Olgu Erkin ÇINAR, Başak SAYINALP, İbrahim Celalettin HAZNEDAROĞLU

Perspectives for immune plasma treatment of COVID-19

Background/aim: The SARS-CoV-2 infection was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020, and the death toll from COVID-19, which is the disease caused by SARS-CoV-2, has already surpassed that of many previous epidemics. A wide variety of treatment options are being considered for COVID-19, but there is still no definitive treatment or vaccine. This study aims to explain the background of convalescent plasma (CP) treatment and its relations with COVID-19 immunity, to define ideal treatment procedures, and to reveal present and future perspectives in the light of the rapidly growing data. Immunological basis of COVID-19-associated immune response and convalescent plasma as a treatment option: Since it has been shown that the impaired immune response of the host is one of the most important factors that increase the severity of the infection, treatment strategies to suppress aberrant immune activation are currently being considered. CP, which is derived from recently recovered patients and contains neutralizing antibodies and many other immunemodulatory substances, seems to be the most convenient strategy to restore normal immune function considering the fast spreading nature of the ongoing pandemic. Conclusion: Even though mechanisms of action of plasma therapy are not fully delineated, it was shown that it could lead to a reduction in mortality since other alternatives such as monoclonal antibodies or SARS-CoV-2 hyperimmunoglobulin require much more time and effort to be developed.Key words: COVID-19, pandemic, convalescent plasma

PDF

___

1. Martin PM, Martin-Granel E. 2,500-year evolution of the term epidemic. Emerging Infectious Diseases 2006;12 (6): 976-980. doi: 10.3201/eid1206.051263
2. Luke TC, Casadevall A, Watowich SJ, Hoffman SL, Beigel JH et al. Hark back: passive immunotherapy for influenza and other serious infections. Critical Care Medicine 2010; 38 (4 Suppl.): e66-e73. doi:10.1097/CCM.0b013e3181d44c1e
3. Zhang JS, Chen JT, Liu YX, Zhang ZS, Gao H et al. A serological survey on neutralizing antibody titer of SARS convalescent sera. Journal of Medical Virology 2005; 77 (2): 147-150. doi: 10.1002/jmv.20431
4. Felsenstein S, Herbert JA, McNamara PS, Hedrich CM. COVID-19: immunology and treatment options. Clinical Immunology 2020; 215: 108448. doi: 10.1016/j. clim.2020.108448
5. De Wit E, Van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: recent insights into emerging coronaviruses. Nature Reviews Microbiology 2016; 14 (8): 523-534. doi: 10.1038/nrmicro.2016.81
6. Yi Y, Lagniton PNP, Ye S, Li EQ et al. COVID-19: what has been learned and to be learned about the novel coronavirus disease. International Journal of Biological Sciences 2020; 16 (10): 1753-1766. doi: 10.7150/ijbs.45134
7. Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Seminars in Immunopathology 2017; 39 (5): 529-539. doi: 10.1007/s00281-017-0629-x
8. Diao B, Wang C, Tan Y, Chen X, Liu Y et al. Reduction and functional exhaustion of T cells in patients with coronavirus disease 2019 (COVID-19). Frontiers in Immunology 2020; 11: 827. doi: 10.3389/fimmu.2020.00827
9. Garraud O, Heshmati F, Pozzetto B, Lefrere F, Girot R et al. Plasma therapy against infectious pathogens, as of yesterday, today and tomorrow. Transfusion Clinique et Biologique 2016; 23 (1): 39-44. doi: 10.1016/j.tracli.2015.12.003
10. Cheng Y, Wong R, Soo YO, Wong WS, Lee CKet al. Use of convalescent plasma therapy in SARS patients in Hong Kong. European Journal of Clinical Microbiology and Infectious Diseases 2005; 24 (1): 44-46. doi: 10.1007/s10096-004-1271-9
11. Hung IF, To KK, Lee CK, Lee KL et al. Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection. Clinical Infectious Diseases 2011; 52 (4): 447-456. doi: 10.1093/cid/ciq106
12. Ko JH, Seok H, Cho SY, Ha YE, Baek JY et al. Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre experience. Antiviral Therapy 2018; 23 (7): 617-622. doi: 10.3851/imp3243
13. Sahr F, Ansumana R, Massaquoi TA, Idriss BR, Sesay FR et al. Evaluation of convalescent whole blood for treating Ebola virus disease in Freetown, Sierra Leone. Journal of Infection 2017; 74 (3): 302-309. doi: 10.1016/j.jinf.2016.11.009
14. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, Cleary P, Khaw FM et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. Journal of Infectious Diseases 2015; 211 (1): 80-90. doi: 10.1093/infdis/jiu396
15. Casadevall A, Pirofski LA. The convalescent sera option for containing COVID-19. Journal of Clinical Investigation 2020; 130 (4): 1545-1548. doi: 10.1172/JCI138003
16. Iwasaki A, Yang Y. The potential danger of suboptimal antibody responses in COVID-19. Nature Reviews Immunology 2020; 20: 339-341. doi: 10.1038/s41577-020-0321-6
17. Brown JF, Dye JM, Tozay S, Jeh-Mulbah G, Wohl DA et al. Anti-ebola virus antibody levels in convalescent plasma and viral load after plasma infusion in patients with ebola virus disease. Journal of Infectious Diseases 2018; 218 (4): 555-562. doi: 10.1093/infdis/jiy199
18. Enria DA, Briggiler AM, Fernandez NJ, Levis SC, Maiztegui JI. Importance of dose of neutralising antibodies in treatment of Argentine haemorrhagic fever with immune plasma. Lancet 1984; 2 (8397): 255-256. doi: 10.1016/s0140-6736(84)90299-x
19. Rojas M, Rodríguez Y, Monsalve DM, Acosta-Ampudia Y, Camacho B et al. Convalescent plasma in Covid-19: possible mechanisms of action. Autoimmunity Reviews 2020; 19 (7): 102554. doi: 10.1016/j.autrev.2020.102554
20. Casadevall A, Pirofski LA. Antibody-mediated regulation of cellular immunity and the inflammatory response. Trends in Immunology 2003; 24 (9): 474-478. doi: 10.1016/s1471- 4906(03)00228-x
21. Yuan RR, Casadevall A, Oh J, Scharff MD. T cells cooperate with passive antibody to modify Cryptococcus neoformans infection in mice. Proceedings of the National Academyof Sciencesof the United States of America 1997; 94 (6): 2483- 2488. doi: 10.1073/pnas.94.6.2483
22. Beenhouwer DO, Shapiro S, Feldmesser M, Casadevall A, Scharff MD. Both Th1 and Th2 cytokines affect the ability of monoclonal antibodies to protect mice against Cryptococcus neoformans. Infection and Immunity 2001; 69 (10): 6445- 6455. doi: 10.1128/IAI.69.10.6445-6455.2001
23. Nasser R, Pelegrin M, Michaud HA, Plays M, Piechaczyk M et al. Long-lasting protective antiviral immunity induced by passive immunotherapies requires both neutralizing and effector functions of the administered monoclonal antibody. Journal of Virology 2010; 84 (19): 10169-10181. doi: 10.1128/ JVI.00568-10
24. Zhang Y, Xiao M, Zhang S, Xia P, Cao W et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. New England Journal of Medicine 2020; 382 (17): e38. doi: 10.1056/NEJMc2007575
25. Epstein J, Burnouf T. Points to consider in the preparation and transfusion of COVID-19 convalescent plasma. Vox Sanguinis 2020; 115 (6). doi: 10.1111/vox.12939
26. Çınar OE, Sayınalp B, Aladağ Karakulak E, Avşar Karataş A, Velet M et al. Convalescent (immune) plasma treatment in a myelodysplastic COVID-19 patient with disseminated tuberculosis. Transfusion and Apheresis Science 2020; 59 (5). doi: 10.1016/j.transci.2020.102821
27. Salazar E, Perez KK, Ashraf M, Chen J, Castillo B et al. Treatment of COVID-19 patients with convalescent plasma in Houston, Texas. The Medical Journal of Pathology 2020; 190 (8): 1680-1690. doi: 10.1016/j.ajpath.2020.05.014
28. Joyner M, Wright RS, Fairweather D, Senefeld J, Bruno K et al. Early safety indicators of COVID-19 convalescent plasma in 5,000 patients. American Society for Clinical Investigation 2020; 130 (9): 4791-4797. doi: 10.1172/JCI140200
29. Erkurt MA, Sarici A, Berber İ, Kuku İ, Kaya E et al. Life-saving effect of convalescent plasma treatment in COVID-19 disease: clinical trial from Eastern Anatolia. Transfusion and Apheresis Science 2020; 102867. doi: 10.1016/j.transci.2020.102867