This study investigated the association between the breadth of SARS-CoV-2 neutralizing antibody response and Long COVID phenotypes. Longitudinal neutralizing and cross-neutralizing antibody responses to pre- and post-SARS-CoV-2 Omicron variants were measured in participants infected during early COVID-19 pandemic waves, before widespread vaccination. While neutralizing antibodies to the original strain weren't associated with Long COVID, cross-neutralization to Omicron BA.5 was significantly associated with increased odds of Long COVID and specific symptoms (gastrointestinal and neurological). Longitudinal modeling showed significant associations between overall neutralization levels and decay rates with Long COVID phenotypes. The findings suggest a complex relationship between immune responses and Long COVID, potentially involving the breadth of antibody neutralization.

Amanda M Buck, Amelia N Deitchman, Saki Takahashi, Scott Lu, Sarah A Goldberg, Rebecca Hoh, Meghann C Williams, Marian Kerbleski, Tyler-Marie Deveau, Sadie E Munter, James Lombardo, Terri Wrin, Christos J Petropoulos, Matthew S Durstenfeld, Priscilla Y Hsue, J Daniel Kelly, Bryan Greenhouse, Jeffrey N Martin, Steven G Deeks, Michael J Peluso, Timothy J Henrich