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Excessive inflammation is a characteristic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, particularly in patients that are hospitalized with coronavirus disease 2019 (COVID-19). Here, Hoepel et al. investigated how human antibodies specific to SARS-CoV-2 spike protein may contribute to exacerbated inflammation. The authors found that spike protein–specific antibodies from patients with COVID-19 who were hospitalized had altered glycosylation, with an enrichment in low-fucosylated antibodies. These antibodies were able to activate human macrophages in vitro to secrete proinflammatory cytokines. Thus, altered antibody glycosylation may contribute to disease severity in COVID-19.
Patients diagnosed with coronavirus disease 2019 (COVID-19) become critically ill primarily around the time of activation of the adaptive immune response. Here, we provide evidence that antibodies play a role in the worsening of disease at the time of seroconversion. We show that e