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Kumar A, Tripathi P, Kumar P, Shekhar R, Pathak R. From Detection to Protection: Antibodies and Their Crucial Role in Diagnosing and Combatting SARS-CoV-2. Vaccines (Basel) 2024; 12:459. [PMID: 38793710 PMCID: PMC11125746 DOI: 10.3390/vaccines12050459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Understanding the antibody response to SARS-CoV-2, the virus responsible for COVID-19, is crucial to comprehending disease progression and the significance of vaccine and therapeutic development. The emergence of highly contagious variants poses a significant challenge to humoral immunity, underscoring the necessity of grasping the intricacies of specific antibodies. This review emphasizes the pivotal role of antibodies in shaping immune responses and their implications for diagnosing, preventing, and treating SARS-CoV-2 infection. It delves into the kinetics and characteristics of the antibody response to SARS-CoV-2 and explores current antibody-based diagnostics, discussing their strengths, clinical utility, and limitations. Furthermore, we underscore the therapeutic potential of SARS-CoV-2-specific antibodies, discussing various antibody-based therapies such as monoclonal antibodies, polyclonal antibodies, anti-cytokines, convalescent plasma, and hyperimmunoglobulin-based therapies. Moreover, we offer insights into antibody responses to SARS-CoV-2 vaccines, emphasizing the significance of neutralizing antibodies in order to confer immunity to SARS-CoV-2, along with emerging variants of concern (VOCs) and circulating Omicron subvariants. We also highlight challenges in the field, such as the risks of antibody-dependent enhancement (ADE) for SARS-CoV-2 antibodies, and shed light on the challenges associated with the original antigenic sin (OAS) effect and long COVID. Overall, this review intends to provide valuable insights, which are crucial to advancing sensitive diagnostic tools, identifying efficient antibody-based therapeutics, and developing effective vaccines to combat the evolving threat of SARS-CoV-2 variants on a global scale.
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Affiliation(s)
- Anoop Kumar
- Molecular Diagnostic Laboratory, National Institute of Biologicals, Noida 201309, India
| | - Prajna Tripathi
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, NY 10021, USA;
| | - Prashant Kumar
- R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
| | - Ritu Shekhar
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Rajiv Pathak
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA
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2
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Burnouf T, Epstein J, Faber JC, Smid WM. Stepwise options for preparing therapeutic plasma proteins from domestic plasma in low- and middle-income countries. Vox Sang 2024; 119:102-109. [PMID: 37872819 DOI: 10.1111/vox.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 10/25/2023]
Abstract
Industrial plasma fractionation, a complex and highly regulated technology, remains largely inaccessible to many low- and middle-income countries (LMICs). This, combined with the limited availability and high cost of plasma-derived medicinal products (PDMPs), creates deficiency of access to adequate treatment for patients in resource-limited countries, and leads to their suffering. Meanwhile, an increasing number of LMICs produce surplus plasma, as a by-product of red blood cell preparation from whole blood, that is discarded because of the lack of suitability for fractionation. This article reviews pragmatic technological options for processing plasma collected from LMICs into therapies and supports a realistic stepwise approach aligned with recent World Health Organization guidance and initiatives launched by the Working Party for Global Blood Safety of the International Society of Blood Transfusion. When industrial options based on contract or toll plasma fractionation programme and, even more, domestic fractionation facilities require larger volumes of quality plasma than is produced, alternative methods should be considered. In-bag minipool or small-scale production procedures implementable in blood establishments or national service centres are the only realistic options available to gradually reduce plasma wastage, provide safer treatments for patients currently treated with non-pathogen-reduced blood products and concurrently improve Good Manufacturing Practice (GMP) levels with minimum capital investment. As a next step, when the available volume of quality-assured plasma reaches the necessary thresholds, LMICs could consider engaging with an established fractionator in a fractionation agreement or a contract in support of a domestic fractionation facility to improve the domestic PDMP supply and patients' treatment.
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Affiliation(s)
- Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | | | - Jean-Claude Faber
- Association Luxembourgeoise des Hémophiles, Luxembourg City, Luxembourg
| | - W Martin Smid
- Sanquin Consulting Services, Amsterdam and Academic Institute IDTM, Groningen, The Netherlands
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3
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Wu J, Yang H, Yu D, Yang X. Blood-derived product therapies for SARS-CoV-2 infection and long COVID. MedComm (Beijing) 2023; 4:e426. [PMID: 38020714 PMCID: PMC10651828 DOI: 10.1002/mco2.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/15/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is capable of large-scale transmission and has caused the coronavirus disease 2019 (COVID-19) pandemic. Patients with COVID-19 may experience persistent long-term health issues, known as long COVID. Both acute SARS-CoV-2 infection and long COVID have resulted in persistent negative impacts on global public health. The effective application and development of blood-derived products are important strategies to combat the serious damage caused by COVID-19. Since the emergence of COVID-19, various blood-derived products that target or do not target SARS-CoV-2 have been investigated for therapeutic applications. SARS-CoV-2-targeting blood-derived products, including COVID-19 convalescent plasma, COVID-19 hyperimmune globulin, and recombinant anti-SARS-CoV-2 neutralizing immunoglobulin G, are virus-targeting and can provide immediate control of viral infection in the short term. Non-SARS-CoV-2-targeting blood-derived products, including intravenous immunoglobulin and human serum albumin exhibit anti-inflammatory, immunomodulatory, antioxidant, and anticoagulatory properties. Rational use of these products can be beneficial to patients with SARS-CoV-2 infection or long COVID. With evidence accumulated since the pandemic began, we here summarize the progress of blood-derived product therapies for COVID-19, discuss the effective methods and scenarios regarding these therapies, and provide guidance and suggestions for clinical treatment.
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Affiliation(s)
- Junzheng Wu
- Chengdu Rongsheng Pharmaceuticals Co., Ltd.ChengduChina
| | | | - Ding Yu
- Chengdu Rongsheng Pharmaceuticals Co., Ltd.ChengduChina
- Beijing Tiantan Biological Products Co., Ltd.BeijingChina
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4
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Yang X. Passive antibody therapy in emerging infectious diseases. Front Med 2023; 17:1117-1134. [PMID: 38040914 DOI: 10.1007/s11684-023-1021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/20/2023] [Indexed: 12/03/2023]
Abstract
The epidemic of corona virus disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus 2 and its variants of concern (VOCs) has been ongoing for over 3 years. Antibody therapies encompassing convalescent plasma, hyperimmunoglobulin, and neutralizing monoclonal antibodies (mAbs) applied in passive immunotherapy have yielded positive outcomes and played a crucial role in the early COVID-19 treatment. In this review, the development path, action mechanism, clinical research results, challenges, and safety profile associated with the use of COVID-19 convalescent plasma, hyperimmunoglobulin, and mAbs were summarized. In addition, the prospects of applying antibody therapy against VOCs was assessed, offering insights into the coping strategies for facing new infectious disease outbreaks.
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Affiliation(s)
- Xiaoming Yang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan, 430207, China.
- Wuhan Institute of Biological Products Co., Ltd., Wuhan, 430207, China.
- China National Biotec Group Company Limited, Beijing, 100029, China.
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Pati I, Cruciani M, Candura F, Massari MS, Piccinini V, Masiello F, Profili S, De Fulvio L, Pupella S, De Angelis V. Hyperimmune Globulins for the Management of Infectious Diseases. Viruses 2023; 15:1543. [PMID: 37515229 PMCID: PMC10385259 DOI: 10.3390/v15071543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
This review is focused on the use of hyperimmune globulin therapy to treat some infectious diseases of viral or bacterial origin. Despite the introduction of antibiotics and vaccines, plasma immunoglobulin therapy from whole blood donation can still play a key role. These treatments provide passive transfer of high-titer antibodies that either reduces the risk or the severity of the infection and offer immediate but short-term protection against specific diseases. Antibody preparations derived from immunized human donors are commonly used for the prophylaxis and treatment of rabies, hepatitis A and B viruses, varicella-zoster virus, and pneumonia caused by respiratory syncytial virus, Clostridium tetani, Clostridium botulinum. The use of hyperimmune globulin therapy is a promising challenge, especially for the treatment of emerging viral infections for which there are no specific therapies or licensed vaccines.
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Affiliation(s)
- Ilaria Pati
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Mario Cruciani
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Fabio Candura
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | | | - Vanessa Piccinini
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Francesca Masiello
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Samantha Profili
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Lucia De Fulvio
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Simonetta Pupella
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Vincenzo De Angelis
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
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6
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Liu X, Zhang Y, Lu L, Li X, Wu Y, Yang Y, Li T, Cao W. Benefits of high-dose intravenous immunoglobulin on mortality in patients with severe COVID-19: An updated systematic review and meta-analysis. Front Immunol 2023; 14:1116738. [PMID: 36756131 PMCID: PMC9900022 DOI: 10.3389/fimmu.2023.1116738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
Background The clinical benefits of high-dose intravenous immunoglobulin (IVIg) in treating COVID-19 remained controversial. Methods We systematically searched databases up to February 17, 2022, for studies examining the efficacy of IVIg compared to routine care. Meta-analyses were conducted using the random-effects model. Subgroup analysis, meta-regression, and trial series analysis w ere performed to explore heterogeneity and statistical significance. Results A total of 4,711 hospitalized COVID-19 patients (1,925 IVIg treated and 2786 control) were collected from 17 studies, including five randomized controlled trials (RCTs) and 12 cohort studies. The application of IVIg was not associated with all-cause mortality (RR= 0.89 [0.63, 1.26], P= 0.53; I2 = 75%), the length of hospital stays (MD= 0.29 [-3.40, 6.44] days, P= 0.88; I2 = 96%), the needs for mechanical ventilation (RR= 0.93 ([0.73, 1.19], P= 0.31; I2 = 56%), or the incidence of adverse events (RR= 1.15 [0.99, 1.33], P= 0.06; I2 = 20%). Subgroup analyses showed that overall mortality among patients with severe COVID-19 was reduced in the high-dose IVIg subgroup (RR= 0.33 [0.13, 0.86], P= 0.02, I2 = 68%; very low certainty). Conclusions Results of this study suggest that severe hospitalized COVID-19 patients treated with high-dose IVIg would have a lower risk of death than patients with routine care. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021231040, identifier CRD42021231040.
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Affiliation(s)
- Xiaosheng Liu
- Tsinghua-Peking Center for Life Sciences, Beijing, China,Department of Basic Medical Sciences, School of Medicine, Tsinghua University, Beijing, China,Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuelun Zhang
- Medical research center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lianfeng Lu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaodi Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuanni Wu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Yang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Taisheng Li
- Tsinghua-Peking Center for Life Sciences, Beijing, China,Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wei Cao
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China,*Correspondence: Wei Cao,
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7
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Ali S, Shalim E, Farhan F, Anjum F, Ali A, Uddin SM, Shahab F, Haider M, Ahmed I, Ali MR, Khan S, Rao S, Guriro K, Elahi S, Ali M, Mushtaq T, Sayeed MA, Muhaymin SM, Luxmi S, Saifullah, Qureshi S. Phase II/III trial of hyperimmune anti-COVID-19 intravenous immunoglobulin (C-IVIG) therapy in severe COVID-19 patients: study protocol for a randomized controlled trial. Trials 2022; 23:932. [DOI: 10.1186/s13063-022-06860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
COVID-19 poses a global health challenge with more than 325 million cumulative cases and above 5 million cumulative deaths reported till January 17, 2022, by the World Health Organization. Several potential treatments to treat COVID-19 are under clinical trials including antivirals, steroids, immunomodulators, non-specific IVIG, monoclonal antibodies, and passive immunization through convalescent plasma.
The need to produce anti-COVID-19 IVIG therapy must be continued, alongside the current treatment modalities, considering the virus is still mutating into variants of concern. In this context, as the present study will exploit pooled diversified convalescent plasma collected from recovered COVID-19 patients, the proposed hyperimmune Anti-COVID-19 intravenous immunoglobulin (C-IVIG) therapy would be able to counter new infectious COVID-19 variants by neutralizing the virus particles. After the successful outcome of the phase I/II clinical trial of C-IVIG, the current study aims to further evaluate the safety and efficacy of single low dose C-IVIG in severe COVID-19 patients for its phase II/III clinical trial.
Methods
This is a phase II/III, adaptive, multi-center, single-blinded, randomized controlled superiority trial of SARS-CoV-2 specific polyclonal IVIG (C-IVIG). Patients fulfilling the eligibility criteria will be block-randomized using a sealed envelope system to receive either 0.15 g/Kg C-IVIG with standard of care (SOC) or standard of care alone in 2:1 ratio. The patients will be followed-up for 28 days to assess the primary and secondary outcomes.
Discussion
This is a phase II/III clinical trial evaluating safety and efficacy of hyperimmune anti-COVID-19 intravenous immunoglobulin (C-IVIG) in severe COVID-19 patients. This study will provide clinical evidence to use C-IVIG as one of the first-line therapeutic options for severe COVID-19 patients.
Trial registration
Registered at clinicaltrial.gov with NCT number NCT04891172 on May 18, 2021.
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8
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Razumikhin M, Smolyanova T, Nikolaeva A, Orlova E, Ivanov A, Belyakova O, Vyaznikova T, Selezneva N, Perevozchikov A, Sokolova A, Zubkova N, Efimova I, Dolzhikova I, Logunov D, Sakanjan E. Development and characterization of anti-SARS-CoV-2 intravenous immunoglobulin from COVID-19 convalescent plasma. Immunotherapy 2022; 14:1133-1147. [PMID: 35892311 PMCID: PMC9328115 DOI: 10.2217/imt-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The authors describe the developmental process of intravenous anti-COVID-19 hyperimmune immunoglobulin from anti-SARS-CoV-2 neutralizing antibody-containing plasma. Furthermore, the authors investigated its safety and protective activity in animal models. Materials & methods: The manufacturing process included standard ethanol fractionation, chromatographic purification steps and virus removal or inactivation. Results: The authors produced pure and safe immunoglobulin for intravenous administration, with 98.1 ± 6.5 mg/ml protein content, of which 97.6 ± 0.7% was IgG. The concentration factor of SARS-CoV-2 neutralizing antibodies was 9.4 ± 1.4-times. Safety studies in animals showed no signs of acute/chronic toxicity or allergenic or thrombogenic properties. Intravenous anti-COVID-19 hyperimmune immunoglobulin protected immunosuppressed hamsters against SARS-Cov-2. Conclusion: The obtained results can allow the start of clinical trials to study the safety and efficacy in healthy adults. An intravenous immunoglobulin with a high concentration of SARS-CoV-2-neutralizing antibodies was prepared from COVID-19 convalescent plasma, which could be utilized as a passive immunization tool in regard to COVID-19 treatment. The manufacturing process employed conforms to commonly held business standards within the intravenous immunoglobulin industry and includes plasma ethanol fractionation following chromatographic purification and special virus removal or inactivation steps. The results of the preclinical in vitro and in vivo experiments demonstrate that the immunoglobulin produced in this study is pure and safe enough to be considered for intravenous applications. The SARS-CoV-2 neutralizing antibody concentration was found to have increased 9.4 ± 1.4-times compared with human plasma. The anti-COVID-19 hyperimmune immunoglobulin showed no signs of toxicity and did not cause any blood clot formations when administered to rabbits. Furthermore, the anti-COVID-19 hyperimmune immunoglobulin was demonstrated to protect immunosuppressed hamsters against SARS-CoV-2. Pure and safe intravenous immunoglobulin with a high concentration of SARS-CoV-2 neutralizing antibodies was produced from #COVID19 convalescent plasma and demonstrated protective effects against SARS-CoV-2 in immunosuppressed hamsters.
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Affiliation(s)
| | | | | | | | | | - Olga Belyakova
- JSC NPO Microgen, 10, 2-nd Volkonsky, Moscow, 127473, Russia
| | | | | | | | - Alina Sokolova
- JSC NPO Microgen, 10, 2-nd Volkonsky, Moscow, 127473, Russia
| | | | - Irina Efimova
- JSC NPO Microgen, 10, 2-nd Volkonsky, Moscow, 127473, Russia
| | - Inna Dolzhikova
- Federal State Budget Institution "National Research Centre for Epidemiology & Microbiology named after Honorary Academician N F Gamaleya" of The Ministry of Health of The Russian Federation, 18 Gamaleya Str., Moscow, 123098, Russia
| | - Denis Logunov
- Federal State Budget Institution "National Research Centre for Epidemiology & Microbiology named after Honorary Academician N F Gamaleya" of The Ministry of Health of The Russian Federation, 18 Gamaleya Str., Moscow, 123098, Russia
| | - Elena Sakanjan
- JSC NPO Microgen, 10, 2-nd Volkonsky, Moscow, 127473, Russia
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Benites BD, Costa-Lima C, Pinto FBR, da Costa VA, Duarte ADSS, Zangirolami AB, Amaro EC, Granja F, Proenca-Modena JL, Saad STO, Addas-Carvalho M. Selection of plasma donors for the production of anti-SARS-CoV-2 immunoglobulin-based therapies: Strategies for quantitative antibody measurements. Transfus Apher Sci 2022; 61:103513. [PMID: 35871137 PMCID: PMC9293395 DOI: 10.1016/j.transci.2022.103513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/02/2022] [Accepted: 07/16/2022] [Indexed: 01/04/2023]
Abstract
Even after two years of the pandemic, a completely effective treatment against SARS-CoV-2 has not yet been established. Considering this fact and the emergence of successive new viral variants, the development of therapies based on natural polyclonal antibodies recovered from convalescent plasma remains relevant. This study presents a comparison between different methods of screening antibodies in samples of 41 individuals previously diagnosed with COVID-19. We found a significant correlation between Abbot Architect anti-SARS-CoV-2 IgG and Abbott Allinity SARS-CoV-2 IgG II Quantitative assay intensity of reactivity and neutralizing antibody (nAb) titers. Thus, we propose an initial antibody screening with IgG anti-N Abbott Architect test, with an index of, for example, > 3.25 or SARS-CoV-2 IgG II Quantitative Abbott Allinity assay > 137.65 AU/mL as good predictors of Nab ≥ 1:80. For the quantitative method, this threshold demonstrated a 100 % sensitivity and 80 % specificity, with 97.3 % accuracy. An interesting observation was the increase in the neutralizing activity of the anti-SARS-CoV-2 antibodies with the longest interval between the end of the symptoms and the collection, demonstrating that the delay in plasma collection does not affect the achievement of adequate nAbs levels. These results demonstrate the possibility of using faster and more widely available commercial serological tests with a good correlation with viral neutralization tests in culture, allowing for optimized large-scale donor selection, which will be of utmost importance for the development of therapies such as hyperimmune immunoglobulin.
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Affiliation(s)
| | | | | | | | | | | | | | - Fabiana Granja
- Laboratory of Emerging Viruses (LEVE), Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Brazil; Biodiversity Research Centre, Federal University of Roraima, Boa Vista, Brazil
| | - José Luiz Proenca-Modena
- Laboratory of Emerging Viruses (LEVE), Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Brazil
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Human Intramuscular Hyperimmune Gamma Globulin (hIHGG) Anti-SARS-CoV-2-Characteristics of Intermediates and Final Product. Viruses 2022; 14:v14061328. [PMID: 35746798 PMCID: PMC9227433 DOI: 10.3390/v14061328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 12/05/2022] Open
Abstract
This study aims to characterize the intermediates, and the final product (FP) obtained during the production of human intramuscular hyperimmune gamma globulin anti-SARS-CoV-2 (hIHGG anti-SARS-CoV-2) and to determine its stability. Material and methods: hIHGG anti-SARS-CoV-2 was fractionated from 270 convalescent plasma donations with the Cohn method. Prior to fractionation, the plasma was inactivated (Theraflex MB Plasma). Samples were defined using enzyme immunoassays (EIA) for anti-S1, anti-RBD S1, and anti-N antibodies, and neutralization assays with SARS-CoV-2 (VN) and pseudoviruses (PVN, decorated with SARS-CoV-2 S protein). Results were expressed as a titer (EIA) or 50% of the neutralization titer (IC50) estimated in a four-parameter nonlinear regression model. Results: Concentration of anti-S1 antibodies in plasma was similar before and after inactivation. Following fractionation, the anti-S1, anti-RBD, and anti-N (total tests) titers in FP were concentrated approximately 15-fold from 1:4 to 1:63 (1800 BAU/mL), 7-fold from 1:111 to 1:802 and from 1:13 to 1:88, respectively. During production, the IgA (anti-S1) antibody titer was reduced to an undetectable level and the IgM (anti-RBD) titer from 1:115 to 1:24. The neutralizing antibodies (nAb) titer increased in both VN (from 1:40 to 1:160) and PVN (IC50 from 63 to 313). The concentration of specific IgG in the FP did not change significantly for 14 months. Conclusions: The hIHGG anti-SARS-CoV-2 was stable, with concentration up to approximately 15-fold nAb compared to the source plasma pool.
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11
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Burnouf T, Gathof B, Bloch EM, Bazin R, de Angelis V, Patidar GK, Rastvorceva RMG, Oreh A, Goel R, Rahimi-Levene N, Hindawi S, Al-Riyami AZ, So-Osman C. Production and Quality Assurance of Human Polyclonal Hyperimmune Immunoglobulins against SARS-CoV-2. Transfus Med Rev 2022; 36:125-132. [PMID: 35879213 PMCID: PMC9183240 DOI: 10.1016/j.tmrv.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Thierry Burnouf
- College of Biomedical Engineering, Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan; International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.
| | - Birgit Gathof
- Department of Transfusion Medicine, University Hospital of Cologne, Köln, Germany.
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Renée Bazin
- Héma-Québec, Medical Affairs and Innovation, Québec, Canada
| | | | - Gopal Kumar Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rada M Grubovic Rastvorceva
- Institute for Transfusion Medicine of RNM, Skopje, North Macedonia; Faculty of Medical Sciences, University Goce Delcev, Štip, North Macedonia
| | - Adaeze Oreh
- Department of Planning, Research and Statistics, National Blood Service Commission, Federal Ministry of Health, Abuja, Nigeria
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine and ImpactLife Blood Center, Springfield, IL, USA
| | | | - Salwa Hindawi
- Haematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Cynthia So-Osman
- Department of Haematology, Erasmus Medical Centre, Rotterdam, The Netherlands; Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
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12
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Kurtović T, Ravlić S, Štimac A, Mateljak Lukačević S, Hećimović A, Kazazić S, Halassy B. Efficient and Sustainable Platform for Preparation of a High-Quality Immunoglobulin G as an Urgent Treatment Option During Emerging Virus Outbreaks. Front Immunol 2022; 13:889736. [PMID: 35655779 PMCID: PMC9152316 DOI: 10.3389/fimmu.2022.889736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022] Open
Abstract
During the pre-vaccine era of the COVID-19 pandemic convalescent plasma has once again emerged as a major potential therapeutic form of passive immunization that in specific cases still represents irreplaceable treatment option. There is a growing concern that variable concentration of neutralizing antibodies, present in convalescent plasma which originates from different donors, apparently affects its effectiveness. The drawback can be overcome through the downstream process of immunoglobulin fraction purification into a standardized product of improved safety and efficacy. All modern procedures are quite lengthy processes. They are also based on fractionation of large plasma quantities whose collection is not attainable during an epidemic. When outbreaks of infectious diseases are occurring more frequently, there is a great need for a more sustainable production approach that would be goal-oriented towards assuring easily and readily available immunoglobulin of therapeutic relevance. We propose a refinement strategy for the IgG preparation achieved through simplification and reduction of the processing steps. It was designed as a small but scalable process to offer an immediately available treatment option that would simultaneously be harmonized with an increased availability of convalescent plasma over the viral outbreak time-course. Concerning the ongoing pandemic status of the COVID-19, the proof of concept was demonstrated on anti-SARS-CoV-2 convalescent plasma but is likely applicable to any other type depending on the current needs. It was guided by the idea of persistent keeping of IgG molecules in the solution, so that protection of their native structure could be assured. Our manufacturing procedure provided a high-quality IgG product of above the average recovery whose composition profile was analyzed by mass spectrometry as quality control check. It was proved free from IgA and IgM as mediators of adverse transfusion reactions, as well as of any other residual impurities, since only IgG fragments were identified. The proportion of S protein-specific IgGs remained unchanged relative to the convalescent plasma. Undisturbed IgG subclass composition was accomplished as well. However, the fractionation principle affected the final product's capacity to neutralize wild-type SARS-CoV-2 infectivity, reducing it by half. Decrease in neutralization potency significantly correlated with the amount of IgM in the starting material.
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Affiliation(s)
- Tihana Kurtović
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Zagreb, Croatia
- Center of Excellence for Virus Immunology and Vaccines, Zagreb, Croatia
| | - Sanda Ravlić
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Zagreb, Croatia
- Center of Excellence for Virus Immunology and Vaccines, Zagreb, Croatia
| | - Adela Štimac
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Zagreb, Croatia
- Center of Excellence for Virus Immunology and Vaccines, Zagreb, Croatia
| | - Sanja Mateljak Lukačević
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Zagreb, Croatia
- Center of Excellence for Virus Immunology and Vaccines, Zagreb, Croatia
| | - Ana Hećimović
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Saša Kazazić
- Division of Physical Chemistry, Ruđer Bošković Institute, Zagreb, Croatia
| | - Beata Halassy
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Zagreb, Croatia
- Center of Excellence for Virus Immunology and Vaccines, Zagreb, Croatia
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13
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Strohl WR, Ku Z, An Z, Carroll SF, Keyt BA, Strohl LM. Passive Immunotherapy Against SARS-CoV-2: From Plasma-Based Therapy to Single Potent Antibodies in the Race to Stay Ahead of the Variants. BioDrugs 2022; 36:231-323. [PMID: 35476216 PMCID: PMC9043892 DOI: 10.1007/s40259-022-00529-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic is now approaching 2 years old, with more than 440 million people infected and nearly six million dead worldwide, making it the most significant pandemic since the 1918 influenza pandemic. The severity and significance of SARS-CoV-2 was recognized immediately upon discovery, leading to innumerable companies and institutes designing and generating vaccines and therapeutic antibodies literally as soon as recombinant SARS-CoV-2 spike protein sequence was available. Within months of the pandemic start, several antibodies had been generated, tested, and moved into clinical trials, including Eli Lilly's bamlanivimab and etesevimab, Regeneron's mixture of imdevimab and casirivimab, Vir's sotrovimab, Celltrion's regdanvimab, and Lilly's bebtelovimab. These antibodies all have now received at least Emergency Use Authorizations (EUAs) and some have received full approval in select countries. To date, more than three dozen antibodies or antibody combinations have been forwarded into clinical trials. These antibodies to SARS-CoV-2 all target the receptor-binding domain (RBD), with some blocking the ability of the RBD to bind human ACE2, while others bind core regions of the RBD to modulate spike stability or ability to fuse to host cell membranes. While these antibodies were being discovered and developed, new variants of SARS-CoV-2 have cropped up in real time, altering the antibody landscape on a moving basis. Over the past year, the search has widened to find antibodies capable of neutralizing the wide array of variants that have arisen, including Alpha, Beta, Gamma, Delta, and Omicron. The recent rise and dominance of the Omicron family of variants, including the rather disparate BA.1 and BA.2 variants, demonstrate the need to continue to find new approaches to neutralize the rapidly evolving SARS-CoV-2 virus. This review highlights both convalescent plasma- and polyclonal antibody-based approaches as well as the top approximately 50 antibodies to SARS-CoV-2, their epitopes, their ability to bind to SARS-CoV-2 variants, and how they are delivered. New approaches to antibody constructs, including single domain antibodies, bispecific antibodies, IgA- and IgM-based antibodies, and modified ACE2-Fc fusion proteins, are also described. Finally, antibodies being developed for palliative care of COVID-19 disease, including the ramifications of cytokine release syndrome (CRS) and acute respiratory distress syndrome (ARDS), are described.
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Affiliation(s)
| | - Zhiqiang Ku
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Sciences Center, Houston, TX USA
| | - Zhiqiang An
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Sciences Center, Houston, TX USA
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14
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Štimac A, Kurtović T, Pavlović N, Halassy B. Development of Improved High-Performance Liquid Chromatography Method for the Determination of Residual Caprylic Acid in Formulations of Human Immunoglobulins. Molecules 2022; 27:molecules27051665. [PMID: 35268765 PMCID: PMC8912018 DOI: 10.3390/molecules27051665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/30/2022] Open
Abstract
Quality control of human immunoglobulin formulations produced by caprylic acid precipitation necessitates a simple, rapid, and accurate method for determination of residual caprylic acid. A high-performance liquid chromatography method for that purpose was developed and validated. The method involves depletion of immunoglobulins, the major interfering components that produce high background noise, by precipitation with acetonitrile (1:1, v/v). Chromatographic analysis of caprylic acid, preserved in supernatant with no loss, was performed using a reverse-phase C18 column (2.1 × 150 mm, 3 μm) as a stationary phase and water with 0.05% TFA–acetonitrile (50:50, v/v) as a mobile phase at a flow rate of 0.2 mL/min and run time of 10 min. The developed method was successfully validated according to the ICH guidelines. The validation parameters confirmed that method was linear, accurate, precise, specific, and able to provide excellent separation of peaks corresponding to caprylic acid and the fraction of remaining immunoglobulins. Furthermore, a 24−1 fractional factorial design was applied in order to test the robustness of developed method. As such, the method is highly suitable for the quantification of residual caprylic acid in formulations of human immunoglobulins for therapeutic use, as demonstrated on samples produced by fractionation of convalescent anti-SARS-CoV-2 human plasma at a laboratory scale. The obtained results confirmed that the method is convenient for routine quality control.
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Affiliation(s)
- Adela Štimac
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, 10000 Zagreb, Croatia;
- Correspondence: (A.Š.); (B.H.)
| | - Tihana Kurtović
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, 10000 Zagreb, Croatia;
| | - Nediljko Pavlović
- Institute of Immunology, Inc., Rockefellerova 10, 10000 Zagreb, Croatia;
| | - Beata Halassy
- Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Rockefellerova 10, 10000 Zagreb, Croatia;
- Correspondence: (A.Š.); (B.H.)
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15
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Rojas-Jiménez G, Solano D, Segura Á, Sánchez A, Chaves-Araya S, Herrera M, Vargas M, Cerdas M, Calvo G, Alfaro J, Molina S, Bolaños K, Moreira-Soto A, Villalta M, Sánchez A, Cordero D, Durán G, Solano G, Gómez A, Hernández A, Sánchez L, Vargas M, Drexler JF, Alape-Girón A, Díaz C, León G. In vitro Characterization of Anti-SARS-CoV-2 Intravenous Immunoglobulins (IVIg) Produced From Plasma of Donors Immunized With the BNT162b2 Vaccine and Its Comparison With a Similar Formulation Produced From Plasma of COVID-19 Convalescent Donors. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:772275. [PMID: 35047966 PMCID: PMC8757726 DOI: 10.3389/fmedt.2021.772275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/03/2021] [Indexed: 01/01/2023] Open
Abstract
Despite vaccines are the main strategy to control the ongoing global COVID-19 pandemic, their effectiveness could not be enough for individuals with immunosuppression. In these cases, as well as in patients with moderate/severe COVID-19, passive immunization with anti-SARS-CoV-2 immunoglobulins could be a therapeutic alternative. We used caprylic acid precipitation to prepare a pilot-scale batch of anti-SARS-CoV-2 intravenous immunoglobulins (IVIg) from plasma of donors immunized with the BNT162b2 (Pfizer-BioNTech) anti-COVID-19 vaccine (VP-IVIg) and compared their in vitro efficacy and safety with those of a similar formulation produced from plasma of COVID-19 convalescent donors (CP-IVIg). Both formulations showed immunological, physicochemical, biochemical, and microbiological characteristics that meet the specifications of IVIg formulations. Moreover, the concentration of anti-RBD and ACE2-RBD neutralizing antibodies was higher in VP-IVIg than in CP-IVIg. In concordance, plaque reduction neutralization tests showed inhibitory concentrations of 0.03-0.09 g/L in VP-IVIg and of 0.06-0.13 in CP-IVIg. Thus, VP-IVIg has in vitro efficacy and safety profiles that justify their evaluation as therapeutic alternative for clinical cases of COVID-19. Precipitation with caprylic acid could be a simple, feasible, and affordable alternative to produce formulations of anti-SARS-CoV-2 IVIg to be used therapeutically or prophylactically to confront the COVID-19 pandemic in middle and low-income countries.
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Affiliation(s)
- Gabriel Rojas-Jiménez
- Sección de Virología Médica, Departamento de Microbiología e Inmunología, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Daniela Solano
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Álvaro Segura
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Andrés Sánchez
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Stephanie Chaves-Araya
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - María Herrera
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Mariángela Vargas
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Maykel Cerdas
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Gerardo Calvo
- Laboratorio Clínico y Banco de Sangre de la Universidad de Costa Rica, Oficina de Bienestar y Salud, Universidad de Costa Rica, San José, Costa Rica
| | - Jonathan Alfaro
- Laboratorio Clínico y Banco de Sangre de la Universidad de Costa Rica, Oficina de Bienestar y Salud, Universidad de Costa Rica, San José, Costa Rica
| | - Sebastián Molina
- Banco Nacional de Sangre, Gerencia Médica, Caja Costarricense del Seguro Social, San José, Costa Rica
| | - Kimberly Bolaños
- Banco Nacional de Sangre, Gerencia Médica, Caja Costarricense del Seguro Social, San José, Costa Rica
| | - Andrés Moreira-Soto
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Centro de Investigación en Enfermedades Tropicales (CIET), Facultad de Microbiología, Universidad de Costa Rica, San Jose, Costa Rica
| | - Mauren Villalta
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Adriana Sánchez
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Daniel Cordero
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Gina Durán
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Gabriela Solano
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Aarón Gómez
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Andrés Hernández
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Laura Sánchez
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Marco Vargas
- Laboratorio Clínico y Banco de Sangre de la Universidad de Costa Rica, Oficina de Bienestar y Salud, Universidad de Costa Rica, San José, Costa Rica
| | - Jean Felix Drexler
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,German Centre for Infection Research (DZIF), Associated Partner Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alberto Alape-Girón
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.,Departamento de Bioquímica, Escuela de Medicina, Universidad de Costa Rica, San José, Costa Rica
| | - Cecilia Díaz
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.,Departamento de Bioquímica, Escuela de Medicina, Universidad de Costa Rica, San José, Costa Rica
| | - Guillermo León
- Instituto Clodomiro Picado, Factulad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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16
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Volk A, Covini-Souris C, Kuehnel D, De Mey C, Römisch J, Schmidt T. SARS-CoV-2 Neutralization in Convalescent Plasma and Commercial Lots of Plasma-Derived Immunoglobulin. BioDrugs 2022; 36:41-53. [PMID: 34843105 PMCID: PMC8628143 DOI: 10.1007/s40259-021-00511-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Patients with primary or secondary immunodeficiency (PID or SID) face increased insecurity and discomfort in the light of the COVID-19 pandemic, not knowing if and to what extent their comorbidities may impact the course of a potential SARS-CoV-2 infection. Furthermore, recently available vaccination options might not be amenable or effective for all patients in this heterogeneous population. Therefore, these patients often rely on passive immunization with plasma-derived, intravenous or subcutaneous immunoglobulin (IVIG/SCIG). Whether the ongoing COVID-19 pandemic and/or the progress in vaccination programs lead to increased and potentially protective titers in plasma-derived immunoglobulins (Ig) indicated (e.g., for humoral immunodeficiency) remains a pressing question for this patient population. PURPOSE We investigated SARS-CoV-2 reactivity of US plasma-derived IVIG/SCIG products from the end of 2020 until June 2021 as well as in convalescent plasma (CP) from May 2020 to August 2020 to determine whether potentially neutralizing antibody titers may be present. METHODS Final containers of IVIG/SCIG and CP donations were analyzed by commercial ELISA for anti-SARS-CoV-2 S1-receptor binding domain (RBD) IgG as well as microneutralization assay using a patient-derived SARS-CoV-2 (D614G) isolate. Neutralization capacities of 313 single plasma donations and 119 plasma-derived IVIG/SCIG lots were determined. Results obtained from both analytical methods were normalized against the WHO International Standard. Finally, based on dense pharmacokinetic profiles of an IVIG preparation from previously published investigations, possible steady-state plasma levels of SARS-CoV-2 neutralization capacities were approximated based on currently measured anti-SARS-CoV-2 potencies in IVIG/SCIG preparations. RESULTS CP donations presented with high variability with regards to anti-SARS-CoV-2 reactivity in ELISA as well as in neutralization testing. While approximately 50% of convalescent donations were not/low neutralizing, approximately 10% were at or above 600 IU/mL. IVIG/SCIG lots derived from pre-pandemic plasma donations did not show neutralizing capacities for SARS-CoV-2. Lots produced between December 2020 and June 2021 entailing plasma donations after the emergence of SARS-CoV-2 showed a rapid and constant increase in anti-SARS-CoV-2 reactivity and neutralization capacity over time. While lot-to-lot variability was substantial, neutralization capacity increased from a mean of 21 IU/mL in December 2020 to 506 IU/mL in June 2021 with a maximum of 864 IU/mL for the most recent lots. Pharmacokinetic extrapolations, based on non-compartmental superposition principles using steady-state reference profiles from previously published pharmacokinetic investigations on IVIG in PID, yielded potential steady-state trough plasma levels of 16 IU/mL of neutralizing SARS-CoV-2 IgG based on the average final container concentration from May 2021 of 216 IU/mL. Maximum extrapolated trough levels could reach 64 IU/mL based on the latest maximal final container potency tested in June 2021. CONCLUSIONS SARS-CoV-2 reactivity and neutralization capacity in IVIG/SCIG produced from US plasma rapidly and in part exponentially increased in the first half of 2021. The observed increase of final container potencies is likely trailing the serological status of the US donor population in terms of COVID-19 convalescence and vaccination by at least 5 months due to production lead times and should in principle continue at least until Fall 2021. In summary, the data support rapidly increasing levels of anti-SARS-CoV-2 antibodies in IVIG/SCIG products, implicating that a certain level of protection could be possible against COVID-19 for regularly substituted PID/SID patients. Nevertheless, more research is still needed to confirm which plasma levels are needed to provide protection against SARS-CoV-2 infection in immune-compromised patients.
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Affiliation(s)
- Andreas Volk
- Virus and Prion Validation, Octapharma Biopharmaceuticals GmbH, Frankfurt, Germany.
| | | | - Denis Kuehnel
- Virus and Prion Validation, Octapharma Biopharmaceuticals GmbH, Frankfurt, Germany
| | | | - Jürgen Römisch
- R&D Plasma, Octapharma Pharmazeutika Produktionsgesellschaft m.b.H., Vienna, Austria
| | - Torben Schmidt
- Virus and Prion Validation, Octapharma Biopharmaceuticals GmbH, Frankfurt, Germany
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17
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The immunology and immunotherapy for COVID-19. Expert Rev Mol Med 2021; 23:e24. [PMID: 34915958 PMCID: PMC8723987 DOI: 10.1017/erm.2021.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The ongoing global pandemic of coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and significantly impacts the world economy and daily life. Symptoms of COVID-19 range from asymptomatic to fever, dyspnoea, acute respiratory distress and multiple organ failure. Critical cases often occur in the elderly and patients with pre-existing conditions. By binding to the angiotensin-converting enzyme 2 receptor, SARS-CoV-2 can enter and replicate in the host cell, exerting a cytotoxic effect and causing local and systemic inflammation. Currently, there is no specific treatment for COVID-19, and immunotherapy has consistently attracted attention because of its essential role in boosting host immunity to the virus and reducing overwhelming inflammation. In this review, we summarise the immunopathogenic features of COVID-19 and highlight recent advances in immunotherapy to illuminate ideas for the development of new potential therapies.
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18
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Gilroy R. Welcome to the 14th volume of Immunotherapy. Immunotherapy 2021; 14:1-4. [PMID: 34889117 DOI: 10.2217/imt-2021-0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ryan Gilroy
- Future Science Group, Unitec House, 2 Albert Place, Finchley, London N3 1QB, UK
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19
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Wittebole X, Montiel V, Mesland JB. Is there a role for immune-enhancing therapies for acutely ill patients with coronavirus disease 2019? Curr Opin Crit Care 2021; 27:480-486. [PMID: 34334626 PMCID: PMC8452248 DOI: 10.1097/mcc.0000000000000862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Although the so-called cytokine storm has been early described and related to a dramatic evolution in severe COVID-19 patients, it soon became clear that those patients display clinical and biological evidence of an immunosuppressive state characterized, among other, by a profound lymphopenia. The negative role of this immune suppression on the outcome raises the question on immune therapies that might improve patient's condition. RECENT FINDINGS Important positive effects of active immune therapies, such as IL-7 or thymosin-α are already described and warrant confirmation in larger prospective trials. For other therapies, such as interferons, firm conclusions for critically ill COVID-19 patients are lacking as those patients were often excluded from the published trials. Treatment with immunoglobulins or convalescent plasma is a passive strategy to provide specific immunity. Unfortunately, results from large RCTs do not support their use presently. SUMMARY In this article, we provide a review on active and passive immune boosting strategies that might help treating the most severe COVID-19 patients. We mainly focus on active strategies that include IL-7, thymosin-α, interferons, and vitamin D. Although some positive effects are described, they certainly warrant confirmation in large randomized controlled trials.
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Affiliation(s)
- Xavier Wittebole
- Critical Care Department, Cliniques universitaires St Luc, UCLouvain, Brussels, Belgium
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20
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Alape-Girón A, Moreira-Soto A, Arguedas M, Brenes H, Buján W, Corrales-Aguilar E, Díaz C, Echeverri A, Flores-Díaz M, Gómez A, Hernández A, Herrera M, León G, Macaya R, Molina-Mora JA, Mora J, Narayanan A, Sanabria A, Sánchez A, Sánchez L, Segura Á, Segura E, Solano D, Soto C, Stynoski JL, Vargas M, Villalta M, Drexler JF, Gutiérrez JM. Heterologous Hyperimmune Polyclonal Antibodies Against SARS-CoV-2: A Broad Coverage, Affordable, and Scalable Potential Immunotherapy for COVID-19. Front Med (Lausanne) 2021; 8:743325. [PMID: 34552950 PMCID: PMC8450768 DOI: 10.3389/fmed.2021.743325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alberto Alape-Girón
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
- School of Medicine University of Costa Rica, San Pedro, Costa Rica
| | - Andrés Moreira-Soto
- Institute of Virology, Charité Medical University of Berlin, Berlin, Germany
| | - Mauricio Arguedas
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Hebleen Brenes
- Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, Ministry of Health, Cartago, Costa Rica
| | - Willem Buján
- School of Medicine University of Costa Rica, San Pedro, Costa Rica
- Caja Costarricense del Seguro Social, San Jose, Costa Rica
| | - Eugenia Corrales-Aguilar
- Research Center for Tropical Diseases, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Cecilia Díaz
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
- School of Medicine University of Costa Rica, San Pedro, Costa Rica
| | - Ann Echeverri
- Caja Costarricense del Seguro Social, San Jose, Costa Rica
| | - Marietta Flores-Díaz
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Aarón Gómez
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Andrés Hernández
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - María Herrera
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Guillermo León
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Román Macaya
- Caja Costarricense del Seguro Social, San Jose, Costa Rica
| | - José Arturo Molina-Mora
- Research Center for Tropical Diseases, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Javier Mora
- Research Center for Tropical Diseases, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Aarthi Narayanan
- National Center for Biodefense and Infectious Diseases, College of Science, George Mason University, Fairfax, VA, United States
| | | | - Andrés Sánchez
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Laura Sánchez
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Álvaro Segura
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Eduardo Segura
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Daniela Solano
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Claudio Soto
- Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, Ministry of Health, Cartago, Costa Rica
| | - Jennifer L. Stynoski
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Mariángela Vargas
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Mauren Villalta
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
| | - Jan Felix Drexler
- Institute of Virology, Charité Medical University of Berlin, Berlin, Germany
| | - José María Gutiérrez
- Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San Pedro, Costa Rica
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Anand U, Jakhmola S, Indari O, Jha HC, Chen ZS, Tripathi V, Pérez de la Lastra JM. Potential Therapeutic Targets and Vaccine Development for SARS-CoV-2/COVID-19 Pandemic Management: A Review on the Recent Update. Front Immunol 2021; 12:658519. [PMID: 34276652 PMCID: PMC8278575 DOI: 10.3389/fimmu.2021.658519] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/07/2021] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a highly pathogenic novel virus that has caused a massive pandemic called coronavirus disease 2019 (COVID-19) worldwide. Wuhan, a city in China became the epicenter of the outbreak of COVID-19 in December 2019. The disease was declared a pandemic globally by the World Health Organization (WHO) on 11 March 2020. SARS-CoV-2 is a beta CoV of the Coronaviridae family which usually causes respiratory symptoms that resemble common cold. Multiple countries have experienced multiple waves of the disease and scientific experts are consistently working to find answers to several unresolved questions, with the aim to find the most suitable ways to contain the virus. Furthermore, potential therapeutic strategies and vaccine development for COVID-19 management are also considered. Currently, substantial efforts have been made to develop successful and safe treatments and SARS-CoV-2 vaccines. Some vaccines, such as inactivated vaccines, nucleic acid-based, and vector-based vaccines, have entered phase 3 clinical trials. Additionally, diverse small molecule drugs, peptides and antibodies are being developed to treat COVID-19. We present here an overview of the virus interaction with the host and environment and anti-CoV therapeutic strategies; including vaccines and other methodologies, designed for prophylaxis and treatment of SARS-CoV-2 infection with the hope that this integrative analysis could help develop novel therapeutic approaches against COVID-19.
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Affiliation(s)
- Uttpal Anand
- Department of Life Sciences, National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shweta Jakhmola
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - Omkar Indari
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - Hem Chandra Jha
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY, United States
| | - Vijay Tripathi
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, India
| | - José M. Pérez de la Lastra
- Instituto de Productos Naturales y Agrobiología (IPNA), Consejo Superior de Investigaciones científicas (CSIS), Santa Cruz de Tenerife, Spain
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Ali S, Uddin SM, Shalim E, Sayeed MA, Anjum F, Saleem F, Muhaymin SM, Ali A, Ali MR, Ahmed I, Mushtaq T, Khan S, Shahab F, Luxmi S, Kumar S, Arain H, Khan M, Khan AS, Mehmood H, Rasheed A, Jahangeer A, Baig S, Quraishy S. Hyperimmune anti-COVID-19 IVIG (C-IVIG) treatment in severe and critical COVID-19 patients: A phase I/II randomized control trial. EClinicalMedicine 2021; 36:100926. [PMID: 34109306 PMCID: PMC8177439 DOI: 10.1016/j.eclinm.2021.100926] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hyperimmune anti-COVID-19 Intravenous Immunoglobulin (C-IVIG) is an unexplored therapy amidst the rapidly evolving spectrum of medical therapies for COVID-19 and is expected to counter the three most life-threatening consequences of COVID-19 including lung injury by the virus, cytokine storm and sepsis. METHODS A single center, phase I/II, randomized controlled, single-blinded trial was conducted at Dow University of Health Sciences, Karachi, Pakistan. Participants were COVID-19 infected individuals, classified as either severely or critically ill with Acute Respiratory Distress Syndrome (ARDS). Participants were randomized through parallel-group design with sequential assignment in a 4:1 allocation to either intervention group with four C-IVIG dosage arms (0.15, 0.20, 0.25, 0.30 g/kg), or control group receiving standard of care only (n = 10). Primary outcomes were 28-day mortality, patient's clinical status on ordinal scale and Horowitz index (HI), and were analysed in all randomized participants that completed the follow-up period (intention-to-treat population). The trial was registered at clinicaltrials.gov (NCT04521309). FINDINGS Fifty participants were enrolled in the study from June 19, 2020 to February 3, 2021 with a mean age of 56.54±13.2 years of which 22 patients (44%) had severe and 28 patients (56%) had critical COVID-19. Mortality occurred in ten of 40 participants (25%) in intervention group compared to six of ten (60%) in control group, with relative risk reduction in intervention arm I (RR, 0.333; 95% CI, 0.087-1.272), arm II (RR, 0.5; 95% CI, 0.171-1.463), arm III (RR, 0.167; 95% CI, 0.024-1.145), and arm IV (RR, 0.667; 95% CI, 0.268-1.660). In intervention group, median HI significantly improved to 359 mmHg [interquartile range (IQR) 127-400, P = 0.009)] by outcome day, while the clinical status of intervention group also improved as compared to control group, with around 15 patients (37.5%) being discharged by 7th day with complete recovery. Additionally, resolution of chest X-rays and restoration of biomarkers to normal levels were also seen in intervention groups. No drug-related adverse events were reported during the study. INTERPRETATION Administration of C-IVIG in severe and critical COVID-19 patients was safe, increased the chance of survival and reduced the risk of disease progression. FUNDING Higher Education Commission (HEC), Pakistan (Ref no. 20-RRG-134/RGM/R&D/HEC/2020).
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Affiliation(s)
- Shaukat Ali
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Syed Muneeb Uddin
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Elisha Shalim
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | | | - Fatima Anjum
- Dow Research Institute of Biotechnology and Biomedical Sciences, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Farah Saleem
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Sheikh Muhammad Muhaymin
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Ayesha Ali
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Mir Rashid Ali
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Iqra Ahmed
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Tehreem Mushtaq
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Sadaf Khan
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Faisal Shahab
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Shobha Luxmi
- Dow University Hospital, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Suneel Kumar
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Habiba Arain
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Mujtaba Khan
- Dow College of Biotechnology, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Abdul Samad Khan
- National Control Laboratory for Biologicals, Islamabad, Pakistan
| | - Hamid Mehmood
- Dow University Hospital, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Abdur Rasheed
- Department of Research, Dow University of Health Sciences, Karachi, Pakistan
| | - Ashraf Jahangeer
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - SaifUllah Baig
- Dow University Hospital, Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
| | - Saeed Quraishy
- Dow University of Health Sciences - Ojha Campus, Karachi, Pakistan
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23
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Rnjak D, Ravlić S, Šola AM, Halassy B, Šemnički J, Šuperba M, Hećimović A, Kurolt IC, Kurtović T, Mačak Šafranko Ž, Polančec D, Bendelja K, Mušlin T, Jukić I, Vuk T, Zenić L, Artuković M. COVID-19 convalescent plasma as long-term therapy in immunodeficient patients? Transfus Clin Biol 2021; 28:264-270. [PMID: 33901641 PMCID: PMC8064810 DOI: 10.1016/j.tracli.2021.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023]
Abstract
Objectives The patients with hematological malignancies are a vulnerable group to COVID-19, due to the immunodeficiency resulting from the underlying disease and oncological treatment that significantly impair cellular and humoral immunity. Here we report on a beneficial impact of a passive immunotherapy with convalescent plasma to treat a prolonged, active COVID-19 infection in a patient with a history of nasopharyngeal diffuse large B-cell lymphoma treated with the therapy inducing substantial impairment of particularly humoral arm of immune system. The specific aim was to quantify SARS-CoV2 neutralizing antibodies in a patient plasma during the course of therapy. Materials and methods Besides the standard of care treatment and monitoring, neutralizing antibody titers in patient's serum samples, calibrated according to the First WHO International Standard for anti-SARS-CoV-2 immunoglobulin (human), were quantified in a time-dependent manner. During the immunotherapy period peripheral blood flow cytometry immunophenotyping was conducted to characterize lymphocyte subpopulations. Results The waves of clinical improvements and worsening coincided with transfused neutralizing antibodies rises and drops in the patient's systemic circulation, proving their contribution in controlling the disease progress. Besides the patient's lack of own humoral immune system, immunophenotyping analysis revealed also the reduced level of helper T-lymphocytes and immune exhaustion of monocytes. Conclusion Therapeutic approach based on convalescent plasma transfusion transformed a prolonged, active COVID-19 infection into a manageable chronic disease.
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Affiliation(s)
- D Rnjak
- Special Hospital for Pulmonary Diseases, Rockefellerova 3, 10000 Zagreb, Croatia.
| | - S Ravlić
- University of Zagreb, Centre for Research and Knowledge Transfer in Biotechnology, Rockefellerova 10, 10000 Zagreb, Croatia; Centre of Excellence for Virus Immunology and Vaccines, Zagreb, Croatia.
| | - A-M Šola
- Special Hospital for Pulmonary Diseases, Rockefellerova 3, 10000 Zagreb, Croatia
| | - B Halassy
- University of Zagreb, Centre for Research and Knowledge Transfer in Biotechnology, Rockefellerova 10, 10000 Zagreb, Croatia; Centre of Excellence for Virus Immunology and Vaccines, Zagreb, Croatia
| | - J Šemnički
- Special Hospital for Pulmonary Diseases, Rockefellerova 3, 10000 Zagreb, Croatia
| | - M Šuperba
- Special Hospital for Pulmonary Diseases, Rockefellerova 3, 10000 Zagreb, Croatia
| | - A Hećimović
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - I-C Kurolt
- University Hospital for Infectious Diseases Dr. Fran Mihaljević, Zagreb, Croatia; Centre of Excellence for Virus Immunology and Vaccines, Zagreb, Croatia
| | - T Kurtović
- University of Zagreb, Centre for Research and Knowledge Transfer in Biotechnology, Rockefellerova 10, 10000 Zagreb, Croatia; Centre of Excellence for Virus Immunology and Vaccines, Zagreb, Croatia
| | - Ž Mačak Šafranko
- University Hospital for Infectious Diseases Dr. Fran Mihaljević, Zagreb, Croatia; Centre of Excellence for Virus Immunology and Vaccines, Zagreb, Croatia
| | - D Polančec
- Srebrnjak Children's Hospital, Zagreb, Croatia
| | - K Bendelja
- University of Zagreb, Centre for Research and Knowledge Transfer in Biotechnology, Rockefellerova 10, 10000 Zagreb, Croatia
| | - T Mušlin
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - I Jukić
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - T Vuk
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - L Zenić
- Srebrnjak Children's Hospital, Zagreb, Croatia
| | - M Artuković
- Special Hospital for Pulmonary Diseases, Rockefellerova 3, 10000 Zagreb, Croatia
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