A consideration of convalescent plasma and plasma derivatives in the care of Severely-ill patients with COVID-19

Abstract

The pathogenesis and immunopathological damage of severe forms of COVID-19 resemble acute autoimmune disease sparked by SARS-CoV-2, including an early systemic overproduction of proinflammatory cytokines. Such immunopathological features provide a rationale for the use of passive immunotherapy with convalescent plasma as a source of neutralizing anti-viral antibodies and of anti-inflammatory plasma components. While convalescent plasma therapy is now being evaluated in prospective clinical trials, we further consider the therapeutic potential of human hyper immune globulins, and of heterologous, engineered and monoclonal neutralizing antibodies as anti-viral agents to treat COVID-19. Good medical practice procedures are still needed and is why we also discuss the potential use of polyclonal polyspecific immunoglobulins (IVIG), a therapeutic plasma derivative, with potent anti-inflammatory activity, in severe forms of Covid-19.

Characterization of a Pan-Immunoglobulin Assay Quantifying Antibodies Directed against the Receptor Binding Domain of the SARS-CoV-2 S1-Subunit of the Spike Protein: A Population-Based Study

“…Serological testing facilitates surveillance and assists in the identification of individuals susceptible to COVID-19 infection [6,7]. The serological analysis of convalescent SARS-CoV-2 antibodies also allows for the identification of individuals that are potentially suited to serve as plasma donors of convalescence plasma, which has been proposed to aid in the therapy of severe cases of COVID-19 [8][9][10]. Further, many individuals have not had access to the molecular diagnosis of COVID-19 with RT-PCR [11].…”

How should we use convalescent plasma therapies for the management of COVID-19?

“…Hyperimmune globulin preparations for COVID-19 are being manufactured globally, with trials underway. 38 Monoclonal antibodies targeting SARS-CoV-2 are entering clinical trials, although data are not yet available on efficacy or safety. 39 Polyclonal immunoglobulins for intravenous (IVIG) or subcutaneous use likely already do, or soon will, contain anti-SARS-CoV-2 antibodies given rising rates of antibody positivity among blood donors.…”

“…39 Polyclonal immunoglobulins for intravenous (IVIG) or subcutaneous use likely already do, or soon will, contain anti-SARS-CoV-2 antibodies given rising rates of antibody positivity among blood donors. 38,39 IVIG is already being used in treatment of COVID-19, although evidence of benefit is limited. 38,41 There is preclinical evidence that platelet-derived IgG may be more potent at viral neutralization than plasma IgG, raising the question of whether platelets could be a novel method of delivering passive immune therapy.…”

“…38,39 IVIG is already being used in treatment of COVID-19, although evidence of benefit is limited. 38,41 There is preclinical evidence that platelet-derived IgG may be more potent at viral neutralization than plasma IgG, raising the question of whether platelets could be a novel method of delivering passive immune therapy. 42 Therapeutic plasma exchange (TPE) is being studied in trials in critically ill COVID-19 patients; however the rationale for this treatment is not related to passive immunity, but rather removal of potentially harmful circulating cytokines and other molecules, and replacement of protective plasma proteins to maintain microcirculatory flow and prevent vascular leak.…”

Convalescent blood plasma (CBP) donated by recovered COVID-19 patients – A comment

“…Pathogen inactivation is has now been achieved applying such methods as Amotosalen UVA which blocks DNA and RNA replication - this Intercept Blood System is used for blood plasma, without compromising anti SARS-CoV-2 activity [ 5 ]. Thus, the containment of anti-SARS-CoV 2 antibodies in CBP produced by the convalescing donor or added as spike, is more and more perceived as bringing therapeutic efficacy to some patients receiving CBP [ 11 , 12 ]. In addition, glycan constitution of the abs seems to confer virotoxicity: afucosylated IgG characterizes enveloped viral responses and correlates with COVID-19 severity [ 13 ].…”