Fully Automated Chemiluminescence Microarray Analysis Platform for Rapid and Multiplexed SARS-CoV-2 Serodiagnostics.

Lateral-flow immunoassays and laboratory diagnostic tests like enzyme-linked immunosorbent assays (ELISAs) are powerful diagnostic tools to help fight the COVID-19 pandemic using them as antigen or antibody tests. However, the need emerges for alternative bioanalytical systems that combine their favorable features─simple, rapid, and cost-efficient point-of-care (POC) analysis of lateral-flow immunoassays and higher reliability of laboratory tests─while eliminating their disadvantages (limited sensitivity and specificity of lateral-flow assays and prolonged time and work expenditure of laboratory analysis). An additional need met by only a few tests is multiplexing, allowing for the analysis of several immunorecognition patterns at the same time. We herein present a strategy to combine all desirable attributes of the different test types by means of a flow-based chemiluminescence microarray immunoassay. Laminated polycarbonate microarray chips were developed for easy production and subsequent application in the fully automated microarray analysis platform MCR-R, where a novel flow cell design minimizes the sample volume to 40 μL. This system was capable of detecting IgG antibodies to SARS-CoV-2 with 100% sensitivity and specificity using recombinant antigens for the SARS-CoV-2 spike S1 protein, nucleocapsid protein, and receptor binding domain. The analysis was accomplished within under 4 min from serum, plasma, and whole blood, making it also useful in POC settings. Additionally, we showed the possibility of serosurveillance after infection or vaccination to monitor formerly unnoticed breakthrough infections in the population as well as to detect the need for booster vaccination after the natural decline of the antibody titer below detectable levels. This will help in answering pressing questions on the importance of the antibody response to SARS-CoV-2 that so far remain open. Additionally, even the sequential detection of IgM and IgG antibodies was possible, allowing for statements on the time response of an infection. While our serodiagnostic application focuses on SARS-CoV-2, the same approach is easily adjusted to other diseases, making it a powerful tool for future serological testing.