1. homeRNA self-blood collection enables high-frequency temporal profiling of presymptomatic host immune kinetics to respiratory viral infection: a prospective cohort study.
- Author
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Lim FY, Lea HG, Dostie AM, Kim SY, van Neel TL, Hassan GW, Takezawa MG, Starita LM, Adams KN, Boeckh M, Schiffer JT, Hyrien O, Waghmare A, Berthier E, and Theberge AB
- Abstract
Background: Early host immunity to acute respiratory infections (ARIs) is heterogenous, dynamic, and critical to an individual's infection outcome. Due to limitations in sampling frequency/timepoints, kinetics of early immune dynamics in natural human infections remain poorly understood. In this nationwide prospective cohort study, we leveraged a Tasso-SST based self-blood collection and stabilization tool (homeRNA) to profile detailed kinetics of the presymptomatic to convalescence host immunity to contemporaneous respiratory pathogens., Methods: We enrolled non-symptomatic adults with recent exposure to ARIs who subsequently tested negative (exposed-uninfected) or positive for respiratory pathogens. Participants self-collected blood and nasal swabs daily for seven consecutive days followed by weekly blood collection for up to seven additional weeks. Symptom burden was assessed during each collection. Nasal swabs were tested for SARS-CoV-2 and common respiratory pathogens. 92 longitudinal blood samples spanning the presymptomatic to convalescence phase of eight participants with SARS-CoV-2 infection and 40 interval-matched samples from four exposed-uninfected participants were subjected to high-frequency longitudinal profiling of 785 immune genes. Generalized additive mixed models (GAMM) were used to identify temporally dynamic genes from the longitudinal samples and linear mixed models (LMM) were used to identify baseline differences between exposed-infected (n = 8), exposed-uninfected (n = 4), and uninfected (n = 13) participant groups., Findings: Between June 2021 and April 2022, 68 participants across 26 U.S. states completed the study and self-collected a total of 691 and 466 longitudinal blood and nasal swab samples along with 688 symptom surveys. SARS-CoV-2 was detected in 17 out of 22 individuals with study-confirmed respiratory infection, of which five were still presymptomatic or pre-shedding, enabling us to profile detailed expression kinetics of the earliest blood transcriptional response to contemporaneous variants of concern. 51% of the genes assessed were found to be temporally dynamic during COVID-19 infection. During the pre-shedding phase, a robust but transient response consisting of genes involved in cell migration, stress response, and T cell activation were observed. This is followed by a rapid induction of many interferon-stimulated genes (ISGs), concurrent to onset of viral shedding and increase in nasal viral load and symptom burden. Finally, elevated baseline expression of antimicrobial peptides was observed in exposed-uninfected individuals., Interpretation: We demonstrated that unsupervised self-collection and stabilization of capillary blood can be applied to natural infection studies to characterize detailed early host immune kinetics at a temporal resolution comparable to that of human challenge studies. The remote (decentralized) study framework enables conduct of large-scale population-wide longitudinal mechanistic studies., Funding: This study was funded by R35GM128648 to ABT for in-lab developments of homeRNA and data analysis, a Packard Fellowship for Science and Engineering from the David and Lucile Packard Foundation to ABT for the study execution, sample collection, and analysis, and R01AI153087 to AW for data analysis., Competing Interests: Declaration of interests FYL, EB, and ABT filed patent 17/361,322 (Publication Number: US20210402406A1) through the University of Washington on homeRNA. ABT reports filing multiple patents through the University of Washington and receiving a gift to support research outside the submitted work from Ionis Pharmaceuticals. EB has ownership in Salus Discovery, LLC, and Tasso, Inc. that develops blood collection systems used in this manuscript, and is employed by Tasso, Inc. Technologies from Salus Discovery, LLC are not included in this publication. He is an inventor on multiple patents filed by Tasso, Inc., the University of Washington, and the University of Wisconsin. ABT and EB have ownership in Seabright, LLC, which will advance new tools for diagnostics and clinical research, potentially including the homeRNA platform. The terms of this arrangement have been reviewed and approved by the University of Washington in accordance with its policies governing outside work and financial conflicts of interest in research. AW reports receiving clinical trial support to their institution from Pfizer, Ansun Biopharma, Allovir, GlaxoSmithKline and Vir; receiving personal fees from Vir and GSK; all outside the submitted work. MB has clinical research support from Ansun Biopharma, GSK, Moderna, Vir Biotechnology, AstraZeneka, and Merck, and received personal fees from Allovir, Moderna, AstraZeneka, and Merck. JTS has clinical trial support from Aicuris and receives personal fees from Glaxo Smith Kline and Pfizer., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2025
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