Covid-19 convalescent plasma is more than neutralizing antibodies: A narrative review of potential beneficial and detrimental co-factors

Daniele Focosi, Massimo Franchini, Liise Anne Pirofski, Thierry Burnouf, Delisa Fairweather, Michael J. Joyner, Arturo Casadevall

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish
Article number1594
JournalViruses
Volume13
Issue number8
DOIs
Publication statusPublished - Aug 2021

Keywords

  • ADAMTS13
  • Antithrombin III
  • Autoantibodies
  • Controlled trials
  • Convalescent plasma
  • Decoy receptors
  • Extracellular vesicles
  • Heterologous immunity
  • Interferons
  • MDA5
  • Thrombosis

ASJC Scopus subject areas

  • Infectious Diseases
  • Virology

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