Rapid diagnostics
that can accurately inform patients of disease
risk and protection are critical to mitigating the spread of the current
COVID-19 pandemic and future infectious disease outbreaks. To be effective,
such diagnostics must rely on simple, cost-effective, and widely available
equipment and should be compatible with existing telehealth infrastructure
to facilitate data access and remote care. Commercial glucometers
are an established detection technology that can overcome the cost,
time, and trained personnel requirements of current benchtop-based
antibody serology assays when paired with reporter molecules that
catalyze glucose conversion. To this end, we developed an enzymatic
reporter that, when bound to disease-specific patient antibodies,
produces glucose in proportion to the level of antibodies present
in the patient sample. Although a straightforward concept, the coupling
of enzymatic reporters to secondary antibodies or antigens often results
in low yields, indeterminant stoichiometry, reduced target binding,
and poor catalytic efficiency. Our enzymatic reporter is a novel fusion
protein that comprises an antihuman immunoglobulin G (IgG) antibody
genetically fused to two invertase molecules. The resulting fusion
protein retains the binding affinity and catalytic activity of the
constituent proteins and serves as an accurate reporter for immunoassays.
Using this fusion, we demonstrate quantitative glucometer-based measurement
of anti-SARS-CoV-2 spike protein antibodies in blinded clinical sample
training sets. Our results demonstrate the ability to detect SARS-CoV-2-specific
IgGs in patient serum with precise agreement to benchmark commercial
immunoassays. Because our fusion protein binds all human IgG isotypes,
it represents a versatile tool for detection of disease-specific antibodies
in a broad range of biomedical applications.