ASSOCIATION BETWEEN SARS-CoV-2 INFECTION AND ANTI-APOLIPOPROTEIN A-1 ANTIBODY IN CHILDREN

Nicolas Vuilleumier ^1,2 Sabrina Pagano ¹ Elsa Lorthe ^1,3,4 Julien Lamour ¹ Mayssam Nehme ¹ Catherine Julliard ¹ Remy Barbe ^1,2 Klara M. Posfay-Barbe ^1,2 Idriss Guessous ^1,2 Silvia Stringhini ^1,2,5 SEROCoV-KIDS study group SEROCoV-KIDS study group ¹ Arnaud Grégoire L'Huillier ^1,2*

• ¹ University Hospitals of Geneva, Geneva, Geneva, Switzerland
• ² University of Geneva, Geneva, Geneva, Switzerland
• ³ University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
• ⁴ Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, Île-de-France, France
• ⁵ Edwin S.H. Leong Centre for Healthy Aging, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

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.