Anti-Receptor-Binding Domain Immunoglobulin G Antibody as a Predictor of Seropositivity for Anti-SARS-CoV-2 Neutralizing Antibody

Neutralizing antibody detection can assess the incidence of coronavirus disease 2019 (COVID-19) and the effectiveness of vaccines. However, commercial reagents for neutralizing antibodies were developed after the anti- severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (Ig) G and IgM antibodies. Therefore, some laboratories did not perform neutralizing antibody testing services due to multiple factors. To find a fast, accurate, and economical alternative for the detection of neutralizing antibodies for the development of COVID-19 screening programs. The response and correlation of three antibodies (anti-spike protein (S) neutralizing antibody, total anti-receptor-binding domain (RBD) antibody, and anti-RBD IgG) was determined by observing the dynamics in 61 participants for 160 days post vaccination. The levels of neutralizing and anti-RBD IgG antibodies reached their peak values on day 42 post vaccination (120.75 IU/mL and 14.38 signal-to-cutoff ratio [S/CO], respectively). The total antibody levels peaked at 138.47 S/CO on day 35 post vaccination. The strongest correlation was found between neutralizing and anti-RBD IgG antibody levels (r = 0.894, P < .001). The area under the receiver operating characteristic curve (ROC-AUC) for total antibody levels for the prediction of seropositivity for neutralizing antibodies was 0.881 (P < .001) and that for anti-RBD IgG antibody levels was 0.937 (P < .001). Neutralizing and anti-RBD IgG antibody levels were strongly correlated, and thus anti-RBD IgG antibody levels can be used for accurate assessment of immunity following SARS-CoV-2 infection or vaccination.