheres. We procured lyophilized WHO quantification standard 20/136 from the National Institute for Biological Standards and Control (NIBSC), which has the arbitrary assignment of 1000 BAU/mL after reconstitution in 0.25 mL. We tested this standard in the range of 10 to 0.01 BAU/mL for the standard curve. We tested NIBSC 20/162 control reagent using this assay for the linearity of dilution. Thirty-seven samples from the NIBSC verification panel were also tested for this evaluation. We also quantified IgG antibodies in 25 samples from vaccinated individuals, ten samples from vaccine breakthrough individuals, 25 samples from PCR-positive individuals, and 75 samples collected before 2019. Results The secondary standard was calibrated using the 20/136 standard. The NIBSC 20/136 and the secondary standard displayed a wide dynamic range of quantitation. The difference in the expected and actual concentrations was less than 20%. Multiple dilutions of the serum or plasma samples were used to get readings within the standard curve range. Excellent linearity was noted at various sample dilutions to get the correct quantification. We observed that vaccinated individuals had a higher concentration of binding antibodies to S1, Trimer, and RBD and were negative for NP antibodies. Conversely, the acute samples from infected individuals collected less than ten days post-positive PCR showed higher antibodies to NP than different spike proteins. The vaccine break-through infection samples showed lower NP antibodies than unvaccinated but infected individuals. Conclusion Our development of a secondary standard calibrated against WHO international standard is vital for quantitatively measuring different SARS-CoV-2 antibodies. A secondary standard can help manufacturers and users to normalize results from various assays and lots over a prolonged period.