High-dose intravenous immunoglobulins might modulate inflammation in COVID-19 patients

Abstract

The use of high-dose of intravenous immunoglobulins (IVIGs) as immunomodulators for the treatment of COVID-19–affected individuals has shown promising results. IVIG reduced inflammation in these patients, who progressively restored respiratory function. However, little is known about how they may modulate immune responses in COVID-19 individuals. Here, we have analyzed the levels of 41 inflammatory biomarkers in plasma samples obtained at day 0 (pretreatment initiation), 3, 7, and 14 from five hospitalized COVID-19 patients treated with a 5-d course of 400 mg/kg/d of IVIG. The plasmatic levels of several cytokines (Tumor Necrosis Factor, IL-10, IL-5, and IL-7), chemokines (macrophage inflammatory protein-1α), growth/tissue repairing factors (hepatic growth factor), complement activation (C5a), and intestinal damage such as Fatty acid–binding protein 2 and LPS-binding protein showed a progressive decreasing trend during the next 2 wk after treatment initiation. This trend was not observed in IVIG-untreated COVID-19 patients. Thus, the administration of high-dose IVIG to hospitalized COVID-19 patients may improve their clinical evolution by modulating their hyperinflammatory and immunosuppressive status.

COVID-19 Related Myocarditis in Adults: A Systematic Review of Case Reports

“…Another drug considered to dump patients’ immune response was tocilizumab (5 reviewed cases), which was shown to reduce mortality even in the group already treated with steroids [ 84 , 85 , 98 ]. Intravenous immunoglobulins were used in 14 patients, yet their use to modulate inflammation in COVID is still under debate [ 99 , 100 ]. Other conceptions for the immunomodulatory treatment in COVID tested interleukin-1β inhibitor—canakinumab; and colchicine.…”

Efficacy of Glucocorticoid plus Intravenous Immunoglobulin in Children with Immunoglobulin-Insensitive Kawasaki Disease

“…Immunoglobulin (Ig), a regulator of the inflammatory process and immune response, is also vital in the effective connection between adaptability and the innate immune system [ 9 ]. Intravenous immunoglobulin (IVIG) has also been proved to be one of the standard treatments for KD, which can not only suppress inflammatory reactions through various regulatory mechanisms but also prevent the activation of innate immune cells [ 10 ]. However, some children with KD did not respond to IVIG treatment, which brings great challenges to disease treatment [ 11 ].…”

Efficacy of intravenous immunoglobulin in the treatment of a COVID-19 patient

“…This viral infections are associated with an excessive and uncontrolled complement activation which contribute to tissue damage and hyperinflammation. IVIg treatment of this infections may reduce complement activation, bind and block C5a and C3a, leading to the decrease of hyperinflamation [14]. IVIg has numerous modes of action like inhibition of T-cell activation and proliferation, down-regulation of antibodies production by B-cells, interruption of complement activation cascade and cytokine modulation (neutralization of inflammatory cytokines, chemokines and complement fragments by endogenous antigen-specific IgG which are present in IVIg), inhibition of neutrophil recruitment and activation and limitation of the differentiation of macrophages (this effects may be induced by blocking the activation of Fcγ receptors on innate immune effector cells) and many more [3,14].…”