Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre experience
Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre experience
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DOI：
10.3851/imp3243
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发表时间：
2018-01-01
影响因子：
1.2
通讯作者：
Peck, Kyong Ran
中科院分区：
文献类型：
--
作者：
Ko, Jae-Hoon;Seok, Hyeri;Peck, Kyong Ran
背景资料：恢复期血浆（CP）输注的影响，严重中东呼吸综合征冠状病毒（MERS-CoV）infections的治疗方案之一，尚未进行evaluated.Methods：血清学反应的CP输注MERS患者在2015年韩国MERS疫情在三级保健中心进行了评估。采用抗MERS-CoV酶联免疫吸附试验（ELISA）免疫球蛋白（IG）G、ELISA伊加、免疫荧光试验IgM和空斑减少中和试验（PRNT）评价血清学活性。评价了供体血浆和一个或两个受者的血清样本，每周的疾病，包括一个采取的第二天后，每次CP输注。为了进行ELISA IgG预测中和活性的灵敏度和特异性分析，使用了138名先前评估的MERS-CoV感染患者的数据集。结果：13名患有呼吸衰竭的MERS患者中，有3名接受了来自恢复期MERS-CoV感染患者的4次CP输注，其中只有2人表现出中和活性。PRNT滴度为1：80的供体血浆在CP输注后表现出有意义的血清学应答，而PRNT滴度为1：40的供体血浆则没有。ELISA IgG预测PRNT滴度≥ 1：80的中和活性，在截止光密度（OD）比为1.6时特异性大于95%，在OD比为1.9时特异性为100%。结论：为有效输注CP治疗MERS，应使用中和活性≥ 1：80的供体血浆。在资源有限的情况下，ELISA IgG可替代中和试验。
Background: The effects of convalescent plasma (CP) infusion, one of the treatment options for severe Middle East respiratory syndrome coronavirus (MERS-CoV) infections, have not yet been evaluated.Methods: Serological responses of CP-infused MERS patients during the 2015 Korean MERS outbreak at a tertiary care centre were evaluated. Serological activity was evaluated with anti-MERS-CoV enzyme-linked immunosorbent assay (ELISA) immunoglobulin (Ig)G, ELISA IgA, immunofluorescence assay IgM and plaque reduction neutralization test (PRNT). Donor plasma and one or two recipient's serum samples per week of illness including one taken the day after each CP infusion were evaluated. For sensitivity and specificity analysis of ELISA IgG in predicting neutralization activity, a data set of 138 previously evaluated MERS-CoV-infected patients was used.Results: Three of thirteen MERS patients with respiratory failure received four CP infusions from convalesced MERS-CoV-infected patients, and only two of them showed neutralizing activity. Donor plasma with a PRNT titre 1:80 demonstrated meaningful serological response after CP infusion, while that with a PRNT titre 1:40 did not. ELISA IgG predicted neutralization activity of a PRNT titre >= 1:80 with more than 95% specificity at a cutoff optical density (OD) ratio of 1.6, and with 100% specificity at an OD ratio of 1.9.Conclusions: For effective CP infusion in MERS, donor plasma with a neutralization activity of a PRNT titre >= 1:80 should be used. ELISA IgG could substitute for the neutralization test in resource-limited situations.