COVID-19 Convalescent Plasma Is More than Neutralizing Antibodies: A Narrative Review of Potential Beneficial and Detrimental Co-Factors.

COVID-19 Convalescent Plasma Is More than Neutralizing Antibodies: A Narrative Review of Potential Beneficial and Detrimental Co-Factors.
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DOI:
10.3390/v13081594
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发表时间:
2021-08-11
期刊:
Viruses
影响因子:
--
通讯作者:
Casadevall A
Casadevall A
中科院分区:
其他
文献类型:
--
作者:
Focosi D;Franchini M;Pirofski LA;Burnouf T;Fairweather D;Joyner MJ;Casadevall A

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COVID-19恢复期血浆(CCP)目前正在研究用于治疗和暴露后预防。CCP介导改善结局的活性成分通常被报道为特异性抗体,特别是中和抗体,其临床疗效根据抗体亲和力水平进行表征。在这篇综述中,我们强调了其他因素在CCP中的潜在作用,这些因素可以是有益的(例如,AT-III、α-lAT、ACE 2+细胞外囊泡)或有害的(例如,抗ADAMTS 13、抗MDA 5或抗干扰素自身抗体、促凝血细胞外囊泡)。CCP中这些因素的变化可能导致接受CCP治疗的COVID-19患者的不同结局。我们建议在对照组中使用新鲜冷冻血浆的随机临床试验中对这些辅助因子进行仔细的回顾性研究。然而,鉴于CCP通常是安全的,中和抗体效应可能占主导地位,因此可能难以在这些组分和结局之间建立因果关系。
COVID-19 convalescent plasma (CCP) is currently under investigation for both treatment and post-exposure prophylaxis. The active component of CCP mediating improved outcome is commonly reported as specific antibodies, particularly neutralizing antibodies, with clinical efficacy characterized according to the level or antibody affinity. In this review, we highlight the potential role of additional factors in CCP that can be either beneficial (e.g., AT-III, alpha-1 AT, ACE2+ extracellular vesicles) or detrimental (e.g., anti-ADAMTS13, anti-MDA5 or anti-interferon autoantibodies, pro-coagulant extracellular vesicles). Variations in these factors in CCP may contribute to varied outcomes in patients with COVID-19 and undergoing CCP therapy. We advise careful, retrospective investigation of such co-factors in randomized clinical trials that use fresh frozen plasma in control arms. Nevertheless, it might be difficult to establish a causal link between these components and outcome, given that CCP is generally safe and neutralizing antibody effects may predominate.
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