Spike-specific circulating T follicular helper cell and cross-neutralizing antibody responses in COVID-19-convalescent individuals

Coronavirus disease 2019 (COVID-19) is caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 1 – 3 and individuals with COVID-19 have symptoms that can be asymptomatic, mild, moderate or severe 4 , 5 . In the early phase of infection, T- and B-cell counts are substantially decreased 6 , 7 ; however, IgM 8 – 11 and IgG 12 – 14 are detectable within 14 d after symptom onset. In COVID-19-convalescent individuals, spike-specific neutralizing antibodies are variable 3 , 15 , 16 . No specific drug or vaccine is available for COVID-19 at the time of writing; however, patients benefit from treatment with serum from COVID-19-convalescent individuals 17 , 18 . Nevertheless, antibody responses and cross-reactivity with other coronaviruses in COVID-19-convalescent individuals are largely unknown. Here, we show that the majority of COVID-19-convalescent individuals maintained SARS-CoV-2 spike S1- and S2-specific antibodies with neutralizing activity against the SARS-CoV-2 pseudotyped virus, and that some of the antibodies cross-neutralized SARS-CoV, Middle East respiratory syndrome coronavirus or both pseudotyped viruses. Convalescent individuals who experienced severe COVID-19 showed higher neutralizing antibody titres, a faster increase in lymphocyte counts and a higher frequency of CXCR3 + T follicular help (T FH ) cells compared with COVID-19-convalescent individuals who experienced non-severe disease. Circulating T FH cells were spike specific and functional, and the frequencies of CXCR3 + T FH cells were positively associated with neutralizing antibody titres in COVID-19-convalescent individuals. No individuals had detectable autoantibodies. These findings provide insights into neutralizing antibody responses in COVID-19-convalescent individuals and facilitate the treatment and vaccine development for SARS-CoV-2 infection. COVID-19-convalescent individuals maintain a strong neutralizing antibody response to SARS-CoV-2 that has cross-reactivity to SARS-CoV and MERS-CoV. Neutralizing antibody titres depend on the severity of the disease and are positively correlated with the frequency of CXCR3 + T follicular helper cells and lymphocyte counts.