Turkiye Klinikleri Journal of Health Sciences

.: REVIEW
COVID-19'da SARS-CoV-2'ye Karşı Antikor Yanıtları ve Serolojik Deneyler
Antibody Responses Against SARS-Cov-2 in COVID-19 and Serological Assays
Bülent ÇAKALa
aİstanbul Üniversitesi İstanbul Tıp Fakültesi, Tıbbi Mikrobiyoloji ABD, İstanbul, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2020;5(2):394-400
doi: 10.5336/healthsci.2020-76285
Article Language: TR
Full Text
ÖZET
Şiddetli akut solunum sendromu koronavirüs-2'nin (severe acute respiratory syndrome coronavirus-2; SARS-CoV-2) etiyolojik etkeni olduğu koronavirüs hastalığı 2019 (coronavirus disease 2019; COVID-19) pandemisi, mevcut ve olası sonuçları açısından tüm dünyayı etkisi altına almıştır. COVID-19 oldukça özgün virolojik, klinik ve immünolojik karakteristik özelliklere sahiptir. COVID-19 tanılı hastalarda SARS-CoV-2'ye karşı antikor yanıtlarının karakterize edilmesi ve tanımlanması, salgının dinamiklerinin anlaşılması ve daha etkin mücadele stratejilerinin geliştirmesi için kritik önem taşımaktadır. SARSCoV-2'ye karşı humoral immün yanıtlara ilişkin bazı belirsizlikler mevcuttur. Bunlardan ilki SARS-CoV-2 enfeksiyonuna karşı oluşan B hücre bellek yanıtlarının süresi ile ilgilidir. Bir virüse yönelik uygun B hücre yanıtlarının, reenfeksiyonlara karşı koruyucu olması beklenir. Buna karşın mevcut veriler, COVID-19 enfeksiyonu sonrası antikor aracılı bağışıklığın, reenfeksiyona karşı koruyucu etkinliğinin sınırlı olduğuna işaret etmektedir. Bir diğer sorun ise serokonversiyonu belirlemek ve antikor yanıtlarını ölçmek amacıyla kullanılan serolojik deneylerin özgüllüğü ve validasyonu ile ilişkilidir. COVID-19'da hastaların bir kısmında antikor yanıtlarının zayıf olması ve diğer CoV'ler ile ilişkili çapraz reaktivitenin varlığı, serolojik deneylerin güvenirliliğini sınırlandırabilmektedir. Bu nedenle anti-SARS-CoV-2 antikorlarının kinetiği, antikor ilişkili immünitenin etkinliği ve immünopatogenezinin anlaşılması ile spesifik ve valide serolojik testlerin geliştirilmesi hususunda yoğun bir araştırma çabası mevcuttur. Bu derlemede anti-SARSCoV-2 antikorlarının kinetiği, antikor aracılı immünitenin etkinliği ve serolojik tanıya yönelik gelişmelerin irdelenmesi amaçlamıştır.

Anahtar Kelimeler: SARS-CoV-2; COVID-19; antikor yanıtları; B hücre bellek yanıtları; reenfeksiyon; nötralzan antikorlar; serolojik deneyler; bağışıklık belgesi
ABSTRACT
Coronavirus disease-2019 (COVID-19) pandemic which is the etiological agent of severe acute respiratory syndrome-associated a coronavirus (SARS-CoV-2) has influenced the whole world with the current and possible results. COVID-19 has very unique characteristic of virological, clinical and immunological. Characterization and identification of antibody responses against SARS-CoV-2 in patients with COVID-19 is critical for understanding the dynamics of the outbreak and to developed more effective interventions strategies. Some of gaps about humoral immune responses to SARS-CoV-2. The first of these is about life-span of B cell memory responses to SARS-CoV-2 infection. It is expected that eligible B cell response to a virus prevents reinfection. However, current evidence is pointed that effectiveness of prevent against reinfection to antibody-mediated immunity after COVID-19 infection is limited. Second else challenge is about to specificity and validation of serological assay used to determine seroconversion and measure antibody responses. In COVID-19, weak antibody responses in some patients and the presence of cross-reactivity associated with other CoVs may limit the reliability of serological experiments. Therefore, there is an intense research effort to reveal kinetics, effectiveness of antibody-mediated immunity and immunopathogenesis of antiSARS-CoV-2 antibodies with to develop specific and validated serological tests. In this review, it is aimed to examination about kinetics of anti-SARS-CoV-2 antibodies, effectiveness of antibody-mediated immunity with also advances in serological diagnosis.

Keywords: SARS-CoV-2; COVID-19; antibody responses; B cell memory responses; reinfection; neutralizing antibodies; serological assays; immunity passports
REFERENCES:
  1. Lee N, Chan PKS, Ip M, Wong E, Ho J, Ho C, et al. Anti-SARS-CoV IgG response in relation to disease severity of severe acute respiratory syndrome. J Clin Virol. 2006;35(2):179-84. [Crossref]  [PubMed]  [PMC] 
  2. Huang AT, Garcia-Carreras B, Hitchings MDT, Yang B, Katzelnick LC, et al. A systematic review of antibody mediated immunity to coronaviruses: antibody kinetics, correlates of protection, and association of antibody responses with severity of disease. medRxiv. 2020;2020.04.14.20065771. [Crossref]  [PubMed] 
  3. Zhao J, Yuan Q, Wang H, Liu W, Liao X, Su Y, et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis. 2020;ciaa344. [Crossref]  [PubMed] 
  4. Wajnberg A, Mansour M, Leven E, Bouvier NM, Patel G, Firpo A, et al. Humoral immune response and prolonged PCR positivity in a cohort of 1343 2 SARS-CoV 2 patients in the New York City region. medRxiv. 2020. [Crossref]  [PMC]  :
  5. Cao WC, Liu W, Zhang, PH, Zhang F, Richardus JH. Disappearance of antibodies to SARS-associated coronavirus after recovery. N Engl J Med. 2007;357(11):1162-3. [Crossref]  [PubMed] 
  6. Zhou W, Wang W, Wang H, Lu R, Tan W. First infection by all four non-severe acute respiratory syndrome human coronaviruses takes place during childhood. BMC Infect Dis. 2013;13:433. [Crossref]  [PubMed]  [PMC] 
  7. Schmidt OW, Allan ID, Cooney MK, Foy HM, Fox JP. Rises in titers of antibody to human coronaviruses OC43 and 229E in Seattle families during 1975-1979. Am J Epidemiol. 1986;123(5):862-8. [Crossref]  [PubMed]  [PMC] 
  8. Gorse GJ, Donovan MM, Patel GB. Antibodies to coronaviruses are higher in older compared with younger adults and binding antibodies are more sensitive than neutralizing antibodies in identifying coronavirus-associated illnesses. J Med Virol. 2020;92(5):512-7. [Crossref]  [PubMed]  [PMC] 
  9. Gaunt ER, Hardie A, Claas ECJ, Simmonds P, Templeton KE. Epidemiology and clinical presentations of the four human coronaviruses 229E, HKU1, NL63, and OC43 detected over 3 years using a novel multiplex real-time PCR method. J Clin Microbiol. 2010;48(8):2940-7. [Crossref]  [PubMed]  [PMC] 
  10. Thevarajan I, Nguyen THO, Koutsakos M, Druce J, Caly L, van de Sandt CE, et al. Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19. Nat Med. 2020;26(4):453-5. [Crossref]  [PubMed]  [PMC] 
  11. Okba NMA, Müller MA, Li W, Wang C, GeurtsvanKessel CH, Corman VM, et al. Severe acute respiratory syndrome coronavirus 2-specific antibody responses in coronavirus disease 2019 patients. Emerg Infect Dis. 2020;26(7):1478-88. [Crossref]  [PubMed]  [PMC] 
  12. Callow KA, Parry HF, Sergeant M, Tyrrell DA. The time course of the immune response to experimental coronavirus infection of man. Epidemiol Infect. 1990;105(2):435-46. [Crossref]  [PubMed]  [PMC] 
  13. Kissler SM, Tedijanto C, Goldstein E, Grad YH, Lipsitch M. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science. 2020;368(6493)860-8. [Crossref]  [PubMed]  [PMC] 
  14. Eyal N, Lipsitch M, Smith PG. Human challenge studies to accelerate coronavirus vaccine licensure. J Infect Dis. 2020;221(11)1752-6. [Crossref]  [PubMed]  [PMC] 
  15. Chan KH, Chan JFW, Tse H, Chen H, Lau CCY, Cai JP, et al. Cross-reactive antibodies in convalescent SARS patients' sera against the emerging novel human coronavirus EMC (2012) by both immunofluorescent and neutralizing antibody tests. J Infect. 2013;67(2):130-40. [Crossref]  [PubMed]  [PMC] 
  16. Yu Y, Jin H, Chen Z, Yu QL, Ma YJ, Sun XL, et al. Children's vaccines do not induce cross reactivity against SARS-CoV. J Clin Pathol. 2007;60(2):208-11. [Crossref]  [PubMed]  [PMC] 
  17. Wu F, Wang A, Liu M, Wang Q, Chen J, Xia S, et al. Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 recovered patient cohort and their implications. medRxiv. [Crossref] 
  18. Amanat F, Stadlbauer D, Strohmeier S, Nguyen THO, Chromikova V, McMahon M, et al. A serological assay to detect SARS-CoV-2 seroconversion in humans. medRxiv. 2020;2020.03.17.20037713. [Crossref]  [PubMed] 
  19. Stadlbauer D, Amanat F, Chromikova V, Jiang K, Strohmeier S, Arunkumar GA, et al. SARS-CoV-2 seroconversion in humans: a detailed protocol for a serological assay, antigen production, and test setup. Curr Protoc Microbiol. 2020;57(1):e100. [Crossref]  [PubMed]  [PMC] 
  20. Okba NMA, Müller MA, Li W, Wang C, GeurtsvanKessel CH, Corman VM, et al. SARS-CoV-2 specific antibody responses in COVID-19 patients. medRxiv. [Crossref] 
  21. Stadlbauer D, Amanat F, Chromikova V, Jiang K, Strohmeier S, Arunkumar GA, et al. SARS-CoV-2 seroconversion in humans: a detailed protocol for a serological assay, antigen production, and test setup. Curr Protoc Microbiol. 2020;57(1):e100. [Crossref]  [PubMed]  [PMC] 
  22. Tan CW, Chia WN, Qin X, Liu P, Chen MIC, Tiu C, et al. A SARS-CoV-2 surrogate virus neutral­ization test based on antibody-mediated block­age of ACE2-spike protein-protein interaction. Nature Biotechnology. 2020; [Crossref]  [PubMed] 
  23. Meyer B, Drosten C, Müller MA. Serological assays for emerging coronaviruses: challenges and pitfalls. Virus Res. 2014;194:175-83. [Crossref]  [PubMed]  [PMC] 
  24. Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell. 2020;181(2):281-92.e6. [Crossref]  [PubMed]  [PMC] 
  25. Paules CI, Marston HD, Fauci AS. Coronavirus infections-more than just the common cold. JAMA. 2020. [Crossref]  [PubMed] 
  26. Tortorici MA, Walls AC, Lang Y, Wang C, Li Z, Koerhuis D, et.al. Structural basis for human coronavirus attachment to sialic acid receptors. Nat Struct Mol Biol. 2019;26(6):481-9. [Crossref]  [PubMed]  [PMC] 
  27. Li F. Structure, function, and evolution of coronavirus spike proteins. Annu Rev Virol. 2016;3(1):237-61. [Crossref]  [PubMed]  [PMC] 
  28. Lv H, Wu NC, Tsang OTY, Yuan M, Perera RAPM, Leung WS, et al. Cross-reactive antibody response between SARS-CoV-2 and SARS-CoV infections. bioRxiv. 2020;2020.03.15.993097. [Crossref]  [PubMed] 
  29. Petherick A. Developing antibody tests for SARS-CoV-2. Lancet. 2020;395(10230):1101-2. [Crossref]  [PubMed] 
  30. Ju B, Zhang Q, Ge X, Wang R, Yu J, Shan S, et al. Potent human neutralizing antibodies elicited by SARS-CoV-2 infection. bioRxiv. 2020. [Crossref] 
  31. Hachim A, Kavian N, Cohen CA, Chin AWH, Chu DKW, Mok CKP, et al. Beyond the spike: identification of viral targets of the antibody responses to SARS-CoV-2 in COVID-19 patients. medRxiv. 2020. [Crossref] 
  32. Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265-9. [Crossref]  [PubMed]  [PMC] 
  33. Long QX, Liu BZ, Deng HJ, Wu GC, Deng K, Chen YK, et al. Antibody responses to SARS-CoV-2 in patients with COVID-19. Nat Med. 2020;26(6):845-8. [PubMed] 
  34. World Health Organization. "Immunity passports" in the context of COVID-19. www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19

.: Up To Date

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com